Planning and analysing 'Green' post-COVID-19 orthopaedic perioperative recovery pathway.

The effect of the severe acute respiratory syndrome coronavirus 2 pandemic on the National Health Service in the United Kingdom has been profound and unprecedented with suspension of most elective surgeries. As we are emerging from lockdown now, restarting elective surgical procedures in a safe and effective manner is an expected challenge. Many perioperative factors including patient prioritisation, risk assessment, health infrastructure and infection prevention strategies need to be considered for patient safety. The British Orthopaedic Association, along with the National Health Service, have provided recent guidelines for restarting non-urgent and orthopaedic care in the United Kingdom. In this article we review the current guidelines and literature to provide some clarity for clinical practice.

Care of the surgical patient: part 1.

This article provides clinical guidance on the care of a patient undergoing an elective surgical procedure. It discusses preoperative care and the preparation of the patient. It aims to provide an awareness of the complications associated with perioperative care. Through the use of a patient case study, the authors demonstrate the care required across the full perioperative journey from diagnosis to discharge.

Identified opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey: Secondary analysis of healthcare professionals' interviews.

AIMS AND OBJECTIVES: To identify opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey in order to support patients' health-related behaviour. BACKGROUND: Gamification provides an opportunity to increase engagement in a given health behaviour and, eventually, the possibility of reaching improved outcomes through continued or consistent behaviour. DESIGN: A secondary analysis. METHODS: Semi-structured interviews were conducted with 20 healthcare professionals in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research were followed. RESULTS: Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalised counselling, monitoring and social support. CONCLUSIONS: Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms. RELEVANCE TO CLINICAL PRACTICE: This study provides an important insight into healthcare professionals' views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalised counselling, monitoring and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalised in other surgical journeys.

The impact of a nurse-led elective direct current cardioversion in atrial fibrillation on patient outcomes: A systematic review.

AIMS AND OBJECTIVES: To examine and present the success rate in relation to nurse-led elective DCCV service in AF patients. BACKGROUND: As the incidence of AF increases healthcare settings will continue to face challenges in providing appropriate timely intervention. The provision of DCCV has primarily been medical-led. Due to the increasing requirement of hospital beds, cost restriction and medical team stress the roles of nurse specialists have been driven to include elective DCCV. DESIGN: A systematic review with a narrative synthesis was undertaken. METHODS: The databases searched include the following: The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Clinical Key, Web of Science, Cochrane Library and HSE library website. A total of 187 articles were identified, and seven studies were included for synthesis. The EBL checklist was used to assess validity. The PRISMA checklist was used for transparency. RESULTS: The results of this review show an acceptable complication rate, no negative patient outcomes and a high rhythm conversion success rate. A disparity was identified due to the lack of distinction between registered nurse (RGN), advanced nurse practitioner (ANP), advanced practice provider (APP) and nurse practitioner (NP) roles. These results support the belief that a highly skilled nurse in this specific background working in a supportive organisational framework can make a valuable contribution to such practices. CONCLUSION: A structured nurse-led elective DCCV service appears safe, effective and has a high success rate in restoration to sinus rhythm in AF. However, the need for further research in order to advance knowledge and support changes in nurse-led DCCV practice is evident. RELEVANCE TO CLINICAL PRACTICE: This review demonstrates that a nurse-led elective DCCV service appears safe and successful in restoring sinus rhythm. It has promising potential effects in terms of waiting time, cost saving and achieving patient satisfaction.

Effect of a newly designed observation, response and discharge chart in the Post Anaesthesia Care Unit on patient outcomes: a quasi-expermental study in Australia.

OBJECTIVES: This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes. METHODS: A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT). RESULTS: Nursing response to patients at-risk of deterioration was higher using PACT, with more medical consultations initiated by PACU nurses (19% vs 30%, P<0.001) and more patients with Medical Emergency Team activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, P<0.001). There were higher rates of analgesia administration (37.3% vs 54.2%, P=0.001), nursing assessment of pain and documentation of ongoing analgesia prior to discharge (55% vs 85%, P<0.001). More adverse events were recorded in PACU after introduction of the PACT (8.3% vs 16.7%, P<0.001). The rate of adverse events after discharge from PACU remained constant (16.5%), but the rate of cardiac events (5.1% vs 2.6%, P=0.021) and clinical deterioration (8.7% vs 4.3%, P=0.001) following PACU discharge significantly decreased, using the PACT. Despite the increased number of patients with adverse events in phase 2, healthcare costs did not increase significantly. Length of stay in PACU and length of hospital admission for those patients who had an adverse event in PACU were significantly reduced after implementation of the PACT. CONCLUSION: This study found that using a structured discharge criteria tool, the PACT, enhanced nurses' recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.

Nursing Care Management: Influence on Bundled Payments.

Fragmented and uncoordinated care is the third highest driver of U.S. healthcare costs. Although less than 10% of patients experience uncoordinated care, these patients represent 36% of total healthcare costs; care management interaction makes a significant impact on the utilization of healthcare dollars. A literature search was conducted to construct a model of care coordination for elective surgical procedures by collecting best practices for acute, transitions, and post-acute care periods. A case study was used to demonstrate the model developed. Care management defines care coordination as a model of care to address improving patient and caregiver engagement, communication across settings of care, and ultimately improved patient outcomes of care. Nurse-led care coordination in the presurgical, inpatient, and post-acute care settings requires systems change and administrative support to effectively meet the goals of the Affordable Care Act of reducing redundancy and costs while improving the patient experience. Nursing is the lynchpin of care management processes in all settings of care; thus, this model of care coordination for elective surgical admissions can provide nursing care management leaders a comprehensive view of coordinating care for these patient across settings of care during the predetermined time period of care. As bundled payment structures increasingly affect hospital systems, nursing leaders need to be ready to create or improve their care management processes; care coordination is one such process requiring immediate attention.

Métodos de aquecimento na prevenção da hipotermia no intraoperatório de cirurgia abdominal eletiva / Heating methods in the prevention of intraoperative hypothermia of elective abdominal surgery / Métodos de calentamiento en la prevención de la hipotermia en el proceso intraoperatorio de unacirugía abdominal electiva

Objetivo: Identificar os métodos de aquecimento para prevenir hipotermia em pacientes adultos no intraoperatório de cirurgia abdominal eletiva com exposição visceral. Métodos: Estudo quantitativo, exploratório e descritivo, prospectivo, realizado num hospital público da região sul do Brasil. Constituiu a amostra 63 pacientes. Observaram-se os métodos de aquecimento utilizados e foi aferida a temperatura timpânica. Para tratamento dos dados, aplicou-se a estatística descritiva por meio do software SEstatNet. Resultados: Foram utilizados métodos de aquecimento ativo e passivo. A infusão de fluidos aquecidos para irrigação da cavidade abdominal foi a medida mais empregada (nº 63; 100%) do método ativo, enquanto que a manutenção do sistema de refrigeração desligado até o início da cirurgia foi a medida mais utilizada (nº 57; 90,5%) do método passivo. Conclusão: Com os métodos de aquecimento empregados não houve hipotermia grave, porém, existem métodos atuais mais eficientes que poderiam prevenir a hipotermia leve e moderada encontradas.

Objective: To identify heating methods to prevent intraoperative hypothermia in elective abdominal surgery with visceral exposure,in adult patients. Methods: Quantitative, exploratory, descriptive and prospective study performed in a public hospital, in southernBrazil. The sample consisted of 63 patients. It was possible to observe the heating methods used and measure the tympanictemperature. For data processing, it was used descriptive statistics through the SEstatNet software. Results: Active and passiveheating methods were used. The infusion of heated fluids for abdominal cavity irrigation was the most used measure (nº 63;100%) of the active process, while maintaining the cooling system off until the surgery beginning was the most used measurement(nº 57; 90.5%) of the passive method. Conclusion: There was no severe hypothermia with the heating methods utilized. However,there are more efficient current methods that could prevent mild and moderate hypothermia found.

Objetivo: Identificar los métodos de calentamiento para prevención de la hipotermia en pacientes adultos en el intraoperatorio decirugía abdominal electiva con exposición visceral. Métodos: Estudio cuantitativo, exploratorio, descriptivo y prospectivo realizadoen un hospital público de la Región Sur de Brasil. Participaron 63 pacientes. Fueron observados los métodos de calentamientoy la temperatura timpánica. Para el tratamiento de los datos, se utilizó la estadística descriptiva a partir del software SEstatNet.Resultados: Se utilizaron métodos de calentamiento activo y pasivo. La infusión de fluidos calentados para la irrigación de lacavidad abdominal fue la medida activa más empleada (nº 63; 100%), mientras el mantenimiento del sistema de refrigeraciónapagado hasta el inicio de la cirugía fue la medida más utilizada (nº 57; 90,5%) del método pasivo. Conclusión: No hubohipotermia grave con los métodos empleados, sin embargo, existen métodos actuales más eficientes que podrían prevenirhipotermias leves y moderadas encontradas.

Strategies to Decrease Maternal Request for Early Elective Induction.

Severe maternal discomfort in the third trimester is not a diagnostic risk justification for elective induction before 39 weeks gestation. Alternative methods of intervention and supportive resources to help sustain a woman at the end of pregnancy have been largely absent in discussions pertaining to best practices. Nurses and midwives are in an ideal position to play a leadership role in working with physician colleagues as well as other members of the health care team to broaden the conversation to include alternative and complementary interventions, and to provide guidance and assistance to help women cope with and manage the discomforts of late pregnancy.

A typical day in cardiac theatres... or was it? Expect the unexpected.

The operating theatre department is a high risk area and the expectations from the surgical teams are very high in terms of delivering safe and good quality patient care. As healthcare practitioners working in this complex environment we are the guardians of our patients and are their eyes and ears. Scrub practitioners need to be focused, alert and vigilant during all surgical procedures and avoid complacency. As this incident account shows, never take anything for granted.

The impact of the enhanced recovery after surgery (ERAS) programme on community nursing.

Early discharge from hospital as a result of enhanced recovery after surgery (ERAS) programmes can be both positive and frightening experiences for surgical patients. In a recently published article by the authors in the British Journal of Nursing, participants described mixed reactions to the ERAS programme, highlighting the period of home convalescence as being particularly challenging. In this article the concept of ERAS is explained, followed by an overview of the research study which led to the authors highlighting the issue of home convalescence. The interventions that have already been established locally as a result of this research are explored, as is the potential impact that both these short hospital stays and further necessary interventions might have on community nursing. The article examines whether health professionals are sufficiently easing the pressures of self-recoveryto fill the apparent'void' that the study participants described as existing between hospital care and community follow-up.

Patient experiences of enhanced recovery after surgery (ERAS).

Enhanced recovery after surgery (ERAS) is a multimodal pathway whose strong evidence base is changing the methods used to care for patients before, during and after surgery. As a result, patients are being safely discharged at a much earlier stage than has previously been thought possible. Literature concentrates on the surgical and economical benefits of ERAS. There is a lack of research into the patients' perspective of the programme. This study used semi-structured interviews to investigate issues of significance to ERAS patients. The issues were grouped into themes: information provision, inpatient experiences, home recovery experiences (i.e. home convalescence) and psychological and emotional experiences. Although participants reported many good aspects of their ERAS experience, the findings highlighted the need for improvement particularly with regard to post-discharge support from both community services and hospital follow-up.

[Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period]. / Prática do enfermeiro no cuidado ao paciente no pré-operatório imediato de cirurgia eletiva.

Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

Prática do enfermeiro no cuidado ao paciente no pré-operatório imediato de cirurgia eletiva / Práctica del enfermero en el cuidado al paciente en el preoperatorio inmediato de cirugía electiva / Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period

A pesquisa objetivou analisar os cuidados dos enfermeiros com os pacientes, no cotidiano da prática profissional, no período pré-operatório imediato de cirurgia eletiva. Trata-se de uma pesquisa descritiva com abordagem qualitativa, em que participaram 15 enfermeiros das unidades cirúrgicas e dois do centro cirúrgico de um hospital da Região Sul do Brasil. Os dados foram coletados no período de abril a julho de 2011, por meio de entrevista semiestruturada. Para análise dos dados, utilizou-se o Discurso do Sujeito Coletivo (DSC). As informações deram origem a três DSCs com as ideias centrais: cuidados administrativos, orientação no pré-operatório e cuidados cirúrgicos no pré-operatório imediato. Os resultados mostram que grande parte dos cuidados se refere à orientação do paciente no pré-operatório. Conclui-se que os cuidados foram direcionados aos aspectos físicos em detrimento do psicológico, em discordância com a metodologia assistencial adotada no hospital, sustentada pela Teoria das Necessidades Humanas Básicas.

Investigación que examinó los cuidados de enfermeros a pacientes, en la práctica profesional cotidiana, en período preoperatorio inmediato de cirugía electiva. Se trata de una investigación descriptiva cualitativa, con la participación de 15 enfermeros de Unidades Quirúrgicas y dos del Centro Quirúrgico de un hospital de la región sur de Brasil. La recolección de datos ocurrió desde abril a julio de 2011 por medio de entrevista semiestructurada. Para el análisis de estos se utilizó el Discurso del Sujeto Colectivo (DSC). Las informaciones originaron tres DSC con las ideas centrales: cuidados administrativos, orientación preoperatoria y cuidados quirúrgicos en el preinmediato. Los resultados retratan que gran parte de los cuidados se refiere a la orientación del paciente en el preoperatorio. Se concluye que la atención se ha dirigido a los aspectos físicos en detrimento del psicológico, en desacuerdo con la metodología de la asistencia aprobada en el hospital, apoyada por la Teoría de las Necesidades Humanas Básicas.

Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

Performance and ease of use evaluation of a new surgical post-operative foam island dressing in 14 patients undergoing elective gynaecological surgery.

AIM: The aim of this evaluation was to investigate ease of use and clinical performance of a new post-operative foam island dressing in female patients undergoing elective gynaecological surgery. Women undergoing surgery have genuine concerns regarding the risk of a hospital acquired infection. METHODOLOGY: The new post-operative dressing was evaluated on 14 patients undergoing elective gynaecological surgery during two weeks in March 2011. Evaluators rated packaging and dressing ease of use, wear time, shower proof ability, skin blistering and ease of removal. Patients rated comfort of the dressing during wear time and removal. RESULTS: Nurses and Midwives rated blister prevention 100% (good), shower proof capabilities 86% (good) and ease of removal 79% (good). Patients rated comfort during wear time, skin integrity, and the importance of bathing (shower proof). No wound infections, peri wound maceration or adverse events were recorded. CONCLUSION: Ensuring best patient outcomes and meeting individual needs remains the cornerstone of nursing practice. Reducing the risk of surgical site infections (SSI) remains a focus for NHS Trust throughout the UK particularly as Gynaelogical procedures require mandatory surveillance by the Health Protection Agency 1(The importance of patient comfort and ability to tend to hygiene needs is fundamental). The evaluated dressing has a flexible island pad allowing further tensile stretch and conformability when in situ. This was demonstrated in this study by both clinicians and patients in blister prevention, conformability, and patient comfort outcomes of this evaluation.

Medical mission volunteering: Ecuador.

This article discusses a volunteer medical mission of 50 people traveling to Ecuador. Included were surgeons, an anesthesiologist, a gastroenterologist, and an ear, nose, and throat surgeon as well as certified registered nurse anesthetists, registered nurses for pre-, intra-, and postrecovery, a certified registered gastroenterology nurse, and helpers. The focus is on the people involved, starting as strangers, working together, crossing bridges, and helping others in a third world country.

Patient-reported outcome measures: implications for nursing.

The Patient Reported Outcome Measures (PROMs) Programme, which was implemented by the NHS in 2009, gives prominence to patients' views about their health. Self-reported measures of health are now being sought from all patients before and after four elective procedures--hip and knee replacement surgery, hernia repair and varicose veins surgery. This information will be used to assess changes in health and provides routine information on NHS patients' health outcomes for the first time. The information will be used to identify and reward good performance by providers; help patients to make choices and clinicians to monitor and improve quality; and inform commissioners' decisions about which services to prioritise. The aim of this article is to inform nurses about PROMs and encourage them to engage with it.