- Email: [email protected]
Engaging The People We Serve Through Collaboration
ASPAN NATIONAL CONFERENCE ABSTRACTS key to maintaining post-operative and post procedural patient safety. Objectives of Project: Provide real life experiences relating to common PACU emergency scenarios for staff in a safe learning environment. Use annual education and simulation to assure PACU staff are competent in their roles during a PACU emergent event. Process of Implementation: PACU staff annually perform online ICU patient, Dysrhythmia, and ACLS education. While baseline scores were good, the feedback from needs assessments indicated the desire for further hands on education. The Perianesthesia Nursing Education Council identified and wrote scenarios for common PACU emergent events (Stroke, Respiratory Arrest, Local Anesthesia Systemic Toxicity, Malignant Hyperthermia, and Septic Shock). Education Council members were educated on running the SimMan 3 G simulation manikin. ACLS instructors from the group were designated room instructors. Date, times and supplies were obtained to hold simulation fairs in the inpatient PACUs. Statement of Successful Practice: Fairs were interactive and provided staff with real time information. Staff were quick to respond to sudden changes in the patient’s condition during scenarios. Emergency fairs were designed to replicate real life situations. The situations progressed at a realistic time frame to be as authentic as possible. Comparing the data from pre fair needs assessments, and post fairs survey results, staff indicated they were more comfortable translating what they learned in the fairs to their daily practice. Per the post fair surveys, staff identified the post scenario debriefings as most valuable in that they allowed the staff to examine both the positives interventions and areas for improvement. Implications for Advancing the Practice of Perianesthesia Nursing: Emergency Scenario fairs assist staff to identify slight changes in patient condition. Early recognition of trends in patient condition decreases untoward outcomes by implementing the patient treatment before his or her condition becomes critical. Simulation in education aids in retention and comprehension of information. Emergency Scenario fairs better prepares the staff to initiate early intervention in an emergent situation.
CAPA CERTIFIED NURSES TO THE RESCUE: RAPID RESPONSE IN THE OUTPATIENT SETTING Team Leader: Deborah White, BSN RN CAPA University of Texas MD Anderson Cancer Center, Houston, Texas Note: All abstracts are printed as received from the authors.
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Team Members: Felicia Selman, BSN RN CAPA, Janelle Kister, BSN RN CAPA
Background Information Related to Problem Identification: In 2005, an ambulatory care building was opened in order to provide diagnostic, oncologic, radiological and surgical procedures. The nursing administration wanted to provide the same services offered to our outpatient customers (patients, workforce members and visitors) as our inpatient customers. In response to, “The 100, 000 Lives Campaign”, a rapid response team was created for the outpatient setting and it was named the Medical Emergency Rapid Intervention Team (MERIT). From 2005 to 2012, inpatient Post Anesthesia Care nurses were staffed as MERIT. In 2012, the outpatient Post Anesthesia Care nurses began to staff the MERIT team. Objectives of Project: To develop a teaching plan in order to train outpatient CAPA certified nurses to handle urgent and emergent situations as a rapid response nurse in an ambulatory setting. Process of Implementation: Identity nurses who could work as autonomous critical thinkers. Develop an educational plan to augment a Post Anesthesia Care nurses’ knowledge base and skillset. Educate current Ambulatory Surgery Center nurses on MERIT processes. Statement of the Successful Practice: The outpatient MERIT Team has cared for more than 450 customers since 2012. Working closely with the primary clinic caregivers, the Code Blue Team, and Case Management, we have a solid, but flexible plan in place for our customers. Patients can be discharged in their own care, allowed to follow-up with their primary practitioner or be transferred to a higher level of care. Implications for Advancing the Practice of Perianesthesia Nursing: In our clinics and outpatient treatment facilities, patients are experiencing severe drug reactions, chest pain, falls, altered mental status, sepsis and, at times, seizure activity. CAPA certified Post Anesthesia Care nurses are autonomous, critical thinkers and excellent patient educators. Our assessment skills are put to good use during emergencies. The focused assessment and on the spot education are the exact tools needed in order to problem solve when determining the disposition of our customers. Although we can respond to emergencies independently, collaboration is another tool we use to provide positive patient outcomes.
ENGAGING THE PEOPLE WE SERVE THROUGH COLLABORATION Team Leader: Deborah White, BSN RN CAPA University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Ofelia Alilain, BSN RN CAPA, Yvette Rosenthal, RN CAPA, Tomar Foster Mills, BSN RN CAPA
Background Information related to problem Identification: After opening an Ambulatory Surgical Center in 2005, the Post Anesthesia Care Unit nurses discovered that there were very few documents dedicated to home care regarding the procedures performed in the outpatient setting. There
ASPAN NATIONAL CONFERENCE ABSTRACTS
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was a need to provide procedure specific discharge instructions and corresponding home care documents, so that the Post Anesthesia Care Nurses would be able to provide clear and concise home care information. Objective of Project: To collaborate with multiple surgical services and the institution’s Patient Education Department in order to create/develop patient education home care documents and discharge instructions that are easy to access and comprehend. Process of Implementation: 1. Identify consistent surgical procedures that were done in this ambulatory surgery center by reviewing the surgery schedule for the past year. a. Common procedures categorized into surgical specialties. 2. Based on the common procedures, we determined which home care documents were salvageable or which needed to be created based current institutional format requirements and on review of literature. 3. Collaborate with surgical teams on the need for surgery specific discharge instructions and educational documents in our Patient Education Online system. 4. Create document drafts of both the discharge instructions and educational documents for each surgical team. Act as the liaison between our Health Information Management and Patient Education On-Line department. 5. Review final drafts with the surgical team and present for publication. Statement of the Successful practice: The Patient Teaching Committee was able to build surgery specific discharge instructions for breast and gynecological surgeries, breast reconstruction, general ambulatory, port insertion/port removal and transrectal ultrasound prostate biopsies which are signed by both patient and surgeon to verify home care teaching. Evidenced-based home care documents were placed online and made available to both staff and patients. Implications for Advancing the Practice of Perianesthesia Nursing: Collaboration among multiple disciplines to generate clear and concise home care instructions reduced the knowledge gap at discharge. Nurses are now empowered with additional tools to educate and engage their patient to provide a safe home care environment.
HYPOGLYCEMIA CAN KILL! NEW PROTOCOLS ARE LONG OVERDUE! Team Leaders: Louise Meymand, DC BSN RN-BC, Jennifer Jones, MSN RN AGCNS-BC CCRN Baylor Heart and Vascular Hospital, Dallas, Texas Team Members: Robert Williams, BSN MBA RN-BC (Mentor), Art Signo, MSN RN-BC (Facilitator), Grace Poon, PharmD, Erin Wandrey, PharmD, Carollyn McAllister, MS RDN LD, Taryn Solomon, RDN LD, Lindsey Bradlley, BSN RN-BC, Lauren Laroe, BSN RN-BC, Tracy Ordrop, MSN RN, Trenton Witt, BSN RN Background Information: The long established protocol for monitoring of diabetic patients in the hospital setting has become unviable due to advancement in diabetic medications. New Diabetic medications have led to longer acting effects, Note: All abstracts are printed as received from the authors.
increasing the incidence of hypoglycemic events for the diabetic inpatient population. Hypoglycemic events can range from manageable symptoms to deadly arrests. Objectives of Project: To identify contributing causes leading to hypoglycemic events in non-critical care diabetic surgical patients, and then develop a process improvement to eliminate hypoglycemic events in this patient population. Process of Implementation: A registered nurse working closely with a diabetes council researched possible causes for the high prevalence of hypoglycemic events among non-critical care diabetic surgical patients. A hypoglycemic event debrief tool was developed to collect data, identify trends leading to these hypoglycemic events, and educate staff in real-time. After several months of data collection, identified trends led to structuring of a process change consisting of nursing, PCT’s, and Nutrition services. A safety step was added on admission to identify diabetic patients who were high risk for developing a hypoglycemic event during their hospital stay. Pre-admission teaching for taking oral and long acting insulins the night before and morning of surgery was updated. Information about current diabetes medications, both oral and insulin, were printed and laminated for reference on all floors. The Education department assisted in teaching the new process improvement to all involved areas and Pharmacy provided concise current diabetic medication teaching. Implementation of this project was cost neutral, limited to printing costs and one week of education roll out to staff. Statement of Successful Practice: Since implementation of the process improvement, hypoglycemic events in non-critical care diabetic surgical patients have been reduced from an average of 8 events per month to almost 0 per month, surpassing System goals. Target goal by the System for 2015 was 0.74% incidence for the subject population. They ended 2015 with 0.05% incidence. Implications for Advancing the Practice of Perianesthesia Nursing: A new process for monitoring of non-critical care diabetic surgical patients will require perianesthesia nurses and floor nurse to implement critical thinking skills followed by an appropriate intervention, by piecing together a thorough patient history with discerning knowledge of current diabetic medications.
ENHANCED RECOVERY FOR ELECTIVE COLORECTAL SURGERY Team Leaders: Joseph Brooks, MD, Mike Kahler, BSN RN CNOR Midland Memorial Health, Midland, Texas Team Members: Jeanette Frantz, MSN RN, Robyn Wood, BSN RN, Jessica Hawkins, MSN RN, Trina Mora, BSN RN CAPA CPAN, Susana Dominguez, BSN RN, Rita Perez, RN
Background Information: Patient length of stay for elective colo-rectal surgery was above national averages according to reports from the National Surgical Quality Improvement Project (NSQIP). An extensive literature review was conducted to assess recommended elements of practice by Enhanced Recovery after Surgery (ERAS) Society compared to our current practice. Implementing the elements of Enhanced Recovery requires a multi-disciplinary approach with input and commitment across all phases of patient care. A proposal was developed by the inter-disciplinary team to adopt components from the pre-op, intraoperative and post-operative element sets.
CAPA CERTIFIED NURSES TO THE RESCUE: RAPID RESPONSE IN THE OUTPATIENT SETTING Team Leader: Deborah White, BSN RN CAPA University of Texas MD Anderson Cancer Center, Houston, Texas Note: All abstracts are printed as received from the authors.
e45
Team Members: Felicia Selman, BSN RN CAPA, Janelle Kister, BSN RN CAPA
Background Information Related to Problem Identification: In 2005, an ambulatory care building was opened in order to provide diagnostic, oncologic, radiological and surgical procedures. The nursing administration wanted to provide the same services offered to our outpatient customers (patients, workforce members and visitors) as our inpatient customers. In response to, “The 100, 000 Lives Campaign”, a rapid response team was created for the outpatient setting and it was named the Medical Emergency Rapid Intervention Team (MERIT). From 2005 to 2012, inpatient Post Anesthesia Care nurses were staffed as MERIT. In 2012, the outpatient Post Anesthesia Care nurses began to staff the MERIT team. Objectives of Project: To develop a teaching plan in order to train outpatient CAPA certified nurses to handle urgent and emergent situations as a rapid response nurse in an ambulatory setting. Process of Implementation: Identity nurses who could work as autonomous critical thinkers. Develop an educational plan to augment a Post Anesthesia Care nurses’ knowledge base and skillset. Educate current Ambulatory Surgery Center nurses on MERIT processes. Statement of the Successful Practice: The outpatient MERIT Team has cared for more than 450 customers since 2012. Working closely with the primary clinic caregivers, the Code Blue Team, and Case Management, we have a solid, but flexible plan in place for our customers. Patients can be discharged in their own care, allowed to follow-up with their primary practitioner or be transferred to a higher level of care. Implications for Advancing the Practice of Perianesthesia Nursing: In our clinics and outpatient treatment facilities, patients are experiencing severe drug reactions, chest pain, falls, altered mental status, sepsis and, at times, seizure activity. CAPA certified Post Anesthesia Care nurses are autonomous, critical thinkers and excellent patient educators. Our assessment skills are put to good use during emergencies. The focused assessment and on the spot education are the exact tools needed in order to problem solve when determining the disposition of our customers. Although we can respond to emergencies independently, collaboration is another tool we use to provide positive patient outcomes.
ENGAGING THE PEOPLE WE SERVE THROUGH COLLABORATION Team Leader: Deborah White, BSN RN CAPA University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Ofelia Alilain, BSN RN CAPA, Yvette Rosenthal, RN CAPA, Tomar Foster Mills, BSN RN CAPA
Background Information related to problem Identification: After opening an Ambulatory Surgical Center in 2005, the Post Anesthesia Care Unit nurses discovered that there were very few documents dedicated to home care regarding the procedures performed in the outpatient setting. There
ASPAN NATIONAL CONFERENCE ABSTRACTS
e46
was a need to provide procedure specific discharge instructions and corresponding home care documents, so that the Post Anesthesia Care Nurses would be able to provide clear and concise home care information. Objective of Project: To collaborate with multiple surgical services and the institution’s Patient Education Department in order to create/develop patient education home care documents and discharge instructions that are easy to access and comprehend. Process of Implementation: 1. Identify consistent surgical procedures that were done in this ambulatory surgery center by reviewing the surgery schedule for the past year. a. Common procedures categorized into surgical specialties. 2. Based on the common procedures, we determined which home care documents were salvageable or which needed to be created based current institutional format requirements and on review of literature. 3. Collaborate with surgical teams on the need for surgery specific discharge instructions and educational documents in our Patient Education Online system. 4. Create document drafts of both the discharge instructions and educational documents for each surgical team. Act as the liaison between our Health Information Management and Patient Education On-Line department. 5. Review final drafts with the surgical team and present for publication. Statement of the Successful practice: The Patient Teaching Committee was able to build surgery specific discharge instructions for breast and gynecological surgeries, breast reconstruction, general ambulatory, port insertion/port removal and transrectal ultrasound prostate biopsies which are signed by both patient and surgeon to verify home care teaching. Evidenced-based home care documents were placed online and made available to both staff and patients. Implications for Advancing the Practice of Perianesthesia Nursing: Collaboration among multiple disciplines to generate clear and concise home care instructions reduced the knowledge gap at discharge. Nurses are now empowered with additional tools to educate and engage their patient to provide a safe home care environment.
HYPOGLYCEMIA CAN KILL! NEW PROTOCOLS ARE LONG OVERDUE! Team Leaders: Louise Meymand, DC BSN RN-BC, Jennifer Jones, MSN RN AGCNS-BC CCRN Baylor Heart and Vascular Hospital, Dallas, Texas Team Members: Robert Williams, BSN MBA RN-BC (Mentor), Art Signo, MSN RN-BC (Facilitator), Grace Poon, PharmD, Erin Wandrey, PharmD, Carollyn McAllister, MS RDN LD, Taryn Solomon, RDN LD, Lindsey Bradlley, BSN RN-BC, Lauren Laroe, BSN RN-BC, Tracy Ordrop, MSN RN, Trenton Witt, BSN RN Background Information: The long established protocol for monitoring of diabetic patients in the hospital setting has become unviable due to advancement in diabetic medications. New Diabetic medications have led to longer acting effects, Note: All abstracts are printed as received from the authors.
increasing the incidence of hypoglycemic events for the diabetic inpatient population. Hypoglycemic events can range from manageable symptoms to deadly arrests. Objectives of Project: To identify contributing causes leading to hypoglycemic events in non-critical care diabetic surgical patients, and then develop a process improvement to eliminate hypoglycemic events in this patient population. Process of Implementation: A registered nurse working closely with a diabetes council researched possible causes for the high prevalence of hypoglycemic events among non-critical care diabetic surgical patients. A hypoglycemic event debrief tool was developed to collect data, identify trends leading to these hypoglycemic events, and educate staff in real-time. After several months of data collection, identified trends led to structuring of a process change consisting of nursing, PCT’s, and Nutrition services. A safety step was added on admission to identify diabetic patients who were high risk for developing a hypoglycemic event during their hospital stay. Pre-admission teaching for taking oral and long acting insulins the night before and morning of surgery was updated. Information about current diabetes medications, both oral and insulin, were printed and laminated for reference on all floors. The Education department assisted in teaching the new process improvement to all involved areas and Pharmacy provided concise current diabetic medication teaching. Implementation of this project was cost neutral, limited to printing costs and one week of education roll out to staff. Statement of Successful Practice: Since implementation of the process improvement, hypoglycemic events in non-critical care diabetic surgical patients have been reduced from an average of 8 events per month to almost 0 per month, surpassing System goals. Target goal by the System for 2015 was 0.74% incidence for the subject population. They ended 2015 with 0.05% incidence. Implications for Advancing the Practice of Perianesthesia Nursing: A new process for monitoring of non-critical care diabetic surgical patients will require perianesthesia nurses and floor nurse to implement critical thinking skills followed by an appropriate intervention, by piecing together a thorough patient history with discerning knowledge of current diabetic medications.
ENHANCED RECOVERY FOR ELECTIVE COLORECTAL SURGERY Team Leaders: Joseph Brooks, MD, Mike Kahler, BSN RN CNOR Midland Memorial Health, Midland, Texas Team Members: Jeanette Frantz, MSN RN, Robyn Wood, BSN RN, Jessica Hawkins, MSN RN, Trina Mora, BSN RN CAPA CPAN, Susana Dominguez, BSN RN, Rita Perez, RN
Background Information: Patient length of stay for elective colo-rectal surgery was above national averages according to reports from the National Surgical Quality Improvement Project (NSQIP). An extensive literature review was conducted to assess recommended elements of practice by Enhanced Recovery after Surgery (ERAS) Society compared to our current practice. Implementing the elements of Enhanced Recovery requires a multi-disciplinary approach with input and commitment across all phases of patient care. A proposal was developed by the inter-disciplinary team to adopt components from the pre-op, intraoperative and post-operative element sets.