Preop to PACU: A Nursing Orientation Program for Preop Nurses to Attain Competency in the Care of the PACU Patient

Abstract

Background Information Perioperative patient throughput has been affected due to infrastructure changes, increased volume of outpatients, new patient populations, admissions, and recovering inpatients returning to their unit. The extended wait times for placement throughout the hospital and the potential increase in the incidence of operating room (OR) holds prompted training of the preoperative nursing staff to a post anesthesia care unit (PACU) in a large academic medical center. Objectives of Project: Objectives of the project include (1) Prepare and train all preoperative nurses with minimal critical care background with the clinical skills to safely care for all patient populations in PACU. Process of Implementation The perioperative leadership team acknowledged cross-training as a judicious solution maximizing patient throughput. The leadership team and 3 clinical level IV nurses developed a comprehensive, cross- training orientation program for the preoperative nursing staff to ensure competency in caring for the PACU patient. The orientation included a two-day, 10 hours in length, critical care course and an 8 week bedside orientation with identified preceptors. The critical care course content encompassed the didactic components of a comprehensive PACU nursing orientation program based on the Perianesthesia Core Curriculum. The didactic curriculum, along with the bedside orientation process, covered patient progression through both phase I and phase II of the perioperative levels of care. The implementation of simulation and the utilization of case studies, and competency assessment tools provided a multimodal approach to ensuring the preoperative nurses acquired sufficient knowledge and assessment skills in the PACU clinical setting. Training began with the ‘pilot’ orientation of 2 preoperative nurses and one medical-surgical nurse to the PACU setting. The goal was to have all preoperative nurses complete the program. Statement of Successful Practice All nurses completed the orientation program and have been successfully trained to safely care for all PACU patients independently. An anonymous survey administered to all nurses who completed the program expressed that the education and training program prepared them to care for all patient populations in the PACU setting. Implications for Advancing the Practice of Perianesthesia Nursing The orientation program has created a comprehensive nursing team which allows for efficient distribution of staffing to facilitate perioperative patient care and throughput. Perioperative patient throughput has been affected due to infrastructure changes, increased volume of outpatients, new patient populations, admissions, and recovering inpatients returning to their unit. The extended wait times for placement throughout the hospital and the potential increase in the incidence of operating room (OR) holds prompted training of the preoperative nursing staff to a post anesthesia care unit (PACU) in a large academic medical center. (1) Prepare and train all preoperative nurses with minimal critical care background with the clinical skills to safely care for all patient populations in PACU. The perioperative leadership team acknowledged cross-training as a judicious solution maximizing patient throughput. The leadership team and 3 clinical level IV nurses developed a comprehensive, cross- training orientation program for the preoperative nursing staff to ensure competency in caring for the PACU patient. The orientation included a two-day, 10 hours in length, critical care course and an 8 week bedside orientation with identified preceptors. The critical care course content encompassed the didactic components of a comprehensive PACU nursing orientation program based on the Perianesthesia Core Curriculum. The didactic curriculum, along with the bedside orientation process, covered patient progression through both phase I and phase II of the perioperative levels of care. The implementation of simulation and the utilization of case studies, and competency assessment tools provided a multimodal approach to ensuring the preoperative nurses acquired sufficient knowledge and assessment skills in the PACU clinical setting. Training began with the ‘pilot’ orientation of 2 preoperative nurses and one medical-surgical nurse to the PACU setting. The goal was to have all preoperative nurses complete the program. All nurses completed the orientation program and have been successfully trained to safely care for all PACU patients independently. An anonymous survey administered to all nurses who completed the program expressed that the education and training program prepared them to care for all patient populations in the PACU setting. The orientation program has created a comprehensive nursing team which allows for efficient distribution of staffing to facilitate perioperative patient care and throughput.