National ASPAN Conference Abstracts*

NATIONAL CONFERENCE PRESENTATIONS

CHILDHOOD OBESITY: PERIANESTHESIACONSIDERATIONSMaureen Schnur, MS, RN, CPAN

Nurse Manager, Perioperative Programs, Children’s Hospital, Boston,

Massachusetts

Childhood obesity in the United States has become an epidemic. There

are individual and societal implications of this growing health threat in

children, including considerations for the perianesthesia care of this

population. There is a rise in procedures in pediatric patients that are as-

sociated with obesity. These patients may present preoperatively with

diagnosed or undiagnosed co-morbidities posing challenges to care.

This session will provide an overview of the current state of the epi-

demic, factors that have contributed to the rise in obesity in children,

its effect on trends in the perioperative setting and information to en-

hance perianesthesia care. The goal is to raise the awareness of the nurse

to the special needs of the obese child to optimize outcomes. Discussion

time at the end of the presentation will focus on sharing successful strat-

egies used to better meet the needs of this population.

PLEASE HELP ME SMILE: I’M DEPENDING ON YOU TOTAKE THE FIRST STEP!Maureen Schnur, MS, RN, CPAN

Nurse Manager, Perioperative Programs, Children’s Hospital, Boston,

Massachusetts

Nurses working postoperatively with children are at the front line to take

the first step in optimal pain management, pain assessment. To most ef-

fectively advocate for pain relief, nurses must internalize pain relief as

a priority, be vigilant for signs of pain and proactively utilize knowledge

of pain management principles to maintain comfort.

This presentation will increase understanding of developmental consid-

erations in the pediatric population, consequences of inadequately

treated pain, identification of helpful pain assessment tools and pain

management strategies that foster optimal pain management for the pe-

diatric population.

Familiar phrases that are sometimes spoken or heard in the postopera-

tive setting that may not meet the needs of the child will be shared. At-

tendees will gain insight into the thoughts of a child about to have

surgery through her writing. Her words will speak volumes to us as

nurses and remind us that we must ask children about their pain,

believe what they tell us and act on it. After all, they are depending

on us.

*These abstracts have not undergone editorial review by the edito-

rial board or the reviewers of the journal.

Journal of PeriAnesthesia Nursing, Vol 24, No 3 (June), 2009: pp e3-e4

QUALITY CIRCLES: AN INNOVATION TO OPTIMIZEQUALITY CARE IN THE PERIOPERATIVE SETTINGMartha Kent, MSN, RN

NYU Langone Medical Center, New York, NY

This presentation will describe the development, implementation and

evaluation of an innovative program, Quality Circles. This program

was established within the Perioperative service at a large academic med-

ical center, to address quality improvement activities. Quality Circles is

a redesigned process for the identification and implementation of pro-

cess improvement within the nursing arena.

Skin Assessment, an exemplar of one of the designated Quality Circles,

was instituted within the service to address the incongruence of skin as-

sessment and documentation. In addition, the new guidelines set forth

by The Centers for Medicare and Medicaid Services (CMS) made it imper-

ative that a consistent method for identification and documentation of

community acquired pressure ulcers are instituted.

A team comprised of staff members representing all areas within the Peri-

operative service was formed to discuss current practices, and explore

evidence-based practices. An instrument to assess and document skin in-

tegrity was developed as well as educational competencies for skin

assessment. To promote communication, Skin Care updates and a news-

letter were developed.

Program evaluation revealed; identification of six community acquired

pressure ulcers in a two month period and the identification of at risk indi-

viduals has promoted early intervention, prevention, and treatment. This

quality improvement innovation has enhanced excellence in nursing

practice, quality patient care and positive outcomes in the Perioperative

setting.

NOT ALL FAT IS BAD, LIPIDS TO THE RESCUE!Elaine Campbell, RN BSN CPAN, Lisa Murphy, RN BSN

South Shore Hospital, South Weymouth, MA

Peripheral nerve blocks have become an increasingly popular adjunct to

anesthesia and post operative pain management. But use of these blocks

does not go without risk. A potentially lethal adverse occurrence with

nerve blocks is local anesthetic toxicity. The purpose of this project is

to review this potential complication. The scientific concepts of toxicity

will be reviewed as well as the immediate response to this event. Toxic-

ity from local anesthetic can have disastrous consequences yet when rec-

ognized early, treatment can render a full recovery.

Being able to recognize signs and symptoms of toxicity is paramount for

the perianesthesia nurse. The perianesthesia nurse should always be pre-

pared to react to any emergency and the use of a ‘‘Lipid Rescue Protocol’’

can save precious minutes and be life saving. Implementation of a Lipid

Rescue protocol as well as two case studies will be discussed. In these

cases the perianesthesia nurse recognized local toxicity rapidly and re-

sponded with full successful resuscitation including lipid rescue.

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