- Email: [email protected]
Alarm Management in the PACU
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non-patient related factors affecting the patient’s Phase I LOS. Top causes included: bed availability, waiting for admission orders, care handoff, and transport delays. Staff received education on initiatives to reduce LOS. This included PowerPoint presentation and five short continuing education articles on nursing interventions to improve patient recovery, with the goal to reduce LOS. An electronic report was developed to track individual LOS as well as view average LOS of each PACU facility across the health system. Individual lengths of stay were deidentified and displayed monthly for staff to review. The LOS task force reviews results monthly and further develops initiatives and identifies barriers to improving LOS. Statement of Successful Practice: Since the implementation of the project, the average LOS in the PACU has been reduced from 129 to 86 minutes without an increase in adverse or untoward effects to patients. Implications for Advancing the Practice of Perianesthesia Nursing: Through education and increased awareness among staff, LOS can be decreased and the patient receives superior value in care.
AN INTERPROFESSIONAL APPROACH TO HYPOTHERMIA PREVENTION IN THE PERIOPERATIVE SETTING Team Leader: Alice Kohler, MSN RN CPAN CCRN NE-BC Ben Taub Hospital, Harris Health System, Houston, Texas Team Members: Mary Ann Agtual, BSN RN, Annamma Mathew, BSN RN CPAN CAPA CCRN, Jewellyn Natividad, BSN RN CPAN, Eleanor Nolledo, BSN RN CPAN CAPA
Background Information: While hypothermia may be intentionally induced in some perioperative patients (e.g., risk of neurological damage following cardiac arrest), maintenance of normothermia is more commonplace to diminish negative sequelae like prolonged recovery times, altered drug metabolism, and wound infections. Inadvertent perioperative hypothermia (IPH) can result from low ambient room temperature, general anesthesia resulting in peripheral vasoconstriction, and patient factors (e.g., elderly, very young, major trauma or burns). Variations in IPH prevention practices, financial impacts, and a commitment to improving patient outcomes prompted the development of an IPH awareness campaign. Objectives of Project: The purpose of this quality improvement project was to use an evidence-based approach to reeducate perioperative staff regarding the rationale and methods for maintaining normothermia. Process of Implementation: The PACU nursing director engaged interprofessional partners (e.g., clinicians, nurse leaders, and anesthesia health care providers) in appraisal of the extant literature (including ASPAN’s normothermia clinical guidelines) and charged nurse clinicians and the educator with developing in-services targeting optimal core temperature, clinical manifestations associated with mild, moderate and severe hypothermia, environmental factors, and potential complications associated with IPH. Problem-based learning, case studies, critical thinking exercises, and peer support from tenured nurses to less experienced personnel were among educational pedagogies that were utilized.
Note: All abstracts are printed as received from the authors.
ASPAN NATIONAL CONFERENCE ABSTRACTS Statement of Successful Practice: The expectation was that staff would implement a normothermia algorithm and document interventions. When the project began, the staffs’ compliance rate was 50%. Following the education, compliance increased to 100% and patients’ lengths of stay decreased by 10%. Improving patient outcomes was undeniably the goal of this project; however, the change with the most impact was among the staff. The nurses are more confident, committed to proactively providing safe care, and use an evidence-based framework which has resulted in anecdotal reports of empowerment. Implications for Advancing the Practice of Perianesthesia Nursing: The program afforded an opportunity to incorporate evidence-based standards of care, imbue nurses and anesthesia health care providers with unique interprofessional perspectives, and create partnerships to place patients in the best position for optimal perioperative outcomes.
ALARM MANAGEMENT IN THE PACU Team Leader: Melissa Sayers, RN BS CPAN Moffitt Cancer Center, Tampa, Florida Identification of the problem e Overview: The Joint Commission identified alarm management as a national patient safety goal for 2015. While reviewing the literature there were no PACU specific studies found. The studies which were reviewed endorsed decreasing alarms for patient safety. Our PACU chose to focus on decreasing the duration of alarms, thus decreasing the amount of time an alarm was sounding. Objectives: Alarms in the PACU are ignored or not heard. There are also a number of nuisance alarms with no nursing intervention required, however, these alarms account for the majority of alarms in the PACU. The purpose of this project was to identify the number and duration of alarms in PACU, discover if the alarms required nursing intervention, and implement a solution to decrease the duration of alarms in PACU. Process of Implementation: Data was gathered on alarms in the PACU. This was accomplished by the investigator identifying and recording all alarms in the PACU for various 1 hour periods of time. The cause and duration of the alarm, as well as the nurse response were recorded. A staff survey was conducted to discover what they observed in relation to alarms in PACU. They were also asked how frequent they felt alarms were. The survey results demonstrated nurses felt alarms were too frequent and ignored because they weren’t necessary. As an intervention monitor alarm volumes were set to default at their highest level, making it more difficult to ignore an alarm. Initial data found an average of 7 alarms per hour and average alarm duration of 11.5 minutes. It also showed 91% of the alarms didn’t require nursing intervention. After alarm volume changes and staff education alarms not requiring nursing intervention dropped marginally to 90%. The average alarm duration significantly decreased to 2 minutes. Statement of Successful Practice: Alarms in the PACU are frequent, but many times avoidable. By raising the awareness of alarms and making them harder to ignore, the duration of alarms was significantly decreased. We will continue to focus on alarms and attempt to decrease the actual number of alarms sounding in an hour. Implications for Advancing the Practice of Perianesthesia Nursing: The duration and number of alarms can be
ASPAN NATIONAL CONFERENCE ABSTRACTS decreased dramatically in the PACU. There were different methods we were unable to try due to equipment restriction. A formalized process for decreasing alarms in PACU is necessary.
THE NURSE RESIDENT IN THE PACU: DESIGNING AND IMPLEMENTING A PROGRAM TO SUPPORT THE TRANSITION OF NEW GRADUATE NURSES INTO A POST ANESTHESIA CARE UNIT (PACU) Team Leader: Bonnie Shope, MS RN CPAN Johns Hopkins Hospital, Baltimore, Maryland Team Members: Patricia Ryan, MSN RN, Elena Lara, BSN RN CPAN, Jing Rodriguez, BSN RN CPAN, Bridgette Frison, BSN RN, Rebecca Griffiths, BSN RN CPAN, Marina Reyes-Maxwell, BSN RN CPAN
Background Information: Post anesthesia care units have historically required that nurses entering this field have one to two years of experience, preferably in the critical care setting. Currently, the postanesthesia care unit (PACU) specialty is experiencing a critical shortage and there is a renewed effort to hire new graduate nurses to augment the workforce. It is estimated that 35-50% of new graduates will leave the workplace within their first year of work (Moore & Cagle, 2012). Objectives of Project: Create a PACU Nurse Residency Program that includes: B Structured critical care and PACU education B Carefully selected PACU preceptors B Professional development for the new nurse graduate Retain Nursing Residents in the PACU Process of Implementation: Collaborated with Johns Hopkins Nurse Residency Program, Intensive Care Unit Educators and PACU leadership team Combined theory, practicum, hands-on experiences, precepted clinical orientation, and regular debriefing with educators and leadership. Created a shared learning experience with: Respiratory Therapy, Anesthesia, Acute Pain Team, Operating Room, Interventional Radiology, and Critical Care Units Designed 3 phases of residency: B Phase 1: Structured orientation using ASPAN Competency Based Orientation Program B Phase 2: Assimilate knowledge into practice with full PACU assignment/ assigned a resource person B Phase 3: Rotation to Pre-op and Interventional Radiology sites within the PACU, Orientation to on call Statement of Successful Practice: Enrolled 2 new graduates into program beginning March 2015 Completed the first and second phase of their program Committed to at least 2 years of work in the PACU Conducted focused Nurse Residency Satisfaction Interviews at 3 and 6 months Note: All abstracts are printed as received from the authors.
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Implications for Advancing the Practice of Perianesthesia Nursing: Conduct descriptive research study relating to PACU workforce nursing integration Continue to investigate retention of PACU Nurse Residency nurses over 2 year period Disseminate findings of research study References: Moore, P., &Cagle, C. (2012). The lived experience of new nurses: Importance of the clinical preceptor. The Journal of Continuing Education, 43(12), 555-565.
BRIEF CPR TRAINING IN THE PERI-OPERATIVE SETTING TO INCREASE NURSE CONFIDENCE Team Leaders: Kelley Kelly, MSN RN CAPA VA-BC, Stephanie Kemery, MSN RN CMSRN Beltway Surgery Center, Indiana University Health, Indianapolis, Indiana Team Members: Connie Wilson, EdD RN CEN, Corinne Wheeler, PhD RN CENP
Background Information: Cardiac arrest can occur in any medical setting and requires immediate intervention. Provider uncertainty with resuscitative proficiency results in suboptimal CPR, which decreases the chance of patient survival. In the ambulatory perioperative setting, it is a rare for any cardiac events to occur; therefore, the staff need to be trained more frequently. It is vital to patient survival that the staff be able to perform CPR confidently and competently. Objectives of Project: The purpose was to determine whether frequent, brief cardiopulmonary resuscitation (CPR) refresher training increases peri-operative Registered Nurses’ confidence. Previous studies have found a lack of confidence in skills, and have implemented targeted training at the bedside. The literature provides evidence that CPR skills decline before certification expires. Evidence points to a need for more frequent preparation in CPR, however there is no concrete recommendation for the best method or time interval for training. Process of Implementation: Bedside refresher training was conducted with staff in groups of two, with each training session lasting five minutes. They were briefed on the purpose of the training then given a scenario of the situation and asked to respond using BLS skills. After they demonstrated the skills, a debriefing occurred immediately with an AHA trained BLS instructor. Seventy Registered Nurses employed at a Midwestern suburban ambulatory surgery center were invited to participate. Statement of Successful Practice: Participants overwhelmingly indicated that they felt this training was effective. Many nurses could articulate what they should do, but this knowledge did not carry over into observed psychomotor skills.Few were able to perform to AHA standards during the refresher periods. This indicates participants may not be aware of the knowledge gap that exists. Implications for Advancing the Practice of Perianesthesia Nursing: Refreshers provide individualized instruction in a relaxed atmosphere. Scenarios can be tailored to a specific practice area. Staff are more receptive to an informal presentations. The cost of conducting brief, on-unit training is less
non-patient related factors affecting the patient’s Phase I LOS. Top causes included: bed availability, waiting for admission orders, care handoff, and transport delays. Staff received education on initiatives to reduce LOS. This included PowerPoint presentation and five short continuing education articles on nursing interventions to improve patient recovery, with the goal to reduce LOS. An electronic report was developed to track individual LOS as well as view average LOS of each PACU facility across the health system. Individual lengths of stay were deidentified and displayed monthly for staff to review. The LOS task force reviews results monthly and further develops initiatives and identifies barriers to improving LOS. Statement of Successful Practice: Since the implementation of the project, the average LOS in the PACU has been reduced from 129 to 86 minutes without an increase in adverse or untoward effects to patients. Implications for Advancing the Practice of Perianesthesia Nursing: Through education and increased awareness among staff, LOS can be decreased and the patient receives superior value in care.
AN INTERPROFESSIONAL APPROACH TO HYPOTHERMIA PREVENTION IN THE PERIOPERATIVE SETTING Team Leader: Alice Kohler, MSN RN CPAN CCRN NE-BC Ben Taub Hospital, Harris Health System, Houston, Texas Team Members: Mary Ann Agtual, BSN RN, Annamma Mathew, BSN RN CPAN CAPA CCRN, Jewellyn Natividad, BSN RN CPAN, Eleanor Nolledo, BSN RN CPAN CAPA
Background Information: While hypothermia may be intentionally induced in some perioperative patients (e.g., risk of neurological damage following cardiac arrest), maintenance of normothermia is more commonplace to diminish negative sequelae like prolonged recovery times, altered drug metabolism, and wound infections. Inadvertent perioperative hypothermia (IPH) can result from low ambient room temperature, general anesthesia resulting in peripheral vasoconstriction, and patient factors (e.g., elderly, very young, major trauma or burns). Variations in IPH prevention practices, financial impacts, and a commitment to improving patient outcomes prompted the development of an IPH awareness campaign. Objectives of Project: The purpose of this quality improvement project was to use an evidence-based approach to reeducate perioperative staff regarding the rationale and methods for maintaining normothermia. Process of Implementation: The PACU nursing director engaged interprofessional partners (e.g., clinicians, nurse leaders, and anesthesia health care providers) in appraisal of the extant literature (including ASPAN’s normothermia clinical guidelines) and charged nurse clinicians and the educator with developing in-services targeting optimal core temperature, clinical manifestations associated with mild, moderate and severe hypothermia, environmental factors, and potential complications associated with IPH. Problem-based learning, case studies, critical thinking exercises, and peer support from tenured nurses to less experienced personnel were among educational pedagogies that were utilized.
Note: All abstracts are printed as received from the authors.
ASPAN NATIONAL CONFERENCE ABSTRACTS Statement of Successful Practice: The expectation was that staff would implement a normothermia algorithm and document interventions. When the project began, the staffs’ compliance rate was 50%. Following the education, compliance increased to 100% and patients’ lengths of stay decreased by 10%. Improving patient outcomes was undeniably the goal of this project; however, the change with the most impact was among the staff. The nurses are more confident, committed to proactively providing safe care, and use an evidence-based framework which has resulted in anecdotal reports of empowerment. Implications for Advancing the Practice of Perianesthesia Nursing: The program afforded an opportunity to incorporate evidence-based standards of care, imbue nurses and anesthesia health care providers with unique interprofessional perspectives, and create partnerships to place patients in the best position for optimal perioperative outcomes.
ALARM MANAGEMENT IN THE PACU Team Leader: Melissa Sayers, RN BS CPAN Moffitt Cancer Center, Tampa, Florida Identification of the problem e Overview: The Joint Commission identified alarm management as a national patient safety goal for 2015. While reviewing the literature there were no PACU specific studies found. The studies which were reviewed endorsed decreasing alarms for patient safety. Our PACU chose to focus on decreasing the duration of alarms, thus decreasing the amount of time an alarm was sounding. Objectives: Alarms in the PACU are ignored or not heard. There are also a number of nuisance alarms with no nursing intervention required, however, these alarms account for the majority of alarms in the PACU. The purpose of this project was to identify the number and duration of alarms in PACU, discover if the alarms required nursing intervention, and implement a solution to decrease the duration of alarms in PACU. Process of Implementation: Data was gathered on alarms in the PACU. This was accomplished by the investigator identifying and recording all alarms in the PACU for various 1 hour periods of time. The cause and duration of the alarm, as well as the nurse response were recorded. A staff survey was conducted to discover what they observed in relation to alarms in PACU. They were also asked how frequent they felt alarms were. The survey results demonstrated nurses felt alarms were too frequent and ignored because they weren’t necessary. As an intervention monitor alarm volumes were set to default at their highest level, making it more difficult to ignore an alarm. Initial data found an average of 7 alarms per hour and average alarm duration of 11.5 minutes. It also showed 91% of the alarms didn’t require nursing intervention. After alarm volume changes and staff education alarms not requiring nursing intervention dropped marginally to 90%. The average alarm duration significantly decreased to 2 minutes. Statement of Successful Practice: Alarms in the PACU are frequent, but many times avoidable. By raising the awareness of alarms and making them harder to ignore, the duration of alarms was significantly decreased. We will continue to focus on alarms and attempt to decrease the actual number of alarms sounding in an hour. Implications for Advancing the Practice of Perianesthesia Nursing: The duration and number of alarms can be
ASPAN NATIONAL CONFERENCE ABSTRACTS decreased dramatically in the PACU. There were different methods we were unable to try due to equipment restriction. A formalized process for decreasing alarms in PACU is necessary.
THE NURSE RESIDENT IN THE PACU: DESIGNING AND IMPLEMENTING A PROGRAM TO SUPPORT THE TRANSITION OF NEW GRADUATE NURSES INTO A POST ANESTHESIA CARE UNIT (PACU) Team Leader: Bonnie Shope, MS RN CPAN Johns Hopkins Hospital, Baltimore, Maryland Team Members: Patricia Ryan, MSN RN, Elena Lara, BSN RN CPAN, Jing Rodriguez, BSN RN CPAN, Bridgette Frison, BSN RN, Rebecca Griffiths, BSN RN CPAN, Marina Reyes-Maxwell, BSN RN CPAN
Background Information: Post anesthesia care units have historically required that nurses entering this field have one to two years of experience, preferably in the critical care setting. Currently, the postanesthesia care unit (PACU) specialty is experiencing a critical shortage and there is a renewed effort to hire new graduate nurses to augment the workforce. It is estimated that 35-50% of new graduates will leave the workplace within their first year of work (Moore & Cagle, 2012). Objectives of Project: Create a PACU Nurse Residency Program that includes: B Structured critical care and PACU education B Carefully selected PACU preceptors B Professional development for the new nurse graduate Retain Nursing Residents in the PACU Process of Implementation: Collaborated with Johns Hopkins Nurse Residency Program, Intensive Care Unit Educators and PACU leadership team Combined theory, practicum, hands-on experiences, precepted clinical orientation, and regular debriefing with educators and leadership. Created a shared learning experience with: Respiratory Therapy, Anesthesia, Acute Pain Team, Operating Room, Interventional Radiology, and Critical Care Units Designed 3 phases of residency: B Phase 1: Structured orientation using ASPAN Competency Based Orientation Program B Phase 2: Assimilate knowledge into practice with full PACU assignment/ assigned a resource person B Phase 3: Rotation to Pre-op and Interventional Radiology sites within the PACU, Orientation to on call Statement of Successful Practice: Enrolled 2 new graduates into program beginning March 2015 Completed the first and second phase of their program Committed to at least 2 years of work in the PACU Conducted focused Nurse Residency Satisfaction Interviews at 3 and 6 months Note: All abstracts are printed as received from the authors.
e41
Implications for Advancing the Practice of Perianesthesia Nursing: Conduct descriptive research study relating to PACU workforce nursing integration Continue to investigate retention of PACU Nurse Residency nurses over 2 year period Disseminate findings of research study References: Moore, P., &Cagle, C. (2012). The lived experience of new nurses: Importance of the clinical preceptor. The Journal of Continuing Education, 43(12), 555-565.
BRIEF CPR TRAINING IN THE PERI-OPERATIVE SETTING TO INCREASE NURSE CONFIDENCE Team Leaders: Kelley Kelly, MSN RN CAPA VA-BC, Stephanie Kemery, MSN RN CMSRN Beltway Surgery Center, Indiana University Health, Indianapolis, Indiana Team Members: Connie Wilson, EdD RN CEN, Corinne Wheeler, PhD RN CENP
Background Information: Cardiac arrest can occur in any medical setting and requires immediate intervention. Provider uncertainty with resuscitative proficiency results in suboptimal CPR, which decreases the chance of patient survival. In the ambulatory perioperative setting, it is a rare for any cardiac events to occur; therefore, the staff need to be trained more frequently. It is vital to patient survival that the staff be able to perform CPR confidently and competently. Objectives of Project: The purpose was to determine whether frequent, brief cardiopulmonary resuscitation (CPR) refresher training increases peri-operative Registered Nurses’ confidence. Previous studies have found a lack of confidence in skills, and have implemented targeted training at the bedside. The literature provides evidence that CPR skills decline before certification expires. Evidence points to a need for more frequent preparation in CPR, however there is no concrete recommendation for the best method or time interval for training. Process of Implementation: Bedside refresher training was conducted with staff in groups of two, with each training session lasting five minutes. They were briefed on the purpose of the training then given a scenario of the situation and asked to respond using BLS skills. After they demonstrated the skills, a debriefing occurred immediately with an AHA trained BLS instructor. Seventy Registered Nurses employed at a Midwestern suburban ambulatory surgery center were invited to participate. Statement of Successful Practice: Participants overwhelmingly indicated that they felt this training was effective. Many nurses could articulate what they should do, but this knowledge did not carry over into observed psychomotor skills.Few were able to perform to AHA standards during the refresher periods. This indicates participants may not be aware of the knowledge gap that exists. Implications for Advancing the Practice of Perianesthesia Nursing: Refreshers provide individualized instruction in a relaxed atmosphere. Scenarios can be tailored to a specific practice area. Staff are more receptive to an informal presentations. The cost of conducting brief, on-unit training is less