Communication Across the Surgical Care Continuum

Communication Across the Surgical Care Continuum

ASPAN NATIONAL CONFERENCE ABSTRACTS e22 Implications for Advancing Perianesthesia Nursing: The PIC Initiative exemplifies many of ASPAN’s core value...

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Implications for Advancing Perianesthesia Nursing: The PIC Initiative exemplifies many of ASPAN’s core values of integrity, saying and doing what we say we will do; respect, respecting the needs of others; and stewardship, overseeing what is best for our patients in the advancement of perianesthesia nursing. The peri-operative nursing arena is often busy and challenging at best; however, we are the advocates not only for our patients but also for their families today. The cell phone has enabled us to provide direct communication between the care team and the PIC to a heightened level of mutual respect and trust through timely updates beginning in SDS, continuing directly from the OR team, and PACU. The PIC Initiative functions as an efficient model of communication with easy adaptability to any setting.

IMPLEMENTING A TRIGGER PROGRAM IN THE POST ANESTHESIA CARE UNIT Team Leaders: Mary Grzybinski, RN, BSN, Eswar Sundar, MD, Michael Cocchi, MD Beth Israel Deaconess Medical Center, Boston, Massachusetts Team Members: Susan Dorion, RN, MSN, Dustin Boone, MD, Elizabeth Sisti, RN, MSN

Background: BIDMC adopted a Trigger program to allow for early detection and intervention for patients who needed increased level of care. A standardized guideline to escalate care concerns was not available in the PACU. A multidisciplinary team with representatives from Nursing, Anesthesia and Surgery developed a framework for PACU staff to follow when a patient unexpectedly decompensates, requires a higher level of care or does not follow normal post op recovery. Objective of the Project:  To define early warning signs of patient decompensation  To define early intervention guidelines to prevent poor patient outcomes and code situations  To maximize resources for positive patient outcomes Process of Implementation:  Literature search to define best practices in other institutions  Defined criteria that may lead to patient decompensation  Developed a guidelines for implementation of the criteria and the steps to follow  Developed a system of communication from nursing to Attending Surgeons and Attending Anesthesiologists  Developed closed loop communication of expected patient outcomes and next steps if outcomes not met  Created an ongoing educational roll out of the Triggers Program  Created a Triggers electronic record in CPOE with a standardized form to be printed in chart.  Implemented an ongoing audit of Triggers and their outcomes  Analyzed PACU Triggers and criteria and make changes as needed for safer patient outcomes Statement of Successful Practice: The implementation of the Triggers program has led to an increase in positive patient outcomes, by providing guidelines and early communication to all involved team members.

Implementation for Advancing the Practice of Perianesthesia Nursing: PeriAnesthesia nurses, working in collaboration with a multidisciplinary group of licensed practitioners, can impact positive patient outcomes with predictability in workflow and early identification and treatment of adverse events.

COMMUNICATION ACROSS THE SURGICAL CARE CONTINUUM Team Leaders: Anita Norton, MSN, RN, CPNP, Sue DeWalt, BSN, RN, CNOR Children’s Hospital of Wisconsin, Milwaukee, Wisconsin Team Members: Lynne Senkerik, MSN, RN, Epic OpTime Analyst, and members of the Joint Surgical Services Partnership CouncildAnne Bentley, BSN, RN, Lisa Boettcher, BSN, RN, Janelle Brinkman, ADN, RN, Terri Carlson, ADN, RN, Mary Grosel, BSN, RN, CSSGB, CPHQ, Matt Mangan, BSN, RN, Rebecca Mather-Smith, BSN, RN, CPN, Catherine Mueller, BSN, RN, CNOR, Ursula Nazarkewich, RN, CPN, Paula Schmidt, MSN, RN, MBA, Augusta Smith, BSN, RN, Daniel Stalewski, MSN, RN, CNL, Karen Suwalski, ADN, RN, Mary Trutwin, BSN, RN, Lizbeth Werner, BSN, RN

Background Information: Handoff communication is an essential component of safety as patients travel through the continuum of surgical care. The nurse-to-nurse handoff within this continuum was noted to be vague and incomplete, which affected the quality of subsequent handoffs through multiple transfers of care. Families also commented about insufficient communication during their experiences in follow-up phone calls. The original handoff tool was not well utilized and was deemed not helpful by perioperative nursing staff because it did not focus on the needs of the pediatric surgical patient. Objectives of Project: The goal of our project was to develop an evidence-based, standardized handoff tool for Surgical Services staff. Utilizing the Shared Governance model, members of the Partnership Councils in the three surgical areas met to determine the most meaningful information to be included in a perioperative handoff. Members of the councils reviewed the literature and developed consensus for the appropriate elements of the handoff. Process of Implementation: The communication plan for implementation of the handoff tool included face-to-face conversations, email notifications, and informational posters in communal areas. The Leadership teams and Partnership Council members set the practice expectation that the tool would be utilized at every phase of care. Observation audits were completed in conjunction with soliciting staff feedback for refinement of the tool. Statement of Successful Practice: The frequency of handoffs increased as well as utilization of the standardized tool, especially with the pre-op to OR handoff. The PACU staff received positive feedback from inpatient unit staff regarding the quality of their handoffs and the OR staff noted the thoroughness of the tool when transferring patients to the ICU. Fewer parent concerns were noted related to a loss of pertinent patient information. Implications for Advancing the Practice of Perianesthesia Nursing: Nurses were empowered to collaborate between the different areas of Surgical Services to improve the handoff process and patient outcomes. The standardized handoff tool for surgical patients is one step forward in providing safe, individualized care to our patients and families. Future work may include promoting the use of the tool with interventional radiology and at a remote ambulatory surgery center.