Serotonin Syndrome

ASPAN NATIONAL CONFERENCE ABSTRACTS scheduling error the most common cause (85%). The number of emails has decreased by more than 45% and responses increased 17%. The systematic collaboration between nursing and surgery to clarify these potentially high risk discrepancies prior to the day of surgery has significantly improved patient safety and readiness on the DOS. Perianesthesia nursing care of a patient begins with the review of the patient chart. Nursing’s understanding of the entire perianesthesia process is essential to safe patient readiness.

IMPROVEMENT OF ISOLATION PRACTICES IN THE POST ANESTHESIA CARE UNIT Team Leaders: Mini Sabu, MSN, RN, CPAN, CAPA, Alita Campbell, BSN, RN, OCN The University of Texas MD Anderson Cancer Center, Houston, Texas Team Members: Jenise Rice, MSN, RN, CPAN, Linda Graviss, MT, CIC, Cindy Segal, PhD, RN

Background Information: The perioperative area of a comprehensive cancer center is a busy unit often treating more than 60 patients a day. A patient with a ‘positive isolation status’ coming to the PACU needs special care. Many of the patients have been on isolation status for a prolonged time period without appropriate follow-up. In addition to psychosocial issues associated with isolation, patient charges related to being on isolation are higher. Objectives: The objective of this project was to implement a multi-dimensional nursing intervention program to advance the infection control practices in PACU, facilitate and expedite the process of clearing surgery patients from isolation status, thus reduce unnecessary patient care charges, and improve the psychosocial image of patients related to their isolation status. Process of Implementation: With the approval from Infection Control practitioners, isolation carts were set up for PACU. An email distribution list is activated to identify surgical patients requiring isolation. A unit guideline on isolation precautions was developed to assist nurses in this process. In-services and team huddles on isolation precautions were arranged for nurses. Statement of the successful practice: This change initiative made an impact on the isolation practices in this unit. PACU nurses display 100% compliance with the care of isolation cases to facilitate clearing the isolation status of eligible patients. All related patient care costs were reduced. Perianesthesia Implications: This project improved the efficacy of infection control practices and promoted clearing patients from isolation status in PACU.

SCIP COMPLIANCE: CASHING IN FOR THE WIN

e33

is also a Value Based Purchasing (VBP) indicator, is SCIP 2. This indicator regulates appropriate preoperative prophylactic antibiotic selection, which has historically been a challenge in our large institution due to physician’s preferences and surgeon specific order sets. Objectives: To transform preoperative surgeon specific order sets to SCIP order sets which contain a limited number of antibiotic choices based on surgery type. This will enhance evidence based practice, guide compliance with the SCIP measures, and positively impact the VBP score. Process of Implementation: After obtaining approval from the Chief Medical Officer and Director of the Quality Department, a multi-disciplinary team began working with specific general surgeons. Collaboratively, a streamlined order set with minimal antibiotic options consistent with SCIP guidelines was created. The team then met with general surgeons’ office staff to provide education and guidance for implementation. Statement of the Successful Practice: Working as a multidisciplinary team can design a standardized approach to ensure compliance with SCIP guidelines. Implications for advancing the practice of perianesthesia nursing: Perianesthesia nursing is involved in ensuring compliance with various quality measures such as SCIP which enhances patient safety and leads to better patient outcomes. While nurses are not solely responsible for antibiotic selection, nurses are members of multi-disciplinary teams that are responsible for helping to provide the best evidence based care possible.

SEROTONIN SYNDROME Team Leader: Pamela Uhrich, RN, MSN, CPAN, CAPA University of Iowa Hospitals and Clinics, Iowa

My goal is to present a poster on serotonin syndrome. I would like to take this opportunity to study this subject in depth. Background: Serotonin is the overstimulation of 5-HT1A and 5- HT2A receptors. It presents as anxiety, agitation, restlessness, diaphoresis, tachycardia, hyperthermia, HTN, tremors, rigidity, myoclonus or hyperrflexia. These are common symptoms seen in the post recovery area. Objective: To educate the perianesthesia nurse on the serotonin syndrome. Process of Implementation: A literature search will be completed with special emphasis on case studies. The information will be divided into cause, mechanism, presentation, and management. Statement of Successful Practice: The perianesthesia nurse will be able to recognize the symptoms and be able to provide supportive measures. Implications for Advancing the Practice of Perianesthesia Nursing: Awareness of serotonin syndrome in the postoperative patient population.

Team Leader: Melissa Thomas, BSN, RN, CAPA Baptist Health Louisville, Louisville, Kentucky Team Members: Mary Ann Laureano, BSN, RN, CCRC, Mary Davenport, Pharm.D, BCPS

ASSESSMENT OF ACCURATE BLOOD PRESSURE CUFF SIZING IN THE PERIANESTHESIA SETTING

Background: Baptist Health Louisville has been measuring compliance with the CMS Surgical Care Improvement Project (SCIP) for many years. One of the components of SCIP, which

Team Leader: Valerie Gillis, RN, MN, CPAN University of Washington, Seattle, Washington Team Members: Renee Sharpe, RN, MN, CCRN, Deborah Thenutai, RN, BSN, Laurel Zimmerman, RN, BSN, Alice Salcido, RN, BSN, CPAN, Gale Uhlenkott, RN, BSN, Ed