Feasibility of Nurse-Managed Tobacco Use Interventions in Outpatient Surgical Practice.

PURPOSE: The aim of this study was to determine the feasibility of developing and implementing a brief nurse-delivered tobacco intervention in an outpatient surgical practice. DESIGN AND METHODS: Initial formative work used a survey and focus groups to determine knowledge, attitudes, and practices of perioperative nurses working in three outpatient surgical practices regarding smoking use and cessation. Based on this work, a brief intervention was designed and implemented in one of the three practices. The documentation of tobacco use and intervention elements was assessed both immediately and approximately 9 months after implementation. FINDINGS: Formative work identified not only several barriers to implementation and little current activity but also favorable attitudes toward interventions. Implementation improved self-efficacy for intervention delivery and compliance with documentation of intervention elements that was sustained for at least 9 months. CONCLUSIONS: Our results suggest that it is feasible for perioperative nurses to play an important role in the delivery of perioperative tobacco interventions.

Outpatient Dismissal With a Responsible Adult Compared With Structured Solo Dismissal: A Retrospective Case-Control Comparison of Safety Outcomes.

OBJECTIVE: To test the hypothesis that patients dismissed alone in a sedation dismissal process (SDP) have no greater risk of adverse outcome compared with those who were dismissed with a responsible adult. PATIENTS AND METHODS: We compared 2441 SDP patients undergoing 2703 procedures with 4923 unique control patients who underwent 5133 procedures between June 1, 2012, and March 31, 2017. RESULTS: The rate of unplanned readmission related to the procedure was 0.11% (n=9), and there was no difference between SDP (0.07%) and controls (0.14%). Similarly, there was no difference in complication rates between SDP patients and controls when restricting to "all causes" unplanned readmissions within 24 hours and unplanned readmissions related to procedure. CONCLUSION: With proper preparation, short-acting anesthetic/sedation medications, and sound clinical judgment, the presence of a responsible adult escort is not associated with reduced risk following discharge after ambulatory anesthesia. This practice may lessen the hardships reported by patients in needing to obtain an escort and the inconveniences and delays experienced by ambulatory procedural facilities when patients arrive without a designated escort.