antibiotics – timing is everything
TRANSCRIPT
ANNUAL ASPAN CONFERENCE ABSTRACTS e15
INCREASING COMPLIANCE TO PERIOPERATIVE CARDIACRISK REDUCTION THERAPY (PCRRT) THROUGH PATIENTEDUCATIONJanet G. Jule, RN MSN
Project Leader/Presenter; and
ASU Staff Nurses, Veterans Affairs Medical Center San Francisco, CA
Background: About 600,000 patients undergo cardiac surgery and
about 30 million undergo non-cardiac surgery everyday. Of these num-
bers, about 6 million are at risk for perioperative cardiac morbidity. Stud-
ies have shown that perioperative beta blockade reduces the incidence
of MI and mortality in patients with intermediate or high risk. Pre-oper-
ative teaching contributes to the most favorable outcome for patients in
the post-operative period.
Objective: To increase compliance with PCRRT through repetitious and
thorough patient education.
Process of Implementation: PCRRT is initiated during the surgical or
anesthesia pre-op visit as appropriate. The ASU nurses educate the pa-
tient on PCRRT on several occasions: during the clinic visit, during the
pre-op phone call, and on the day of surgery. The pre-op note was revised
to include a PCRRT reminder and documentation of med administration.
SuccessfulPractice: Compliance to PCRRTincreased from 83% (October
2007) to 100% (June, July, August 2008)
Positive Outcomes:
- Clearer process for patient education and teaching
- Increased staff satisfaction for outstanding QI results
- Clear documentation of perioperative beta blockade or clonidine ad-
ministration
Implications: Patient education yields positive outcomes and must be
part of the perioperative nursing care plan.
ANTIBIOTICS – TIMING IS EVERYTHINGMary Ann Pengiel, RN, MS
MacNeal Hospital, Berwyn, IL
Purpose: To develop procedures in order to ensure that the antibiotics
are given in the 30 to 60 minute range prior to incision and that they are
subsequently discontinued within 24 hours as per the guidelines of the
Surgical Care Improvement Project (SCIP).
Method: The Perioperative area went through several missteps trying to
make certain that our antibiotics were infused on time. We began by hav-
ing the antibiotics, via intravenous (IV) piggy-back, started in Same Day
Surgery (SDS), by the nurse from that unit when the operating room
(OR) team would come to take the patient to the surgery. We then moved
on to having the IVantibiotic started by either anesthesia or the OR nurse
just as they took the patient into surgery. Finally, we instituted the use of
pre-mixed syringes. Anesthesia or the OR nurse obtains them in SDS and
the antibiotic is given in the OR, IV push, by anesthesia, after the patient
is moved onto the OR table. This method has been our greatest success.
To address the issue of discontinuation, a simple matter of instituting the
use of a stamp, noting when the surgery ends and when the first dose of
the antibiotic was given, aids the units and pharmacy in keeping the tim-
ing of the dosages on the correct time schedule.
Results: An overall decrease in outliers of both on time administration
and discontinuation of antibiotics for surgical procedures.
Implications: The changes in our methods enable us to better ensure
that we are following protocols put forth by SCIP.
AN EVIDENCE BASED STUDY ON THE MINIMUM VOLUMEOF BLOOD WASTAGE FROM ARTERIAL LINESWanda Rodriguez, MA, RN, CCRN, CPAN, Doreen McCarty, BSN, RN, CPAN,
Stephanie Nolan, MS, RN, CPAN, Joyce Kane, MSN, RN, CCRN,
Mary O’Sullivan, BSN, RN, CPAN, Denise Stone, BSN, RN, CPAN
Memorial Sloan-Kettering Cancer Center, New York, New York
Frequent laboratory testing, convenience of arterial catheters and incon-
sistent practices contribute to blood loss in postoperative patients.
EBP Question: What is the minimum discard volume required
when drawing blood from arterial lines?
50 evidence-based articles were reviewed. Expert opinions and guide-
lines were evaluated. Literature recommends using a blood-conserving
device or equating the discard volume to double the arterial line dead
space from the catheter tip to the sampling port. Given the compro-
mised immunity of our patients, a closed system was not optimal. We
measured 3ml to be double the arterial line dead space. A dedicated
3ml waste tube was proposed and approved by our multidisciplinary
partners, resulting in decreasing the discard volume from 9ml to
3ml.This practice change provides standardization and numerous safety
advantages in PACU and ICU settings. The waste tube is plastic as op-
posed to glass and is significantly more cost effective. It is distinct
from our current inventory of laboratory tubes so to avoid being mistak-
enly analyzed as a diagnostic test. A dedicated 3ml waste tube has main-
tained accurate test results while minimizing blood loss to the adult
perianesthesia patient.
DREAMS BECOME LEGACY: FAMILY CENTERED CARE INA RURAL GUATEMALA HOSPITALDenise Sullivan, MSN, RN,BC, CPAN, CNA-BC,
Eileen Oates, MSN, RN, ANP-BC, APHN-BC, CEN
Riverview Medical Center Red Bank, New Jersey and Jersey Shore
University Medical Center, Neptune, New Jersey
Background: What started over 30 years ago as a small dispensing phar-
macy is today a medical facility offering health care services in a family-
centered environment. The hospital has expanded to include other fam-
ily oriented programs, including a malnutrition therapy clinic. The hos-
pital annually treats over 15,000 patients from Guatemala, Mexico and
other parts of Central America. Of this number US surgical teams per-
form surgery on 1600 of the 5000 patients they see during their visits.
Objective of the project: To provide accessible and affordable medical
and health care to a population of Central America that would otherwise
have none.
Implementation: Volunteer US surgical teams including PACU nurses
visit the hospital four times a year. During these visits a variety of surger-
ies are performed based on the specialties represented on the team.
Teams consistently achieve positive outcomes and high patient satisfac-
tion, based on absence of postoperative infections and complications,
and the smiles of discharged patients and families. Implications for
PACU Nurses: Practice in a rural setting without the benefit of advanced
technology requires PACU nurses to use critical thinking and basic nurs-
ing skills to successfully care for patients and families, while challenged
with the barriers of location, language, education and resources.