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Creating an Educational Day
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Collaboration between anesthesia and the diabetic resource nurses has increased delivery of individualized hyperglycemic control for our perioperative patients.
CREATING AN EDUCATIONAL DAY Victoria Sherry, RN, Deidre Devaux, MSN, RN, Jeanette Cote, MSN, RN, Jeanne Lanchester, RN, Med Brigham and Women’s Hospital, Boston, Massachusetts Our PeriAnesthesia Leadership and our Nurse Educator convened a group of nurses to participate in presenting an Educational Day. The need for an environment that would have the audio visual components was identified and arrangements were made for a classroom. Presentations were developed to address a variety of topics. Staff was given an Educational Day to participate in this day. The goal of this day was to educate staff, engage them in the learning process and have them participate by sharing their wealth of knowledge as well. Staff evaluated the topics and the environment at the end of their day.
ASPAN NATIONAL CONFERENCE ABSTRACTS management, and developed new order sets and protocol for PONV. Our objective now is to revisit this year’s survey data to see how our new practices have impacted the PACU experience and our client’s post surgical recovery process in general. Process of implementation: An interview tool was developed. It was then presented to the ward staff for ease of use, efficiency and revision. Ward RNs were responsible for client surveys upon transfer to the ward. Clients were interviewed within 24 hours of surgery when possible by PACU RN staff. We completed our initial interviews, compiled data, made some changes in our practice and followed up with a second set of interviews. Statement of the successful practice: Client satisfaction with pain control, presence or absence of nausea and vomiting, and overall evaluation of PACU nursing care. Ward nurse’s assessment of pain control upon arrival to the ward. Quantifiable data served as a baseline for our pain control improvement project. Implications for advancing the practice of perianesthesia nursing: Support of starting PCAs in the PACU. Support for the benefit of early PONV assessment and treatment. Support for expanding the awareness of the surgical clients continuum of care.
WALK IN MY SHOES Victoria Sherry, RN, Deidre Devaux, MSN, RN, Marie Courtney, BSN, RN, Jeanne Lanchester, RN, Med Brigham and Women’s Hospital, Boston, Massachusetts This initiative is a collaborative effort of the Operating Room and Post Anesthesia Care Unit nursing staff. The goal is to gain insight and encourage understanding of the unique role and responsibilities of the nursing staff in their respective departments, while promoting collaborative practice. The objectives are: to define and communicate specific nursing care practices, as well as the unique priorities of each staff, in the operating room and post anesthesia care units, to increase understanding of the role and responsibilities of each department, for the other, and to enhance professional working relationships that will lead to increased job satisfaction; interrelationship and coordination of patient care, and the formation of an alliance of the operating room and post-anesthesia care unit nursing staff.
POST PACU CLIENT SURVEY Team Leader: Denise E. Smith, RN, CCRN Portland VA Medical Center, Portland, Oregon Jennifer L. Johnson, MS, BSN, RN, CPAN, Tim Harrington, PSA, nursing research, Linda Kitchen, BSN, RN, LaVonne Albertson, BSN, RN, CGRN, Ellen Lane, BA, RN Problem Identified: A rapid response was called for three clients that had been through the recovery room within 24 hours prior to the event. We found that all three events were related to pain crisis and subsequently overmedication. As a unit, we wanted to find out how our care in the recovery process affected the continuum of care for our clients in post op recovery. Objectives: To determine overall client satisfaction with the PACU experience. We also wanted to determine the ward RN’s satisfaction with client status upon transfer from PACU, and increase collaboration between PACU and ward RNs with the mutual goal of optimizing pain management. With the information gained from our first set of data we made some adjustments in our order sets and protocols for PCA pain
IMPLEMENTATION OF INDIVIDUALIZED ELECTRONIC DISCHARGE INSTRUCTIONS FOR AMBULATORY SURGERY PATIENTS Team Leaders: Lenore Smykowski, MA, RN, CPAN, Kathleen Lombardo, BSN, RN, CAPA Memorial Sloan Kettering Cancer Center, NY, New York Team Members: Donna Robinson, Manager, IT, Philippe Milord, BA, IT, Chris Chao, PharmD, Karen Yeung, PharmD Problem Identification: Patients in the ambulatory surgery unit were discharged home with generic paper instructions and prescriptions. Supplemental handwritten instructions were time- consuming and sometimes illegible and inaccurate, which contributed to delays in patient discharge as nurses needed to seek clarification from physicians. Objectives: The objective was to implement computerized service-specific discharge instructions and prescriptions. Process of Implementation: A multidisciplinary group comprised of physicians, representatives from IT, nurses, and pharmacists was formed to develop service- specific computerized discharge order sets using the existing computerized physician order entry system. Drafts of service specific order sets with drop-down features for physician preferences were constructed by the team. Revisions and approvals were obtained from physician chiefs or designees. Physicians were asked to standardize instructions and medication whenever possible. The nurse educator provided education to the ambulatory surgery nurses. Education and go-live date were provided to physicians via email and a PowerPoint presentation of relevant screen shots. Representatives from information technology provided one week of go-live support. Successful practice: Patient-specific discharge order sets were developed for the ambulatory surgery patients and are printed upon admission to the PACU. These include emergency contact information and prescriptions and individualized discharge instructions. Positive outcome achieved: Discharge instructions are individualized, accurate and legible, for both RN and patient.
Collaboration between anesthesia and the diabetic resource nurses has increased delivery of individualized hyperglycemic control for our perioperative patients.
CREATING AN EDUCATIONAL DAY Victoria Sherry, RN, Deidre Devaux, MSN, RN, Jeanette Cote, MSN, RN, Jeanne Lanchester, RN, Med Brigham and Women’s Hospital, Boston, Massachusetts Our PeriAnesthesia Leadership and our Nurse Educator convened a group of nurses to participate in presenting an Educational Day. The need for an environment that would have the audio visual components was identified and arrangements were made for a classroom. Presentations were developed to address a variety of topics. Staff was given an Educational Day to participate in this day. The goal of this day was to educate staff, engage them in the learning process and have them participate by sharing their wealth of knowledge as well. Staff evaluated the topics and the environment at the end of their day.
ASPAN NATIONAL CONFERENCE ABSTRACTS management, and developed new order sets and protocol for PONV. Our objective now is to revisit this year’s survey data to see how our new practices have impacted the PACU experience and our client’s post surgical recovery process in general. Process of implementation: An interview tool was developed. It was then presented to the ward staff for ease of use, efficiency and revision. Ward RNs were responsible for client surveys upon transfer to the ward. Clients were interviewed within 24 hours of surgery when possible by PACU RN staff. We completed our initial interviews, compiled data, made some changes in our practice and followed up with a second set of interviews. Statement of the successful practice: Client satisfaction with pain control, presence or absence of nausea and vomiting, and overall evaluation of PACU nursing care. Ward nurse’s assessment of pain control upon arrival to the ward. Quantifiable data served as a baseline for our pain control improvement project. Implications for advancing the practice of perianesthesia nursing: Support of starting PCAs in the PACU. Support for the benefit of early PONV assessment and treatment. Support for expanding the awareness of the surgical clients continuum of care.
WALK IN MY SHOES Victoria Sherry, RN, Deidre Devaux, MSN, RN, Marie Courtney, BSN, RN, Jeanne Lanchester, RN, Med Brigham and Women’s Hospital, Boston, Massachusetts This initiative is a collaborative effort of the Operating Room and Post Anesthesia Care Unit nursing staff. The goal is to gain insight and encourage understanding of the unique role and responsibilities of the nursing staff in their respective departments, while promoting collaborative practice. The objectives are: to define and communicate specific nursing care practices, as well as the unique priorities of each staff, in the operating room and post anesthesia care units, to increase understanding of the role and responsibilities of each department, for the other, and to enhance professional working relationships that will lead to increased job satisfaction; interrelationship and coordination of patient care, and the formation of an alliance of the operating room and post-anesthesia care unit nursing staff.
POST PACU CLIENT SURVEY Team Leader: Denise E. Smith, RN, CCRN Portland VA Medical Center, Portland, Oregon Jennifer L. Johnson, MS, BSN, RN, CPAN, Tim Harrington, PSA, nursing research, Linda Kitchen, BSN, RN, LaVonne Albertson, BSN, RN, CGRN, Ellen Lane, BA, RN Problem Identified: A rapid response was called for three clients that had been through the recovery room within 24 hours prior to the event. We found that all three events were related to pain crisis and subsequently overmedication. As a unit, we wanted to find out how our care in the recovery process affected the continuum of care for our clients in post op recovery. Objectives: To determine overall client satisfaction with the PACU experience. We also wanted to determine the ward RN’s satisfaction with client status upon transfer from PACU, and increase collaboration between PACU and ward RNs with the mutual goal of optimizing pain management. With the information gained from our first set of data we made some adjustments in our order sets and protocols for PCA pain
IMPLEMENTATION OF INDIVIDUALIZED ELECTRONIC DISCHARGE INSTRUCTIONS FOR AMBULATORY SURGERY PATIENTS Team Leaders: Lenore Smykowski, MA, RN, CPAN, Kathleen Lombardo, BSN, RN, CAPA Memorial Sloan Kettering Cancer Center, NY, New York Team Members: Donna Robinson, Manager, IT, Philippe Milord, BA, IT, Chris Chao, PharmD, Karen Yeung, PharmD Problem Identification: Patients in the ambulatory surgery unit were discharged home with generic paper instructions and prescriptions. Supplemental handwritten instructions were time- consuming and sometimes illegible and inaccurate, which contributed to delays in patient discharge as nurses needed to seek clarification from physicians. Objectives: The objective was to implement computerized service-specific discharge instructions and prescriptions. Process of Implementation: A multidisciplinary group comprised of physicians, representatives from IT, nurses, and pharmacists was formed to develop service- specific computerized discharge order sets using the existing computerized physician order entry system. Drafts of service specific order sets with drop-down features for physician preferences were constructed by the team. Revisions and approvals were obtained from physician chiefs or designees. Physicians were asked to standardize instructions and medication whenever possible. The nurse educator provided education to the ambulatory surgery nurses. Education and go-live date were provided to physicians via email and a PowerPoint presentation of relevant screen shots. Representatives from information technology provided one week of go-live support. Successful practice: Patient-specific discharge order sets were developed for the ambulatory surgery patients and are printed upon admission to the PACU. These include emergency contact information and prescriptions and individualized discharge instructions. Positive outcome achieved: Discharge instructions are individualized, accurate and legible, for both RN and patient.