surgical cancelations: a six month review of extended stay cancelations
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ANNUAL ASPAN CONFERENCE ABSTRACTS 187
THE HEALING GARDEN WAITING AREA, ACOMPREHENSIVE VISITATION PROGRAM FOR PATIENTSAND THEIR FAMILIES DURING THE PHASE 1 LEVEL OFCAREGladys Fields, BSN, RN
University of Maryland Medical Center, Baltimore, MD
Background Information: A perioperative customer service team was
developed to create a visitation system for the Adult PACU that executed
the ASPAN position statement.
Objectives: Develop a program which provides the patient’s families
with updates during the all phases of postoperative care.
Implement a comprehensive and structured visitation system for pa-
tient’s families.
Process of Implementation: A team including an RN and Hospitality
liaison was developed to coordinate communication between the pa-
tient’s families and health care providers while providing visits to the
Adult PACU.
Statement of Successful Practice: Patient and family satisfaction
scores have increased to the 90th percentile in regards to postoperative
visitation.
Implications for Nursing Practice Advancement: Educating staff to
ASPAN position on visitation, providing emotional support and educa-
tion for the patient and their families and enhancing communication be-
tween surgeons, ASCU, OR and PACU nurses.
PACU OXYGEN DELIVERY EBP SAVES $$$ ANDEMPOWERS STAFFBetsy Garton-Park, BSN, RN, CPAN, Mimi Brado, BS, RN,
Sara Lacava, BSN, RN, CPAN
Highland Hospital an Affiliate of the University of Rochester Medical
Center Rochester, NY
Applying humidified oxygen mask sets on our post-operative patients
was accepted practice. Whose practice? Why were we using a system
that required time to assemble bulky tubing and occupied valuable cubi-
cle storage space? Simultaneously, couldn’t we reduce our contribution
of waste into our landfills? Couldn’t the PACU engage in cost cutting?
We set about finding out the best practice.
The literature and evidence led us to redefine our supplemental oxygen
delivery. Replacing a humidified mask system with a one piece oxygen
mask was tested in other studies and found to be effective and safe.
We made the switch and collected our own data that showed no change
in oxygen saturation levels. We were equally pleased when our patients
complained less about the ill fitting humidified oxygen mask. With over
6,000 masks needed per year, replacing the costly humidified mask as-
sembly with the simple oxygen mask saved us one dollar per mask or
at least $6,000 per year. It also allowed our support technicians more
time to help with patient care. Increased use of regional anesthesia
has also played a role in our ability to become more cost effective. Oxy-
gen saturation levels for the majority of these patients can be safely main-
tained on nasal cannula.
Our PACU is empowered after this trial, as we define our own practice.
We learned a lot about EBP and research and are anxious to tackle other
practice questions.
SURGICAL CANCELATIONS: A SIX MONTH REVIEW OFEXTENDED STAY CANCELATIONSMary Gibson, BSN, RN, CPN, Susan Boudreau, MSN, NP-C, RN
Children’s Hospital, Boston, MA
PICO Question: Are there potential nursing practice changes in
the Pre-Op Clinic that may influence the overall cancelation
rate? (P) Pediatric surgical patients anticipating a postoperative inpa-
tient stay. (I) Prospective chart review of scheduled and canceled cases
over a six month period. (C) Total number of scheduled cases was com-
pared with the number of canceled surgical cases. (O)To identify poten-
tial nursing practice changes in the Pre-Op Clinic that may influence the
overall surgical cancelation rate.
Significance to Nursing Practice: Surgical cancelations can be costly
not only to the institution, but also to families and patients who have
carefully coordinated surgical dates with other important commitments.
It is critical for Pre-Op Clinic nursing staff to constantly analyze practice
in an attempt to provide optimal pre-operative assessments which min-
imize the potential for surgical cancelations.
Scientific Merit: Review of the Literature: Few studies have exam-
ined overall surgical cancelation rates and no studies reviewed surgical
cancelations in the pediatric population.
Interpretation: No surgical cancelations were attributable to omissions
in nursing pre-operative work-up or follow-up.
Outcomes/Desired Outcomes: Illness (49%) was responsible for the
majority of surgical cancelations between the time of the pre-op visit
and the day of surgery; NPO status 4.5%.
Nursing Practice Implemented: Specific health promotion teaching
has been incorporated into a Family Education Sheet which is discussed
and distributed during the preoperative visit. A read back-feedback pol-
icy for teaching/documenting NPO guidelines has been implemented.
MEETING THE CHALLENGE: A COLLABORATIVE TEAMEFFORT TO PROVIDE OFF-SHIFT POST-ANESTHESIA CAREFOR PEDIATRIC PATIENTSLucille Graboff, BSN, RN, CAPA, Nursing Care Coordinator
Jeanne Prota, RN Level III, CAPA, Robert Boebert, RN, Director of
Perioperative Services Patricia Schiavi, BSN, RN, Patient Care Manager
Saint Raphael Healthcare System, New Haven, CT
All post-anesthesia pediatric patients are recovered in the Ambulatory
PACU. The hours of operation for the Ambulatory PACU are Monday –
Friday 6:00 a.m. – 7:00 p.m. These limited hours created a problem in
caring for pediatric patients. If a pediatric patient had surgery after
hours, they would need to recover in the in-house PACU. However,
the in-house PACU nurses lacked the competency to care for pediatric
patients. A solution was required to provide coverage to post-anesthesia
pediatric patients on a 24/7 basis.
Provide competent and safe post-anesthesia care for the pediatric popu-
lation. A) Developing an ‘‘on-call’’ system for the ambulatory nurses. B)
Provide PALS certification for all post-anesthesia nurses.
In order to meet the ASPAN standard, two licensed nurses must be pres-
ent to care for any patient. This caused a major staffing/scheduling pro-
cess change between the two PACU units. The primary nurse is the
Ambulatory PACU nurse and the in-house PACU nurse is the back-up.
This necessitated ‘‘on-call’’ scheduling for both nursing staffs. Overall,
the major goal of this project was achieved as the hospital was able to
provide competent, PALS certified nurses to care for the post-anesthesia
pediatric patient when the Ambulatory PACU is closed.
Expanded knowledge base of all PACU nurses to care for the emergent
pediatric post anesthesia patient. By requiring PALS certification we en-
hanced our daily practice by increasing our competency level in all post-
anesthesia care units.
Improved the quality of care for the pediatric PACU patients. ASPAN stan-
dards for nurse/patient ratio were met. Increased collaboration between
Short Term Surgery and Main PACU nursing staffs.
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