- Email: [email protected]
Empowering PACU Nurses to Lead and Manage an Emergent Event
ASPAN NATIONAL CONFERENCE ABSTRACTS
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Process of Implementation: Nurses completed a learning needs assessment. We evaluated the results and implemented an individualized plan. Knowledge comprehension was tested utilizing a national aptitude exam (BKAT) and a dysrhythmia exam. All RN staff were trained in Presurgical, PACU, and extended recovery. Based on learning needs, staff attended a critical care and/or a dysrhythmia course, Perianesthesia Specialty Day, IV skills day, and ICU observation. A color coded spread sheet was created to map out the progress of each individual employee. The complexities of the educational plan also included facilitating training to new technologies, equipment and facility. Statement of Successful Practice: We developed an educational plan that met the individualized learning needs of all staff, creating a cohesive group of competent cross trained staff. We successfully trained staff to a new facility, technology, and work flows to meet our goal of opening on time. Implications for Advancing the Practice of Perianesthesia Nursing: Cross-training staff to all phases of perianesthesia care has been identified as not only cost effective, but beneficial to patient care and patient flow. A cross trained perianesthesia nurse is equipped with the knowledge and skills to intervene for a patient at any stage of care.
RISING AND SHINING IN THE PEDIATRIC DAY HOSPITAL Team Leader: Aimee Dannaoui, RN BSN CPHON CAPA Memorial Sloan Kettering, New York, New York Team Members: Rachel Bright, RN BSN CPHON, Caitlin Gillen, RN BSN CPHON, Tara O’Neill, RN BSN CPEN
Background Information: The procedure room is designated treatment area in the outpatient Pediatric Day Hospital (PDH). The pediatric heme/onc RNs in this area had no prior specific training in pre and post anesthesia care. These nurses provide care pre, during, and post procedures that require anesthesia and work collaboratively with the anesthesiologist and support staff both on the platform and off-site for scans. These procedures include bone marrow aspirations and biopsies, placement of central venous catheters, lumbar punctures, removal of tunneled catheters and mediports, scans that require anesthesia, radiation therapy, wound care, minor orthopedic procedures, and skin biopsies. Objectives of Project: Identify ways to improve patient safety and incorporate the ASPAN guidelines for pediatric patients receiving anesthesia Identify the gaps in education between the current plan and ASPAN competencies Standardize the orientation required of the RN caring for patients in the PDH Procedure Room Process of Implementation: The nurses in the procedure and recovery rooms cross-walked the ASPAN competency guidelines with the current orientation plan to identify the learning needs to be addressed. By tailoring the training of
Note: All abstracts are printed as received from the authors.
the nurse to the unique needs of perianesthesia patients, we created a standard of care for all pediatric perianesthesia patients in the PDH. Statement of Successful Practice: PDH staff report positive feedback with the increase in staffing and education on the unit. By demonstrating the need to maintain the national staffing guidelines to ensure the safety or our pediatric patients we were able to justify the need for more FTE’s and increased the nurse to patient ratio. The increased knowledge base of the core nursing staff in the Procedure Room has empowered the nurses to own their practice. Implications for Advancing the Practice of Perianesthesia Nursing: This nursing initiative created a level of accountability for all Team Members to work cohesively with the common goal of increasing patient safety for pediatric patients receiving anesthesia and established an education plan and core competencies for the perianesthesia nurses. This has significantly improved procedure room efficiency and staff satisfaction.
EMPOWERING PACU NURSES TO LEAD AND MANAGE AN EMERGENT EVENT Team Leader: Trisha Friend, BSN RN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Julia Fulton, BSN RN, Staci Eguia, MSN RN CCRN
Background Information: Rapid growth and expansion of our medical facility created a delay in response time for the code blue hospital team. Post Anesthesia Care Unit (PACU) nursing team determined there was a need to develop and empower PACU nurses for emergent cardiopulmonary issues. The American Heart Association consensus statement on the quality of CPR emphasized team management as a way to improve quality of resuscitation. Objectives of Project: The project objective was to build knowledge/ skills that allow the PACU nurses to confidently identify and manage an emergent event in a timely manner, in order to improve patient outcomes and empower nurses in their role. Process of Implementation: Identified the need for improved response given an emergent event Evaluated resources and developed education plan Presented plan to PACU leadership and Anesthesiologist Assessed the knowledge and skill base of PACU nurses pre and post project implementation Nurses were educated with skill stations and case scenario reviews to build confidence in roles during an emergent event. Written information and data provided A daily staffing grid was developed, allowing nurses to voluntarily sign up for a specific role, ensuring the nurse was confident in their ability to perform their role. Ongoing education provided to build confidence in the various roles. Ongoing evaluation of the process allows for improvement in the process and patient outcomes Statement of Successful Practice: An anonymous survey was given to the nurses prior to implementation of defined code
ASPAN NATIONAL CONFERENCE ABSTRACTS roles and training. The survey indicated that 69% of the nursing team was not competent in use of current defibrillator pads and 35% of the nursing team was not confident functioning as team lead during an emergent airway event. The post implementation survey indicates that 100% of the respondents were able to correctly identify placement and proper use of defibrillator pads, 76% of respondents indicated confidence in emergent airway management, and 100% of respondents stated the training session improved their abilities to provide clinical leadership during emergent situations. Implications for Advancing the Practice of Perianesthesia Nursing: Implementing an education plan, skills stations, scenario based simulation and voluntary sign up, can empower nurses to develop competencies and prevent failure to rescue in the PACU setting.
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Addressed the barriers to safe practice and knowledge gaps Administered a second post-survey that illustrated 98% validation of understanding of the correct policy and procedures among the respondents Implemented measures, such as staff surveillance, utilization of superusers, and partnership with lab, to sustain the standardized process
STANDARDIZING CENTRAL VENOUS CATHETER LAB COLLECTION PROCESS TO REDUCE RISK OF CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION
Statement of Successful Practice: Pre-survey results indicated knowledge deficits among clinical nurses related to proper disinfection, collection techniques, and institutional policies. The post survey results, following reeducation and simulation, illustrated 98% validation of understanding correct CVC blood draw policies and procedures to prevent CLABSI. Implications for Advancing the Practice of Perianesthesia Nursing: The use of standardized guidelines for the collection of blood samples from CVC lines can potentially reduce the risk of CLABSI. The use of skill stations to provide education can enhance understanding of correct policy and procedure as indicated by the post survey.
Team Leader: Shanet Sumesh, BSN RN CPAN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Jules Enriquez, BSN RN CPAN CCRN, Staci Eguia, MSN RN CCRN
SOLVING THE MYSTERY OF POST ANESTHESIA RECOVERY SCORES
Background Information: According to the Centers for Disease Control CDC, an estimated 30,100 central line associated bloodstream infections (CLABSI) occur in acute care facilities each year. The Joint Commission National Patient Safety Goals recommends implementing proven guidelines to prevent CLABSI. In a major cancer center, with an average of 60 to 80 surgical procedures performed daily, the risk of CLABSI is significant considering the immunocompromised patient population. Post Anesthesia Care Unit (PACU) nurses committed to infection control developed a standardized process for collecting lab samples from the Central Venous Catheter (CVC). Objectives of Project: The objective of the project was to identify barriers in obtaining CVC blood samples among PACU nurses. The project aimed to assess any knowledge deficit and barriers to safe nursing practice related to CVC blood draw. The goal was to implement and educate nurses on a standardized process of CVC blood draw in compliance with institutional policy and CDC recommendations. Process of Implementation: Obtained the primary needs assessment via electronic survey Collaborated with lab educator to identify best practice and obtained training Trained superusers to assist with educating PACU nurses regarding standard guidelines and current policies Provided skill station and training for nurses followed by return demonstration and competency validation Identified a need to re-educate as illustrated by a post survey
Note: All abstracts are printed as received from the authors.
Team Leaders: Anna Mae Josue, BSN RN CPAN, Elizabeth Trejo, BSN RN, Donna Conde, BSN RN CPAN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Staci Eguia, MSN RN CCRN, Cori Kopecky, MSN RN OCN, Modesto Herrera, BSN RN CPAN, Anita Jogee, MSN RN CPAN, Rechelle Falguera, BSN RN CPAN BC, Lauren Mills, BSN RN, Alan Villareal, BSN RN CPAN
Background Information: In a progressive oncology facility that recently transitioned to an electronic health record (EHR), variances in discharge scoring by nursing staff were observed. A focus group was established to identify and address barriers related to consistent understanding and application of post anesthesia recovery scoring and discharge criteria. Objectives of Project:
Assess nursing staffs’ current knowledge and practice Review established ASPAN standards and guidelines Identify variations in the EHR charting system Develop and provide education to Team Members Promote standardization in practice and EHR documentation of discharge scoring
Process of Implementation: Chart audits and staff feedback revealed variances in nursing staffs’ understanding and application of post anesthesia recovery scoring and discharge criteria. A timeline with deadlines and action items was developed by a focus group to ensure objectives were met. Knowledge deficits of ASPAN definitions and guidelines were identified. Inconsistences in the EHR charting system related to various patient populations were a source of confusion amongst staff. Education included team huddles, one to one discussion, case scenarios were developed and disseminated. Statement of Successful Practice: The initial survey showed that 50% of the nursing team were unable to appropriately
e24
Process of Implementation: Nurses completed a learning needs assessment. We evaluated the results and implemented an individualized plan. Knowledge comprehension was tested utilizing a national aptitude exam (BKAT) and a dysrhythmia exam. All RN staff were trained in Presurgical, PACU, and extended recovery. Based on learning needs, staff attended a critical care and/or a dysrhythmia course, Perianesthesia Specialty Day, IV skills day, and ICU observation. A color coded spread sheet was created to map out the progress of each individual employee. The complexities of the educational plan also included facilitating training to new technologies, equipment and facility. Statement of Successful Practice: We developed an educational plan that met the individualized learning needs of all staff, creating a cohesive group of competent cross trained staff. We successfully trained staff to a new facility, technology, and work flows to meet our goal of opening on time. Implications for Advancing the Practice of Perianesthesia Nursing: Cross-training staff to all phases of perianesthesia care has been identified as not only cost effective, but beneficial to patient care and patient flow. A cross trained perianesthesia nurse is equipped with the knowledge and skills to intervene for a patient at any stage of care.
RISING AND SHINING IN THE PEDIATRIC DAY HOSPITAL Team Leader: Aimee Dannaoui, RN BSN CPHON CAPA Memorial Sloan Kettering, New York, New York Team Members: Rachel Bright, RN BSN CPHON, Caitlin Gillen, RN BSN CPHON, Tara O’Neill, RN BSN CPEN
Background Information: The procedure room is designated treatment area in the outpatient Pediatric Day Hospital (PDH). The pediatric heme/onc RNs in this area had no prior specific training in pre and post anesthesia care. These nurses provide care pre, during, and post procedures that require anesthesia and work collaboratively with the anesthesiologist and support staff both on the platform and off-site for scans. These procedures include bone marrow aspirations and biopsies, placement of central venous catheters, lumbar punctures, removal of tunneled catheters and mediports, scans that require anesthesia, radiation therapy, wound care, minor orthopedic procedures, and skin biopsies. Objectives of Project: Identify ways to improve patient safety and incorporate the ASPAN guidelines for pediatric patients receiving anesthesia Identify the gaps in education between the current plan and ASPAN competencies Standardize the orientation required of the RN caring for patients in the PDH Procedure Room Process of Implementation: The nurses in the procedure and recovery rooms cross-walked the ASPAN competency guidelines with the current orientation plan to identify the learning needs to be addressed. By tailoring the training of
Note: All abstracts are printed as received from the authors.
the nurse to the unique needs of perianesthesia patients, we created a standard of care for all pediatric perianesthesia patients in the PDH. Statement of Successful Practice: PDH staff report positive feedback with the increase in staffing and education on the unit. By demonstrating the need to maintain the national staffing guidelines to ensure the safety or our pediatric patients we were able to justify the need for more FTE’s and increased the nurse to patient ratio. The increased knowledge base of the core nursing staff in the Procedure Room has empowered the nurses to own their practice. Implications for Advancing the Practice of Perianesthesia Nursing: This nursing initiative created a level of accountability for all Team Members to work cohesively with the common goal of increasing patient safety for pediatric patients receiving anesthesia and established an education plan and core competencies for the perianesthesia nurses. This has significantly improved procedure room efficiency and staff satisfaction.
EMPOWERING PACU NURSES TO LEAD AND MANAGE AN EMERGENT EVENT Team Leader: Trisha Friend, BSN RN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Julia Fulton, BSN RN, Staci Eguia, MSN RN CCRN
Background Information: Rapid growth and expansion of our medical facility created a delay in response time for the code blue hospital team. Post Anesthesia Care Unit (PACU) nursing team determined there was a need to develop and empower PACU nurses for emergent cardiopulmonary issues. The American Heart Association consensus statement on the quality of CPR emphasized team management as a way to improve quality of resuscitation. Objectives of Project: The project objective was to build knowledge/ skills that allow the PACU nurses to confidently identify and manage an emergent event in a timely manner, in order to improve patient outcomes and empower nurses in their role. Process of Implementation: Identified the need for improved response given an emergent event Evaluated resources and developed education plan Presented plan to PACU leadership and Anesthesiologist Assessed the knowledge and skill base of PACU nurses pre and post project implementation Nurses were educated with skill stations and case scenario reviews to build confidence in roles during an emergent event. Written information and data provided A daily staffing grid was developed, allowing nurses to voluntarily sign up for a specific role, ensuring the nurse was confident in their ability to perform their role. Ongoing education provided to build confidence in the various roles. Ongoing evaluation of the process allows for improvement in the process and patient outcomes Statement of Successful Practice: An anonymous survey was given to the nurses prior to implementation of defined code
ASPAN NATIONAL CONFERENCE ABSTRACTS roles and training. The survey indicated that 69% of the nursing team was not competent in use of current defibrillator pads and 35% of the nursing team was not confident functioning as team lead during an emergent airway event. The post implementation survey indicates that 100% of the respondents were able to correctly identify placement and proper use of defibrillator pads, 76% of respondents indicated confidence in emergent airway management, and 100% of respondents stated the training session improved their abilities to provide clinical leadership during emergent situations. Implications for Advancing the Practice of Perianesthesia Nursing: Implementing an education plan, skills stations, scenario based simulation and voluntary sign up, can empower nurses to develop competencies and prevent failure to rescue in the PACU setting.
e25
Addressed the barriers to safe practice and knowledge gaps Administered a second post-survey that illustrated 98% validation of understanding of the correct policy and procedures among the respondents Implemented measures, such as staff surveillance, utilization of superusers, and partnership with lab, to sustain the standardized process
STANDARDIZING CENTRAL VENOUS CATHETER LAB COLLECTION PROCESS TO REDUCE RISK OF CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION
Statement of Successful Practice: Pre-survey results indicated knowledge deficits among clinical nurses related to proper disinfection, collection techniques, and institutional policies. The post survey results, following reeducation and simulation, illustrated 98% validation of understanding correct CVC blood draw policies and procedures to prevent CLABSI. Implications for Advancing the Practice of Perianesthesia Nursing: The use of standardized guidelines for the collection of blood samples from CVC lines can potentially reduce the risk of CLABSI. The use of skill stations to provide education can enhance understanding of correct policy and procedure as indicated by the post survey.
Team Leader: Shanet Sumesh, BSN RN CPAN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Jules Enriquez, BSN RN CPAN CCRN, Staci Eguia, MSN RN CCRN
SOLVING THE MYSTERY OF POST ANESTHESIA RECOVERY SCORES
Background Information: According to the Centers for Disease Control CDC, an estimated 30,100 central line associated bloodstream infections (CLABSI) occur in acute care facilities each year. The Joint Commission National Patient Safety Goals recommends implementing proven guidelines to prevent CLABSI. In a major cancer center, with an average of 60 to 80 surgical procedures performed daily, the risk of CLABSI is significant considering the immunocompromised patient population. Post Anesthesia Care Unit (PACU) nurses committed to infection control developed a standardized process for collecting lab samples from the Central Venous Catheter (CVC). Objectives of Project: The objective of the project was to identify barriers in obtaining CVC blood samples among PACU nurses. The project aimed to assess any knowledge deficit and barriers to safe nursing practice related to CVC blood draw. The goal was to implement and educate nurses on a standardized process of CVC blood draw in compliance with institutional policy and CDC recommendations. Process of Implementation: Obtained the primary needs assessment via electronic survey Collaborated with lab educator to identify best practice and obtained training Trained superusers to assist with educating PACU nurses regarding standard guidelines and current policies Provided skill station and training for nurses followed by return demonstration and competency validation Identified a need to re-educate as illustrated by a post survey
Note: All abstracts are printed as received from the authors.
Team Leaders: Anna Mae Josue, BSN RN CPAN, Elizabeth Trejo, BSN RN, Donna Conde, BSN RN CPAN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Staci Eguia, MSN RN CCRN, Cori Kopecky, MSN RN OCN, Modesto Herrera, BSN RN CPAN, Anita Jogee, MSN RN CPAN, Rechelle Falguera, BSN RN CPAN BC, Lauren Mills, BSN RN, Alan Villareal, BSN RN CPAN
Background Information: In a progressive oncology facility that recently transitioned to an electronic health record (EHR), variances in discharge scoring by nursing staff were observed. A focus group was established to identify and address barriers related to consistent understanding and application of post anesthesia recovery scoring and discharge criteria. Objectives of Project:
Assess nursing staffs’ current knowledge and practice Review established ASPAN standards and guidelines Identify variations in the EHR charting system Develop and provide education to Team Members Promote standardization in practice and EHR documentation of discharge scoring
Process of Implementation: Chart audits and staff feedback revealed variances in nursing staffs’ understanding and application of post anesthesia recovery scoring and discharge criteria. A timeline with deadlines and action items was developed by a focus group to ensure objectives were met. Knowledge deficits of ASPAN definitions and guidelines were identified. Inconsistences in the EHR charting system related to various patient populations were a source of confusion amongst staff. Education included team huddles, one to one discussion, case scenarios were developed and disseminated. Statement of Successful Practice: The initial survey showed that 50% of the nursing team were unable to appropriately