ASPAN NATIONAL CONFERENCE ABSTRACTS 191

Introduction/Problem: Historically, visitors have not been

allowed in the Phase I PACU at UCSD Medical Center. Our

PACU often has a mixture of patients including those of Phase

II, Pediatric, and ICU-floor overflow who are allowed to have

limited visitation. Inconsistent visiting practices have created

anxiety and frustration for patients, families and nursing staff.

Objective of the project: The purpose of this study was to

evaluate the perceived patient benefit to family-centered care

in the PACU by patients, family members and staff.

Methods: This is an Evidence-Based Project based on an exten-

sive literature review. Pre/post survey design was used with in-

vestigator-developed surveys containing Likert scale items

about family-centered care and perceived benefit to open visita-

tion. Prior to and three months after open visitation was imple-

mented surveys were administered to patients, families, and

nurses in the PACU. Approximately 20 nurses and 320 pa-

tients/families were recruited in this project. Descriptive statis-

tics were used to describe the sample and the answers to survey

questions. Inferential statistics were used to analyze the differ-

ence between groups during the pre and post test intervals.

Result/Discussion: Overall results showed improvement in

perceived benefit of open visitation. With open visitation 67%

of patients strongly agreed that family presence benefited their

recovery vs 30% from pre-survey. 71% of patients preferred

“family help taking care of me” with only 35% from pre-

implementation. Of themajority of familymembers surveyed af-

ter open visitation, 90% strongly agreed that allowing visiting in

the PACU is beneficial to the patient up from 49% pre-survey.

Response to “family presence provides support to the patient”

increased to 88% from 54% pre-survey. 82% of families from

post-survey agreed to “being the patient’s advocate,” vs 57%

pre-implementation. Nurses rated their level of concern about

PACU space, privacy, etc. had significantly decreased after

opening visitation and benefit of open visitation significantly in-

creased.

Conclusion/Implication: Family members, patients and

nurses all responded that there was a significant increase of per-

ceived benefit and positive support to open visitation in the

PACU. Based on the result of this project, family-centered care

has been adopted throughout UC San Diego Health System in

all PACUs.

IMPROVEMENTS IN PATIENT READINESS FORON-TIME FIRST CASE STARTS IN A TEACHINGHOSPITAL OUTPATIENT SURGERY DEPARTMENTTeam Leader: Robyn Little, BSN, RN, CAPA

Oklahoma University Medical Center, Oklahoma City,

Oklahoma

Team Members: Shaun Horton, MBA, BSN, RN,

Susan Goodwin, MS, APRN, CNS-BC, CPAN

Background: On-time first case starts are critical to the effi-

cient flow of patients through the operating room, and increase

surgeon, anesthesiologist, patient, and staff satisfaction.

Objective: To increase the on-time preparation of first case

starts by OPS RNs, which can increase the percentage of on-

time first case OR starts.

Process: Modifications in patient admission and preparation

were identified to streamline the processes. Changes included:

increased number of patients completed a pre-admission unit

(PAU) visit; when patients completed their preadmission paper-

work during their PAU visit, their registration phase on the

morning of surgery was bypassed; a Smart Fax system was im-

plemented to ensure delivery of faxed documents to Surgical

Services; all OPS staff was granted access to the electronic med-

ical record from the clinics; an RN Document Manager role was

created to focus exclusively on collection of required paper-

work prior to the day of surgery; RNs came to work at 0500 in-

stead of 0530; 2 additional RNs were added; if mandatory

paperwork was missing the morning of surgery, the attending

physician was contacted instead of a resident; first case starts

bypass holding and go directly from OPS to the OR.

Results: In 2010, the percentage of first start surgical patients

ready for surgery through OPSwas 75%. In 2009 the percentage

of first start surgical patients ready for surgery through OPS was

45%. Additional modifications are planned in the future.

Implications: Of the multitude of variables that affect on-time

first case starts, many can be positively impacted by modifica-

tion of processes specific to OPS.

IMPROVED PRE-OPERATIVE PROCESSFOR SURGICAL PATIENTSPresenter: Tess Mazloomian, RN, MN, CPAN, CAPA, CCRN,

Clinical Educator, PACU/OU/PAT

Co-Presenter: Maria Gutierrez, BS, RN, CPAN

Manager, PeriAnesthesia Department Saddleback Memorial

Medical Center, Laguna Hills, California

Background Information:

� Problems were identified related to consents, unreported

abnormal diagnostic and lab results, IVs, NPO status, hand

off, belongings and incomplete pre-op checklist.

� After the Lean Project, the process was streamlined, un-

necessary steps eliminated, more efficient ways of patient

preparation implemented.

Objectives:

� Timely, complete and accurate patient readiness for sur-

gery

� Eliminate delays in surgery start times

� Improve patient comfort and safety

Implementation:

� Consents obtained as soon as order is written and surgeon

has spoken with patient and family

� Labs are done, abnormals acted upon/reported the night

before surgery

� After one IVattempt, Floor Nurse defers to OU, OU defers

to Anesthesia

� Sending unit stores patient belongings

� Pre op checklist revised and used by Sending and Receiv-

ing RNs to give hand off communication

� Pre-op RN calls for Transport to pick up patient 1 hour be-

fore scheduled time

� ICU transports andmonitors patient in Pre-op holding un-

til direct hand-off to the Anesthesiologist and OR RN.

Successful Practice Identified:

� Reduced delays in obtaining consents especially from

DPOA

� Primary Nurse has time to report and act upon abnormal

tests results