Effectiveness of Pediatric Competency-Based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses.

PURPOSE: To evaluate the effectiveness of the American Society of Perianesthesia Nurses (ASPAN) pediatric competency-based orientation (PCBO) education program on knowledge, confidence, and early recognition of nursing expertise among perianesthesia nurses in an acute care setting. DESIGN: A quasi-experimental pre/post survey-intervention design. METHODS: Sixty perianesthesia nurses with experience ranging from less than 5 years to more than 20 years were included. A chapter review survey was completed to assess knowledge before reviewing the chapters and again after reviewing the ASPAN PCBO materials. A presurvey assessing confidence levels, decision making abilities, and early detection of knowledge regarding pediatric patients' expertise were obtained at the beginning of the study. At the end of the study, a post-study survey was completed to evaluate the effectiveness of the intervention. Random codes were assigned to each participant to ensure that the participants' information was blinded. FINDINGS: Perianesthesia nurses' knowledge increased from pre to post intervention with one of the three sets of chapters (Set 2) statistically significant. Perianesthesia nurses' confidence and recognition of nursing expertise scores increased statistically significant from pre to post intervention. Both confidence (with 33 items [P value ≤ .001]) and recognition of nursing expertise (with 16 items [P value ≤ 0.001]) were statistically significant. CONCLUSIONS: The ASPAN PCBO was shown to be statistically effective at increasing knowledge, building expertise, promoting confidence, and improving decision making skills. The plan is for the ASPAN PCBO to be incorporated into the new-hire perianesthesia orientation didactic and the competency plan.

Patients' Perceptions of Importance for Self-Administered Correct Site Surgery Checklist: A Multisite Study.

PURPOSE: The purpose of this study was to describe and validate the association between patient's self-administered correct site checklist and perceptions of importance for safe surgery. DESIGN: A multisite nonexperimental, quantitative, descriptive study. METHODS: A convenience sample of 173 adult patients from four different geographical multisite hospitals was included in the study. Inclusion criteria were age 18 to 75 years old, scheduled for surgery/procedure with laterality and ability to follow instructions. After IRB approval, investigators explained the purpose of the study, process and obtained consent from willing participants. Participants with clinical or behavioral limitations were excluded from the study. Participants completed a 24 item survey before and during surgery using a four-point Likert scale from one (not important) to four (extremely important). Descriptive data was analyzed using means, standard deviations, and percentage. All data was summarized and analyzed with STATA 12. FINDINGS: Most of the participants perceived the importance of the survey checklist items positively implying that the active engagement is an important role for safe surgery. However, a few participants reported some of the items as not important/somewhat important: "It is on my left or right side" (6.9%); "surgery on my: (state your limb) and (right or left site) (1.9-3%); "check electronic access or copy of imaging with correct name and site" (14.9%); "state your name and birthday" (4%), "check correct ID bracelet information" (2.9%) and "believe in having an active role in preventing error" (2.3%). Some participants responded, "My surgeon knows it or surgery has been scheduled".  Findings indicated that even though the importance of correct site surgery is critical for patient's surgery, a few patients reported it as noncritical and relied on healthcare team for their safety. CONCLUSIONS: This study validated the importance of the patients' perceived roles in promoting safe, correct site surgery and by engaging patients in mitigating correct site surgical errors. Therefore, inclusion of patients as an integral part of the healthcare team is necessary through education and encouragement to speak out.

Effectiveness of Buffered Lidocaine for Local Anesthesia During Liver Biopsy.

The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate. Immediately after they received the lidocaine injection, both groups were asked to rate their preprocedure anxiety and pain using a 0-10 visual analog scale. Mean postprocedure pain was statistically significantly different between the two arms with the intervention group reporting less pain (1.65 vs. 2.27, p = .037). Change in pain scores between the two groups were also statistically significantly different with the intervention group reporting a mean change in pain score of 0.93 compared to 1.63 in the control group (p = .021). However, no differences were found for reported anxiety. This study has shown that using sodium bicarbonate with lidocaine significantly decreased pain sensation at the injection site when used for deep visceral anesthesia during percutaneous liver biopsy.

Nonrandomized Clinical Trial of the Effectiveness of a Laxative Treatment Protocol to Time of First Bowel Movement After Uterine Artery Embolization Procedure: A Pilot Study.

PURPOSE: The purpose of this pilot study was to determine the efficacy of a proactive laxative protocol for constipation prevention in patients undergoing uterine artery embolization (UAE). DESIGN: A nonrandomized clinical trial. METHODS: A nonrandomized trial study design was piloted using a convenience sample of 35 patients undergoing UAE in the course of 1 year. FINDINGS: There was a statistically significant difference (P < .0001) in time of first bowel movement after UAE when patients followed a proactive laxative protocol. A combination of senna and stool softener taken twice a day for 2 days preoperatively was associated with a shorter time to first bowel movement postoperatively. CONCLUSIONS: This pilot study supports the benefits of a proactive laxative protocol in helping achieve procedural recovery uncomplicated by constipation in patients undergoing UAE.

Perianesthesia Nurses Pain Management Practices: Findings and Recommendations From a National Descriptive Study of Members of the American Society of Perianesthesia Nurses.

PURPOSE: The purpose of this study was to identify current individual practice of perianesthesia nurses regarding assessment and documentation of pain. DESIGN: Descriptive cross-sectional design using vignette technique. METHODS: Vignettes with questions available via electronic survey offered to attendees of the 2017 American Society of PeriAnesthesia Nurses National Conference. FINDINGS: Total of 1,680 perianesthesia nurses participated; 41.4% reported assessment of pain compared with 36.7% who reported documentation of pain assessment. The numeric (0 to 10) pain intensity score was the most commonly used assessment method. Only 16.4% assessed for and documented pain location, 14.4% assessed for and documented quality of pain. CONCLUSIONS: Pain assessment should include intensity, location, quality, and functional impact. The gap between nurses' practices in assessment and documention of pain may be related to system barriers. Embedding evidence-based best practice within electronic health records may improve both. Prior literature, as well as our findings, indicate these trends (missed documentation and assessment) are more global than only perianesthesia nursing.

Delphi Study: ASPAN Adult Patient Pain and Comfort Practices.

PURPOSE: The American Society of PeriAnesthesia Nurses (ASPAN) is responsible for establishing evidence-based standards to guide perianesthesia nursing practice. The ASPAN model for evidence-based practice acknowledges the potential for the Delphi technique to identify priorities for perianesthesia research. The purpose of this Delphi study was to generate a consensus on pain and comfort among a panel of experts. DESIGN: ASPAN convened a panel of experts to provide recommendations based on seven categories, this led to the development of a questionnaire to build consensus. METHODS: Survey conducted among panel of experts to obtain consensus. Two survey rounds were completed. FINDINGS: A consensus was obtained reaching a 70% benchmark for an acceptance. CONCLUSIONS: The results found a consensus on topics required for education and competency among perianesthesia nurses including transfer and discharge criteria related to pain and comfort, resources for perianesthesia nurses, policy guidelines, and the management of the special needs of perianesthesia patients.

The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units.

STUDY OBJECTIVE: To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs). DESIGN: Prospective, unblinded cross-sectional study. SETTING: Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually. PATIENTS: One hundred three surgery patients. INTERVENTIONS: During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase. MEASUREMENTS: Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter. MAIN RESULTS: A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses. CONCLUSIONS: The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.

Perspective on pain management in the 21st century.

Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiologic, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients. Thus, techniques for effective acute pain management (APM) represent unmet educational needs. The significance of this unmet need is reflected in the number of journal and textbook publications dedicated to disseminating research, evidence-based guidelines, and clinical information. Acknowledging the importance of APM, health care accrediting agencies and professional societies have become increasingly focused on ensuring that patients receive prompt and acceptable pain relief.

Assessment, physiological monitoring, and consequences of inadequately treated acute pain.

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for interindividual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychologic and emotional distress and may lead to prolonged chronic pain states. To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiologic changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient monitoring practices.

Pharmacotherapy for acute pain: implications for practice.

Effective treatment of perioperative acute pain requires that information about the patient's goals for pain relief, previous history with analgesics, and type of surgical procedure is used to guide decisions about analgesic regimens. Analgesics are selected based on the location of surgery, degree of anticipated pain, and patient characteristics (such as comorbidities), and routes of administration and dosing schedules are determined to maximize the effectiveness and safety of analgesia while minimizing the potential for adverse events. Pain management therapy is then extended into the postsurgical phase of recovery. To accomplish this, nurses must have a thorough understanding of the pharmacology of analgesics. This article provides useful information for commonly used analgesics, primarily nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and local anesthetics for control of acute postoperative pain.

Emerging trends and new approaches to acute pain management.

New approaches to the management of acute perioperative pain have focused on ways to improve the risk/benefit profile of various analgesics, enhance the consistency of pain control, address interpatient differences in responses to pain and treatments, and avoid periods of ineffective pain relief (analgesic gaps). Although intravenous patient-controlled analgesia has been the "gold standard" for acute pain management, there are now more analgesic options and compelling data to support combinations of analgesics or multimodal therapy, timing of analgesic interventions, and the use of newer drug delivery systems. Maximizing pain control with preemptive analgesia and multimodal therapy and the availability of transdermal fentanyl by iontophoresis and of extended-release epidural morphine have expanded the armamentarium of effective options for perioperative pain control. This article explores emerging trends in acute pain therapy and discusses their implications for improving patient care.

Assessment, physiological monitoring, and consequences of inadequately treated acute pain.

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for inter-individual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychological and emotional distress, and may lead to prolonged chronic pain states. To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiological changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient-monitoring practices.

Pharmacotherapy for acute pain: implications for practice.

Effective treatment of perioperative acute pain requires that information about the patient's goals for pain relief, previous history with analgesics, and type of surgical procedure is used to guide decisions about analgesic regimens. Analgesics are selected based on the location of surgery, degree of anticipated pain, and patient characteristics such as comorbidities, and routes of administration and dosing schedules are determined to maximize the effectiveness and safety of analgesia, while minimizing the potential for adverse events. Pain management therapy is then extended into the postsurgical phase of recovery. To accomplish this, nurses must have a thorough understanding of the pharmacology of analgesics. This article provides useful information for commonly used analgesics, primarily nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and local anesthetics for control of acute postoperative pain.

Perspective on pain management in the 21st century.

Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiological, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients. Thus, techniques for effective acute pain management (APM) represent unmet educational needs. The significance of these unmet needs is reflected in the number of journal and textbook publications dedicated to disseminating research, evidence-based guidelines, and clinical information. Acknowledging the importance of APM, health care accrediting agencies and professional societies have become increasingly focused on ensuring that patients receive prompt and acceptable pain relief.

Emerging trends and new approaches to acute pain management.

New approaches to the management of acute perioperative pain have focused on ways to improve the risk/benefit profile of various analgesics, enhance the consistency of pain control, address interpatient differences in responses to pain and treatments, and avoid periods of ineffective pain relief (analgesic gaps). Although intravenous patient-controlled analgesia has been the "gold standard" for acute pain management, there are now more analgesic options and compelling data to support combinations of analgesics or multimodal therapy, timing of analgesic interventions, and the use of newer drug delivery systems. Maximizing pain control with preemptive analgesia and multimodal therapy, and the availability of transdermal fentanyl by iontophoresis and extended-release epidural morphine have expanded the armamentarium of effective options for perioperative pain control. This article explores emerging trends in acute pain therapy, and discusses their implications for improving patient care.

Development and initial testing of the perianesthesia safe practices instrument: an ASPAN pilot study.

The perianesthesia environment of care is a unique high-risk health care setting that has a high susceptibility to error because of the vulnerability of patients who are undergoing surgery and anesthesia as well as the high levels of activity in these units. Safe practice in this environment is essential to quality patient care and positive patient outcomes. Consequently, ASPAN conducted a descriptive cross-sectional pilot study to test initial reliability and validity of the Perianesthesia Safe Practices Survey Instrument. The instrument was designed to assess specific safe practices in perianesthesia areas by identifying the following: (1) what are the current perianesthesia safety practices, (2) what are the recommended safety practices that are not in place, and (3) what are the differences in safety practices within areas along the perianesthesia continuum of care. Thirty-six respondents found the instrument to be clear, easy to complete, and containing appropriate content. The alpha coefficients for internal consistency for the unit specific components were preadmission testing (.79), pre-op (.94), Phase I PACU recovery (.92), and Phase II PACU recovery (.90). The results of this pilot study provided information about areas of excellence and areas for improvement for safe clinical practice in the specialty setting, as well as initial reliability and validity for the safe practices questionnaire.