ASPAN NATIONAL CONFERENCE ABSTRACTS e9

HOW NOT TO ‘GO BLUE’Janet Gilbert, BSN, RN, CPAN, Sharon Taylor, BSN, RN, CPAN

University of Michigan Health System, Ann Arbor, MI

Background Information: The first 24 hours after surgery is

a high risk period for respiratory depression secondary to opi-

oid administration.

Hypoventilation and collapse of alveolar tissue is common in

the PACU setting.

Pulse oximetry is commonly used to assess oxygenation, but not

ventilation. It does not measure the build-up of CO2.

Pulse oximetry is not a good tool to detect hypoventilation in

patients receiving supplemental oxygen. Oxygen therapy can

mask hypoventilation.

Objectives of Project: To identify patients with respiratory de-

pression in the PACU so as to allow reduction in opioid dosing,

addition of non-opioid adjunct analgesia or the use of regional

analgesia

Process of implementation: At least every hour, PACU nurse

will perform a 5 minute room air PaO2 test. The patient is re-

moved from supplemental oxygen for 5 minutes to determine

PaO2 on room air. At any point during those 5 minutes, the ox-

ygen will be re-applied if PaO2 falls below 90%. This is a simple

test to identify patients with hypoventilation.

Statement of successful practice: Hypoventilation is identi-

fied in the PACUbefore thepatient is transferred to the in-patient

unit. Nurses are promoting use of stir-up regime and inspirome-

ter therapy. Several adjunct therapies are utilized in the PACU to

alleviate pain including the use of Acetaminophen, Ketorolac,

Ibuprofen, and peripheral nerve blocks.

Implications for Advancing Perianesthesia Nursing:

PACU nurses are able to provide safer patient care by early iden-

tification of patients with respiratory depression. Patients and

families can be taught the importance of inspirometer therapy

and deep breathing/coughing in the prevention of respiratory

complications.

ABDOMINAL COMPARTMENT SYNDROME:EXPANDING CRITICAL THINKING IN THE PACUTeam Leader: Kathy Jo Carter, RN, MSN, MBA, CPAN

Saint John’s Health System, Anderson, IN

The expectation that our PACU will hold overflow surgical and

nonsurgical ICU patients led to a review of the ASPAN Position

Statement 5. The need for review and expansion of critical care

skills, alongwith caring for two patientswho presentedwith se-

vere Compartment Syndrome in extremities, led to this educa-

tional presentation.

The objective was to educate OR and PACU staff on identifica-

tion of patients at risk and allow for early intervention.

Literature review provided the material. Power Point presenta-

tionwas given. Pretest andpost testwere given tomeasure com-

prehension. Each participant completed a short evaluation on

the value of the information and understanding of the material.

Pretest results demonstrated only 49% of answers were correct.

Post test resultswere 100% correct. Evaluation scale of 1 strongly

disagree to 5 strongly agree were as follows: Information was

helpful to practice 4.7, visual materials were helpful 4.7, and

easy to understand 4.6.

Early identification of risk for our trauma patients and nonsurgi-

cal ICU holds, along with early intervention, will provide best

outcome for our patients.

PERIOPERATIVE GLUCOSE MANAGEMENT:PROTOCOL REFINEMENT AND IMPLEMENTATIONTeam Leader: Barbara Moore, RN, CNML

Mission Hospital, Asheville, NC

Andrew Hart, MD, Janice Hovey, RN, Larry Buckner, RN,

Ed Green, RN, Susan Fulbright, PharmD, Barbara Massey, RN,

Dianne Gambrell, RN, Donna Peek, RN, Jeffrey Russell, MD,

William Berry, MD, William Maples, MD, Doug Roberts, CRNA,

Vallire Hooper, PhD, RN, CPAN, FAAN

Background: Evidence supports that poor perioperative glyce-

mic control contributes to adverse clinical outcomes, including

increased SSI. Quality improvement data at a large tertiary-care

center revealed inconsistent glycemic management throughout

the perioperative period.

Objectives: The purpose of this Best Practice project was to es-

tablish a consistent glycemic management plan for at-risk surgi-

cal patients.

Implementation: A multi-disciplinary team was formed to ex-

amine current practices and implement an improved glycemic

management protocol for surgical patients. The protocol was

pilotedwith vascular patients in July 2011, with planned expan-

sion to all surgical populations. Specific details include:

� 100% of patients will have a preoperative CBG

� IV insulin protocol will be initiated on any surgical patient

with a CBG. 125 or a diabetic patient with a CBG. 100

� 95% of patients meeting inclusion criteriawill have a stan-

dard insulin infusion initiated by the preoperative nurse

with continuation through the first 24 hours postopera-

tively

� Infusion patients will attain perioperative CBGs between

70 and 180within 3 hours of infusion initiation 95% of the

time.

Outcomes: Data from the vascular pilot revealed 100% compli-

ance with preoperative CBGs, 83% compliance with protocol

initiation, and 80% of protocol patients reaching target CBG

ranges within 3 hours of initiation. Reinforcement of protocol

procedures and dissemination to additional surgical popula-

tions is ongoing.

Implications for Practice: Perianesthesia nurses provide

a critical link in perioperative glycemic control and the preven-

tion of SSI. This project provides an example of the effective-

ness of a multi-disciplinary approach to this issue.

IMPROVING POSTOPERATIVE GLUCOSE CONTROLTHROUGH THE USE OF DIABETES MENTORSJillian Fetzner, RN, BSN, Catherine Prince, RN, CPAN

Cleveland Clinic, Cleveland, OH

Two staff nurses in the Post Anesthesia Care Unit (PACU) of

a 1200+ bed medical center were selected to take part in the

Diabetes Mentor program. To become a Diabetes Mentor, train-

ing includes a two-day course on in-patient management of