American Society Of PeriAnesthesia Nurses Research Articles

Universal protocol for preventing wrong site, wrong procedure, wrong person surgery

EFFECTIVE JULY 1, 2004, compliance with the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery became required of all Joint Commission accredited organizations, to the extent that the requirements are relevant to the services provided by the organization. 1 Frequently asked questions about the Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. Available at: www.jcaho.org/accredited+organizations/patient+safety/universal+protocol/faq. Accessed July 2, 2004 Google Scholar As of July 1, it became mandatory for all members of the surgical team in accredited organizations to call a formal “time out” before starting the surgical procedure. The Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery is designed to ensure that all personnel focus only on the patient just before the beginning of surgery to ensure that everyone agrees they are performing the right procedure on the right patient on the right site of the patient’s body. Nancy M. Saufl, MS, RN, CPAN, CAPA, is a Past President of the American Society of PeriAnesthesia Nurses. She is the coordinator of the Preadmission Testing Center at Florida Hospital-Memorial Division, Ormond Beach, FL.

American Society of Perianesthesia Nurses (ASPAN) 2004 National Conference: April 18–22 2004; Philadelphia, Pennsylvania, USA

American Society of Perianesthesia Nurses (ASPAN) 2004 National Conference: April 18–22 2004; Philadelphia, Pennsylvania, USA

“Do not use” these abbreviations!

AS OF JANUARY 1, 2004, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began to survey accredited organizations on the 2004 National Patient Safety Goals (NPSG). 1 Available at: http://www.jcaho.org/accredited+organizations/patient+safety/04+npsg/04_npsg.htm. Accessed April 10, 2004 Google Scholar Patient safety goal number 2 is to “improve the effectiveness of communication among caregivers.” A further explanation of this goal is to “standardize the abbreviations, acronyms and symbols used throughout the organization, including a list of abbreviations, acronyms and symbols to use.” 1 Available at: http://www.jcaho.org/accredited+organizations/patient+safety/04+npsg/04_npsg.htm. Accessed April 10, 2004 Google Scholar The JCAHO approved a “minimum list” of dangerous abbreviations, acronyms, and symbols that must be included on each accredited organization’s “Do Not Use” list as of January 1, 2004. 2 Available at: http://www.jcaho.org/accredited+organizations/patient+safety/04+npsg/04_faqs.htm. Accessed April 10, 2004 Google Scholar Nancy M. Saufl, MS, RN, CPAN, CAPA, is a Past President of the American Society of PeriAnesthesia Nurses. She is the Coordinator of the Preadmission Testing Center at Florida Hospital-Memorial Division, Ormond Beach, FL.

Understanding the complete blood count with differential

The complete blood count (CBC) with differential is one of the most common laboratory tests performed today. It gives information about the production of all blood cells and identifies the patient's oxygen-carrying capacity through the evaluation of red blood cell (RBC) indices, hemoglobin, and hematocrit. It also provides information about the immune system through the evaluation of the white blood cell (WBC) count with differential. These tests are helpful in diagnosing anemia, certain cancers, infection, acute hemorrhagic states, allergies, and immunodeficiencies as well as monitoring for side effects of certain drugs that cause blood dyscrasias. Nurses in the perianesthesia arena are frequently challenged to obtain and evaluate all or parts of the CBC as a part of the patient's preoperative, intraoperative, and postoperative assessments. An enhanced understanding of this laboratory test is essential to providing quality care. © 2003 by American Society of PeriAnesthesia Nurses.

Heart failure and treatment: Part 1

Diagnosis of heart failure is increasingly prevalent. Each year, 550,000 new cases are anticipated. To provide quality outcomes, nurses and physicians must understand the etiology and pathophysiology of heart failure. Research into heart failure provides information about treatment and drug therapies that reduce heart failure symptoms and improve quality of life. PACU nurses care for heart failure patients in various stages of this syndrome. Determining the plan of care for this high acuity population requires nurses with skills to manage complex patients in the perianesthesia period. © 2003 by American Society of PeriAnesthesia Nurses.

Extubation of pediatric patients by PACU nurses

Traditionally, the role of the PACU nurse has been to evaluate patient readiness for extubation, with the responsibility of tracheal extubation performed by the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA). In our PACU, registered nurses routinely evaluate and extubate the majority of surgical cases. Our experience has shown that extubation by the PACU nursing staff improves airway management skills without compromising patient safety and facilitates OR turnover time. In this article, tracheal extubation performed by PACU nurses is detailed and a case study is presented. © 2003 by American Society of PeriAnesthesia Nurses.

Latex allergies in the health care worker

A dramatic increase in the incidence of latex allergies in health care workers followed the surge in latex glove use accompanying the rise of human immunodeficiency virus (HIV) in the early 1980s. This increase in latex glove use was driven by the release of Universal Precautions issued by the Centers for Disease Control (CDC) in response to the rise of HIV and other blood-borne pathogens. Efforts to stem allergic responses in the workplace have relied on the substitution of other materials for latex. Unfortunately, there is so much latex in everyday life that avoiding this allergen is exceedingly difficult once one is sensitized. Additionally, there are numerous cross reactants that are present in the environment. The situation is further confounded by the introduction of genetically manipulated foods and agricultural products that contain defense proteins genetically inserted to protect plants from pests and pathogens. Many of these defense proteins are antigens that will cross react with latex. Sensitivity reactions, once developed, may progress to the point at which the health care worker is excluded from working. This report provides an overview of rubber products and cross reactants, allergic reactions, and latex sensitivity for the health care worker. © 2003 by American Society of PeriAnesthesia Nurses.

Factors affecting nurses' decisions to join and maintain membership in professional associations

Large organized associations are the most effective tools for the nursing profession for influencing policies that protect the members and continues to provide the highest quality nursing care to the public. Although nursing comprises the largest number of health care workers in the country, fewer and fewer nurses are joining the professional associations that represent them. This study explores factors affecting the membership decisions of nurses practicing in the perianesthesia setting. Surveys were mailed to a random sample of current and former members of ASPAN. All participants identified variables that affected their decision to join their professional association. Nonmembers were asked to identify reasons for not renewing membership. The variables most strongly influencing members and nonmembers to join ASPAN were self-improvement, education, new ideas, programs, professionalism, validation of ideas, improvement of my profession, improvement of my work, and maintenance of professional standards. The only variable that was rated statistically significantly higher by current members was “improvement of my work.” All other 28 variables rated in the study were scored similarly by both groups, indicating that members and nonmembers continue to possess the same professional values. Former members indicated that major deterrents to membership were cost and lack of time. In an economic and cultural environment that requires balancing multiple demands, professional associations need to consider the limited time available to nurses and examine ways to provide professional development opportunities that are more easily accessible. © 2003 by American Society of PeriAnesthesia Nurses.

The postanesthesia care of an adult renal transplant recipient

Renal transplantation is the most common type of solid organ transplant performed in this country. For the PACU nurse, the immediate postoperative care of a renal transplant recipient can present a very unique and interesting challenge. Like all patients arriving to the PACU, the initial assessment of an immediate postoperative renal transplant recipient should first address the routine postsurgical concerns of airway, respiration, and hemodynamics. Most renal transplant programs have set protocols for the care required during the immediate posttransplant stay in the PACU. The postanesthesia nurse caring for these patients must become knowledgeable of these protocols. The following is a review of the immediate postanesthesia care for both the “fresh” renal transplant and the care of the long-term renal transplant recipient who has had surgery. © 2003 by American Society of PeriAnesthesia Nurses.

Cross-cultural comparison of perianesthesia nursing: Challenges encountered in the PACU

Nurses often consider caring for the pediatric patient in the PACU stressful. This stress may be compounded when providing this care in a foreign country. This article compares and contrasts the challenges experienced by one nurse when working in both Russia and China as a PACU nurse for the volunteer group, Operation Smile. Topics discussed in this article include the physical setup of the PACU; safety issues within the PACU; and the importance of communication, pain management, and parents within the PACU. The author elaborates on how to provide safe, competent, and culturally sensitive care to children within the PACU setting. © 2003 by American Society of PeriAnesthesia Nurses.

Acute postoperative delirium: Definitions, incidence, recognition, and interventions

Emergence excitement or delirium is a common postanesthesia complication. Often, the emergence excitement resolves quickly, and the patient's continued recovery is uneventful. Although the initial period of excitement may be short lived and resolve without long-term sequela, some patients may experience acute postoperative delirium, a phenomenon that is more difficult to assess and of potentially longer duration. Although patients are spending less time in the hospital after surgical procedures, concern over the potential development of acute postoperative delirium remains. Patients at risk present in ambulatory surgery centers and inpatient perianesthesia settings daily. Identification of at-risk patients is crucial to avoiding the development of delirium in the acute postanesthesia care setting. The purpose of this selective review is to define acute postoperative delirium and its incidence, discuss assessment and recognition, describe interventions, and identify future considerations related to this phenomenon. © 2002 by American Society of PeriAnesthesia Nurses.

A systematic approach to the management of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV), a common complication after anesthesia and surgery, often results in delayed discharge with the patient's unpleasant symptoms continuing at home. To effectively prevent and treat PONV, it is important to understand the factors implicated in PONV, the mechanisms of PONV, the pharmacology of the antiemetic agents, and the nonpharmacologic measures that have been shown to be effective. The cause of PONV is likely to be multifactorial, with important predictors being female gender, history of PONV, and history of motion sickness. The vomiting center can be triggered by activation of dopamine, serotonin (type 3), histamine (type 1), and muscarinic cholingergic receptors in the chemoreceptor trigger zone and the nucleus tractus solitarus, as well as acetylcholine receptors in the vestibular apparatus, vagal afferents from the periphery, and the endocrine environment. Antiemetic agents such as the serotonin antagonists (eg, ondansetron, dolasetron), droperidol, antihistamines (eg, diphenhydramine, dimenhydrinate), and promethazine can prevent and treat PONV effectively. Transdermal scopolamine and dexamethasone have a role in the prevention of PONV, particularly for certain high-risk patients. Nonpharmacologic measures and alternative treatments such as hydration, maintaining blood pressure, acupressure techniques, trancutaneous acupoint stimulation, and isopropyl alcohol must not be overlooked. Finally, an evidence-based algorithm for the prevention and treatment of PONV in adults is presented. © 2002 by American Society of PeriAnesthesia Nurses.

Hemolytic transfusion reaction: Safeguards for practice

Most hemolytic transfusion reactions result from administration of ABO-incompatible blood. Even a small amount of incompatible blood may initiate a reaction and cause devastating consequences leading to death. Careful monitoring of the anesthetized patient is important in recognizing symptoms of a transfusion reaction so that the reaction may be promptly detected and treatment quickly initiated. Many factors contribute to blood transfusion errors resulting from the misidentification of either the patient or the blood product. Nursing has opportunities to establish policies and procedures, design nursing practices, and educate staff to help avoid blood transfusion errors. © 2002 by American Society of PeriAnesthesia Nurses.

Abdominal compartment syndrome: A case review

Compartment syndrome is classically considered a complication of a musculoskeletal injury. Recent research has confirmed the abdomen as a potential compartment with the capability to cause life-threatening local and systemic manifestations. Abdominal compartment syndrome (ACS) is precipitated by an acute increase in abdominal contents volume with resulting intraabdominal hypertension. Presenting signs of ACS include a firm tense abdomen, increased peak inspiratory pressures, and oliguria, all of which improve after abdominal decompression. Patients at risk for ACS include trauma (blunt or open), retroperitoneal hemorrhage, massive fluid resuscitation, pancreatitis, pneumoperitoneum, and neoplasm. Surgical decompression is the treatment of choice. The perianesthesia nurse plays a critical role in the team managing a patient at risk for abdominal compartment syndrome through intraabdominal pressure monitoring, wound care, and end organ perfusion support. © 2002 by American Society of PeriAnesthesia Nurses.

Tension pneumothorax: A pulmonary complication secondary to regional anesthesia from brachial plexus interscalene nerve block

Interscalene brachial plexus anesthesia is often used for surgeries involving the shoulder and upper arm. This method of regional anesthesia decreases pain, nausea, and vomiting associated with general anesthesia. One infrequent complication of interscalene brachial plexus block is tension pneumothorax. Recognition of early signs and symptoms of tension pneumothorax and expeditious treatment for rapid decompression before physiologic decompensation is mandatory. This article discusses the interscalene brachial plexus block procedure leading to the pathogenesis, clinical presentation, diagnosis, and treatment of tension pneumothorax. © 2002 by American Society of PeriAnesthesia Nurses.

Allergic reactions to drugs: Implications for perioperative care

Clinically, one must be able to differentiate between an allergic reaction and an adverse reaction. Clinical manifestations of allergic reactions range from urticaria and rash to bronchoconstriction, laryngeal edema, hematologic disorders, and other serious reactions. Many drugs administered in the perioperative setting can cause allergic reactions. Antibiotics such as penicillins, β-lactam antibiotics, and sulfonamides are the most common class of drugs that produce allergic reactions. A detailed allergy history is important when deciding if a patient can receive a drug that may cross-react (eg, a cephalosporin in a patient with a penicillin allergy). Vancomycin can cause a reaction that ranges from erythema and pruritis to clinically significant hypotension. Proper dilution and rate of administration are essential in minimizing the histamine from vancomycin that is thought to produce this reaction. “Sulfa allergy” describes an allergy to sulfonamide antibiotics; a patient with a “sulfa allergy” is not allergic to drugs containing sulfur, sulfites, or sulfates. Although true allergic reactions to opioids are rare, naturally occurring compounds like morphine and codeine can cause allergic reactions. After stopping the offending drug, mild allergic reactions can be managed with diphenhydramine, with or without a steroid. Significant allergic reactions require more aggressive management with oxygen, intravenous fluids, epinephrine, and histamine blockers. © 2002 by American Society of PeriAnesthesia Nurses.

Distance learning: An option for your future?

Distance learning programs are proving to be very popular for advancing nursing education from both a continuing education and academic degree perspective. Whether one is exploring opportunities to maintain perianesthesia certification or to pursue an advanced academic degree, distance learning technologies offer many feasible options. The following article provides prospective distance learning students with a brief description of distance learning, including its history and evolution. Distance learning technologies are reviewed and key elements that can determine student satisfaction and success are discussed. © 2002 by American Society of PeriAnesthesia Nurses.

Simplifying the writing process for the novice writer

Nurses take responsibility for reading information to update their professional knowledge and to meet relicensure requirements. However, nurses are less enthusiastic about writing for professional publication. This article explores the reluctance of nurses to write, the reasons why writing for publication is important to the nursing profession, the importance of mentoring to potential writers, and basic information about simplifying the writing process for novice writers. © 2002 by American Society of PeriAnesthesia Nurses.

A looming public health crisis: The nursing shortage of today

The present and anticipated nursing shortage poses a public health concern. This is a unique shortage because nursing is encountering both an increased demand for nursing care and a lower supply of nurses available to deliver it. Nurses, known for patient advocacy, are ethically bound to provide competent, quality care. Currently, nurses comprise the largest group of health care providers in the United States. Through increased understanding of the current situation, the profession will be in a better position to advocate and promote nursing as a viable, attractive career. © 2002 by American Society of PeriAnesthesia Nurses.

Incidence of adult immunization for influenza and pneumonia in a preadmission testing unit

Health care–associated (nosocomial) infection is now more common in surgical patients than surgical-site or wound infection. Elderly patients and those having abdominal, neck, cardiac, or other thoracic procedures are at the highest risk. Pneumococcal pneumonia and influenza are the fifth leading cause of mortality in the elderly population. In the United States, only 54% of persons older than 65 years have received a pneumococcal vaccine, whereas approximately 67% have been immunized for influenza. In this study, interviews were conducted with 160 elderly patients seen in the preadmission testing unit of a large community hospital. Results showed immunization rates of 57% for pneumonia and 76% for influenza. Similar to findings of previous studies, minorities were less likely to be immunized than whites. Of those who were not immunized for pneumonia or could not recall their immunization status, 71% stated they had not been offered immunization. Sixty-four percent stated they would take the vaccine to prevent pneumonia if it were offered. Of those patients who were not immunized for influenza, 54% had not been offered this protection and 41% stated they would take the influenza vaccine if offered. Although vaccination rates of participants in the present study surpassed the 1998 national baseline for noninstitutionalized adults, there is much opportunity for improvement. Perianesthesia nurses have an important role in reducing surgical patients' risks of developing health care–associated pneumonia and invasive bacteremia by assessing the patient's immunization status and being proactive in helping surgical patients obtain appropriate vaccinations. Routine documentation of a vaccination history for pneumococcal pneumonia and influenza during preadmission testing and use of a standard protocol for educating and immunizing those who lack this protection are strategies that can be easily implemented by nurses practicing in perianesthesia settings such as ambulatory surgical sites and preadmission testing units. This practice would foster achievement of the Healthy People 2010 goal of 90% vaccination rates for persons at high risk for these deadly diseases. © 2002 by American Society of PeriAnesthesia Nurses.