Implementing a Preoperative Anemia Optimization Protocol for Cardiovascular Surgery Patients: A Quality Improvement Project.

BACKGROUND: Patients with anemia have poorer outcomes following cardiac surgery than do those without anemia. To improve outcomes, the Enhanced Recovery After Surgery cardiac recommendations include optimizing patients' condition, including treating anemia, before surgery. LOCAL PROBLEM: Despite implementing Enhanced Recovery After Surgery initiatives, a midwestern cardiothoracic surgery group recognized a care gap in preoperative patients with anemia. No standardized protocol was in use. METHODS: An anemia optimization protocol was developed for perioperative care of patients with anemia. Data from retrospective medical record review were analyzed to determine relationships between protocol use and secondary outcomes. The protocol was created using best evidence and expert consensus. Cardiac surgery and hematology specialists revised the protocol and agreed on a final version. The protocol was integrated into the consultation process for cardiac surgery patients. RESULTS: During the implementation period, 23 of 55 patients with anemia (42%) received interventions via the anemia optimization protocol. The mean quantity of packed red blood cells transfused perioperatively per patient was 1.9 U in the protocol group and 3.5 U in the nonprotocol group. In the subgroup of patients experiencing postoperative acute kidney injury, the mean increase in creatinine level was 0.65 mg/dL in the protocol group and 1.52 mg/dL in the nonprotocol group. Four patients in the protocol group (17%) and 6 patients in the nonprotocol group (19%) experienced postoperative acute kidney injury. CONCLUSION: Preoperative anemia is associated with poorer cardiac surgical outcomes. Incorporating the anemia optimization protocol into practice may mitigate the risk of postoperative complications for patients with anemia. Continued use of the protocol is recommended.

Using a Normothermia Bundle With Perioperative Prewarming to Reduce Patient Hypothermia.

PURPOSE: To determine if implementing a normothermia bundle, which includes preoperative forced-air warming blankets, reduces incidence of inadvertent perioperative hypothermia (IPH). DESIGN: Intervention study using retrospective chart review. METHODS: Patients received a preoperative forced-air warming blanket and temperature management with the normothermia bundle. Temperature status data was collected from patient charts to evaluate the incidences of IPH and findings from this data analysis was used to measure improvement in perioperative temperature management. FINDINGS: Of 200 patients, 63 (31.5%) remained normothermic, 37 (18.5%) had at least one documented hypothermic temperature, and 100 (50%) had no documented temperature during the intraoperative phase of care. Although compliance with intraoperative temperature monitoring decreased by 13% postintervention, the incidence of documented IPH in reviewed records was decreased by 3.6-fold. CONCLUSION: Implementing a normothermia bundle that includes a preoperative forced-air warming blanket may lower the incidences of IPH, especially in surgical cases lasting over 120 minutes.

Restrictions on Nursing Students' Electronic Health Information Access.

BACKGROUND: Restrictions on students' use of electronic health information have been anecdotally reported as a threat to clinical learning, development of informatics competency, and adherence to personal health information privacy laws. However, evidence on which informatics education and policy strategies can be designed is lacking. PURPOSE: This study describes the scope of nursing students' access to and use of electronic health information systems as reported by clinical instructors. METHODS: Clinical faculty (n = 193) in prelicensure programs from 25 states completed the online survey. RESULTS: Students are often restricted in retrieving patient health information, charting assessment data and delivered care, and using medication administration systems. Students alternatively use faculty or staff nurses' system security access. CONCLUSIONS: Results suggest the need for critical review of nursing curriculum related to informatics competency and clinical site health records access policies.