Optimizing Outcomes in Urological Surgery: Postoperative Care.

INTRODUCTION: Understanding best practices in perioperative care is critical for quality of care for our urology patients. We compiled a single, concise resource that provides recommendations for optimizing postoperative outcomes in patients undergoing urological surgery. METHODS: Optimal postoperative care includes minimizing complications, optimizing recovery and improving patient outcomes. The assembled White Paper multidisciplinary writing team included experts in a number of different areas (urologists, nurses, anesthesiologists) to address a comprehensive set of topics that urological providers face when caring for postoperative patients. This article provides a summary of key elements to optimize postoperative care in adult urological surgery, including in-hospital considerations, transition/discharge, and followup and surveillance. RESULTS: In-hospital postoperative considerations include checklists, handoffs for safe transitions from the anesthesia to surgical team, level of care planning and enhanced recovery after surgery (ERAS®). Embedded in ERAS are postoperative nutrition, mobilization, wound care, judicious use of catheters and drains, and postoperative medications and transfusions. As the patient transitions to the outpatient setting, the urologist must provide clear and readable postoperative education, which includes medication management and coordinated followup with primary care providers and home health as needed. Finally, followup visits should be carefully considered using innovative methods such as telehealth and patient reported outcomes to elevate postoperative and long-term care. CONCLUSIONS: This article summarizes postoperative factors that may impact surgical outcomes in urology. By understanding and applying best practices for postoperative care, urologists can optimize the quality of care for their patients.

Critical Thinking WOCNCB APN Examination.

EDITOR'S NOTE: This feature from the WOCNCB is linked to supplemental digital content (Supplemental Digital content 1, http://links.lww.com/JWOCN/A21) discussing the use of critical thinking when taking a WOCNCB examination.

Suspected deep tissue injury evaluated by North Carolina WOC nurses: a descriptive study.

PURPOSE: The purpose of this prospective exploratory study was to determine the percentage of suspected deep tissue injuries (sDTI) that evolve into full-thickness skin loss, to describe the progression from sDTI to full-thickness skin loss, and to explore associated conditions. SUBJECTS AND SETTINGS: The study was conducted by WOC nurses at 6 acute care medical facilities in North Carolina. Inclusion criteria were age 21 years or older and presence of an sDTI lesion. Participating members of the North Carolina WOC Nurse's Group identified 40 patients with a total of 45 sDTI. METHODS: A 2-part data collection tool was developed by 1 of the investigators and validated by members of the North Carolina WOC Nurse Group; data were collected at the time of initial consult and at a follow-up visit that occurred 1 to 20 days later (average 6 days). Data collected included description of wound appearance as well as information about comorbid and potential risk factors. RESULTS: The sample comprised 40 subjects with 45 sDTI; 3 were lost to follow-up, resulting in a total of 37 subjects with 42 sDTI at the second assessment. Eleven (26%) sDTI developed into full-thickness skin loss, and 7 (17%) evolved from purple/maroon discoloration to thin blisters over dark wound beds. Twenty (48%) did not change between the time of initial consult and the follow-up visit up between 1 and 20 days later. Two lesions healed (1 at 6 days and the other at 8 days). CONCLUSION: Despite preventive care, 26% of the sDTI evolved into full-thickness lesions at follow-up visit, and 17% evolved into unstageable pressure ulcers. However, 5% healed and 48% remained the same, suggesting that preventive care may be effective for many sDTI lesions.

North Carolina wound nurses examine heel pressure ulcers.

PURPOSE: Heels are the second most common location for pressure ulcers, and their prevalence is increasing. The purpose of this multisite research project was to describe physical characteristics and medical history of patients experiencing heel pressure ulcers (PUs). SUBJECTS AND SETTING: The settings for this study were different healthcare settings (acute care, long-term care, and homecare) in North Carolina and Virginia, where member WOC nurses perform consultative services for patients with heel ulcers. Patients older than 18 years with a heel PU were included in the study. METHODS: A data collection tool was developed by the authors. Participating members of the NC WOC Nurses Group identified 84 participants. Descriptive statistics were used to summarize the data by using proportions, means, standard deviations, and ranges. RESULTS: Over half of the population had a palpable pedal pulse. Full-thickness PUs were found in 45% of the sample while 19% had suspected deep tissue loss. Subjects tended to be elderly and have low nutritional markers, high body mass index, multiple comorbid conditions such as diabetes mellitus, systemic infection, end-stage renal disease and peripheral arterial disease, as well as low Braden Scale scores. CONCLUSION: The study revealed important factors specific to heel PUs including advanced age, malnutrition, high body mass index, and multiple comorbid conditions. Further research is needed to further refine our knowledge of our factors associated with an increase likelihood of heel PUs. Our findings also point out the need for a tool specific for the evaluation of heel PU risk.

Ostomy pouch wear time in the United States.

PURPOSE: The purpose of this study was to determine average pouch wear times of persons with an ostomy living in the United States. SUBJECTS AND SETTING: In this national survey, subjects were identified by ostomy nurses and through ostomy support groups in the United States. Participants responding to a survey represented all 6 geographic regions of the United States identified by US Bureau of Census. DESIGN AND PROCEDURE: Persons with colostomies, ileostomies, and urostomies were queried concerning their average pouch wear time. RESULTS: The mean wear time for ostomy pouches in the United States is 4.8 days. Persons with urostomies reported an average wear time of 5.02 days (SD = 1.74), those with ileostomies reported 5.01 days (SD = 2.25), and those with colostomies reported an average of 4.55 days (SD = 2.08). CONCLUSIONS: This study is the first of its kind to utilize a large, national sample to determine average wear time of ostomy pouches. Further research is needed to establish a benchmark for ostomy pouch wear time in the United States and to determine what factors affect wear time.

Difficulties experienced by the ostomate after hospital discharge.

PURPOSE: This descriptive study used a mailed survey to identify difficulties related to the stoma that ostomates experience after discharge from the hospital, who they sought help from, and if the advice was perceived as helpful. SUBJECTS AND SETTING: Ostomates who are 18 years or older and have undergone a urinary or fecal diversion at a North Carolina hospital between January 1, 2003 and June 30, 2005, were asked to respond to a survey about the difficulties related to their ostomy. INSTRUMENT: The survey gathered demographic and anthropometric data, information regarding stomal complications, self-evaluation of emotional state, and contact with clinicians and support groups. RESULTS: Of the 140 surveys mailed, 43 were returned, demonstrating a return rate of 31%. Thirty-four returned surveys were useable for statistical analysis. The top 5 difficulties experienced by the respondents were peristomal skin irritation (76%), pouch leakage (62%), odor (59%), reduction in previously enjoyed activities (54%), and depression/anxiety (53%). Twenty percent of the ostomates who experienced difficulties after surgery did not seek help. Ostomates primarily sought help from nurses when they experienced problems related to the stoma and its maintenance. For mental health, sleep, and sexual problems, a medical doctor was the practitioner of choice. Ostomates were satisfied with most of the help they received from an ostomy nurse; satisfaction was lower for home health nurses and surgeon or primary care physician practices. Average wear time for a stoma pouch was 4 days. CONCLUSION: The majority of the ostomates experienced difficulty with pouch leakage, skin irritation, odor, depression or anxiety, and uneven pouching surfaces. Ostomates desire assistance with these problems and will benefit from long-term follow-up by an ostomy nurse.