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Improving the Anesthesia Telephone Interview Completion Rate
ASPAN NATIONAL CONFERENCE ABSTRACTS Cindy Butler, RN, Denise O’Brien, DNP, RN, ACNS-BC, FAAN, CPAN, CAPA, Nancy Strzyzewski, MSN, RN, CPAN, CAPA, Toni Szpara, BSN, RN, CAPN, CAPA, CCRN
Background Information: Patient anxiety seems to decrease once I.V. is successfully started in Preop Patient preference regarding lidocaine use and 1 ‘poke’ vs. 2 Preop RN anxiety about inserting large gauge I.V. catheters and the changes to technique when using lidocaine Objectives of Project: Develop a process to use lidocaine for I.V. insertions Increase patient awareness about the option to use lidocaine for insertion Encourage Prop nurses to use lidocaine Process of Implementation: Identify a process to obtain a physician order for lidocaine use Identify a process to obtain lidociane that meets hospital pharmacy requirements for safe medication preparation, administration and storage Encourage nurses to use lidocaine Statement of Successful Practice: Preop nurses report increased success rate gaining I.V. access using lidocaine and are satisfied with the patient’s response to I.V. insertion Patients express greater satisfaction and are more relaxed when lidocaine is used for I.V. insertion Implications for Advancing Practice: Having a successful policy and process for I.V. insertion using lidocaine increases patient satisfaction and reduces preop anxiety Preop nurses are very pleased to see patient anxiety decreased
IMPROVING THE ANESTHESIA TELEPHONE INTERVIEW COMPLETION RATE Susan Padgett, RN, CAPA, Joanne Gittens, RN, CAPA CaroMont Health, Gastonia, NC Denny Powell, RN, Sheila Weathers, PBT, ACSP
In our department, Pre-Anesthesia Screening Services, we identified the need to increase the completion rate of our anesthesia telephone interviews to prevent procedure delays due to an inadequately prepared patient and an incomplete anesthesia assessment. We set out to improve the process for completing anesthesia telephone interviews. During our initial data collection, we identified two main issues that impacted our completion rate: the patients were not consistently scheduled by the physician’s office for a call and the patients did not understand the importance of speaking with a pre-anesthesia screening nurse. Our plan was to provide education to the Physician’s offices and develop a patient information sheet to be given to the
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patient at the time the procedure was scheduled. Our goal was to increase the number of completed calls to 95% or greater in three months. The team developed a “How To” guide on scheduling a preanesthesia telephone interview for the physician’s procedure schedulers. Also we created a preeanesthesia patient instruction sheet for the office to give to the patient so that the patient would know to expect the PSS nurse to call to complete the telephone interview. We visited the offices and distributed the handouts and provided education. Our data revealed that 3 months post initiation of our new process, our completion rate went from 88% to 98%. We continue to track and have had no competition rate less than 95% in any month.
STOP-BANG: DO YOU HAVE OSA? Beth Brown, BSN, RN, CPAN, Fran Paisley, RN Mercy Medical Center, Dubuque, Iowa Linda Recker, BSN, RN, Heather Wuebker, BSN, RN, Ann Brandel, RN, Deb Mueller, RN, CPAN, Marie Trannel, RN, CPAN
Background: Complications of Obstructive Sleep Apnea (OSA) are known to include cardiovascular dysfunction, arrhythmia occurrence and hypertension. The patient with suspected but undiagnosed Obstructive Sleep Apnea who presents to the hospital/ ambulatory setting for outpatient surgery poses a challenge for the perianesthesia nurse. Adverse events that occur intraoperatively as well as postoperatively may lead the nurse to suspect that the patient could have OSA. Such events include difficulty achieving satisfactory pain relief due to pain/sedation mismatch. Compromised airway issues can lead to reintubation or necessitate the use of aerosol, BIPAP or ventilator devices in PACU. Objectives of the Study: Could a screening tool be used to identify at risk individuals preoperatively? Could additional intraoperative and postoperative factors be monitored to determine a correlation with the findings of the preoperative screening tool? Could the screening information be used to educate the patient so as increase the number of self-referrals to confirm a positive diagnosis of OSA through polysomnography? Process of Implementation: A multidisciplimentary team was composed of Phase I and Phase II perianesthesia nurses and the Coordinator of the Polysomnography Lab. The STOPBANG tool was identified through the literature review as a reliable and easy to use screening tool. It was enhanced to include data elements from the intraoperative and immediate postop Phase I period. Patient education was provided that resulted in self-referral to the Sleep lab. Statement of Successful Practice: The STOP-BANG tool successfully identified a large volume of high-risk patients among all the undiagnosed patients who presented for surgery. High scores on the prescreening STOP-BANG assessments correlated with the occurrence of adverse events intraoperatively and immediately postop in the PACU. Currently, self-referral information and polysomnography information continues to be collected. However, all patients who self referred (100%) were confirmed through polysomnography to have OSA. Implications for Practice: Findings thus far support continued use of the enhanced STOP-BANG assessment tool.
Background Information: Patient anxiety seems to decrease once I.V. is successfully started in Preop Patient preference regarding lidocaine use and 1 ‘poke’ vs. 2 Preop RN anxiety about inserting large gauge I.V. catheters and the changes to technique when using lidocaine Objectives of Project: Develop a process to use lidocaine for I.V. insertions Increase patient awareness about the option to use lidocaine for insertion Encourage Prop nurses to use lidocaine Process of Implementation: Identify a process to obtain a physician order for lidocaine use Identify a process to obtain lidociane that meets hospital pharmacy requirements for safe medication preparation, administration and storage Encourage nurses to use lidocaine Statement of Successful Practice: Preop nurses report increased success rate gaining I.V. access using lidocaine and are satisfied with the patient’s response to I.V. insertion Patients express greater satisfaction and are more relaxed when lidocaine is used for I.V. insertion Implications for Advancing Practice: Having a successful policy and process for I.V. insertion using lidocaine increases patient satisfaction and reduces preop anxiety Preop nurses are very pleased to see patient anxiety decreased
IMPROVING THE ANESTHESIA TELEPHONE INTERVIEW COMPLETION RATE Susan Padgett, RN, CAPA, Joanne Gittens, RN, CAPA CaroMont Health, Gastonia, NC Denny Powell, RN, Sheila Weathers, PBT, ACSP
In our department, Pre-Anesthesia Screening Services, we identified the need to increase the completion rate of our anesthesia telephone interviews to prevent procedure delays due to an inadequately prepared patient and an incomplete anesthesia assessment. We set out to improve the process for completing anesthesia telephone interviews. During our initial data collection, we identified two main issues that impacted our completion rate: the patients were not consistently scheduled by the physician’s office for a call and the patients did not understand the importance of speaking with a pre-anesthesia screening nurse. Our plan was to provide education to the Physician’s offices and develop a patient information sheet to be given to the
e25
patient at the time the procedure was scheduled. Our goal was to increase the number of completed calls to 95% or greater in three months. The team developed a “How To” guide on scheduling a preanesthesia telephone interview for the physician’s procedure schedulers. Also we created a preeanesthesia patient instruction sheet for the office to give to the patient so that the patient would know to expect the PSS nurse to call to complete the telephone interview. We visited the offices and distributed the handouts and provided education. Our data revealed that 3 months post initiation of our new process, our completion rate went from 88% to 98%. We continue to track and have had no competition rate less than 95% in any month.
STOP-BANG: DO YOU HAVE OSA? Beth Brown, BSN, RN, CPAN, Fran Paisley, RN Mercy Medical Center, Dubuque, Iowa Linda Recker, BSN, RN, Heather Wuebker, BSN, RN, Ann Brandel, RN, Deb Mueller, RN, CPAN, Marie Trannel, RN, CPAN
Background: Complications of Obstructive Sleep Apnea (OSA) are known to include cardiovascular dysfunction, arrhythmia occurrence and hypertension. The patient with suspected but undiagnosed Obstructive Sleep Apnea who presents to the hospital/ ambulatory setting for outpatient surgery poses a challenge for the perianesthesia nurse. Adverse events that occur intraoperatively as well as postoperatively may lead the nurse to suspect that the patient could have OSA. Such events include difficulty achieving satisfactory pain relief due to pain/sedation mismatch. Compromised airway issues can lead to reintubation or necessitate the use of aerosol, BIPAP or ventilator devices in PACU. Objectives of the Study: Could a screening tool be used to identify at risk individuals preoperatively? Could additional intraoperative and postoperative factors be monitored to determine a correlation with the findings of the preoperative screening tool? Could the screening information be used to educate the patient so as increase the number of self-referrals to confirm a positive diagnosis of OSA through polysomnography? Process of Implementation: A multidisciplimentary team was composed of Phase I and Phase II perianesthesia nurses and the Coordinator of the Polysomnography Lab. The STOPBANG tool was identified through the literature review as a reliable and easy to use screening tool. It was enhanced to include data elements from the intraoperative and immediate postop Phase I period. Patient education was provided that resulted in self-referral to the Sleep lab. Statement of Successful Practice: The STOP-BANG tool successfully identified a large volume of high-risk patients among all the undiagnosed patients who presented for surgery. High scores on the prescreening STOP-BANG assessments correlated with the occurrence of adverse events intraoperatively and immediately postop in the PACU. Currently, self-referral information and polysomnography information continues to be collected. However, all patients who self referred (100%) were confirmed through polysomnography to have OSA. Implications for Practice: Findings thus far support continued use of the enhanced STOP-BANG assessment tool.