Advocacy for the Perioperative Patient

Thousands of surgeries and procedures happen daily. Patients place their lives and well-being in the hands of the surgical team. The operating room is a high risk environment and unfortunately, errors can occur resulting in harm and even death. Each surgical team member has a role and responsibilities during the surgical case. One main role of the perioperative nurse is patient advocacy and patient safety. However, this role can be impeded due to hierarchy and the operating room culture. Identifying the perioperative nurse\u27s role and responsibility relating to patient advocacy will provide directions in the perioperative nurse\u27s daily practice. An educational session designed to address the perioperative nursing role of patient advocacy is described. Watson\u27s theoretical framework of caring, presence, and empowerment enlightens the nurses to be more fully engaged in providing care to perioperative patients

A Model to Evaluate Efficiency in Operating Room Processes.

In the operating room, efficiency is related to minutes pared from surgical time. The link between operating room efficiency and the composition of surgical teams has been investigated, yet research on the efficiency of surgical nursing staff members and operating room durations is scant. The purpose of this study was to assess the effects of nursing staff arrangements in surgery, with a view to better planning of staff training and structure to achieve savings in time and money. A conceptual framework based on scientific management theory was used to evaluate efficiency in operating room processes as time within and between surgical cases, and projected that nursing staff arrangements including specialization, standardization, and skill mix in surgical processes were key factors in reducing operating room process time. This retrospective, cross-sectional study examined data from electronic records of general surgery cases conducted in 2008 in a large U.S. teaching hospital. The research questions addressed the amount of variation in operating room process efficiency explained by nursing staff arrangement variables after controlling for environmental, patient health status, and case complexity variables. The explanatory statistical model included four independent variables to reflect operating room nursing staff patterns; four control variables to represent environmental conditions, patient health status, and case complexity; and five dependent variables for separate timeframes. Hierarchical regression analysis confirmed that the degree of nursing staff specialization in general surgery explained a significant portion of the variation in process timeframes spanning the surgical procedure, the duration between surgical cases, and the entirety of time within and between cases. Findings that scientific management principles may represent nursing staff arrangements indicate a need for further research to understand the factors that affect the use of perioperative time. One research avenue is to explore the cost-effectiveness of organizing the operating room nursing staff into specialty service teams; another is to evaluate turnover time as an opportunity cost from the perspective of patients, staff, and payers. Use of this model will improve both day-to-day and longer-term planning to optimize use of resources, in particular, nursing labor inputs, that contribute to an efficient and harmonious health care economy.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/96155/1/mmmcl_1.pd

Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Inefficiency in the Post Anesthesia Care Unit: A Quality Improvement Initiative

Background: The post anesthesia care unit (PACU) is a busy environment in which nurses communicate with patients, family members, and a large team of perioperative professionals. PACU nurses were experiencing an unmanageable number of work interruptions due to a higher patient census which increased the daily surgical caseload. Aim: The purpose of this project was to improve efficiency and nurses’ job satisfaction by making work interruptions manageable in the PACU. Methods: Based on Kotter’s Change Theory, a quality improvement initiative was implemented using a change in the communication process. Qualitative and quantitative data was gathered in the PACU and on other units with the intervention roll-out. A pre and post-intervention survey was used to evaluate work interruptions and their effects experienced by nurses in the PACU environment. Results: The use of communication technology impacted work interruptions, but not significantly enough to improve nursing efficiency and nurse satisfaction in the PACU. Conclusion and Implications for CNL® Practice: The next step is to recommend adding a CNL® as a surgical nurse liaison (SNL) to the perioperative team. Ideally, a CNL® with excellent communication and quality improvement skills will exemplify the roles of lateral integrator and patient advocate to improve efficiency. This physical solution, coupled with the communicative technology tool being widely integrated to all members of the perioperative team is expected to influence work interruptions and improve nurse satisfaction more dramatically

Patient anxiety and conscious surgery

The amount of surgery undertaken on the conscious patient is increasing. However, many patients are anxious and resistant to such surgery. Patients (n=214) were surveyed to determine their related apprehensions. Being awake, feeling or seeing the body cut open and experiencing pain all increased anxiety. The potential for insufficient information provision was also a source of concern. Formal management of intra-operative apprehension may help limit anxiety and expel apparent misapprehensions

Improve Intra-Operative Nurse-to-Nurse Communication Using a Safety Checklist

Poor and inadequate handoff, or transfer of care of the surgical patient care from the primary to the relief operating room registered nurse circulators, can result in irreversible patient harm, or sentinel events, such as retained foreign items. In this study, Rogers\u27 diffusion of innovation theory was the framework for implementing the handoff safety checklist. Also, Donabedian\u27s structure process and outcome was the model to investigate the feasibility, acceptability, and improvement in the quality of patient handoff communication and improvement of nurse satisfaction over time. Nineteen-statement surveys, conducted at multiple timeframes, were completed by volunteer operating room nurse participants. In comparison, outcomes of the pre-intervention and post-intervention surveys illustrated significance in the quality of nurse communication and satisfaction of the handoff safety checklist. The value of standardized handoff safety checklists is evident in the study. However, further research of handoff safety checklists in the intraoperative arena is warranted

Succession Planning and the Identification of Future Perioperative Leaders: A Mixed Methods Study

Purpose: The purposes of this study were to determine if there is a relationship between succession planning and the identification of future perioperative leaders; if there is a relationship between mentoring for leadership and the identification of future perioperative leaders; to understand the current state of leadership in the operating room (OR), and to determine what methods are being used to identify perioperative nurse leaders. Background: An impending nursing shortage is expected to occur in the next decade, particularly within the specialty of perioperative practice and leadership. Providing access to surgical care is a major challenge for meeting the nation’s health needs and is a concern of the Institute of Medicine (IOM). Perioperative registered nurse orientation involves almost a year of competency-based mentoring and training while the perioperative nurse leader orientation may take even longer. The nursing shortage combined with the extensive training needed for leadership positions may contribute to a reduction of active ORs during the time period that nurses are undergoing training. The inability to staff the OR may in turn have a negative effect for the remaining five concerns of the IOM aims of quality, safety, equality, efficiency, and cost. Solutions to successfully close the gap between the supply and demand of perioperative nurses and nurse leaders need to be identified

Building a collaborative culture in cardiothoracic operating rooms: Pre and postintervention study protocol for evaluation of the implementation of teamSTEPPS training and the impact on perceived psychological safety

IntroductionThe importance of effective communication, a key component of teamwork, is well recognised in the healthcare setting. Establishing a culture that encourages and empowers team members to speak openly in the cardiothoracic (CT) operating room (OR) is necessary to improve patient safety in this high-risk environment.Methods and analysisThis study will take place at Barnes-Jewish Hospital, an academic hospital in affiliation with Washington University School of Medicine located in the USA. All team members participating in cardiac and thoracic OR cases during this 17-month study period will be identified by the primary surgical staff attending on the OR schedule.TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training course will be taught to all CT OR staff. Before TeamSTEPPS training, staff will respond to a 39-item questionnaire that includes constructs from the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, Edmondson’s ‘Measure of psychological safety’ questionnaire, and questionnaires on turnover intentions, job satisfaction and ‘burnout’. The questionnaires will be readministered at 6 and 12 months.The primary outcomes to be assessed include the perceived psychological safety of CT OR team members, the overall effect of TeamSTEPPS on burnout and job satisfaction, and observed turnover rate among the OR nurses. As secondary outcomes, we will be assessing self-reported rates of medical error and near misses in the ORs with a questionnaire at the end of each case.Ethics and disseminationEthics approval is not indicated as this project does not meet the federal definitions of research requiring the oversight of the Institutional Review Board (IRB). Patient health information (PHI) will not be generated during the implementation of this project. Results of the trial will be made accessible to the public when published in a peer-reviewed journal following the completion of the study.</jats:sec

In Situ Surgery: Is It Safe ? (Experience with 60 cases)

Background/Purpose: Neonatal surgical unit (NSU) is the area of a hospital where sick babies having surgical problem go once they are born. Performing in-situ surgery (ISS) in the NSU is relatively a new concept that is gaining popularity in the last decade. Critically ill neonates who are too ill to transfer to the operating room can undergo safe surgery in the NSU environment of a fully-equipped pediatric hospital. Transfer of the critically ill neonates is time consuming, utilizing manpower and requiring suitable portable ventilators and extensive monitoring equipments. Materials & Methods: This is a prospective study conducted on 60 neonates admitted in the surgical neonatal unit of the Cairo University pediatric hospital (Abou-Elrish) and where subjected to surgical procedures in the unit itself. The patients were categorized into 3 groups: The First group was the group at the beginning of the study for which minor procedures were selected. The second group was those neonates that were operated upon on emergency base for which transfer could be hazardous. The last group included those patients on high settings of ventilation and critically ill neonates with extensive monitoring. Results: There was no mortality in the study related to the procedures itself. Group I patients: the time of the surgical procedures was longer than that in the OR and no increase in the infection rate was noticed. Group II in which emergency procedures were carried on showed also increase in operating time but better perioperative circumstances regarding secondary insult to viable structures & less infection rate. Group III: no significant change in outcome in comparison to cases transferred to OR except that the perioperative circumstances were better for the surgeon, anesthesiiologist & nursing teams. Conclusion: NSU is a safe place for performing in-situ surgery (ISS) without increased risk of infection. Successful operative intervention within NSU requires good planning and cooperation between anesthesiologist, surgeons, neonatologist and nursing staff. Maximum benefit is observed in neonates who have definite risk attached to transfer to operating room. Index Word: In-Situ Surgery (ISS) – Neonatal Surgical Unit (NSU)