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2.
Rev. SOBECC ; 24(4): 231-237, 30-12-2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1096096

RESUMO

Objetivo: Identificar o conhecimento de acadêmicos de enfermagem relacionado aos cuidados e às ações desenvolvidas pelo enfermeiro em sala de recuperação pós-anestésica com vistas à segurança do paciente. Método: Estudo descritivo-exploratório, de abordagem qualitativa, realizado com 30 acadêmicos de enfermagem de uma instituição privada de ensino superior da Região Sul do Brasil. A coleta de dados ocorreu no mês de outubro de 2018, mediante aplicação de questionário semiestruturado. Empregou-se a análise de conteúdo de Bardin para tratamento dos dados. Resultados: Com base nos depoimentos dos entrevistados, emergiu a seguinte categoria: Cuidados e ações do enfermeiro para segurança do paciente, em sala de recuperação pós-anestésica, percebidos pelos acadêmicos de enfermagem. Cuidados rotineiros e mecanicistas, comunicação, liderança, aplicação do processo de enfermagem e uso de protocolos e escalas foram reconhecidos pelos acadêmicos como fundamentais para a segurança do paciente na recuperação. Conclusão: Os acadêmicos de enfermagem reconheceram elementos promotores do cuidado seguro relacionados à assistência de enfermagem na recuperação anestésica.


Objective: To identify the knowledge of nursing students about nursing care and actions in the post-anesthesia care unit regarding patient safety. Method: This is an exploratory descriptive study with a qualitative approach, conducted with 30 nursing students from a private higher education institution in Southern Brazil. Data were collected by administering a semi-structured questionnaire in October 2018. We adopted Bardin's content analysis for data processing. Results: The following category emerged based on the interviewees' statements: Nursing care and actions in the post-anesthesia care unit regarding patient safety, perceived by nursing students. The students acknowledge routine and mechanistic care, communication, leadership, nursing process application, and use of protocols and scales as fundamental for patient safety when recovering. Conclusion: Nursing students identified safe care elements related to nursing care in anesthesia recovery


Objetivo: identificar el conocimiento de los estudiantes de enfermería relacionados con la atención y las acciones desarrolladas por las enfermeras en la sala de recuperación postanestésica, con miras a la seguridad del paciente. Método: Este es un estudio descriptivo y exploratorio con un enfoque cualitativo, realizado con 30 estudiantes de enfermería de una institución privada de educación superior en el sur de Brasil. La recopilación de datos tuvo lugar en octubre de 2018, mediante la aplicación de un cuestionario semiestructurado. El análisis de contenido temático de Bardin se utilizó para el procesamiento de datos. Resultados: surgió la siguiente categoría: Atención de enfermería y acciones para la seguridad del paciente en una sala de recuperación postanestésica, según lo perciben los estudiantes de enfermería. Los cuidados académicos y de rutina, la comunicación, el liderazgo, la aplicación del proceso de enfermería y el uso de protocolos y escalas fueron reconocidos por los académicos como críticos para la seguridad del paciente en la recuperación. Conclusión: los estudiantes de enfermería reconocieron elementos que promueven la atención segura, relacionados con la atención de enfermería en la recuperación anestésica


Assuntos
Humanos , Sala de Recuperação , Enfermagem , Anestesia , Enfermagem Perioperatória , Período de Recuperação da Anestesia , Segurança do Paciente
3.
PLoS One ; 14(12): e0226038, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869333

RESUMO

BACKGROUND: Despite the availability of effective warming systems, the prevalence of hypothermia remains high in patients undergoing surgery. Occurrence of perioperative hypothermia may influence the rate of postoperative complications. Recommendations for the prevention of inadvertent perioperative hypothermia have been developed and are effective to reduce the frequency of perioperative hypothermia when professionals comply with. French Society of Anesthesiology (SFAR) decided to promote guidelines for the prevention of inadvertent hypothermia, and to conduct beforehand a pragmatic assessment of the prevalence of hypothermia in France. The hypothesis was that the rate of hypothermic patients (Tc<36°C) admitted to the RR remains high (around 50%), and that was the consequence of a warming device underutilization and/or was related to the type of health facilities. METHODS: An observational, prospective and multi-centric study was conducted in France between October 2014 and May 2016 among patients over 45 years undergoing non-cardiac, non-outpatient surgery with anesthesia lasting >30 minutes in 52 centers. Patients undergoing pulmonary or proctologic surgery and those having non-invasive procedures performed under general anesthesia (for example, digestive endoscopy) were excluded from our study. Patients being operated under plexus anesthesia alone, surgeries involving hemorrhaging or infection, and patients presenting at least one organ failure were also excluded. The primary endpoint was the percentage of patients with a core temperature (Tc) <36°C on admission to the recovery room (RR). RESULTS: Among 893 subjects (median age 66.9 years), prevalence of hypothermia on admission to the RR was 53.5%. At least one warming system was used for 90.4% of the patients. Identified risk factors for Tc<36°C included age≥70 years (OR = 1.41 [CI95%: 1.02-1.94]), duration of anesthesia from 1 to 2 hours (OR = 1.94 [CI95%: 1.04-3.64]) and a decrease in Tc of >0.5°C between anesthesia induction and surgical incision (OR = 1.82 [CI95%: 1.15-2.89]). Only a combination of pre-warming and intraoperative warming prevented a Tc<36°C (OR = 0.48 [CI95%: 0.24-0.96]). CONCLUSIONS: The prevalence of hypothermia among patients admitted to the RR remains high. Our results suggest that only the combination of pre-warming and intraoperative warming significantly decreases it.


Assuntos
Hipotermia/diagnóstico , Assistência Perioperatória , Fatores Etários , Idoso , Anestesia Geral , Temperatura Corporal , Feminino , França/epidemiologia , Humanos , Hipotermia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Sala de Recuperação , Fatores de Risco
4.
Int J Pediatr Otorhinolaryngol ; 127: 109661, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476606

RESUMO

INTRODUCTION: Obstructive Sleep Apnea (OSA) and Sleep Disordered Breathing (SDB) in children tend to be a more complex and multifactorial disease than in adults. Although adult screening tools, such as the STOP-BANG questionnaire, their application limited in pediatrics. We used our previously described 6-point questionnaire to identify OSA in children and evaluated its use for predicting post-operative respiratory events. METHODS: Children from 3 to 18 years of age presenting for surgery were eligible. Exclusion criteria were emergency surgery or refusal to participate. A 6-question survey regarding symptoms of OSA/SDB was administered preoperatively. Neck circumference was measured. Height and weight were recorded from preoperative data and the body mass index (BMI) percentile obtained. RESULTS: 749 patients were enrolled in the study. 707 patients were in the final analysis (359 boys and 348 girls, mean age 12 ±â€¯4 years). The median 6-item questionnaire score was 1 (interquartile range: 0, 2) and 186 (26%) scored ≥ 2 of 6 points. Children with predicted OSA (yes on ≥ 2 questions) were more likely than without predicted OSA to require supplemental oxygen in the PACU (24% vs. 17%; 95% confidence interval [CI] of difference: -0.3%, 13%; p = 0.049). Amongst 681 patients with available data on Post Anesthesia Care Unit (PACU) length of stay (LOS), prolonged LOS (>1 h) was not more likely among children with predicted OSA (42%) compared to those without predicted OSA (39%; 95% CI of difference: -5%, 11%; p = 0.479). Outcomes assessed after PACU discharge noted no differences. Specifically, overnight hospital stay was required in 33% of patients with predicted OSA as compared to 29% of those without (95% CI of difference: -4%, 11%; p = 0.399). On POD 0, supplemental oxygen was used on the inpatient ward for 6% of patients with predicted OSA compared to 4% of patients without predicted OSA (95% CI of difference: -2%, 6%; p = 0.272). CONCLUSION: The incidence of OSA/SDB is under-appreciated in children presenting for non-otolaryngological surgical procedures. Although patients judged to have OSA on the 6-item question may need for supplemental oxygen longer in the PACU, no other outcomes differences were noted.


Assuntos
Tempo de Internação , Oxigênio/administração & dosagem , Apneia Obstrutiva do Sono/diagnóstico , Inquéritos e Questionários , Adolescente , Índice de Massa Corporal , Criança , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Sala de Recuperação
5.
Rev. esp. anestesiol. reanim ; 66(7): 394-404, ago.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187554

RESUMO

El shock hemorrágico es una de las principales causas de muerte en los pacientes politraumáticos graves. Para aumentar la supervivencia de estos pacientes se ha desarrollado una estrategia combinada de tratamiento conocida como Control de Daños. Los objetivos de este artículo son analizar el concepto actual de la Reanimación de Control de Daños y sus tres niveles de tratamiento, describir la mejor estrategia transfusional y abordar la coagulopatía aguda del paciente traumático como entidad propia. Se describen también los potenciales cambios que podrían producirse en los próximos años en esta estrategia de tratamiento


Haemorrhagic shock is one of the main causes of mortality in severe polytrauma patients. To increase the survival rates, a combined strategy of treatment known as Damage Control has been developed. The aims of this article are to analyse the actual concept of Damage Control Resuscitation and its three treatment levels, describe the best transfusion strategy, and approach the acute coagulopathy of the traumatic patient as an entity. The potential changes of this therapeutic strategy over the coming years are also described


Assuntos
Humanos , Traumatismo Múltiplo/cirurgia , Choque Hemorrágico/terapia , Recuperação Demorada da Anestesia/terapia , Perda Sanguínea Cirúrgica/prevenção & controle , Hidratação/métodos , Traumatismo Múltiplo/complicações , Sala de Recuperação/organização & administração , Ácido Tranexâmico/uso terapêutico , Transfusão de Sangue/métodos , Transtornos da Coagulação Sanguínea/tratamento farmacológico
6.
Holist Nurs Pract ; 33(5): 295-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415009

RESUMO

The purpose of the study is to determine the effects of music on the life signs of patients in the postanesthesia care unit after laparoscopic surgery. The study was carried out as a quasi-experimental model with pretest-posttest and control group in the postanesthesia care unit of a training and education hospital from March 2017 to May 2018. The sample consisted of 148 patients (74 experiment and 74 control) who were selected by the method of nonprobability sampling determined on the basis of power analysis who met the inclusion criteria. When the change in the life signs between the groups was examined, after music treatment (second measurement), there was a significant difference only in the respiratory rates (P < .05). There was a significant difference in terms of diastolic blood pressures and respiratory rates in the first admission to the clinic from the postanesthesia care unit (third measurement) (P < .05).


Assuntos
Musicoterapia/normas , Manejo da Dor/normas , Sinais Vitais/fisiologia , Adolescente , Adulto , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Musicoterapia/métodos , Musicoterapia/tendências , Manejo da Dor/métodos , Medição da Dor/métodos , Sala de Recuperação/organização & administração , Sala de Recuperação/estatística & dados numéricos
7.
Comput Intell Neurosci ; 2019: 1431509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31281333

RESUMO

Rehabilitation is essential for disabled people to achieve the highest level of functional independence, reducing or preventing impairments. Nonetheless, this process can be long and expensive. This fact together with the ageing phenomenon has become a critical issue for both clinicians and patients. In this sense, technological solutions may be beneficial since they reduce the costs and increase the number of patients per caregiver, which makes them more accessible. In addition, they provide access to rehabilitation services for those facing physical, financial, and/or attitudinal barriers. This paper presents the state of the art of the assistive rehabilitation technologies for different recovery methods starting from in-person sessions to complementary at-home activities.


Assuntos
Pessoas com Deficiência/reabilitação , Recuperação de Função Fisiológica , Reabilitação , Equipamentos de Autoajuda , Humanos , Sala de Recuperação , Reabilitação/instrumentação , Reabilitação/métodos
8.
Bull Hosp Jt Dis (2013) ; 77(2): 132-135, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128583

RESUMO

BACKGROUND: Routine immediate postoperative laboratory studies, including metabolic panels and hematologic profiles, are commonly ordered after arthroplasty procedures. However, their values only occasionally influence management. This study investigated the clinical utility and value of these tests. METHODS: A large retrospective cohort study of 18,935 patients spanning a 6-year period from 2008 to 2013 from a single high-volume institution was evaluated. Only immediate postoperative labs drawn on postoperative day 0 in the recovery room were included in the study. Complete blood counts (CBC) and basic metabolic panels (BMP) were reviewed, and ranges of abnormal were set for each lab test based on values significant enough to impact patient management. Cost effectiveness calculations were made based on current cost of the laboratory tests. RESULTS: Actionably low hemoglobin values ( < 8 g/dL) were found in 1.44% of the overall cohort. Unilateral primary total knee arthroplasty was associated with the fewest hemoglobin abnormalities at 0.59%. Primary unilateral total hip arthroplasty was associated with abnormal hemoglobin values in 1.81% of cases. Significant electrolyte abnormalities were far less common, with hyperkalemia (> 6.5 mEq/L) in 0.19%, hyponatremia ( < 120 mEq/L) in 0.01% and elevated creatinine (> 2.0 mg/dL) was found in 0.25%. Hemoglobin values were calculated at a cost of $1,710 to detect a single significantly abnormal result. The cost to detect a single actionably abnormal BMP value was $1,000. CONCLUSIONS: Routine immediate postoperative laboratory tests represent a high institutional cost and are seldom abnormal enough to warrant a change in patient management. The routine use of these tests can likely be safely eliminated in uncomplicated primary unilateral arthroplasty procedures.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Testes Hematológicos , Cuidados Pós-Operatórios/métodos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Idoso , Análise Custo-Benefício , Feminino , Testes Hematológicos/economia , Testes Hematológicos/métodos , Testes Hematológicos/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Sobremedicalização/prevenção & controle , Pessoa de Meia-Idade , Sala de Recuperação/estatística & dados numéricos , Estudos Retrospectivos
9.
Anesth Analg ; 128(6): 1225-1233, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31094792

RESUMO

BACKGROUND: Many children recovering from anesthesia experience pain that is severe enough to warrant intravenous (IV) opioid treatment within moments of admission to the postanesthesia care unit (PACU). Postoperative pain has several negative consequences; therefore, preventing significant PACU pain in children is both a major clinical goal and a moral/ethical imperative. This requires identifying patient-level and perioperative factors that may be used to predict PACU IV opioid requirement. This should allow for the development of personalized care protocols to prevent clinically significant PACU pain in children. Our objective was to develop prediction models enabling practitioners to identify children at risk for PACU IV opioid requirement after various painful ambulatory surgical procedures. METHODS: After Institutional Review Board approval, clinical, demographic, and anthropometric data were prospectively collected on 1256 children 4-17 years of age scheduled for painful ambulatory surgery (defined as intraoperative administration of analgesia or local anesthetic infiltration). Three multivariable logistic regression models to determine possible predictors of PACU IV opioid requirement were constructed based on (1) preoperative history; (2) history + intraoperative variables; and (3) history + intraoperative variables + PACU variables. Candidate predictors were chosen from readily obtainable parameters routinely collected during the surgical visit. Predictive performance of each model was assessed by calculating the area under the respective receiver operating characteristic curves. RESULTS: Overall, 29.5% of patients required a PACU IV opioid, while total PACU analgesia requirement (oral or IV) was 41.1%. Independent predictors using history alone were female sex, decreasing age, surgical history, and non-Caucasian ethnicity (model area under the receiver operating characteristic curve [AUROC], 0.59 [95% confidence interval {CI}, 0.55-0.63]). Adding a few intraoperative variables improved the discriminant ability of the model (AUROC for the history + intraoperative variables model, 0.71 [95% CI, 0.67-0.74]). Addition of first-documented PACU pain score produced a substantially improved model (AUROC, 0.85 [95% CI, 0.82-0.87]). CONCLUSIONS: Postoperative pain requiring PACU IV opioid in children may be determined using a small set of easily obtainable perioperative variables. Our models require validation in other settings to determine their clinical usefulness.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos Opioides/administração & dosagem , Anestesia Local/métodos , Pacientes Ambulatoriais , Dor Pós-Operatória/prevenção & controle , Pediatria/métodos , Administração Intravenosa , Adolescente , Antropometria , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Análise Multivariada , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Sala de Recuperação , Risco , Sensibilidade e Especificidade
10.
Rev Gaucha Enferm ; 40(spe): e20180398, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038610

RESUMO

OBJECTIVE: Describe the implementation of care transfer flow chart in postoperative, based on a risk classification model. METHOD: Experience report on the implementation of a pilot project between the post-anesthetic recovery room and the surgical hospitalization unit, developed between December/2016 and March/2017, aimed at transferring s the care of patients with low risk of postoperative mortality, in a university hospital in the South of Brazil. RESULTS: The project made it possible to expedite the discharge of the patient from the Post-Anesthetic Recovery Room to the surgical hospitalization unit, to qualify the records regarding nursing care and to optimize the time of nurses in both units for care activities. CONCLUSION: The implementation of a care transfer flow chart from the risk classification for postoperative patients contributed to a more effective communication, culminating in improvements in patient safety.


Assuntos
Transferência de Pacientes , Cuidados Pós-Operatórios , Brasil , Registros Hospitalares , Unidades Hospitalares , Hospitais Universitários/organização & administração , Humanos , Registros de Enfermagem , Transferência de Pacientes/métodos , Projetos Piloto , Cuidados Pós-Operatórios/mortalidade , Cuidados Pós-Operatórios/enfermagem , Sala de Recuperação , Risco , Design de Software
13.
Neurosurgery ; 84(3): 616-623, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30767017

RESUMO

BACKGROUND: Accurate assessment of the need for glucocorticoid therapy is essential after transsphenoidal surgery (TSS) for pituitary tumors. Agreement on the best test to use in the early postoperative setting is lacking. OBJECTIVE: To examine recovery room (RR) cortisol as a predictor of long-term need for glucocorticoids. METHODS: We conducted a retrospective cohort study of 149 patients who underwent TSS for pituitary tumors between January 2007 and December 2014. Pathological tumor diagnoses were confirmed. Endocrinologists assessed the need for glucocorticoid supplementation within 6 to 8 wk after TSS. We extracted data on preoperative, RR, and day 1 to 3 post-TSS morning serum cortisol (MSC). We reported areas under the receiver operating characteristic curve (AUC) and diagnostic measures for different cortisol measures. We also conducted a logistic regression to identify the most predictive variables. RESULTS: Eighteen patients required glucocorticoid supplementation at follow-up. RR cortisol was the most accurate measurement in the early postoperative period (AUC [95% confidence interval (CI)], .92 [.85-.99]; P < .001), followed by day 1, 2, and 3 post-TSS MSC, respectively. A threshold RR cortisol of 744.0 nmol/L (26.97 µg/dL) had 90.9% sensitivity and 73.7% specificity for detecting patients in the hypocortisolism group, while 757.5 nmol/L (27.46 µg/dL) had 100% and 70.0%, respectively. The logistic regression identified RR cortisol as the sole significant predictor (odds ratio [CI], .36[.18-.71] for every 100 nmol/L increase; P = .0033). CONCLUSION: The RR cortisol is accurate in predicting long-term glucocorticoid supplementation and may be the best early postoperative measure. Future larger studies should validate these findings and derive optimal RR cortisol threshold values.


Assuntos
Adenoma/sangue , Glucocorticoides/administração & dosagem , Hidrocortisona/sangue , Neoplasias Hipofisárias/sangue , Sala de Recuperação/tendências , Adenoma/tratamento farmacológico , Adenoma/cirurgia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Seio Esfenoidal/cirurgia
14.
Am J Obstet Gynecol ; 220(4): 367.e1-367.e7, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30639089

RESUMO

BACKGROUND: Hysterectomy is one of the most common surgical procedures performed each year with substantial related health care costs. This trial studied the effect of postoperative bladder backfilling to submicturition level in the operating room and its effect on early postoperative patient care and related cost. OBJECTIVE: The objective of the study was to compare the effect of bladder backfilling on early postoperative patient care and related cost. STUDY DESIGN: This was a randomized, single-blinded, controlled trial conducted between April 2016 and February 2017 at a single urban university hospital providing tertiary care for minimally invasive gynecologic surgery. Ninety-one patients undergoing straight-stick laparoscopic and robot-assisted hysterectomy by minimally invasive gynecologic surgeons for benign indications were recruited. The bladder was partially backfilled with 150 mL of normal saline postoperatively in the intervention group and drained in the control group, as per standard of care. Main outcomes studied were time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit cost after minimally invasive hysterectomy. Our secondary outcomes were postoperative complications. RESULTS: Forty-six patients (50.5%) were randomized to the intervention group, and 45 patients (49.5%) to the control group. Baseline comparative analysis of demographics and preoperative patient-specific variables, surgical history, intraoperative characteristics, and administered medications found the 2 groups to be largely homogenous. After regression analyses for adjustment, we found a significant reduction in the time needed to void, time spent in the postanesthesia care unit, and postanesthesia care unit-associated cost in the intervention group. Patients voided 64.9 minutes earlier than the control group (P = .015) ans spent 64 fewer minutes in the postanesthesia care unit (P = .006), resulting in $401.5 (USD) saving per patient (P = .006). None of the patients encountered any postoperative complications. CONCLUSION: Based on the findings of this randomized clinical trial, postoperative bladder backfilling to submicturition level shortens the time needed for patients to void in the postanesthesia care unit, resulting in shorter postanesthesia care unit stay and resultant cost savings. Conservatively projecting our findings on minimally invasive hysterectomy procedure is estimated to result in $69 million to $139 million (USD) per year in savings. Initiating similar investigations in other ambulatory surgical fields will likely result in a more substantial impact.


Assuntos
Histerectomia/métodos , Tempo de Internação/estatística & dados numéricos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Sala de Recuperação/estatística & dados numéricos , Doenças Uterinas/cirurgia , Adulto , Feminino , Humanos , Laparoscopia , Tempo de Internação/economia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Sala de Recuperação/economia , Procedimentos Cirúrgicos Robóticos , Método Simples-Cego , Fatores de Tempo , Bexiga Urinária , Retenção Urinária
15.
J Perianesth Nurs ; 34(3): 606-613, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30665744

RESUMO

PURPOSE: Room ventilation in the postanesthesia care unit (PACU) is often poor, although patients exhale anesthetic gases. We investigated the PACU personnel's environmental and biological sevoflurane (SEVO) burden during patient care. DESIGN: Prospective, observational study. METHODS: Air pollution was measured by photoacoustic gas monitoring in the middle of the PACU, above the patient's face, and on the PACU corridor. Urinary SEVO and hexafluoroisopropanol concentrations were determined. FINDINGS: Mean air pollution was 0.34 ± 0.07 ppm in the middle of the PACU, 0.56 ± 0.17 ppm above the patient's face, and 0.47 ± 0.06 ppm on the corridor. Biological preshift exposure levels were 0.13 ± 0.03 mcg/L (SEVO) and 4.72 ± 5.41 mcg/L (hexafluoroisopropanol). Postshift concentrations increased significantly to 0.20 ± 0.06 mcg/L (P = .004) and 42.18 ± 27.82 mcg/L (P < .001). CONCLUSIONS: PACU personnel were environmentally and biologically exposed to SEVO, but exposure levels were minimal according to current recommendations.


Assuntos
Monitoramento Ambiental/métodos , Exposição Ocupacional/análise , Propanóis/análise , Sevoflurano/análise , Poluentes Ocupacionais do Ar/análise , Anestésicos Inalatórios/análise , Monitoramento Biológico/métodos , Feminino , Humanos , Masculino , Recursos Humanos em Hospital , Técnicas Fotoacústicas , Estudos Prospectivos , Sala de Recuperação
16.
J Perianesth Nurs ; 34(1): 66-73, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29754874

RESUMO

PURPOSE: Practice guidelines from the perianesthesia community suggest that preoperative identification of patients with obstructive sleep apnea (OSA) and standardized longer observation in postanesthesia care unit (PACU) promotes safety after general anesthesia. The purpose of this study was to determine if longer monitoring of patients with OSA in the PACU improves patient outcomes after general anesthesia. DESIGN: Evidence-based best practices literature review. METHODS: PACU patient charts were retrospectively analyzed for the presence of OSA diagnosis and screening scores. Information was compared with the postoperative oxygen saturation in PACU and nursing respiratory assessment documentation. FINDINGS: Most patients (96.5%) did not experience oxygen desaturation regardless of OSA diagnosis or STOP (snore, tired, observed, pressure) score. There was no evidence extracted from this sample that suggested patients with OSA experienced a higher incidence of respiratory symptoms while in the PACU. CONCLUSIONS: This study did not affirm that patients with OSA experienced a higher incidence of oxygen desaturation or respiratory symptoms despite receiving additional monitoring in PACU.


Assuntos
Programas de Rastreamento/métodos , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Apneia Obstrutiva do Sono/diagnóstico , Idoso , Anestesia Geral/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Guias de Prática Clínica como Assunto , Sala de Recuperação , Estudos Retrospectivos , Apneia Obstrutiva do Sono/complicações
17.
J Perianesth Nurs ; 34(3): 600-605, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30528306

RESUMO

PURPOSE: Evidence demonstrates that allowing visitation in the postanesthesia care unit (PACU) leads to decreased anxiety and increased satisfaction. The purpose of this project was to create a visitation policy for families of patients staying overnight in the PACU, which would lead to improved satisfaction with the surgical waiting room experience and decreased family member anxiety. DESIGN: Evidence-based practice project. METHODS: Survey data were sent to staff registered nurses to implement a visitation policy. On the basis of the feedback, a visitation policy was implemented. Family satisfaction was measured preimplementation and postimplementation. FINDINGS: Family satisfaction increased from a mean score of 4.5 to 9.6 and 10. Anecdotally, patients and families reported less anxiety after the visit. CONCLUSIONS: Family satisfaction can be increased and anxiety decreased by allowing a brief visit in the PACU. Although registered nurses expressed concerns before the change, the new visitation policy was successfully implemented and met with enthusiasm. It continues in practice today.


Assuntos
Ansiedade/prevenção & controle , Família/psicologia , Sala de Recuperação , Visitas a Pacientes/psicologia , Prática Clínica Baseada em Evidências , Humanos , Satisfação Pessoal , Enfermagem em Pós-Anestésico , Inquéritos e Questionários
18.
J Perianesth Nurs ; 34(3): 622-632, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30528308

RESUMO

PURPOSE: Anesthesia to postanesthesia care unit (PACU) handoffs are often incomplete, imprecise, and highly variable with respect to information transfer, and therefore can jeopardize patient safety. A standardized anesthesia to PACU electronic medical record (EMR)-based patient handoff checklist was implemented and evaluated for its effect on the information transfer. DESIGN: An observational preimplementation and postimplementation design was used. METHODS: Assessment of the completeness and accuracy of information transfer during the PACU handoff was performed for a convenience samples of 100 patients preimplementation, 3 weeks postimplementation, and 3 months postimplementation. FINDINGS: The mean percentage of total handoff checklist items addressed significantly increased 3 weeks and 3 months postimplementation compared with baseline. CONCLUSIONS: The use of a standardized anesthesia to PACU EMR-based handoff checklist significantly increased the percent of accurate information transferred without considerably affecting the duration of the PACU handoff process.


Assuntos
Transferência da Responsabilidade pelo Paciente/normas , Segurança do Paciente , Melhoria de Qualidade , Sala de Recuperação/normas , Anestesiologia/organização & administração , Lista de Checagem , Registros Eletrônicos de Saúde , Humanos , Fatores de Tempo
19.
J Perianesth Nurs ; 34(2): 403-424.e3, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30340958

RESUMO

PURPOSE: The purpose of this integrative review was to synthesize and critique the literature related to protocols, checklists, and tools designed to facilitate information transfers, that is, handovers, from the operating room to postanesthesia care unit clinicians and to provide guidance for selecting an appropriate instrument. DESIGN: Integrative review of the literature. METHODS: Guided by the framework of Whittemore and Knafl, an integrative literature search was conducted and included literature sources dated January 2000 to January 2015. Select search terms included the following: post-operative handover(s), handover(s), handoff, post-operative handoff, communication, information transfer, checklists, tools, measurement, communication, and PACU. Articles were selected that described development of postoperative handover instruments. FINDINGS: Seventeen articles were identified. Instruments described in the articles were tabled and synthesized based on a priori categories described by the Donabedian conceptual model. CONCLUSIONS: Developing an instrument to improve postoperative handover should integrate recommendations from key stakeholders, include evidence-based practices, and reference information from existing instruments.


Assuntos
Continuidade da Assistência ao Paciente/normas , Transferência da Responsabilidade pelo Paciente/normas , Cuidados Pós-Operatórios/normas , Lista de Checagem , Humanos , Salas Cirúrgicas , Período Pós-Operatório , Sala de Recuperação
20.
J Perianesth Nurs ; 34(2): 425-430, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30340960

RESUMO

PURPOSE: To assess the safety and feasibility of early oral hydration (EOH) in the postanesthesia care unit (PACU) after laparoscopic cholecystectomy. DESIGN: Prospective, randomized, controlled trial. METHODS: Patients were randomly assigned to the EOH group or the conventional oral hydration (COH) group. Outcomes were the incidence of nausea and vomiting, thirst scale, incidence of oropharyngeal discomfort, and patient satisfaction. FINDINGS: Compared with the COH group, the EOH group had lower incidence of nausea before and after the first drink in the ward (P < .05); lower incidence of vomiting before and after the first drink in the ward (P < .05); lower thirst scale when patients were transferred out of the PACU (P < .05) and at 6 hours postoperatively (P < .05); and greater patient satisfaction on postoperative day 1 (P < .05). CONCLUSIONS: Early oral hydration in the PACU following laparoscopic cholecystectomy was safe and well-tolerated.


Assuntos
Colecistectomia Laparoscópica/métodos , Ingestão de Líquidos , Satisfação do Paciente , Cuidados Pós-Operatórios/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Sala de Recuperação , Sede , Fatores de Tempo
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