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Development of the Block Nurse Role: Challenges and Successes
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ASPAN NATIONAL CONFERENCE ABSTRACTS to the institution’s approval process, a review by key stakeholders and a senior risk manager was completed. The compiled clinical practice guidelines utilize a systems approach and include assessment, common complications, and practice recommendations. Implementation plans include individual review of the guidelines by current staff, and use as an educational tool in the orientation of new PACU RNs. In order to provide a quick reference for care of their patients, nurses in the PACU will have access to the guidelines via the electronic documentation system. By standardizing practice, these comprehensive clinical practice guidelines will serve to promote quality and safety by providing evidence-based recommendations for general patient care and treatment interventions after general anesthesia, monitored anesthesia care, and regional anesthesia.
DEVELOPMENT OF THE BLOCK NURSE ROLE: CHALLENGES AND SUCCESSES Team Leader: Cidalia J. Vital, RN, MS, CNL, CPAN Baystate Medical Center, Springfield Massachusetts Lee Nutting, RN, Penny Bertolasio, RN, MSN
Perianesthesia nurses in the preoperative holding unit were seeing an increase in the placement of ultra sound guided peripheral nerve blocks due to a change in anesthesia practice. The boost was particularly evident in the total knee replacement population with the femoral nerve and fascia iliaca block technique. They recognized an opportunity to assure consistency, safety and compliance with hospital policy and procedures. The block nurse role was developed to ensure that these requirements were met. Competencies were created utilizing research and evidence through ASPAN standards, Joint Commission, Board of Registration in Nursing, and hospital policies. Lipid therapy, moderate sedation and dysrhythmia training were some of the courses given to staff during annual skills validations. The unit leadership and a preoperative nurse also developed a standard documentation tool. It was trialed and after minor changes was part of the permanent medical record. The block nurse is a registered nurse who has completed the nursing block competency program and is present during all nerve block and epidural placements. The block nurse coordinates the procedure by assisting the anesthesia provider, initiates universal protocol, administers moderate sedation medications and monitors/documents the patient’s vital signs and condition before, during and after the procedure. This process was not without its challenges. Multiple barriers were faced and overcome. After a few months staff felt satisfied that this role was a necessary part of patient safety and standardization of care. Anesthesia, perioperative leadership and preoperative nursing staff worked together to make this a successful practice change.
MAINTAINING PERIANESTHESIA COMPETENCIES ON A TIGHT BUDGET! Team Leader: Cidalia J. Vital, RN, MS, CNL, CPAN Baystate Medical Center, Springfield MA
Cinnamon Desgres, RN, MSN, C, Alison Colburn, RN, CAPA, Esther Brown, RN, Maryann Tourtellotte, RN, Maureen Maynard, RN, CAPA, Anne Marie Culver, RN, Deb Pond, RN, Barbara Zahm, RN, CAPA
During tough economic times creativity and out of the box thinking was needed to meet our yearly validation requirements. The unit based education committee was given a one hour time frame to complete validations instead of the usual 4 hour allotment. The committee met and decided to do a simulation based validation. Utilizing the latest technology, our Nursing Practice and Professional Development colleagues and Sim Man, we created three different scenarios. Each case study included the high risk low frequency competencies seen in our hospital based ambulatory phase I and II surgery center. The ASPAN standards were also used to include evidence based practice standards and recommended competencies for the perianesthesia nurse. The main objectives were to effectively work with team members and utilize critical thinking. Each individual scenario had situation specific objectives that were to be met by the team. Education committee members validated and confirmed findings. Sim Man was placed on the unit so the nurses were in their environment and able to use their equipment. At the end of the simulation there was opportunity for reflective discussion. Overall staff felt the simulation was a successful way to complete their annual validations. They were happy to have a one hour time block instead of the usual four hours on a Saturday morning. The education committee recommended for the following year we request a two hour time frame so we can review other skills that they felt were not covered well during the simulation.
GENERATION Z: CARE OF ADOLESCENTS IN THE ADULT PACU Team Leader: Jillian Fetzner, BSN, RN Cleveland Clinic, Cleveland, OH Team Member: Katie Zacharyasz, BSN, RN, CPAN
The physical layout and size of this institution allows for separate Pediatric and Adult PACUs. In many instances, however, adolescent patients may be cared for by surgeons and anesthesia providers from “adult” service lines based on specific disease processes, and ultimately are transferred to the Adult PACU for care. Although many adolescents are physically the size of adult patients, they have unique needs. Nurses in Adult PACU area reported low levels of confidence in meeting this patient population’s needs. The objective was to increase staff confidence in the care they provide to adolescent patients in Adult PACU. A computerized online module was created for the nurses. This educational module reviewed stages of development, fears, hospitalization, postoperative management, and anesthesia-related problems. A post-test was implemented to assess nursing competence. The module was submitted for continuing education credit. More resources have been provided for the PACU staff nurses. This information is based in current, best practices which allow PACU nurses to feel confident in the quality of care that they
ASPAN NATIONAL CONFERENCE ABSTRACTS to the institution’s approval process, a review by key stakeholders and a senior risk manager was completed. The compiled clinical practice guidelines utilize a systems approach and include assessment, common complications, and practice recommendations. Implementation plans include individual review of the guidelines by current staff, and use as an educational tool in the orientation of new PACU RNs. In order to provide a quick reference for care of their patients, nurses in the PACU will have access to the guidelines via the electronic documentation system. By standardizing practice, these comprehensive clinical practice guidelines will serve to promote quality and safety by providing evidence-based recommendations for general patient care and treatment interventions after general anesthesia, monitored anesthesia care, and regional anesthesia.
DEVELOPMENT OF THE BLOCK NURSE ROLE: CHALLENGES AND SUCCESSES Team Leader: Cidalia J. Vital, RN, MS, CNL, CPAN Baystate Medical Center, Springfield Massachusetts Lee Nutting, RN, Penny Bertolasio, RN, MSN
Perianesthesia nurses in the preoperative holding unit were seeing an increase in the placement of ultra sound guided peripheral nerve blocks due to a change in anesthesia practice. The boost was particularly evident in the total knee replacement population with the femoral nerve and fascia iliaca block technique. They recognized an opportunity to assure consistency, safety and compliance with hospital policy and procedures. The block nurse role was developed to ensure that these requirements were met. Competencies were created utilizing research and evidence through ASPAN standards, Joint Commission, Board of Registration in Nursing, and hospital policies. Lipid therapy, moderate sedation and dysrhythmia training were some of the courses given to staff during annual skills validations. The unit leadership and a preoperative nurse also developed a standard documentation tool. It was trialed and after minor changes was part of the permanent medical record. The block nurse is a registered nurse who has completed the nursing block competency program and is present during all nerve block and epidural placements. The block nurse coordinates the procedure by assisting the anesthesia provider, initiates universal protocol, administers moderate sedation medications and monitors/documents the patient’s vital signs and condition before, during and after the procedure. This process was not without its challenges. Multiple barriers were faced and overcome. After a few months staff felt satisfied that this role was a necessary part of patient safety and standardization of care. Anesthesia, perioperative leadership and preoperative nursing staff worked together to make this a successful practice change.
MAINTAINING PERIANESTHESIA COMPETENCIES ON A TIGHT BUDGET! Team Leader: Cidalia J. Vital, RN, MS, CNL, CPAN Baystate Medical Center, Springfield MA
Cinnamon Desgres, RN, MSN, C, Alison Colburn, RN, CAPA, Esther Brown, RN, Maryann Tourtellotte, RN, Maureen Maynard, RN, CAPA, Anne Marie Culver, RN, Deb Pond, RN, Barbara Zahm, RN, CAPA
During tough economic times creativity and out of the box thinking was needed to meet our yearly validation requirements. The unit based education committee was given a one hour time frame to complete validations instead of the usual 4 hour allotment. The committee met and decided to do a simulation based validation. Utilizing the latest technology, our Nursing Practice and Professional Development colleagues and Sim Man, we created three different scenarios. Each case study included the high risk low frequency competencies seen in our hospital based ambulatory phase I and II surgery center. The ASPAN standards were also used to include evidence based practice standards and recommended competencies for the perianesthesia nurse. The main objectives were to effectively work with team members and utilize critical thinking. Each individual scenario had situation specific objectives that were to be met by the team. Education committee members validated and confirmed findings. Sim Man was placed on the unit so the nurses were in their environment and able to use their equipment. At the end of the simulation there was opportunity for reflective discussion. Overall staff felt the simulation was a successful way to complete their annual validations. They were happy to have a one hour time block instead of the usual four hours on a Saturday morning. The education committee recommended for the following year we request a two hour time frame so we can review other skills that they felt were not covered well during the simulation.
GENERATION Z: CARE OF ADOLESCENTS IN THE ADULT PACU Team Leader: Jillian Fetzner, BSN, RN Cleveland Clinic, Cleveland, OH Team Member: Katie Zacharyasz, BSN, RN, CPAN
The physical layout and size of this institution allows for separate Pediatric and Adult PACUs. In many instances, however, adolescent patients may be cared for by surgeons and anesthesia providers from “adult” service lines based on specific disease processes, and ultimately are transferred to the Adult PACU for care. Although many adolescents are physically the size of adult patients, they have unique needs. Nurses in Adult PACU area reported low levels of confidence in meeting this patient population’s needs. The objective was to increase staff confidence in the care they provide to adolescent patients in Adult PACU. A computerized online module was created for the nurses. This educational module reviewed stages of development, fears, hospitalization, postoperative management, and anesthesia-related problems. A post-test was implemented to assess nursing competence. The module was submitted for continuing education credit. More resources have been provided for the PACU staff nurses. This information is based in current, best practices which allow PACU nurses to feel confident in the quality of care that they