Especialidad de Enfermería Médico-Quirúrgica, una asignatura pendiente después de 14 años / Specialty of Medical Surgical Nursing, a subject still pending after 14 years

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Use of a Checklist for the Postanesthesia Care Unit Patient Handoff.

PURPOSE: This quality improvement project aimed to evaluate the benefits of implementing a checklist in the postanesthesia care unit (PACU) setting to decrease the omission of health information during the handoff from anesthesia to PACU nurses. DESIGN: Patient handoffs from anesthesia providers were anonymously assessed by PACU nurses before and after the implementation of a handoff checklist with the Situation, Background, Assessment, Recommendation format. METHODS: PACU nurses recorded use of the handoff checklist and if five items of health information were included in the handoff during the preintervention and postintervention phase. FINDINGS: Checklist use increased from 0% to 73% with omitted information decreasing with checklist use: procedure from 19% to 2%, allergies 23% to 4%, input and output 16% to 0%, antiemetic used 21% to 4%, and lines 19% to 11%. Completed handoffs increased from 13% to 82% whereas checklist use remained high, at over 79%, for the 12 weeks after implementation. CONCLUSIONS: The project was successful in implementing a standardized checklist and echoed the success of the articles reviewed. The use of a PACU handoff checklist can improve transfer of care by ensuring the provider receives more pertinent medical information during these transfers.

Family Visitation in the Postanesthesia Care Unit: Implementation of a Nurse Liaison Role.

The purpose of this article was to report on the nurse liaison role developed at a 400-bed community hospital in response to a previously published best practice project on the effect of family visitation in the PACU on family member anxiety. The evidence resulted in the development of the nurse liaison role, which changed nursing practice and involved each area of perioperative services as we embarked on family-centered care (FCC). The nurse liaison program has served as a model for other hospital departments as well as area hospitals. Guidelines for implementation of the program, which included FCC, are discussed as well as job guidelines, job descriptions, challenges, and outcomes.

Rol de enfermería en los programas de recuperación intensificada (fast-track) / Nursing role on rapid recovery programmes fast-track

Los programas de recuperación intensificada (PRI) o fast-track tienen por objetivo disminuir el estrés quirúrgico y conllevan una reducción de la carga laboral enfermera, de los costes y la estancia hospitalaria, un mayor empoderamiento del paciente, una recuperación posquirúrgica precoz y una reducción de las tasas de morbimortalidad. Para ello se requiere de la participación coordinada de un equipo multidisciplinar. A partir de una revisión integrativa de la literatura, el presente trabajo pretende ofrecer una definición del concepto de PRI o fast-track, así como mostrar la evidencia existente sobre la implantación de dichos programas en el ámbito de la Enfermería. Los beneficios y escasos perjuicios de los PRI en Enfermería justifican su implementación, que precisa un mayor apoyo y difusión para su desarrollo, así como mayor investigación que aumente la evidencia sobre la eficacia y eficiencia del protocolo

Rapid recovery (RR) or fast-track programmes are aimed at reducing surgical stress, leading to a reduction in nurse workload, costs and hospital stay, greater patient empowerment, early post-surgical recovery and reduced morbidity and mortality. These new protocols require the coordinated participation of a multidisciplinary team. Based on an integrative review of the literature, this paper aims to define the concept of a RR or fast track programme and show the existing evidence on the implementation of these programmes in nursing. The benefits and low incidence of damage of RR programmes in nursing justify their implementation. The programmes require greater support and diffusion in order to develop, as well as more research to increase the evidence on the effectiveness and efficiency of the protocols

Dispositivo supraglóticos. Estado de la cuestión / Supraglotic devices. State of the art

Introducción. Los dispositivos supraglóticos (DSG) se diseñaron para facilitar la intubación endotraqueal (IET), pueden insertarse correctamente con menor grado de formación y ofrecen una gran tasa de éxito de inserción al primer intento. Objetivo. Nombrar los DSG más utilizados en España, describir sus características principales, ventajas e inconvenientes y detallar su técnica de inserción. Metodología. Se analizaron los 30 trabajos más relevantes obtenidos en la búsqueda de la literatura biomédica realizada en las bases de datos PubMed, The Cochrane Library, Web of Science y Scopus. De los 30 trabajos consultados había un caso clínico, tres revisiones sistemáticas, tres guías clínicas, tres artículos de revisión, cinco metaanálisis, siete artículos originales y ocho ensayos clínicos aleatorizados. Resultados. La mascarilla laríngea (ML) no produce cambios hemodinámicos importantes durante su colocación y retirada. Para insertar la ML Fastrach(R) no es necesario movilizar la cabeza del paciente y se puede colocar con una sola mano desde cualquier posición. La ML Supreme(R) produce menor riesgo de desarrollar ronquera, tos y laringoespasmo durante el despertar de una anestesia general en comparación con el tubo endotraqueal. La ML I-Gel(R) permite la IET a través suyo y cuenta con un canal gástrico para la introducción de una sonda nasogástrica. Conclusiones. Los DSG constituyen un método seguro y efectivo en el manejo de la vía aérea en diferentes situaciones. Las enfermeras que han recibido una hora de formación son capaces de utilizar los DSG con altas probabilidades de éxito al primer intento (AU)

Introduction. Supraglottic devices (SGD), designed to facilitate endotracheal intubation (EIT), can be correctly inserted with less training and offer a high rate of success on the first try of insertion. Objective. Name the most frequently SGD used in Spain, describe their main characteristics, advantages and disadvantages, and detail their technique of insertion. Methodology. The 30 most relevant papers obtained after a biomedical literature search using PubMed, The Cochrane Library, Web of Science and Scopus databases, were analyzed. Among the 30 texts consulted, there was one clinical case, three systematic reviews, three clinical guidelines, three literature review articles, five meta-analyses, seven original articles and eight randomized clinical trials. Results. The laryngeal mask airway (LMA) does not produce significant hemodynamic changes during its placement and removal. To insert LMA Fastrach(R) it’s not necessary to mobilize the patient's head and it can be placed using one hand from any position. The ML Supreme(R) produces lower risk of hoarseness, cough and laryngospasm during the awakening from general anesthesia compared to the endotracheal tube. ML I-Gel(R) allows for EIT and has a gastric channel for the introduction of a nasogastric tube. Conclusions. SGD are a safe and effective method of airway management in different situations. Nurses receiving one hour of training are able to use SGD with high success probabilities on the first try (AU)

High Variance in Pupillary Examination Findings Among Postanesthesia Care Unit Nurses.

PURPOSE: On arrival to the postanesthesia care unit (PACU), patients are observed closely for significant neurological status changes. In particular, patients require frequent neurological examinations, which include assessment of the pupils for changes and/or abnormalities. DESIGN: This is a prospective, nonrandomized, observational study to examine the findings of pupillary examinations by nurses using different light sources in patients with existing pupillary assessments as ordered by standard of care. METHODS: PACU nurses were asked to perform their pupillary assessments using either a penlight with a gauge or a penlight without a gauge. Assessments were completed on the same patient within 5 minutes of one another, and results were compared. FINDINGS: PACU nurses using the same penlight with a gauge had more consistent results than those using different penlights without a gauge. CONCLUSIONS: Pupil assessments should be done with standardized light source.

The Benefits of a Preoperative MRSA Swabbing Protocol.

Infection control practices pose a challenge to nursing care in general, but can have a huge negative impact on the perioperative process. Prior to July of 2012, our institution did not perform routine methacillin resistant staphylococcus aureus (MRSA) screening on preoperative patients with a prior history of MRSA. This resulted in patients remaining in isolation throughout their entire perioperative course. Screening for MRSA was delayed until the patient arrived in the medical surgical unit. Many of these patients were later found to have negative nasal swabs. The delay in screening often resulted in the unnecessary use of supplies (increased cost), delayed post anesthesia care unit (PACU) bay turnover and decreased staff satisfaction. Meetings with Hospital Infection Control, lab personnel and PACU staff resulted in the development of a preoperative MRSA swabbing protocol. In July of 2012 a preoperative MRSA swabbing protocol was implemented. Since implementation, the PACU has experienced a cost savings between $7,200- $11,800, a minimum of 40 minutes on PACU bay turnover and an increase in staff satisfaction.

Strategies to maintain operating room functionality following the complete loss of the recovery room due to an internal disaster.

The post-anesthesia care unit (PACU) is a major contributor to the operating room (OR) process flow and efficiency. A sudden failure of hospital facility infrastructure due to a burst pipe resulted in the complete loss of a 66-bed combined preoperative and PACU facility of a major academic medical center. The OR suites were undamaged. The clinical and administrative challenges of caring for surgical patients without the usual preoperative and postoperative care areas are discussed. Our strategy for maintaining OR functions and management of patient flow, OR personnel, case prioritization, and equipment needs are detailed from the time of initial crisis until restoration of these clinical care areas. Utilization of the hospital disaster Incident Command Structure and the activation and decision support provided by the hospital Emergency Operations Center (EOC) for the week immediately following the crisis, helped maintain OR functionality.

CE: critical care recovery center: an innovative collaborative care model for ICU survivors.

OVERVIEW: Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post-critical illness morbidities and improving the ICU survivor's quality of life.

Information needs for the OR and PACU electronic medical record.

OBJECTIVE: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers. MATERIALS AND METHODS: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings. RESULTS: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU. CONCLUSION: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error.