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The Valuable Role of Perianesthesia Nursing in Fast Tracking Minimally Invasive Thoracic Surgery Patients
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Conclusion: Quality nursing care, assessment, management and teaching are all vital components, when providing for the pediatric surgical patients and their families.
JOINING FORCES TO IMPROVE PATIENT SAFETY ASSOCIATED WITH OPIOID ADMINISTRATION IN THE PACU Cassie Merkle, MSN, RN, Administrative Nurse Manager, Bone and Joint Surgical Services, Paula Kobelt, MSN, RN-BC, Clinical Outcomes Manager, Paula Renker, PhD, RN, Senior Research Nurse Grant Medical Center, Columbus, Ohio
Post-Anesthesia Care Unit (PACU) nurses in our main hospital PACU identified concerns after several adverse drug events occurred associated with opioid administration for pain management. Despite aggressive administration of opioid medications to treat acute post-operative pain, a standardized method of assessing sedation was not used. After consultation with the pain management team, the Pasero Opioid- Induced Sedation Scale currently being used in the medical-surgical units was selected for use in the main PACU. The new protocol was shared with the nurse administrator of the hospital’s orthopedic PACU who indicated interest in adopting the protocol in their unit. Together, the administrators developed a plan to implement and support the new patient safety initiative. In order to successfully implement the POSS protocol for care and monitoring of PACU patients, nursing policies and documentation forms required revision. This eight month process included input from PACU shared governance members and other staff nurses, approvals from appropriate hospital and system committees. Detailed educational programs and aides were developed and implemented in both PACUs. Post-implementation chart reviews indicated that the POSS scale was being successfully and consistently utilized with opioid administration. Anecdotal comments by the nurses support their positive regard for the utility of the scale in helping them to provide commendable and safe patient care. Adoption of a standardized sedation assessment for medication administration is critical not only to provide patient safety, but also to address national guidelines and Joint Commission recommendations for patient care.
THE VALUABLE ROLE OF PERIANESTHESIA NURSING IN FAST TRACKING MINIMALLY INVASIVE THORACIC SURGERY PATIENTS Team Leader: Sally Schermer, RN, BSN, MBA, CPAN, CAPA, CCRN Inova Fairfax Hospital, Falls Church, VA Christy Schatz, BSN, MSN, RNFA, NP, Christina Tabor, MSN, NP, Sandeep Khandhar, MD, Daniel Fortes, MD, Dina Krenzischek, PhD, RN, MAS, CPAN, FAAN
The Video Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgery to perform thoracic procedures. Compared
ASPAN NATIONAL CONFERENCE ABSTRACTS with a traditional thoracotomy, VATS may provide patients with a lower rate of morbidity and mortality, a shorter length of stay, and earlier return to regular activities.1 The medical staff started the VATS in INOVA Fairfax Hospital and patients were admitted to the hospital initially. A program was developed based on evidence based practices/ best practices for ambulatory care practices.2,3 A program was started and the role of the Cardiovascular Perianesthesia Nurse was valuable in fast tracking minimally invasive throracic surgery patients. The objective of this project is to evaluate the role of the perianesthesia nurse in facilitating early ambulation and discharge of VATS patients to home. Four years ago, the vision and strategic plan of the VATS Outpatient Program was expanded with the involvement of the perianesthesia nurses. A multidisciplinary team developed a clinical pathway to map the care plan for this population. The multidisciplinary collaborative management and nurses’ implementation of the early ambulation activities contributed to the success of the VATS Outpatient Program. The patients’ average LOS was reduced to 4.5 hrs. The number of patients increased from 98 in 2009 and 177 annualized volume in 2012. About 95% were discharged to home. The VATS Outpatient Program provided perianesthesia nurses an opportunity to be engaged in a multidisciplinary team to improve patient care. Nurses are committed in ensuring that their patients receive an individualized care until they are discharged to home. References: 1. McKenna, Robert, 2012 //POSTOPERATIVE MANAGEMENT AFTER VIDEO-ASSISTED . www.expertconsultbook.com/./ob/linkTo?type. - Cached Chapter 3 - Preoperative Evaluation of Thoracic Surgery Patients ... Early ambulation (three times a day in the hallways, starting on postoperative day 1) ... Accessed 10-12-2012. 2. Perme, Christiane and Chandrashekar, 2009, Early Mobility and Walking Program for Patients in Intensive Crae Units: Creating a Standard of Carel 18: 212-221. http:// dx.doi.org/10,4037/ajcc2009598.
EVALUATION OF PEDIATRIC SEDATION PROGRAM PROCESS IN THE PACU ENVIRONMENT Team Leader: Leilani Jankus, RN, MSN, CCRN, CPAN INOVA Fairfax Hospital, Falls Church, VA Julie Dubuc, BSN, RN, Michael Vish, MD, Dina Krenzischek, PhD, RN, MAS, CPAN, FAAN
Sedation and/or analgesia are standards of care for pediatric patients during painful interventions or medical imaging requiring immobility.1 In some situations, nonanesthesia providers initiate IV sedation if general anesthesia is not required.2 Operational issues are encountered when there is no designated location with consistently trained staff or standardized approach to provide pediatric procedural sedation. In INOVA Fairfax Hospital, the Pediatric PACU was selected to provide sedation with trained staff under the direction of a physician. So, the objective of this project is to evaluate
Conclusion: Quality nursing care, assessment, management and teaching are all vital components, when providing for the pediatric surgical patients and their families.
JOINING FORCES TO IMPROVE PATIENT SAFETY ASSOCIATED WITH OPIOID ADMINISTRATION IN THE PACU Cassie Merkle, MSN, RN, Administrative Nurse Manager, Bone and Joint Surgical Services, Paula Kobelt, MSN, RN-BC, Clinical Outcomes Manager, Paula Renker, PhD, RN, Senior Research Nurse Grant Medical Center, Columbus, Ohio
Post-Anesthesia Care Unit (PACU) nurses in our main hospital PACU identified concerns after several adverse drug events occurred associated with opioid administration for pain management. Despite aggressive administration of opioid medications to treat acute post-operative pain, a standardized method of assessing sedation was not used. After consultation with the pain management team, the Pasero Opioid- Induced Sedation Scale currently being used in the medical-surgical units was selected for use in the main PACU. The new protocol was shared with the nurse administrator of the hospital’s orthopedic PACU who indicated interest in adopting the protocol in their unit. Together, the administrators developed a plan to implement and support the new patient safety initiative. In order to successfully implement the POSS protocol for care and monitoring of PACU patients, nursing policies and documentation forms required revision. This eight month process included input from PACU shared governance members and other staff nurses, approvals from appropriate hospital and system committees. Detailed educational programs and aides were developed and implemented in both PACUs. Post-implementation chart reviews indicated that the POSS scale was being successfully and consistently utilized with opioid administration. Anecdotal comments by the nurses support their positive regard for the utility of the scale in helping them to provide commendable and safe patient care. Adoption of a standardized sedation assessment for medication administration is critical not only to provide patient safety, but also to address national guidelines and Joint Commission recommendations for patient care.
THE VALUABLE ROLE OF PERIANESTHESIA NURSING IN FAST TRACKING MINIMALLY INVASIVE THORACIC SURGERY PATIENTS Team Leader: Sally Schermer, RN, BSN, MBA, CPAN, CAPA, CCRN Inova Fairfax Hospital, Falls Church, VA Christy Schatz, BSN, MSN, RNFA, NP, Christina Tabor, MSN, NP, Sandeep Khandhar, MD, Daniel Fortes, MD, Dina Krenzischek, PhD, RN, MAS, CPAN, FAAN
The Video Assisted Thoracoscopic Surgery (VATS) is a minimally invasive surgery to perform thoracic procedures. Compared
ASPAN NATIONAL CONFERENCE ABSTRACTS with a traditional thoracotomy, VATS may provide patients with a lower rate of morbidity and mortality, a shorter length of stay, and earlier return to regular activities.1 The medical staff started the VATS in INOVA Fairfax Hospital and patients were admitted to the hospital initially. A program was developed based on evidence based practices/ best practices for ambulatory care practices.2,3 A program was started and the role of the Cardiovascular Perianesthesia Nurse was valuable in fast tracking minimally invasive throracic surgery patients. The objective of this project is to evaluate the role of the perianesthesia nurse in facilitating early ambulation and discharge of VATS patients to home. Four years ago, the vision and strategic plan of the VATS Outpatient Program was expanded with the involvement of the perianesthesia nurses. A multidisciplinary team developed a clinical pathway to map the care plan for this population. The multidisciplinary collaborative management and nurses’ implementation of the early ambulation activities contributed to the success of the VATS Outpatient Program. The patients’ average LOS was reduced to 4.5 hrs. The number of patients increased from 98 in 2009 and 177 annualized volume in 2012. About 95% were discharged to home. The VATS Outpatient Program provided perianesthesia nurses an opportunity to be engaged in a multidisciplinary team to improve patient care. Nurses are committed in ensuring that their patients receive an individualized care until they are discharged to home. References: 1. McKenna, Robert, 2012 //POSTOPERATIVE MANAGEMENT AFTER VIDEO-ASSISTED . www.expertconsultbook.com/./ob/linkTo?type. - Cached Chapter 3 - Preoperative Evaluation of Thoracic Surgery Patients ... Early ambulation (three times a day in the hallways, starting on postoperative day 1) ... Accessed 10-12-2012. 2. Perme, Christiane and Chandrashekar, 2009, Early Mobility and Walking Program for Patients in Intensive Crae Units: Creating a Standard of Carel 18: 212-221. http:// dx.doi.org/10,4037/ajcc2009598.
EVALUATION OF PEDIATRIC SEDATION PROGRAM PROCESS IN THE PACU ENVIRONMENT Team Leader: Leilani Jankus, RN, MSN, CCRN, CPAN INOVA Fairfax Hospital, Falls Church, VA Julie Dubuc, BSN, RN, Michael Vish, MD, Dina Krenzischek, PhD, RN, MAS, CPAN, FAAN
Sedation and/or analgesia are standards of care for pediatric patients during painful interventions or medical imaging requiring immobility.1 In some situations, nonanesthesia providers initiate IV sedation if general anesthesia is not required.2 Operational issues are encountered when there is no designated location with consistently trained staff or standardized approach to provide pediatric procedural sedation. In INOVA Fairfax Hospital, the Pediatric PACU was selected to provide sedation with trained staff under the direction of a physician. So, the objective of this project is to evaluate