- Email: [email protected]
Same Day Surgery Follow-Up Phone Calls
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Introduction: Preoperative anxiety is a common psychological issue affecting many patients who are faced with the prospect of undergoing surgery. The need for a robust preoperative teaching plan is central to patient comfort, decreasing patient anxiety and better patient outcomes. Identification of the problem: Research suggests that anxiety levels are greatest when the individual is least informed. The growing emphasis on daystay surgical procedures has limited the amount of time the preadmission nurse has to psychologically prepare and educate the patient for surgery. Purpose of the Study: The purpose of this study is to determine if adding an on-line educational video to the standard preoperative teaching phone call will decrease patient anxiety in first-time daystay surgical patients. Methodology: This study is a randomized clinical trial. Eligible patients were first-time daystay surgery patients (non-cancer diagnosis). Patients were randomly assigned to one of two groups: Control Group: pre-operative education via a pre-surgery phone call; Video Group: addition of a BMC-produced on-line video describing what they would experience during daystay surgery. Patients were administered a Visual Analog Scale (VAS) to measure their level of anxiety at (1) baseline, (2) after video viewing & phone call, or standard (phone call) education, and (3) immediately prior to surgery. Results: 126 subjects were randomized. One patient assigned to the video group was later deemed ineligible because of prior surgery. Eight subjects (all assigned to the video group) dropped out. The remaining 118 patients (55 video subjects and 63 controls) were analyzed. Anxiety VAS scores for the Video Group remained relatively stable throughout the three time periods, while those in the Control Group significantly increased anxiety from baseline to pre-surgery (p50.02). Changes in anxiety VAS scores were more pronounced in males than females, with transgender patients falling in between. Discussion: Patients have anxiety when faced with the prospect of surgery. By implementing enhanced teaching using an educational video, our patients came to surgery more informed and less anxious. Conclusion: Providing an on-line educational video was found to be an effective adjunct for patient education helping to decrease pre-surgery anxiety. Implications for future research: This enhanced teaching methodology may be implemented in other surgical areas to achieve similar success.
DOES DISRUPTIVE BEHAVIOR CAUSE PROBLEMS WITH PATIENT CARE? Primary Investigators: Deborah L. Threats, MDIV BSN RN CAPA, Anne Burke, BA BSN RN CAPA MedStar Georgetown University Hospital, Washington, DC Identification of the problem e Overview: The purpose of this project is to assess if nurses are aware that disruptive behavior may cause harm to patients. P: OR holding nursing staff I: Education on disruptive behaviors C: Comparing nurses knowledge pre education and post education using an adapted Rosenstein survey O: Staff awareness of potential harm to patients Note: All abstracts are printed as received from the authors.
ASPAN NATIONAL CONFERENCE ABSTRACTS EP Question/Purpose: Nurses’ usage of language and standardization of messaging are essential in delivering optimal care to patients. However, it is noted that disruptive behavior among nurses can have a negative effect and potential harm to patients (Protector 2010). The aim of this project was to assess nurse awareness of disruptive behavior, to define disruptive behavior and to acknowledge disruptive behavior in a hospital unit. Identification and acknowledgement lead to education of staff and provision of skills to manage this behavior(s). Methods/Evidence: A survey used by Rosenberg (TJCJIQ 2008) was adapted to assess staffs’ views of disruptive behavior. Surveys were administered prior to education sessions and staff was able to complete them anonymously. Educational sessions were offered to all staff nurses, managers and director and included information on verbal and non-verbal disruptive interactions. Staff was then re-surveyed. The research included articles review and personal interviews. Significance of Findings/Outcomes: Of the pre-surveys, eleven of seventeen were returned. Thirteen of seventeen post-surveys were completed. The survey was composed of yes/no questions, multi-answer questions, and written answers. In the pre-survey, 17% of the respondents affirmed and understanding of the hospital policy as compared to 76% in the post survey with similar increases in understanding that disruptive behavior does affect patient care. Implications for perianesthesia nurses and future research: 1. To do further research to find out where did this behavior begin in nursing. 2. Nurse’s need to know how to change and be given tools to help with change. 3. Therefore our next project will be to give tools on assertive behavior. 4. Address leaderships training on this topic to make it a success. 5. A nurse to nurse survey (versus the nurse to physician survey) was difficult to find so an increase in nurse to nurse documentation is essential.
SAME DAY SURGERY FOLLOW-UP PHONE CALLS Primary Investigator: Amy Berardinelli, DNP RN CPAN Cleveland Clinic/Hillcrest Hospital, Mayfield Heights, Ohio Co-Investigator: Angela Sotka, BSN RN CPAN
Introduction: Research supports same day surgery (SDS) follow-up phone calls to reduce post-operative complications, readmissions, and adverse events. Identification of the problem: Theory is post-discharge follow-up phone calls by registered nurses (RN) to SDS patients will decrease post-operative complications and improve patients’ confidence in understanding home-going instructions. Purpose of the Study: Purpose was to analyze the differences of SDS patients’ increased confidence levels in their discharge instructions if received a follow-up phone call from a RN within 72 hours of discharge as opposed to instruction at discharge only.
ASPAN NATIONAL CONFERENCE ABSTRACTS Methodology: Study used mixed method, comparative, descriptive design to answer the research questions. Results: Hypothesis was null and void. Both groups were highly confident in implementing discharge instructions. One-tailed t-test revealed similar confidence levels. The intervention group, mean 9.05 (t(19), SD51.545). The control group, mean 9.00 (t(29), SD52.268). RN follow-up phone calls to SDS patients proved insignificant. Verbatim comments revealed excellent care and instructions from the phase II nurses, as well as the surgeon’s following up once patients discharged home. Attending post-operative appointments revealed equal variance assumed 2-tailed significance of 0.04 (t(48), p5.036. Seeking additional care was insignificant. Those who received a follow-up phone call were more likely to attend their post-operative surgical appointment. No relation between demographic information and confidence level, nor problems post-operatively between groups. Correlate-bivariate of demographic and confidence level relationships were insignificant. Discussion: This study has revealed beneficial information about surgeon behaviors, avenues for collaboration, and cost savings, by decreasing duplicity of work. Conclusion: Post-operative follow-up phone calls assist patients in managing their illness and provide an opportunity to ask questions. Competence, patience, and kindness of perioperative nurses allows patients time to focus, absorb, and understand what constitutes safe, and uneventful recovery. Healthcare collaboration and team approach to patient care can strengthen outcomes, satisfaction, and confidence for patients and providers. Implications for perianesthesia nurses and future research: Recommendations are to expand the study across the enterprise to determine if a standardized process can be successfully created and sustained. Developing an interprofessional process where nurses and surgeons team together is an opportunity to positively impact patient satisfaction and outcomes.
OBSTRUCTIVE SLEEP APNEA: EMPHASIS ON DISCHARGE EDUCATION AFTER SURGERY Primary Investigator: Arbert Nazareno, DNP APRN University of San Diego/UC San Diego Health, San Diego, California Co-Investigators: Cresilda Newsom, DNP RN CPAN, Esther Lee, MBA MNP RN, Joseph Burkard, DNSc CRNA Identification of the problem e Overview: Over half of the surgical patients with obstructive sleep apnea (OSA) are predisposed to increased incidence of perioperative complications. The American Society of Perianesthesia Nurses recommends that discharge education (DCE) on OSA should be provided after surgery to OSA patients to promote continuous positive airway pressure (CPAP) compliance and self-care behaviors at home. EP Question/Purpose: To evaluate the effectiveness of DCE on OSA for increasing CPAP compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.
Note: All abstracts are printed as received from the authors.
e45
Methods/Evidence: Participants were adult surgical patients over 18 years old diagnosed with OSA, who use CPAP. Phase one was completed using the Apnea Knowledge Test to measure patients’ knowledge on OSA. Phase two included a second set of surgical patients that were provided DCE on OSA by telephone, five to seven days before surgery. Education was reinforced on the day of surgery and seven to 10 days after surgery. Outcomes measured were CPAP usage and the Epworth Sleepiness Scale score to evaluate effectiveness of this evidence-based practice project. Significance of Findings/Outcomes: Sixty-six participants were provided DCE on OSA. In phase one, the mean patients’ knowledge demonstrated a 23.9% increase from pretest to three days after discharge. In phase two, the mean CPAP hours per night usage increased by a total of 72 minutes after DCE on OSA provided. There was no clinically significant change in ESS over time. Implications for perianesthesia nurses and future research: The DCE on OSA demonstrated effectiveness in increasing CPAP compliance after surgery. Thus, it could be implemented in the surgical setting as part of routine clinical care.
EXPLORATION OF THE SCOTT TRIGGERSÔ INSTRUMENT IN PREDICTING POSTOPERATIVE PRESSURE ULCER RISK IN THE ON-PUMP CARDIOVASCULAR SURGERY POPULATION Primary Investigator: Jeanie Bollinger, MSN RN ACCNS-AG CCRN Mission Health System, Asheville, North Carolina Co-Investigators: Cheryl Postlewaite, MS RN CWCN, Sheri Denslow, PhD MPH, Vallire Hooper, PhD RN CPAN FAAN
Introduction: Hospital acquired pressure ulcers continue to pose a significant health problem in the US, affecting up to 3 million adults at a cost of up to $11 billion annually. Postoperative pressure ulcer (PPU) rates are as high as 66%, with the incidence rates in cardiovascular (CV) surgical patients ranging as high as 50%. Identification of the problem: The Braden Score (BrS) is well accepted as a predictor of pressure ulcer risk; however, the preoperative BrS may not accurately reflect postoperative risk. The Scott TriggersTM (ST) scale shows great potential as a predictor of PPU development, but has not been tested for accuracy and precision. Purpose of the study: The purpose of this study was to explore the use of the ST instrument in predicting PPU risk in on-pump CV surgical patients. Methodology: A retrospective, exploratory design was used. A purposive convenience sample of medical records of adult patients ($ 18 years) undergoing an on-pump surgical procedure over a 1-year period was included. Data were abstracted via electronic medical record abstraction. Results: 675 charts were abstracted. First postoperative BrS was used as a proxy for PPU risk due to an absence of PPU. Significant decreases in mean preoperative to postoperative BrS were noted (20 to 14 respectively, p , 0.01), particularly in patients with preoperative scores . 18. Most patients were considered at risk for PPU, with 98% having a ST score $ 2 on a 4 point scale. Surgery duration was highly predictive
Introduction: Preoperative anxiety is a common psychological issue affecting many patients who are faced with the prospect of undergoing surgery. The need for a robust preoperative teaching plan is central to patient comfort, decreasing patient anxiety and better patient outcomes. Identification of the problem: Research suggests that anxiety levels are greatest when the individual is least informed. The growing emphasis on daystay surgical procedures has limited the amount of time the preadmission nurse has to psychologically prepare and educate the patient for surgery. Purpose of the Study: The purpose of this study is to determine if adding an on-line educational video to the standard preoperative teaching phone call will decrease patient anxiety in first-time daystay surgical patients. Methodology: This study is a randomized clinical trial. Eligible patients were first-time daystay surgery patients (non-cancer diagnosis). Patients were randomly assigned to one of two groups: Control Group: pre-operative education via a pre-surgery phone call; Video Group: addition of a BMC-produced on-line video describing what they would experience during daystay surgery. Patients were administered a Visual Analog Scale (VAS) to measure their level of anxiety at (1) baseline, (2) after video viewing & phone call, or standard (phone call) education, and (3) immediately prior to surgery. Results: 126 subjects were randomized. One patient assigned to the video group was later deemed ineligible because of prior surgery. Eight subjects (all assigned to the video group) dropped out. The remaining 118 patients (55 video subjects and 63 controls) were analyzed. Anxiety VAS scores for the Video Group remained relatively stable throughout the three time periods, while those in the Control Group significantly increased anxiety from baseline to pre-surgery (p50.02). Changes in anxiety VAS scores were more pronounced in males than females, with transgender patients falling in between. Discussion: Patients have anxiety when faced with the prospect of surgery. By implementing enhanced teaching using an educational video, our patients came to surgery more informed and less anxious. Conclusion: Providing an on-line educational video was found to be an effective adjunct for patient education helping to decrease pre-surgery anxiety. Implications for future research: This enhanced teaching methodology may be implemented in other surgical areas to achieve similar success.
DOES DISRUPTIVE BEHAVIOR CAUSE PROBLEMS WITH PATIENT CARE? Primary Investigators: Deborah L. Threats, MDIV BSN RN CAPA, Anne Burke, BA BSN RN CAPA MedStar Georgetown University Hospital, Washington, DC Identification of the problem e Overview: The purpose of this project is to assess if nurses are aware that disruptive behavior may cause harm to patients. P: OR holding nursing staff I: Education on disruptive behaviors C: Comparing nurses knowledge pre education and post education using an adapted Rosenstein survey O: Staff awareness of potential harm to patients Note: All abstracts are printed as received from the authors.
ASPAN NATIONAL CONFERENCE ABSTRACTS EP Question/Purpose: Nurses’ usage of language and standardization of messaging are essential in delivering optimal care to patients. However, it is noted that disruptive behavior among nurses can have a negative effect and potential harm to patients (Protector 2010). The aim of this project was to assess nurse awareness of disruptive behavior, to define disruptive behavior and to acknowledge disruptive behavior in a hospital unit. Identification and acknowledgement lead to education of staff and provision of skills to manage this behavior(s). Methods/Evidence: A survey used by Rosenberg (TJCJIQ 2008) was adapted to assess staffs’ views of disruptive behavior. Surveys were administered prior to education sessions and staff was able to complete them anonymously. Educational sessions were offered to all staff nurses, managers and director and included information on verbal and non-verbal disruptive interactions. Staff was then re-surveyed. The research included articles review and personal interviews. Significance of Findings/Outcomes: Of the pre-surveys, eleven of seventeen were returned. Thirteen of seventeen post-surveys were completed. The survey was composed of yes/no questions, multi-answer questions, and written answers. In the pre-survey, 17% of the respondents affirmed and understanding of the hospital policy as compared to 76% in the post survey with similar increases in understanding that disruptive behavior does affect patient care. Implications for perianesthesia nurses and future research: 1. To do further research to find out where did this behavior begin in nursing. 2. Nurse’s need to know how to change and be given tools to help with change. 3. Therefore our next project will be to give tools on assertive behavior. 4. Address leaderships training on this topic to make it a success. 5. A nurse to nurse survey (versus the nurse to physician survey) was difficult to find so an increase in nurse to nurse documentation is essential.
SAME DAY SURGERY FOLLOW-UP PHONE CALLS Primary Investigator: Amy Berardinelli, DNP RN CPAN Cleveland Clinic/Hillcrest Hospital, Mayfield Heights, Ohio Co-Investigator: Angela Sotka, BSN RN CPAN
Introduction: Research supports same day surgery (SDS) follow-up phone calls to reduce post-operative complications, readmissions, and adverse events. Identification of the problem: Theory is post-discharge follow-up phone calls by registered nurses (RN) to SDS patients will decrease post-operative complications and improve patients’ confidence in understanding home-going instructions. Purpose of the Study: Purpose was to analyze the differences of SDS patients’ increased confidence levels in their discharge instructions if received a follow-up phone call from a RN within 72 hours of discharge as opposed to instruction at discharge only.
ASPAN NATIONAL CONFERENCE ABSTRACTS Methodology: Study used mixed method, comparative, descriptive design to answer the research questions. Results: Hypothesis was null and void. Both groups were highly confident in implementing discharge instructions. One-tailed t-test revealed similar confidence levels. The intervention group, mean 9.05 (t(19), SD51.545). The control group, mean 9.00 (t(29), SD52.268). RN follow-up phone calls to SDS patients proved insignificant. Verbatim comments revealed excellent care and instructions from the phase II nurses, as well as the surgeon’s following up once patients discharged home. Attending post-operative appointments revealed equal variance assumed 2-tailed significance of 0.04 (t(48), p5.036. Seeking additional care was insignificant. Those who received a follow-up phone call were more likely to attend their post-operative surgical appointment. No relation between demographic information and confidence level, nor problems post-operatively between groups. Correlate-bivariate of demographic and confidence level relationships were insignificant. Discussion: This study has revealed beneficial information about surgeon behaviors, avenues for collaboration, and cost savings, by decreasing duplicity of work. Conclusion: Post-operative follow-up phone calls assist patients in managing their illness and provide an opportunity to ask questions. Competence, patience, and kindness of perioperative nurses allows patients time to focus, absorb, and understand what constitutes safe, and uneventful recovery. Healthcare collaboration and team approach to patient care can strengthen outcomes, satisfaction, and confidence for patients and providers. Implications for perianesthesia nurses and future research: Recommendations are to expand the study across the enterprise to determine if a standardized process can be successfully created and sustained. Developing an interprofessional process where nurses and surgeons team together is an opportunity to positively impact patient satisfaction and outcomes.
OBSTRUCTIVE SLEEP APNEA: EMPHASIS ON DISCHARGE EDUCATION AFTER SURGERY Primary Investigator: Arbert Nazareno, DNP APRN University of San Diego/UC San Diego Health, San Diego, California Co-Investigators: Cresilda Newsom, DNP RN CPAN, Esther Lee, MBA MNP RN, Joseph Burkard, DNSc CRNA Identification of the problem e Overview: Over half of the surgical patients with obstructive sleep apnea (OSA) are predisposed to increased incidence of perioperative complications. The American Society of Perianesthesia Nurses recommends that discharge education (DCE) on OSA should be provided after surgery to OSA patients to promote continuous positive airway pressure (CPAP) compliance and self-care behaviors at home. EP Question/Purpose: To evaluate the effectiveness of DCE on OSA for increasing CPAP compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.
Note: All abstracts are printed as received from the authors.
e45
Methods/Evidence: Participants were adult surgical patients over 18 years old diagnosed with OSA, who use CPAP. Phase one was completed using the Apnea Knowledge Test to measure patients’ knowledge on OSA. Phase two included a second set of surgical patients that were provided DCE on OSA by telephone, five to seven days before surgery. Education was reinforced on the day of surgery and seven to 10 days after surgery. Outcomes measured were CPAP usage and the Epworth Sleepiness Scale score to evaluate effectiveness of this evidence-based practice project. Significance of Findings/Outcomes: Sixty-six participants were provided DCE on OSA. In phase one, the mean patients’ knowledge demonstrated a 23.9% increase from pretest to three days after discharge. In phase two, the mean CPAP hours per night usage increased by a total of 72 minutes after DCE on OSA provided. There was no clinically significant change in ESS over time. Implications for perianesthesia nurses and future research: The DCE on OSA demonstrated effectiveness in increasing CPAP compliance after surgery. Thus, it could be implemented in the surgical setting as part of routine clinical care.
EXPLORATION OF THE SCOTT TRIGGERSÔ INSTRUMENT IN PREDICTING POSTOPERATIVE PRESSURE ULCER RISK IN THE ON-PUMP CARDIOVASCULAR SURGERY POPULATION Primary Investigator: Jeanie Bollinger, MSN RN ACCNS-AG CCRN Mission Health System, Asheville, North Carolina Co-Investigators: Cheryl Postlewaite, MS RN CWCN, Sheri Denslow, PhD MPH, Vallire Hooper, PhD RN CPAN FAAN
Introduction: Hospital acquired pressure ulcers continue to pose a significant health problem in the US, affecting up to 3 million adults at a cost of up to $11 billion annually. Postoperative pressure ulcer (PPU) rates are as high as 66%, with the incidence rates in cardiovascular (CV) surgical patients ranging as high as 50%. Identification of the problem: The Braden Score (BrS) is well accepted as a predictor of pressure ulcer risk; however, the preoperative BrS may not accurately reflect postoperative risk. The Scott TriggersTM (ST) scale shows great potential as a predictor of PPU development, but has not been tested for accuracy and precision. Purpose of the study: The purpose of this study was to explore the use of the ST instrument in predicting PPU risk in on-pump CV surgical patients. Methodology: A retrospective, exploratory design was used. A purposive convenience sample of medical records of adult patients ($ 18 years) undergoing an on-pump surgical procedure over a 1-year period was included. Data were abstracted via electronic medical record abstraction. Results: 675 charts were abstracted. First postoperative BrS was used as a proxy for PPU risk due to an absence of PPU. Significant decreases in mean preoperative to postoperative BrS were noted (20 to 14 respectively, p , 0.01), particularly in patients with preoperative scores . 18. Most patients were considered at risk for PPU, with 98% having a ST score $ 2 on a 4 point scale. Surgery duration was highly predictive