ASPAN National Conference Abstracts

CLINICAL POSTER ABSTRACTS

GERIATRIC EDUCATION AND COMPETENCE A NURSINGNECESSITYJennifer Allen, MSQSM, RN, CPAN

National Naval Medical Center, Bethesda, MD

Background: In the year 2000, the United States Census Bureau re-

ported that there were approximately 35 million people age 65 or older

in the United States. The geriatric patient has been identified as the pre-

dominant recipient of all health care services. Though a large proportion

of these patients are seen in all areas of the perianesthesia continuum,

many nurses have not received education specific to the care of this

age group.

Objectives: Focus on perianesthesia resources and continuing educa-

tion related to the geriatric population.

Process of Implementation: Through an initial grant from Nurse Com-

petence in Aging (NCA) and a continuation grant from Resourcefully En-

hancing Aging in Specialty Nursing (REASN), ASPAN has identified and

focused on improving geriatric education for perianesthesia nurses.

Successful Practice: Success is measured with the improved knowl-

edge, skills, and competence of the perianesthesia nurse.

Positive Outcomes: According to the ASPAN Geriatric Position State-

ment, ‘‘The perianesthesia nurse will be respectful, knowledgeable,

and insightful of special considerations related to aging when caring

for geriatric patients.’’

Implications: This is an opportunity to improve nurses’ knowledge of

geriatrics and patient outcomes.

The views expressed in this abstract are those of the author and do not

necessarily reflect the official policy or position of the Department of

the Navy, Department of Defense, nor the U.S. Government.

"BUNDLING’’ SCIP FOR THE PERIOPERATIVE STAFFPresenters: Maggie Colabuono, RN, CPAN, Debra L. Bennett-Carey, RN,

BSN, Lina S. Munoz, RN, BSN, CPAN, CAPA, Peggy Guastella, RN, MAOL,

Margie Winfield, RN, MAOL, Grant Smith, RN, BA,

Sharon Serenda, RN, BSN, Katrina Spears, MAOL, Robert Hanson

Advocate Good Samaritan Hospital

The Surgical Care Improvement Project (SCIP) is a national quality part-

nership of organizations focused on improving surgical care by reducing

surgical complications by 25 percent by the year 2010. To achieve this

reduction numerous performance measures were identified and moni-

tored including antibiotics, normothermia, glycemic control, appropri-

ate hair removal, venous thromboembolism (VTE), and beta blocker

therapy. The SCIP team is a multi-disciplinary team compromised of staff

from OR, CV, CCU, PST, PACU, Pharmacy, Med-Surg, QI, and IC. A core

group communicates to identify each potential SCIP case and ‘‘drill

down fall out’’ cases identifying what aspect of SCIP was non-compliant

and utilizes each as an opportunity for making improvements. The team

has implemented many strategies for improvements: revising standing

orders, antibiotics verbiage in the time out, prophylactic antibiotic lam-

inated cards, beta blocker med cards, action plans for warming patients,

and incorporation of documentation into our electronic medical record.

Monthly monitoring of the ‘‘bundle’’ compliance is shared and posted

within Surgical Services. The bundled average for 2008 - November

2009 averages 93% compliance.

Journal of PeriAnesthesia Nursing, Vol 25, No 3 (June), 2010: pp 185-195

PACU ALGORITHMSAmity Arora, BSN, RN, MBA, Linda Bowles, RN, CPAN,

Laurie Cushman, BSN, RN, CPAN, Holly Huffman, BSN, RN, MSM

Georgetown University Hospital, Washington, DC

In 2008 our Medstar hospital introduced the SBAR format as the standard

form of communication between the nursing staff and other medical

teams. As senior staff members one problem became apparent to us. A

large number of staff members in our PACU were either new graduates

or had less than five years of experience. These nurses, while quickly

able to address the situation, background and assessment were less con-

fident in making recommendations to the medical personnel they were

communicating with.

PACU algorithms of common post-operative problems, such as chest

pain, hypertension, hypotension, etc. were created to provide a quick

reference guide. These were patterned after our ACLS algorithms. The

objective behind creating the algorithms was to help our staff identify

specific suggestions regarding what should be considered when request-

ing orders.

Our staff was educated on the existence of this resource, contacting se-

nior resource nurses if they needed help using the algorithms.

New graduate nurses and new staff have used the algorithms to help re-

solve patient issues in an informed, confident manner, thereby expand-

ing their problem solving skills.

We believe these algorithms can be of benefit to PACU staff by improving

the quality of care patients receive.

UTILIZING LEAN PRINCIPLES TO IMPROVE ON-TIMEPERFORMANCE IN THE PRESURGICAL DEPARTMENTSandra Bryan, RN CPAN

St. Joseph Medical Center, Towson, MD

A multidisciplinary Lean team, led by an accomplished Lean sensei, com-

mitted to eliminating delays with the first surgical case of the day. Delays

into the operating room averaged 10 minutes. The team focused on fac-

tors leading up to surgery.

Patients were late into surgery because:

1. PAT was missing and not reviewed.

2. Patients had not been successfully contacted, so the Nursing History

and Assessment, preoperative education, and Medication Reconcilia-

tion were not initiated.

3. There was poor coordination of the surgical team on the day of surgery.

The objective was to determine how the application of Lean principles

would positively impact specific metrics leading to on-time surgical

starts.

The entire presurgical process was improved by addressing the prob-

lems listed, matching staff to workload, choreographing the morning

of surgery, and improving the visibility of patient flow.

Daily measurements were recorded: 1) preadmission testing complete 2)

patient interview complete 3) patient preparation complete 20 minutes

prior to OR start. Day of surgery outcomes were measured using a com-

puterized patient flow tracking system. Clear results produced a 50% re-

duction of delay into OR with efforts continuing to drive on-time

performance.

These principles can be reproduced in any presurgical department and

will favorably impact day of surgery performance.

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