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Improving Communications and Patient Safety within Post Anesthesia Care Units
National ASPAN Conference Abstracts* RESEARCH POSTER ABSTRACTS
AN EVIDENCE BASED STUDY ON THE MINIMUM VOLUME OF BLOOD WASTAGE FROM ARTERIAL LINES Wanda Rodriguez, MA, RN, CCRN, CPAN, Doreen McCarty, BSN, RN, CPAN, Stephanie Nolan, MS, RN, CPAN, Joyce Kane, MSN, RN, CCRN, Mary O’Sullivan, BSN, RN, CPAN, Denise Stone, BSN, RN, CPAN Memorial Sloan-Kettering Cancer Center, New York, New York Frequent laboratory testing, convenience of arterial catheters and inconsistent practices contribute to blood loss in postoperative patients. EBP Question: What is the minimum discard volume required when drawing blood from arterial lines? 50 evidence-based articles were reviewed. Expert opinions and guidelines were evaluated. Literature recommends using a blood-conserving device or equating the discard volume to double the arterial line dead space from the catheter tip to the sampling port. Given the compromised immunity of our patients, a closed system was not optimal. We measured 3 ml to be double the arterial line dead space. A dedicated 3 ml waste tube was proposed and approved by our multidisciplinary partners, resulting in decreasing the discard volume from 9 ml to 3 ml.This practice change provides standardization and numerous safety advantages in PACU and ICU settings. The waste tube is plastic as opposed to glass and is significantly more cost effective. It is distinct from our current inventory of laboratory tubes so to avoid being mistakenly analyzed as a diagnostic test. A dedicated 3 ml waste tube has maintained accurate test results while minimizing blood loss to the adult perianesthesia patient.
TEMPERATURE MEASUREMENT IN PATIENTS UNDERGOING COLORECTAL SURGERY & GYNECOLOGY SURGERY: A COMPARISON OF ESOPHAGEAL CORE, TEMPORAL ARTERY, & ORAL METHODS E. Calonder,1 C. Machemer,1 C. Gustafson,1 S. Sendelbach,1 D. Johnson,1 L. Reiland,1 G. Trummel,1 L. Lovejoy,1 J. Hodges2 1 Abbott Northwestern Hospital, Minneapolis, MN; and 2 Minneapolis Heart Institute Foundation, Minneapolis, MN Maintaining perioperative normothermia reduces postoperative complications. There is a need for accurate, non-invasive methods to take temperatures representative of core temperatures. The study purpose was to determine which noninvasive thermometry method most accurately represents core. A repeated-measures design was used with a convenience sample of 23 patients undergoing colorectal or gynecology surgery. Two series of intraoperative temperatures (oral & temporal artery) were compared to core temperature (esophageal probe). Repeated-measures ANOVA tested for biases of oral or temporal vs. core temperatures. Bland-Altman plots were drawn to test dependence of bias on actual core temperature. Average differences (95% confidence interval; P-value) were 0.124 (0.061-0.187; 0.0008) for oral minus esophageal thermometry and 0.074 (0.010-0.138; 0.033) for temporal artery minus esophageal thermometry. Differences between esophageal & oral or temporal artery thermometry were statistically significant, but within 0.4 C; they are acceptable alternatives to core temperatures. Funded by Minnesota Nurses’ Association Foundation and American Society of PeriAnesthesia Nurses.
IMPROVING COMMUNICATIONS AND PATIENT SAFETY WITHIN POST ANESTHESIA CARE UNITS
PREFERENCES FOR VISITATION IN THE POST ANESTHESIA CARE UNIT (PACU)
Rebecca Arndt, BSN, CNOR Vanderbilt University Medical Center, Nashville, TN
Lori A. DeWitt, BSN, RN, CAPA, CPAN, Nancy M. Albert, PhD, RN, CCNS, CCRN, NE-BC Cleveland Clinic, Cleveland OH
Purpose: Failures of communication have been associated with poor quality care. Effective communication may be especially critical during care transitions. We developed a communication improvement intervention focusing on handoffs between anesthesia providers (AP) and Post anesthesia Care Unit (PACU) nurses (RN). We hypothesized that a targeted simulation-based training and performance improvement intervention would increase handoff quality, enhance culture of communication, and improve overall care quality in the PACU. This abstract reports the effects of the intervention on the quality of actual PACU handoffs. Methods: The curriculum and supporting hand-off tools were designed based on live observations of PACU hand-offs and targeted interviews of APs and RNs. The focus was on obstacles to effective handoffs that were identified to include clarity of roles and responsibilities, lack of standardization, and interruptions and distractions. The intervention included a didactic webinar, a new handoff report tool, and a 2 hour simulationbased training session that used standardized patients, clinicians, manikin simulators, and facilitated debriefing. A handoff assessment tool was iteratively developed and validated to measure core elements. RNs were trained to use the tool during 865 actual handoffs. Conclusion: We demonstrated a significant improvement in actual PACU handoff effectiveness following a simulation-based training and performance improvement intervention.
*These abstracts have not undergone editorial review by the editorial board or the reviewers of the journal. Journal of PeriAnesthesia Nursing, Vol 24, No 3 (June), 2009: pp e1-e2
Introduction: The surgical experience provokes anxiety and stress. PACU nurses are first communicators to families awaiting news about post-operative recovery. The term family now includes people outside of the immediate home environment: grandparents, distant relatives, friends and neighbors. Little is known about PACU visitation preferences based on characteristics of visitors. Purpose: To identify PACU update/visitation preferences to learn if one model is best and if differences exist based on visitor characteristics. Methods: Using a cross-sectional design and convenience sample, visitors of patients having elective or emergency surgery completed a survey of five update/visitation options and visitor characteristics. Descriptive statistics were obtained and bivariate relationships between update/visitation options and family member characteristics were assessed. Results: Of 249 visitors, 64% were female; 94% visited adult patients. Of visitation options, a one time, 5-10 minute visit within 2 hours of patient transfer to PACU was most frequent (27.3%). Visitor type (close family vs. distant relative/friend) was associated with visitation preference; close family preferred a one-time visit and distant relative/friend preferred a verbal report 30 minutes after PACU arrival; P 5 0.015. Discussion: While there was no single preference for visitation type, close family preferred a verbal update and a single visitation and distant relatives/friend preferred a verbal report only. Future research should expand on these findings. Implications: Understanding visitor preferences will enhance flexibility to the current update/visitation system to facilitate optimal communication for close and distant family members and improve overall satisfaction with the surgical experience. e1
AN EVIDENCE BASED STUDY ON THE MINIMUM VOLUME OF BLOOD WASTAGE FROM ARTERIAL LINES Wanda Rodriguez, MA, RN, CCRN, CPAN, Doreen McCarty, BSN, RN, CPAN, Stephanie Nolan, MS, RN, CPAN, Joyce Kane, MSN, RN, CCRN, Mary O’Sullivan, BSN, RN, CPAN, Denise Stone, BSN, RN, CPAN Memorial Sloan-Kettering Cancer Center, New York, New York Frequent laboratory testing, convenience of arterial catheters and inconsistent practices contribute to blood loss in postoperative patients. EBP Question: What is the minimum discard volume required when drawing blood from arterial lines? 50 evidence-based articles were reviewed. Expert opinions and guidelines were evaluated. Literature recommends using a blood-conserving device or equating the discard volume to double the arterial line dead space from the catheter tip to the sampling port. Given the compromised immunity of our patients, a closed system was not optimal. We measured 3 ml to be double the arterial line dead space. A dedicated 3 ml waste tube was proposed and approved by our multidisciplinary partners, resulting in decreasing the discard volume from 9 ml to 3 ml.This practice change provides standardization and numerous safety advantages in PACU and ICU settings. The waste tube is plastic as opposed to glass and is significantly more cost effective. It is distinct from our current inventory of laboratory tubes so to avoid being mistakenly analyzed as a diagnostic test. A dedicated 3 ml waste tube has maintained accurate test results while minimizing blood loss to the adult perianesthesia patient.
TEMPERATURE MEASUREMENT IN PATIENTS UNDERGOING COLORECTAL SURGERY & GYNECOLOGY SURGERY: A COMPARISON OF ESOPHAGEAL CORE, TEMPORAL ARTERY, & ORAL METHODS E. Calonder,1 C. Machemer,1 C. Gustafson,1 S. Sendelbach,1 D. Johnson,1 L. Reiland,1 G. Trummel,1 L. Lovejoy,1 J. Hodges2 1 Abbott Northwestern Hospital, Minneapolis, MN; and 2 Minneapolis Heart Institute Foundation, Minneapolis, MN Maintaining perioperative normothermia reduces postoperative complications. There is a need for accurate, non-invasive methods to take temperatures representative of core temperatures. The study purpose was to determine which noninvasive thermometry method most accurately represents core. A repeated-measures design was used with a convenience sample of 23 patients undergoing colorectal or gynecology surgery. Two series of intraoperative temperatures (oral & temporal artery) were compared to core temperature (esophageal probe). Repeated-measures ANOVA tested for biases of oral or temporal vs. core temperatures. Bland-Altman plots were drawn to test dependence of bias on actual core temperature. Average differences (95% confidence interval; P-value) were 0.124 (0.061-0.187; 0.0008) for oral minus esophageal thermometry and 0.074 (0.010-0.138; 0.033) for temporal artery minus esophageal thermometry. Differences between esophageal & oral or temporal artery thermometry were statistically significant, but within 0.4 C; they are acceptable alternatives to core temperatures. Funded by Minnesota Nurses’ Association Foundation and American Society of PeriAnesthesia Nurses.
IMPROVING COMMUNICATIONS AND PATIENT SAFETY WITHIN POST ANESTHESIA CARE UNITS
PREFERENCES FOR VISITATION IN THE POST ANESTHESIA CARE UNIT (PACU)
Rebecca Arndt, BSN, CNOR Vanderbilt University Medical Center, Nashville, TN
Lori A. DeWitt, BSN, RN, CAPA, CPAN, Nancy M. Albert, PhD, RN, CCNS, CCRN, NE-BC Cleveland Clinic, Cleveland OH
Purpose: Failures of communication have been associated with poor quality care. Effective communication may be especially critical during care transitions. We developed a communication improvement intervention focusing on handoffs between anesthesia providers (AP) and Post anesthesia Care Unit (PACU) nurses (RN). We hypothesized that a targeted simulation-based training and performance improvement intervention would increase handoff quality, enhance culture of communication, and improve overall care quality in the PACU. This abstract reports the effects of the intervention on the quality of actual PACU handoffs. Methods: The curriculum and supporting hand-off tools were designed based on live observations of PACU hand-offs and targeted interviews of APs and RNs. The focus was on obstacles to effective handoffs that were identified to include clarity of roles and responsibilities, lack of standardization, and interruptions and distractions. The intervention included a didactic webinar, a new handoff report tool, and a 2 hour simulationbased training session that used standardized patients, clinicians, manikin simulators, and facilitated debriefing. A handoff assessment tool was iteratively developed and validated to measure core elements. RNs were trained to use the tool during 865 actual handoffs. Conclusion: We demonstrated a significant improvement in actual PACU handoff effectiveness following a simulation-based training and performance improvement intervention.
*These abstracts have not undergone editorial review by the editorial board or the reviewers of the journal. Journal of PeriAnesthesia Nursing, Vol 24, No 3 (June), 2009: pp e1-e2
Introduction: The surgical experience provokes anxiety and stress. PACU nurses are first communicators to families awaiting news about post-operative recovery. The term family now includes people outside of the immediate home environment: grandparents, distant relatives, friends and neighbors. Little is known about PACU visitation preferences based on characteristics of visitors. Purpose: To identify PACU update/visitation preferences to learn if one model is best and if differences exist based on visitor characteristics. Methods: Using a cross-sectional design and convenience sample, visitors of patients having elective or emergency surgery completed a survey of five update/visitation options and visitor characteristics. Descriptive statistics were obtained and bivariate relationships between update/visitation options and family member characteristics were assessed. Results: Of 249 visitors, 64% were female; 94% visited adult patients. Of visitation options, a one time, 5-10 minute visit within 2 hours of patient transfer to PACU was most frequent (27.3%). Visitor type (close family vs. distant relative/friend) was associated with visitation preference; close family preferred a one-time visit and distant relative/friend preferred a verbal report 30 minutes after PACU arrival; P 5 0.015. Discussion: While there was no single preference for visitation type, close family preferred a verbal update and a single visitation and distant relatives/friend preferred a verbal report only. Future research should expand on these findings. Implications: Understanding visitor preferences will enhance flexibility to the current update/visitation system to facilitate optimal communication for close and distant family members and improve overall satisfaction with the surgical experience. e1