e14 ANNUAL ASPAN CONFERENCE ABSTRACTS

IMPLEMENTATION OF THE PACU FAMILY RN ROLEAT MEMORIAL SLOAN KETTERING CANCERCENTERLenore Smykowski, RN, MA, CPAN

Memorial Sloan Kettering Cancer Center

The family visitation process in the PACU needed improvement.

Although there was a preexisting program, families were often

unprepared for the patient’s condition and not aware of hospital

etiquette. Visits were often unescorted and the PACU RNs

needed support in coordinating and supporting visits while tak-

ing care of the patient. A committee was formed to develop the

role of ‘‘The PACU Family RN’’. The objectives of the role are to

provide education and escorted visits for family.

The successful practice was implemented in March of 2007. A

PACU RN serves in the role of PACU Family RN each day from

9:30am to 10pm.

A pre and post survey was obtained with positive outcomes

noted. PACU RNs report that visitors more often receive educa-

tion and support and are escorted in and out of the PACU. The

PACU RNs report being more satisfied with the process. Sharing

this well developed PACU visitation program will promote

greater awareness and acceptance of visitation in the PACU.

DECREASING POST-OP NALOXONE (NARCAN)ADMINISTRATION ON THE NURSING UNIT

Best Practices at the Point of CareKaren Melderis, RN, BS, CPAN

Sarasota Memorial, Healthcare System, Sarasota, Florida

Background: After discharge from the post anesthesia care unit

(PACU), an increasing use of Naloxone was observed.

Objectives: Decrease use of naloxone on the nursing unit. Pro-

cess: A team identified issues throughout the perioperative con-

tinuum that lead to naloxone administration. A literature review

was conducted and an evidence based action plan was devel-

oped.

Findings: Inconsistent ways of assessing, communicating, and

intervening with patients with risk factors. Successful Prac-

tice: Education and documentation of sedation risk factors; doc-

umentation of significant events in the electronic record;

consistent documentation of medications in PACU; revision of

patient-controlled analgesia (PCA) criteria and PCA order sets

for high-risk patients; a pain risk factors education module;

use of capnography for assessment; and revision of PACU dis-

charge criteria and order sets. Outcomes: Comparing the

fourth quarter 2006 to the fourth quarter 2007, there was

a 50% reduction in the number of surgically-related naloxone

events. The data shows a definitive shift in the early recognition

and treatment of the issue.

Implications: Identification of the surgical patient’s risk fac-

tors, risk factor based interventions in the perioperative setting,

and changes in hand-off communication can improve outcomes.

A protocol for safe opioid administration especially in the high

risk patients can keep the patient safe.

A WORKFORCE INITIATIVE: THE CALGARYHEALTH REGION PACU NURSING PROGRAMShelley Jeske, RN, BScN, Tracy Boivin Oldale, RN, BN,

Nancy Andrews, RN, BN

Calgary Health Region, Calgary, Alberta, Canada

Nursing is experiencing staff shortages in all domains. With high

attrition rates and institutional growth, the need for increased

numbers of qualified PACU nurses is a priority. Our goal is to pro-

vide education and clinical experience to non-critical care

nurses in order to facilitate successful transition to the challeng-

ing environment of the PACU.

Curriculum design is based on ASPAN standards, educational

modules and clinical expectations. Time frames include 4 weeks

of classroom theory; an 8 week preceptorship; followed by a 12

week mentorship. Evaluations include examinations, presenta-

tions and successful clinical practice.

Over the past 2 years, 4 sessions of the Program have been com-

pleted with a 92% retention rate of the participants. Enhanced

PACU recruitment and ongoing staff development through pre-

ceptorship/mentorship remain a positive outcome. Incorporat-

ing innovative teaching strategies such as high fidelity

simulation enhances the professional development of the pro-

gram educators.

Our success with this program is a strong indicator that a special-

ized nursing program is a viable workplace initiative for institu-

tions faced with nurse shortages in specialty areas.

POSTOPERATIVE NAUSEA/VOMITING -POSTDISCHARGE NAUSEA/VOMITING GUIDELINEIMPLEMENTATION IN AN ACADEMIC MEDICALCENTER PERIANESTHESIA SETTINGMichael Snyder, RN, CCRN, CPAN, EMT-P, Brenda Hicks, BSN,

RN, Denise O’Brien, MSN, RN, CNS-BC, CPAN, CAPA, FAAN;

UH PACU, Department of Operating Rooms/PACU, University of

Michigan Hospitals and Health Centers, Ann Arbor, MI

Background Information: Use of ASPAN’s Evidence-Based Clin-

ical Practice Guideline for the Prevention and/or Treatment of

Postoperative Nausea and Vomiting and Postdischarge Nau-

sea and Vomiting in Adult Patients may eliminate or reduce

PONV/PDNV incidence. Anesthesia/ pharmacy/perianesthesia

nursing representatives developed new departmental guide-

lines for adults. Objectives: develop/ implement easy to use de-

partmental guidelines for the anesthesia care providers (ACP)/

perianesthesia nursing staff (PNS); decrease incidence of

PONV/PDNV; improve patient outcomes/satisfaction. Imple-

mentation: guideline developed, approved by department/ insti-

tution; education provided to ACP/ PNS; guidelines accessible

via the Web/laminated pocket cards/bulletin boards in PACU;

survey to determine use/effectiveness of new PONV/PDNV

guidelines; creation of multidisciplinary team to evaluate guide-

line effectiveness/ develop research interests. Successful Prac-

tice: algorithm established for ACP based on ASPAN Guideline;

PONV study group developed. Positive Outcomes: Survey data

supports reduction of PONV/PDNV; guidelines streamline ap-

proach to management of PONV/PDNV. Implication for prac-

tice: Adherence to PONV/PDNV guidelines improves patient

outcome/satisfaction and promotes staff efficiency.