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Improving Interdepartmental Relations
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ANNUAL ASPAN CONFERENCE ABSTRACTS
PREFERENCES FOR VISITATION IN THE POST ANESTHESIA CARE UNIT (PACU)
ENDING TURF WARS: CRITICAL CARE EDUCATION SERVICE LINE COLLABORATION
Lori A. DeWitt, BSN, RN, CAPA, CPAN, Nancy M. Albert, PhD, RN, CCNS, CCRN, NE-BC Cleveland Clinic, Cleveland, OH
Betsy Garton-Park, BSN, RN, CPAN Highland Hospital an Affiliate of the University of Rochester Medical Center, Rochester, NY
Introduction: The surgical experience provokes anxiety and stress. PACU nurses are first communicators to families awaiting news about post-operative recovery. The term family now includes people outside of the immediate home environment: grandparents, distant relatives, friends and neighbors. Little is known about PACU visitation preferences based on characteristics of visitors. Purpose: To identify PACU update/ visitation preferences to learn if one model is best and if differences exist based on visitor characteristics. Methods: Using a cross-sectional design and convenience sample, visitors of patients having elective or emergency surgery completed a survey of five update/visitation options and visitor characteristics. Descriptive statistics were obtained and bivariate relationships between update/visitation options and family member characteristics were assessed. Results: Of 249 visitors, 64% were female; 94% visited adult patients. Of visitation options, a one time, 5-10 minute visit within 2 hours of patient transfer to PACU was most frequent (27.3%). Visitor type (close family vs. distant relative/friend) was associated with visitation preference; close family preferred a one-time visit and distant relative/friend preferred a verbal report 30 minutes after PACU arrival; P 5 0.015. Discussion: While there was no single preference for visitation type, close family preferred a verbal update and a single visitation and distant relatives/friend preferred a verbal report only. Future research should expand on these findings. Implications: Understanding visitor preferences will enhance flexibility to the current update/visitation system to facilitate optimal communication for close and distant family members and improve overall satisfaction with the surgical experience.
The reality of the nursing shortage can be felt in many ways including limited resources for staff education. After a casual conversation with the ICU RN educator on the enormity of getting staff through the myriad of mandatory skills like hemodynamic and ICP monitoring and defibrillation/ cardioversion/pacing, we realized that ED, ICU, PCU and PACU had the same goals and objectives. By joining forces and creating The Critical Care Service Line, we promote collaboration between all critical care areas. The service line concept breaks down departmental silos, prevents duplication of efforts, and offers integrated comprehensive content. After assessing the commonalities, we revamped our educational programs. We offer a bi-monthly Critical Care Orientation Class Day combining didactic, hands on and critical thinking content. Orientees travel hospital wide, with our ‘‘Passport’’ shadowing program. The drudgery of yearly mandatory competencies is replaced with our Critical Care Fun Fair, a weeklong nonthreatening celebration of mandatory and FYI topics. As interest in individual journal clubs was waning, participation in a combined Critical Care Journal Club is increasing. The feedback over the two years has been overwhelmingly positive. Our orientation documentation and mandatory competency tracking is more complete with standardization. Our new hires report an immediate sense of belonging, there is decreased floating anxiety between units, and there is an upswing in nurse retention in the critical care areas.
IMPROVING INTERDEPARTMENTAL RELATIONS
REDUCING THE RISK OF DEEP VEIN THROMBOSIS (DVT) FOR SURGICAL PATIENTS
Elaine Enochs, RN, CAPA Maine Medical Center, Portland, Maine The Maine Medical Center opened a new outpatient Surgery Center in August 2007 that doubled the number of operating rooms. In preparation for our move to this beautiful new facility, one of our goals was to preserve our culture and maintain the high level of patient and physician satisfaction that was previously exemplified. Staff nurses articulated a vision and strategic plan to administration that was intended to ensure that the surgical, pre/post operative and central sterile departments were functioning as an optimally collaborative team. Staff completed surveys on their perceptions of interdisciplinary Relationships, Cooperation, Role clarity and Conflict management. Results of our initial survey showed an opportunity for improvement. Representatives from Human Resources worked with the nursing staff to facilitate three team building sessions; Getting to know you, Change process, and Moving forward and letting go of the past. All employees participated and had the opportunity to voice concerns, ideas and feelings related to this major transition. The result was a significant increase in staff satisfaction and collaboration which was validated by a resurvey six months after the move to the new facility. Together, we have created both an amazing physical work environment and a professional, dynamic and collaborative culture. We have created an atmosphere for effective conflict resolution. The staff is committed to continuing the processes that have proven so successful and to helping others build strong and rewarding team relationships.
Janet Gilmore, MSN, RN, Carol Nicoladis, BSN, RN, CPAN, Art Shumate, BSN, RN The Methodist Hospital, Houston, Texas Background: The Methodist Hospital identified an opportunity to promote perioperative patient safety through DVT reduction. Objective: To reduce the risk for DVT with increased use of Sequential Compression Devices (SCD) for eligible perioperative patients. Implementation: In January 2008, a nurse-driven protocol was initiated requiring preoperative placement of SCDs on all surgical patients meeting criteria. An algorithm was developed to guide the nurse through a process of patient identification and treatment to reduce the risk of perioperative DVT. This campaign is called ‘‘Everyone Gets Pumped.’’ Successful Practice: After tracking perioperative SCD utilization for 4 quarters, appropriate SCD compliance has increased dramatically. Positive Outcomes Achieved: Surgical patients have SCDs placed preoperatively to expedite treatment during anesthesia and is continued through the postoperative phases. The nurse-driven protocol has increased the use of inpatient perioperative SCDs by 32% in one year. Implications for the Perianesthesia Nurse: A nurse-driven protocol gives staff nurses the autonomy to initiate SCD treatment; therefore, increasing SCD use and timely placement.
ANNUAL ASPAN CONFERENCE ABSTRACTS
PREFERENCES FOR VISITATION IN THE POST ANESTHESIA CARE UNIT (PACU)
ENDING TURF WARS: CRITICAL CARE EDUCATION SERVICE LINE COLLABORATION
Lori A. DeWitt, BSN, RN, CAPA, CPAN, Nancy M. Albert, PhD, RN, CCNS, CCRN, NE-BC Cleveland Clinic, Cleveland, OH
Betsy Garton-Park, BSN, RN, CPAN Highland Hospital an Affiliate of the University of Rochester Medical Center, Rochester, NY
Introduction: The surgical experience provokes anxiety and stress. PACU nurses are first communicators to families awaiting news about post-operative recovery. The term family now includes people outside of the immediate home environment: grandparents, distant relatives, friends and neighbors. Little is known about PACU visitation preferences based on characteristics of visitors. Purpose: To identify PACU update/ visitation preferences to learn if one model is best and if differences exist based on visitor characteristics. Methods: Using a cross-sectional design and convenience sample, visitors of patients having elective or emergency surgery completed a survey of five update/visitation options and visitor characteristics. Descriptive statistics were obtained and bivariate relationships between update/visitation options and family member characteristics were assessed. Results: Of 249 visitors, 64% were female; 94% visited adult patients. Of visitation options, a one time, 5-10 minute visit within 2 hours of patient transfer to PACU was most frequent (27.3%). Visitor type (close family vs. distant relative/friend) was associated with visitation preference; close family preferred a one-time visit and distant relative/friend preferred a verbal report 30 minutes after PACU arrival; P 5 0.015. Discussion: While there was no single preference for visitation type, close family preferred a verbal update and a single visitation and distant relatives/friend preferred a verbal report only. Future research should expand on these findings. Implications: Understanding visitor preferences will enhance flexibility to the current update/visitation system to facilitate optimal communication for close and distant family members and improve overall satisfaction with the surgical experience.
The reality of the nursing shortage can be felt in many ways including limited resources for staff education. After a casual conversation with the ICU RN educator on the enormity of getting staff through the myriad of mandatory skills like hemodynamic and ICP monitoring and defibrillation/ cardioversion/pacing, we realized that ED, ICU, PCU and PACU had the same goals and objectives. By joining forces and creating The Critical Care Service Line, we promote collaboration between all critical care areas. The service line concept breaks down departmental silos, prevents duplication of efforts, and offers integrated comprehensive content. After assessing the commonalities, we revamped our educational programs. We offer a bi-monthly Critical Care Orientation Class Day combining didactic, hands on and critical thinking content. Orientees travel hospital wide, with our ‘‘Passport’’ shadowing program. The drudgery of yearly mandatory competencies is replaced with our Critical Care Fun Fair, a weeklong nonthreatening celebration of mandatory and FYI topics. As interest in individual journal clubs was waning, participation in a combined Critical Care Journal Club is increasing. The feedback over the two years has been overwhelmingly positive. Our orientation documentation and mandatory competency tracking is more complete with standardization. Our new hires report an immediate sense of belonging, there is decreased floating anxiety between units, and there is an upswing in nurse retention in the critical care areas.
IMPROVING INTERDEPARTMENTAL RELATIONS
REDUCING THE RISK OF DEEP VEIN THROMBOSIS (DVT) FOR SURGICAL PATIENTS
Elaine Enochs, RN, CAPA Maine Medical Center, Portland, Maine The Maine Medical Center opened a new outpatient Surgery Center in August 2007 that doubled the number of operating rooms. In preparation for our move to this beautiful new facility, one of our goals was to preserve our culture and maintain the high level of patient and physician satisfaction that was previously exemplified. Staff nurses articulated a vision and strategic plan to administration that was intended to ensure that the surgical, pre/post operative and central sterile departments were functioning as an optimally collaborative team. Staff completed surveys on their perceptions of interdisciplinary Relationships, Cooperation, Role clarity and Conflict management. Results of our initial survey showed an opportunity for improvement. Representatives from Human Resources worked with the nursing staff to facilitate three team building sessions; Getting to know you, Change process, and Moving forward and letting go of the past. All employees participated and had the opportunity to voice concerns, ideas and feelings related to this major transition. The result was a significant increase in staff satisfaction and collaboration which was validated by a resurvey six months after the move to the new facility. Together, we have created both an amazing physical work environment and a professional, dynamic and collaborative culture. We have created an atmosphere for effective conflict resolution. The staff is committed to continuing the processes that have proven so successful and to helping others build strong and rewarding team relationships.
Janet Gilmore, MSN, RN, Carol Nicoladis, BSN, RN, CPAN, Art Shumate, BSN, RN The Methodist Hospital, Houston, Texas Background: The Methodist Hospital identified an opportunity to promote perioperative patient safety through DVT reduction. Objective: To reduce the risk for DVT with increased use of Sequential Compression Devices (SCD) for eligible perioperative patients. Implementation: In January 2008, a nurse-driven protocol was initiated requiring preoperative placement of SCDs on all surgical patients meeting criteria. An algorithm was developed to guide the nurse through a process of patient identification and treatment to reduce the risk of perioperative DVT. This campaign is called ‘‘Everyone Gets Pumped.’’ Successful Practice: After tracking perioperative SCD utilization for 4 quarters, appropriate SCD compliance has increased dramatically. Positive Outcomes Achieved: Surgical patients have SCDs placed preoperatively to expedite treatment during anesthesia and is continued through the postoperative phases. The nurse-driven protocol has increased the use of inpatient perioperative SCDs by 32% in one year. Implications for the Perianesthesia Nurse: A nurse-driven protocol gives staff nurses the autonomy to initiate SCD treatment; therefore, increasing SCD use and timely placement.