Developing a model for quantifying staffing requirements in the post-anaesthesia care unit.

Nurse managers in charge of a post-anaesthesia care unit (PACU) face the task of optimising staffing levels and must be able to justify staffing needs to the wider operational team. The high variability in patient numbers and acuity that characterises the PACU, as well as the broader factors that affect patient flow to and from the PACU, make it challenging to quantify staffing requirements. Staffing models often fail to reflect accurately the needs of patients and therefore the needs of the unit and there is no recommended model for quantifying PACU staffing requirements. In this article, the author describes the challenges of quantifying PACU staffing requirements and the suitability of different types of data. The author also discusses factors to consider when developing model for quantifying PACU staffing requirements.

Fatores clínicos e preditores do ressecamento ocular em pacientes no período pós-operatório / Factores clínicos y predictores de sequedad ocular en pacientes postoperados / Clinical factors and predictors of dry eye in postoperative patients

Objetivo: avaliar os fatores clínicos preditores para o ressecamento ocular e para o diagnóstico de enfermagem Risco de ressecamento ocular em pacientes no pós-operatório em Unidade de Recuperação Pós-Anestésica. Método: estudo transversal realizado entre maio e agosto de 2017. Amostra foi de 157 pacientes adultos submetidos a procedimentos cirúrgicos eletivos. Os dados foram analisados mediante estatística descritiva e inferencial. Resultados: o diagnóstico clínico de ressecamento ocular prevaleceu em 85,35% dos pacientes, e o diagnóstico de enfermagem Risco de ressecamento ocular em 14,65%. Observou-se diferenças estatísticas entre a hiperemia, lacrimejamento excessivo e teste de Schirmer insuficiente com o diagnóstico de ressecamento ocular no olho direito e com o diagnóstico Risco de ressecamento ocular. No olho esquerdo o teste de Schirmer foi insuficiente. Conclusão: a hiperemia, o lacrimejamento excessivo e o teste de Schirmer insuficiente são fatores clínicos preditores relevantes no perioperatório para promover medidas preventivas e/ou detectar precocemente o ressecamento ocular.

Objetivo: evaluar los predictores clínicos de ojo seco y el diagnóstico de enfermería Riesgo de ojo seco en pacientes postoperados en la Unidad de Recuperación Postanestésica. Material y método: estudio transversal realizado entre mayo y agosto de 2017. La muestra fue de 157 pacientes adultos sometidos a procedimientos quirúrgicos electivos. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: el diagnóstico clínico de ojo seco predominó en el 85,35% de los pacientes, y el diagnóstico de enfermería Riesgo de ojo seco en el 14,65%. Se observaron diferencias estadísticas entre la hiperemia, el lagrimeo excesivo y el test de Schirmer insuficiente con el diagnóstico de sequedad ocular en el ojo derecho y con el diagnóstico Riesgo de ojo seco. En el ojo izquierdo el test de Schirmer fue insuficiente. Conclusión: la hiperemia, el lagrimeo excesivo y el test de Schirmer insuficiente son predictores clínicos perioperatorios relevantes para promover medidas preventivas y/o la detección precoz del ojo seco.

Objective: to evaluate the clinical predictors for dry eye and the nursing diagnosis Risk of dry eye in postoperative patients in the Post-Anesthesia Care Unit. Method: cross-sectional study conducted between May and August, 2017. The sample was 157 adult patients undergoing elective surgical procedures. Data were analyzed using descriptive and inferential statistics. Results: the clinical diagnosis of dry eye prevailed in 85.35% of patients, and the nursing diagnosis Risk of dry eye in 14.65%. Statistical differences were observed between hyperemia, excessive tearing and insufficient Schirmer test with the diagnosis of ocular dryness in the right eye and with the diagnosis Risk of dry eye. In the left eye the Schirmer test was insufficient. Conclusão: hyperemia, excessive tearing and insufficient Schirmer test are relevant perioperative clinical predictors to promote preventive measures and/or early detection of dry eye.

Escala de avaliação de enfermagem para o paciente na sala de recuperação pós-anestésica: construção e validação / Nursing assessment scale for patients in the post-anesthesia care unit: construction and validation

Introdução: a ocorrência de complicações no paciente em Sala de Recuperação Pós-Anestésica está diretamente relacionada às condições clínicas pré-operatórias, à extensão e tipo de cirurgia, às intercorrências cirúrgicas e anestésicas, bem como à efetividade das medidas terapêuticas aplicadas. Objetivo: construir e validar escala de Avaliação de Enfermagem para o paciente na Sala de Recuperação Pós-Anestésica. Metodologia: trata-se de uma pesquisa metodológica, para construção e validação de uma escala denominada "Avaliação de Enfermagem para o paciente na Sala de Recuperação Pós-Anestésica - AEPRA", desenvolvida em dois campos, o primeiro, um Hospital da Rede Pública Federal de Belo Horizonte, e o segundo, um Hospital da rede Municipal de Sete Lagoas. A escolha dos itens que compuseram a escala foi baseada nos resultados evidenciados em síntese de literatura, a saber: temperatura axilar, frequência cardíaca, respiração, pressão arterial sistólica, saturação periférica de oxigênio, consciência, movimentação, dor, náusea e vômito e ferida operatória, onde cada um dos dez (10) itens tem o escore mínimo de um (1) e o máximo de quatro (4), assim o escore pode variar de 10 a 40 pontos. A validação aparente e de conteúdo foi realizada com dez (10) juízes, por meio dos Índices de Validade de Conteúdo. A análise de confiabilidade foi realizada por meio do Coeficiente de Correlação Intraclasse. Foram avaliados cada item que compôs a escala, bem como globalmente, por dois interobservadores, separadamente e concomitantemente. Para validade de critério concorrente e validação de critério preditiva, realizou-se o cálculo amostral, e a aplicação da escala em 86 pacientes, adultos, com classificação de American Society of Anesthesiologists I, II ou III, submetidos a diversos tipos de procedimentos anestésicos-cirúrgicos. Para validação de critério concorrente, considerou-se como padrão ouro a Escala de Aldrete e Kroulik, e a análise por meio da correlação de Spearman. Para validade de critério preditivo da complicação foi utilizado o método Generalized Equations Estimating. A verificação do melhor ponto de corte do escore total para a alta, foram avaliadas as curvas Receiver Operating Characteristic e a Area Under the Curve. Resultados: a validação aparente e de conteúdo obteve a média global de 89% e a análise de confiabilidade por meio do Coeficiente de Correlação Intraclasse obteve confiabilidade global de 0,91. Quanto a validade de critério, foi realizada a comparação entre a escala proposta e a padrão ouro, sendo que houve correlação significativa (Valor-p <0,001) e positiva, com "r" igual ou maior 0,5, para todos os parâmetros e entre o total de cada uma das escalas; exceto para o parâmetro ventilação/respiração (Valor-p = 0,397). Em relação à validade de critério preditiva, a análise multivariada revelou fortemente a relação dos parâmetros temperatura, pressão arterial sistólica, saturação periférica de oxigênio e mobilidade como ocorrência de complicações. Por meio das curvas Receiver Operating Characteristic e a Area Under the Curve, tem-se nos pontos de corte 39 (AUC = 0,667) e 38 (AUC = 0,594), evidenciando os melhores pontos de corte. Conclusão: A escala de Avaliação de Enfermagem para o paciente na Sala de Recuperação Pós-Anestésica, é um instrumento confiável e válido para avaliação do paciente na Sala de Recuperação Pós-Anestésica.

Introduction: the occurrence of complications in patients in the Post-Anesthetic Recovery Room is directly related to preoperative clinical conditions, the extent and type of surgery, surgical and anesthetic complications, as well as the effectiveness of therapeutic measures applied. Objective: build and validate the Nursing Assessment Scale for patient in Post-Anesthetic Recovery Room. Methodology: this is a methodological research, for the construction and validation of a scale called "Nursing Assessment for patient in Post-Anesthetic Recovery Room - NAPPARR", developed in two fields, first, a Hospital of the Federal Public Network. of Belo Horizonte, and second, a Hospital Municipal of Sete Lagoas. The choice of items that made up the scale was based on the results evidenced in a synthesis of literature, namely: axillary temperature, heart rate, breathing, systolic blood pressure, peripheral oxygen saturation, consciousness, movement, pain, nausea and vomiting and surgical wound, each of ten (10) items has a minimum score of one (1) and a maximum of four (4), so the score can vary from 10 to 40 points. The face and content validation was performed with ten (10) judges, using Content Validity Indexes. Reliability analysis was performed using the Intraclass Correlation Coefficient. Each item that composed the scale was evaluated, as well as globally, by two interobservers, separately and concomitantly. For concurrent criterion validity and predictive criterion validation, the sample size calculation was performed, and the scale was applied to 86 adult patients classified as American Society of Anesthesiologists I, II or III, who underwent different types of anesthetic procedures- surgical. For validation of concurrent criteria, the Aldrete and Kroulik Scale was considered as the gold standard, and the analysis by means of the Spearman correlation. For validity of predictive criteria for complications, the Generalized Equations Estimating method was used. To verify the best cut-off point of the total score for discharge, the Receiver Operating Characteristic and Area Under the Curve curves were evaluated. Results: the apparent validation and the content obtained an overall average of 89% and the reliability analysis using the Intraclass Correlation Coefficient obtained an overall reliability of 0.91. As criterion validity, a comparison was made between the proposed scale and the gold standard, and there was a significant (p-value <0.001) and positive correlation, with "r" equal to or bigger than 0.5, for all parameters and between the total of each of the scales; except for the ventilation/respiration parameter (p-value = 0.397). Regarding the predictive criterion validity, the multivariate analysis strongly revealed the relationship of the parameters temperature, systolic blood pressure, peripheral oxygen saturation and mobility as the occurrence of complications. Through the Receiver Operating Characteristic curves and the Area Under the Curve, the cut-off points 39 (AUC = 0.667) and 38 (AUC = 0.594) are found, showing the best cut-off points. Conclusion: The Nursing Assessment Scale for the patient in the Post-Anesthetic Recovery Room is a reliable and valid instrument for the evaluation of the patient in the Post-Anesthetic Recovery Room.

Dor na sala de recuperação pós-anestésica: incidência e fatores preditivos / Pain in the post-anesthetic recovery room: incidence and predictive factors

Objetivo: Analisar a incidência da dor e seus fatores preditivos na sala de recuperação anestésica. Método: Trata-se de um estudo em três fases: (1) revisão sistemática de literatura. Esta fase seguiu as recomendações metodológicas do Instituto Joanna Briggs para revisões de etiologia e fatores de risco; (2) estudo observacional, analítico, prospectivo, realizado em dois momentos de avaliação, antes e depois do procedimento cirúrgico. Como local para o estudo, foi escolhido o Centro Cirúrgico de um hospital universitário do estado de Minas Gerais. Para seleção dos pacientes, foi feita uma amostragem não probabilística, por conveniência, dos casos consecutivos os quais realizaram cirurgia eletiva, nos meses de fevereiro a setembro de 2019. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais. A coleta de dados ocorreu em duas fases, primeira durante o período pré-operatório, na sala de recepção do Centro Cirúrgico e a segunda na sala de recuperação pós-anestésica. (3) formulação deum modelo preditivo utilizando como tratamento estatístico Path Analysis. Os ajustes do modelo foram verificados por meio dos índices de ajuste Comparative Fit Indexe Root Mean Square Error of Approximation. Resultados:(1) Na revisão sistemática foram achados 735 estudos e selecionados 10 para a síntese. Os principais fatores de risco achados foram idade, sexo, ansiedade, tabagismo, uso de opioide, classificação do estado clínico, tempo de cirurgia, tipo de cirurgia. Com estes resultados foi construído um questionário para coleta de dados utilizado na segunda fasedo estudo. (2) No estudo observacional, a amostra final foi constituída por 226pacientes,189 (83,6%) foi do sexo feminino e com idade média de 47,58 anos, com desvio padrão de 13,96 anos; 154(68,1%) com classificação do estado clínico pela American Society Anesthesiologists igual a II. A média do tempo de duração da cirurgia foi de 163,9minutos, com desvio padrão de 75,9 minutos. Na sala de recuperação pós-anestésica72 (31,9%) dos pacientes referiram dor, a média da máxima dor sentida foi de 2,2 pontos, com desvio padrão de 3,4 pontos(valor mínimo de 0 e máximo de 10pontos). (3) Na construção do modelo preditivo, foi testado um modelo com as variáveis sociodemográficas, variáveis clínicas e variáveis cirúrgicas. Os resultados não indicaram bom ajuste aos dados para o modelo, incluindo todas as variáveis preditivas. Do mesmo modo, foi testado o modelo final com índices de modificação com resultados que indicaram um ajuste aceitável a os dados. Assim, idade, sexo, tipo de diagnostico, tipo de cirurgia, tempo de cirurgia e analgésico intraoperatório foram variáveis preditoras para dor na sala de recuperação pós-anestésica. Conclusão: A incidência da dor na sala de recuperação pós-anestésica é alta e foram identificados seis preditores para dor na sala de recuperação pós-anestésica. Estes devem ser reconhecidos como fatores potencialmente importantes ao desenvolver protocolos de cuidados clínicos específicos para melhorar os resultados da dor e orientar futuras pesquisas sobre dor pós-operatória.

Objective: To analyze the incidence of pain and its predictive factors in the anesthetic recovery room. Method: This is a three-phase study: (1) systematic literature review. This phase followed the Joanna Briggs Institute methodological recommendations for etiology and risk factor reviews; (2) observational, analytical, prospective study, carried out in two evaluation moments, before and after the surgical procedure. As the place for the study, the Surgical Center of a university hospital in the state of Minas Gerais was chosen. For patient selection, a nonprobabilistic convenience sampling was performed of consecutive cases who underwent elective surgery, from February to September 2019. The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais. Data collection took place in two phases, the first during the preoperative period, in the reception room of the Surgical Center and the second in the postanesthetic recovery room. (3) formulation of a predictive model using Path Analysis as statistical treatment. The model fits were verified using the Comparative Fit Index and Root Mean Square Error of Approximation indices. Results: (1) In the systematic review, 735 studies were found and 10 were selected for synthesis. The main risk factors found were age, sex, anxiety, smoking, use of opioids, classification of clinical status, time of surgery, type of surgery. With these results, a questionnaire was constructed for data collection used in the second stage of the study. (2) In the observational study, the final sample consisted of 226 patients, 189 (83.6%) were female and had a mean age of 47.58 years, with a standard deviation of 13.96 years; 154 (68.1%) with clinical status classification by the American Society Anesthesiologists equal to II. The mean duration of the surgery was 163.9 minutes, with a standard deviation of 75.9 minutes. In the post-anesthetic recovery room, 72 (31.9%) of the patients reported pain, the mean maximum pain felt was 2.2 points, with a standard deviation of 3.4 points (minimum value of 0 and maximum value of 10 points). ). (3) In the construction of the predictive model, a model was tested with sociodemographic variables, clinical variables and surgical variables. The results did not indicate a good fit to the data for the model, including all predictive variables. Likewise, the final model was tested with modification indices with results that indicated an acceptable fit to the data. Thus, age, sex, type of diagnosis, type of surgery, duration of surgery and intraoperative analgesic were predictive variables for pain in the post-anesthesia care unit. Conclusion: The incidence of pain in the post-anesthesia care unit is high and six predictors for pain in the post-anesthesia care room were identified. These should be recognized as potentially important factors when developing specific clinical care protocols to improve pain outcomes and guide future research on postoperative pain.

Evaluation of the Implementation of Multiple Enhanced Recovery After Surgery Pathways Across a Provincial Health Care System in Alberta, Canada.

Importance: Engaging multidisciplinary care teams in surgical practice is important for the improvement of surgical outcomes. Objective: To evaluate the association of multiple Enhanced Recovery After Surgery (ERAS) pathways with ERAS guideline adherence and outcomes. Design, Setting, and Participants: This quality improvement study compared a pre-ERAS cohort (2013-2017) with a post-ERAS cohort (2014-2018). All patients were from Alberta Health Services in Alberta, Canada, and had available ERAS and up to 1-year postsurgery administrative data. Data collected included age, sex, body mass index, tobacco and alcohol use, diabetes, comorbidity index, and surgical characteristics. Data analysis was performed from May 7, 2020, to February 1, 2021. Interventions: Implementation of 5 ERAS pathways (colorectal, liver, pancreas, gynecologic oncology, and radical cystectomy) across 9 sites. Main Outcomes and Measures: Adherence to ERAS guidelines was measured by the percentage of patients whose care met the common ERAS pathway care element criteria. Surgical procedures were grouped by complexity; complications were classified by severity. Outcome measures for the pre-post-ERAS cohorts included length of stay (LOS), readmission, complications, and mortality. Results: A total of 7757 patients participated in the study, including 984 in the pre-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 526 [53.5%] female) and 6773 in the post-ERAS cohort (median [interquartile range] age, 62 [53-71] years; 3470 [51.2%] male). In the total cohort, care-element adherence improved from 52% to 76% (P < .001), no significant differences were found in serious complications (from 6.2% to 4.9%; P = .08) or 30-day mortality (from 0.71% to 0.93%; P = .50), 1-year mortality decreased from 7.1% to 4.6% (P < .001), mean (SD) LOS decreased from 9.4 (7.0) to 7.8 (5.0) days (P < .001), and 30-day readmission rates were unchanged (from 13.4% to 11.7%; P = .12). After adjustment for patient characteristics, the LOS mean difference decreased 0.71 days (95% CI, -1.13 to -0.29 days; P < .001), with no significant differences in adjusted 30-day readmission (-3.5%; 95% CI, -22.7% to 20.4%; P = .75), serious complications (1.3%; 95% CI, -26.2% to 39.0%; P = .94), or mortality (30-day mortality: 42% [95% CI, -35.4% to 212.3%]; P = .38; 1-year mortality: 8% [95% CI, -20.5% to 46.8%]; P = .62). The adjusted 1-year readmission rate was -15.6% (95% CI, -27.7% to -1.5%; P = .03) in favor of ERAS, and readmission LOS was shorter by 1.7 days (95% CI, -3.3 to -0.1 days; P = .04). Conclusions and Relevance: The results of this quality improvement study suggest that implementation of ERAS across multiple pathways may improve health care practitioner adherence to ERAS guidelines, LOS, and readmission rates at a system level.

Effects of Full Inhalation of Sevoflurane and Total Intravenous Anesthesia on Hemodynamics, Serum Myocardial Enzymes, and Myocardial Markers in Elderly Patients Undergoing Hysterectomy.

OBJECTIVE: To compare the effects of sevoflurane inhalation and intravenous anesthesia on hemodynamics, serum myocardial enzymes, and myocardial markers in elderly patients undergoing hysterectomy. METHODS: Group A and group B were established randomly regarding a total of 126 elderly patients who underwent an elective hysterectomy. Patients in group A were given full anesthesia with sevoflurane, and patients in group B were given anesthesia with intravenous anesthesia. The operation time, anesthesia time, and recovery time in Postanesthesia Care Unit (PACU) were compared; plasma cortisol concentration, hemodynamics, serum myocardial enzymes, and myocardial markers were detected and compared between the two groups of patients before anesthesia (T 0), after anesthesia (T 1), and after surgery (T 2). RESULTS: Group A observed a longer extubation time and recovery time in PACU than group B (P < 0.05). Results show a lower systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and plasma cortisol concentration of T 1 by comparison with those of T 0 (P < 0.05), but no significant difference remains in terms of intergroup SBP, DBP, and HR (P > 0.05), and there was no interaction effect of groups and time (P > 0.05). The two groups showed no great disparity in the levels of lactate dehydrogenase (LDH), aspartate transaminase (AST), creatine kinase (CK), and CK-MB as a subtype of CK before surgery between the two groups of patients (P > 0.05). After surgery, LDH, AST, CK, and CK-MB levels in both groups were witnessed a surge, in which group A obtained higher levels of LDH, AST, CK, and CK-MB (all P < 0.05). CONCLUSION: Total intravenous anesthesia will not increase the hemodynamic fluctuation of elderly patients undergoing hysterectomy and can reduce the damage to the myocardium of patients with surgical trauma, which can protect the myocardium of elderly patients to a certain extent, so it can be adopted as the optimal anesthesia protocol for surgery.

Diagnósticos de enfermagem em recuperação pós-anestésica: intervenções e resultados segundo linguagens padronizadas / Nursing diagnoses in post-anesthetic recovery: outcomes and interventions according to standardized languages

Introdução: os sistemas de classificação com linguagens padronizadas se estabelecem em um conjunto de conhecimentos estruturados, conceitos fundados de forma lógica e coerente, com base em suas similaridades. Nesse sentido, identificar um perfil junto a populações pode cooperar para uma melhor definição e compreensão situacional para aquela unidade e/ou pacientes. Objetivos: realizar mapeamento cruzado entre os diagnósticos de enfermagem da NANDA-I com os registros manuais de enfermagem em sala de recuperação pós-anestésica; e propor intervenções e resultados, segundo linguagens padronizadas. Método: estudo exploratório, retrospectivo com análise estatística descritiva de registros de enfermagem de 187 pacientes que estiveram hospitalizados no período de junho a julho de 2018, em sala de recuperação pós-anestésica de um hospital oncológico. O mapeamento cruzado foi realizado em três etapas: identificação dos indicadores dos diagnósticos; proposição de intervenções e atividades; e indicadores de resultados. Os dados foram analisados e descritos em frequências absoluta e relativa. Resultados: dos 13 domínios da NANDA-I, cinco foram representados; identificaram-se cinco diagnósticos de risco e 11 com foco no problema; observou-se 100% de frequência para os diagnósticos de: Risco de aspiração; Risco de infecção; Risco de queda; Capacidade de transferência prejudicada; Mobilidade no leito prejudicada; Integridade da pele/tissular prejudicada e Conforto prejudicado. Conclusões: para os 16 diagnósticos de enfermagem mapeados, foram selecionadas 22 intervenções e 58 atividades; 23 resultados e 48 indicadores de resultados.

Introduction: the classification systems with standardized languages are established in a set of structured knowledge, concepts founded in a logical and coherent way, based on their similarities. In this sense, identifying a profile with the populations can cooperate for a better definition and situational understanding for that unit and/or patients. Objectives: to perform cross-mapping between the nursing diagnoses of NANDA-I with the manual nursing records in the post-anesthetic recovery room; and, to propose interventions and outcomes, according to standardized language. Method: exploratory, descriptive and retrospective analysis of the nursing records of 187 patients hospitalized from June to July 2018, in the post-anesthetic recovery room of an oncology hospital. Cross-mapping was carried out in three stages: identification of diagnostic indicators; proposition of interventions and activities; and outcomes indicators. The data were analyzed and described in absolute and relative frequencies. Results: of the 13 NANDA-I domains, five were highlighted; were identified five risk diagnoses and 11 focused on the problem; 100% frequency was observed for the diagnoses of: Aspiration, infection and falling risk; Impaired transfer capacity; Impaired bed mobility; Impaired skin/tissue integrity and impaired comfort. Conclusions: from the 16 nursing diagnoses mapped, were selected 22 interventions and 58 activities; 23 results and 48 outcomes indicators.

Missed Nursing Care in the Postanesthesia Care Unit: A Cross-Sectional Study.

PURPOSE: This study aimed to investigate the prevalence, activities, and reasons for missed nursing care in the postanesthesia care unit (PACU) and the effect of intensive care unit (ICU) overflow patients. DESIGN: This is a single-center, cross-sectional survey. METHODS: Nineteen PACU-registered nurses of a tertiary care hospital participated. Over a 7-month period, participants were asked to complete a validated questionnaire, which included 19 items related to missed nursing care activities and 10 items related to reasons for missed nursing care. χ2 test and 1-way analysis of variance were used for data analysis. FINDINGS: Questionnaires (N = 397) were completed. Prevalence of missed nursing care activities was 78.1% and was significantly higher in cases of ICU overflow patients (P < .001). The three most reported missed nursing care activities were "drug preparation, administration, and assessment of effectiveness," "patient surveillance and assessment," and "care associated with pain"; prevalence was significantly higher in cases of ICU overflow patients (P = .036, P = .003, and P = .004, respectively). The three most reported reasons for missed nursing care were "inadequate number of nursing personnel," "unexpected rise in patient volume or acuity," and "heavy admission or discharge activity". CONCLUSIONS: The findings indicated missed nursing care was common in the PACU and increased in case of ICU overflow patients. Therefore, missed nursing care needs to be identified and minimized, while the number and length of stay of critically ill patients admitted to the PACU should be limited.

Education, Competence, and Role of the Nurse Working in the PACU: An International Survey.

PURPOSE: The aim of this research project was to describe the education, competence, and role of nurses working in the postanesthesia care unit (PACU) in 11 countries having an established perianesthesia specialty nursing organization and membership on the International Collaboration of PeriAnaesthesia Nurses, Inc (ICPAN) Global Advisory Council (GAC). DESIGN: This is a descriptive international cross-sectional study. METHODS: A Web-based survey was distributed to members of the ICPAN GAC to be completed by the GAC representative or another expert perianesthesia nurse member from the organization (n = 11). The GAC has one representative from the following 11 ICPAN organizational members: ACPAN, Australian College of PeriAnaesthesia Nurses (Australia); BRV, Beroepsvereniging Recovery Verpleegkundigen (Belgium/The Netherlands); NAPANc, National Association of PeriAnesthesia Nurses of Canada (Canada); FSAIO, The Danish Association of Anaesthesia, Intensive Care and Recovery Nurses (Denmark); FANA, Finnish Association of Nurse Anaesthetists (Finland); Hellenic Perianesthesia Nursing Organization (Greece); IARNA, Irish Anaesthetic and Recovery Nurses Association (Ireland); PNC of NZNO, Perioperative Nurses College of the New Zealand Nurses Organisation (New Zealand); ANIVA, Swedish Association of Nurse Anesthetists and Intensive Care Nurses (Sweden); BARNA, British Anaesthetic and Recovery Nurses Association (United Kingdom); and ASPAN, American Society of PeriAnesthesia Nurses (USA). FINDINGS: Perianesthesia nursing was recognized as a professional nursing specialty in 6 of 11 countries, and 8 of 11 have established national guidelines or practice standards for perianesthesia nurses. The Netherlands, Ireland, and Australia are the only countries that have a formal education program for perianesthesia nurses. There were variations in nurse-to-patient ratios between the 11 countries, ranging from 2:1 to 1:3 in the Phase I recovery of critically ill patients; in Phase II recovery (day surgery) it was most common to have up to three to four patients per nurse. Perianesthesia nurses were mainly the only profession stationed in the PACU, with professions such as the anesthesiologist and surgeon on call. The nurses performed many job tasks autonomously; however, this differed between countries. CONCLUSIONS: Perianesthesia nurse education, clinical guidelines, other professions working in the PACU, and job tasks differ between countries. This knowledge can be used in international collaboration to further develop education and training for nurses working in the PACU. Continued international perianesthesia nursing partnership can only bring us closer and strengthen our specialty practice with the focus not on our differences but on our common denominators.

Incidence of Respiratory Depression in a Postanesthesia Care Unit in Patients Undergoing Anesthesia Using Opioids.

PURPOSE: To analyze the incidence of respiratory depression (RD) in patients undergoing anesthesia using opioids in a postanesthesia care unit. DESIGN: Retrospective cohort study. METHODS: Quantitative approach, performed by documentary analysis of medical records in the postanesthesia care unit. FINDINGS: A total of 330 patients were included in the study, with a prevalence of female (186; 56.36%) and nonobese patients (295; 89.39%). Five cases of RD in the immediate postoperative period were found, corresponding to an incidence of 1.52%. Each case in this study showed different risk factors related to opioid-induced RD. CONCLUSIONS: Nursing surveillance is essential in the decision-making process regarding the knowledge of physiological, pharmacologic, and risk factors to detect clinical signs of RD.

A brief intervention to standardize postanesthetic clinical handoff.

This naturalistic, pre- and post-design study explored the feasibility and acceptability of a brief patient safety intervention to introduce a tool to standardize interdisciplinary communication processes at patient handoff between anesthetists and postanesthesia nurses in the postanesthetic care unit. Observation and interview data were collected pre- and post-intervention from a convenience sample of 27 nurses and 23 anesthetists in a large tertiary hospital in Melbourne, Australia. Following the intervention, significant improvement was observed in nurses' performance of several patient safety behaviors, but trends in nurses' interdisciplinary communication behaviors such as asking questions and escalation of care were nonsignificant. This research provides evidence that tools to standardize clinical handoff communication may empower nurses to perform desired patient safety behaviors during interprofessional handoff. It underpins future research to explore strategies to empower nurses to advocate for patient safety during interdisciplinary communication, and provides a foundation for patient handoff improvement, education, and further research.

Aquecimento do paciente no período de recuperação pós-anestésica: ensaio clínico randomizado / Patient warming in the post-anesthetic recovery period: a randomized clinical trial

Hypothermia is one of the main events and consequently nursing diagnoses found in patients undergoing anesthetic-surgical procedures. The consequences caused by hypothermia directly interfere with the individual's recovery after the surgical anesthetic procedure, which can cause an increase in cardiac and respiratory morbidity, an increase in the rate of infections and an increase in the hospital stay. It aimed to evaluate the patient's warm-up using the Forced Air Heating System, during the post-anesthetic recovery period. The method used was a clinical trial, randomized-controlled, without blinding, following the recommendations of the Consolidated Standards of Reporting Trials, carried out from August to October 2020, in a large, public Municipal Hospital in the city of Belo Horizonte, Minas Gerais. The sample consisted of 66 patients, 33 belonging to the Control Group (standard care of the Institution) and 33 to the Experimental Group (heating intervention by Forced Air Heating System), allocated by systematic probabilistic sampling technique, associated with random sampling simple. Data were collected with sociodemographic, clinical, surgical aspects and parameters evaluated in the post-anesthetic recovery period. The research project followed all ethical principles and was submitted to the Brazilian Registry of Clinical Trials. The Chi-square test, Fisher's exact test, Mann-Whitney test and the Generalized Equations Estimating method were used. The software used in the analyzes was R (version 4.0.2). The results demonstrate that the patient heating as a forced air system was not efficient and did not reestablish the normothermic state, but other benefits related to the heating were evidenced. The mean temperature of the patients at the exit of the post-anesthetic recovery room was higher for the experimental group (35.78ºC) than for the control group (35.60ºC), but this difference was not significant (p = 0.274); the experimental group shows a higher mean time of permanence in the post-anesthetic recovery room (96.97 minutes) than the control group (82.67 minutes) (p = 0.011); the mean body temperature of the patient's entry into the post-anesthetic recovery room was higher in patients in the control group (34.91ºC) than in the experimental group (34.57ºC), this difference being significant (p = 0.003); the mean difference in body temperature in and out of the post-anesthetic recovery room was higher in the experimental group (1.21ºC) than in the control group (0.69ºC); the control group patients present a higher mean systolic blood pressure in the 15 minutes (p = 0.043) and 90 minutes (p = 0.007) of anesthetic recovery and more episodes of hypertension and hypotension (p <0.001) than the patients in the experimental group; the patients of the control group present more episodes of mild and moderate hypoxemia (p <0.001) than the patients of the experimental group; and only the patients in the experimental group presented reports of improvement in the sensation of cold and tremors.