PACU Nurses Research Articles

PACU Nurses' Perception and Experience with Postoperative Discharge Calls

PACU Nurses' Perception and Experience with Postoperative Discharge Calls

Post-Operative Surgical Team Handoff to Bedside PACU Nurse

Post-Operative Surgical Team Handoff to Bedside PACU Nurse

Emerging From Burnout: Keeping PACU Nurses Engaged After COVID

Emerging From Burnout: Keeping PACU Nurses Engaged After COVID

Effectiveness of Pediatric Competency-based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses

Effectiveness of Pediatric Competency-based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses

Effectiveness of Pediatric Competency-Based Orientation (PCBO) on Knowledge, Confidence, and Manifestation of Early Recognition of Nursing Expertise Among PACU Nurses

To evaluate the effectiveness of the American Society of Perianesthesia Nurses (ASPAN) pediatric competency-based orientation (PCBO) education program on knowledge, confidence, and early recognition of nursing expertise among perianesthesia nurses in an acute care setting. A quasi-experimental pre/post survey-intervention design. Sixty perianesthesia nurses with experience ranging from less than 5 years to more than 20 years were included. A chapter review survey was completed to assess knowledge before reviewing the chapters and again after reviewing the ASPAN PCBO materials. A presurvey assessing confidence levels, decision making abilities, and early detection of knowledge regarding pediatric patients' expertise were obtained at the beginning of the study. At the end of the study, a post-study survey was completed to evaluate the effectiveness of the intervention. Random codes were assigned to each participant to ensure that the participants' information was blinded. Perianesthesia nurses' knowledge increased from pre to post intervention with one of the three sets of chapters (Set 2) statistically significant. Perianesthesia nurses' confidence and recognition of nursing expertise scores increased statistically significant from pre to post intervention. Both confidence (with 33 items [P value ≤ .001]) and recognition of nursing expertise (with 16 items [P value ≤ 0.001]) were statistically significant. The ASPAN PCBO was shown to be statistically effective at increasing knowledge, building expertise, promoting confidence, and improving decision making skills. The plan is for the ASPAN PCBO to be incorporated into the new-hire perianesthesia orientation didactic and the competency plan.

Improving Nursing Knowledge and Patient Education About Aprepitant's Effects on Hormonal Contraception: A Performance Improvement Project

The purpose of this project was to improve the consistency of verbal and written discharge instructions for women of childbearing age (13-55 years) taking hormonal contraceptives who receive aprepitant perioperatively, to address the need to use a secondary form of birth control for 28 days, as well as to increase the knowledge and confidence of Registered Nurses when providing discharge instructions. This quality improvement project used a pre-/postdesign to evaluate two separate groups of patients and registered nurses. The patient sample consisted of 30 total women of childbearing age who received aprepitant during the perioperative period (15 pre and 15 post). The PACU nurse sample included 15 ambulatory surgery center nurses and 58 main hospital nurses for a combined sample of 73 PACU nurses. The PACU nurses were provided with educational in-service regarding information about aprepitant and its drug interactions. PACU nurses were additionally instructed to provide patient discharge instructions using both a written and verbal format. Patients were called postoperatively before and after both the written after visit summary (AVS) changes and the PACU nurse in-services, PACU nurses were evaluated on their knowledge, confidence, and frequency of discharge teaching before and after their educational in-service. The PACU nurses were surveyed 90 days after the intervention to assess their long-term knowledge retention. There was a significant increase in nurse knowledge about aprepitant from preimplementation to postimplementation (61.39% vs 81.95%, P < .001). Nursing knowledge showed a nonsignificant decline at 90-days postimplementation (81.95% vs 73.68%, P=.096) although remained significantly higher than preimplementation scores (73.68% vs 61.39%, P=.003). There was an overall 33.3% increase in the percentage of patients who were able to recall receiving aprepitant and the need to use a secondary form of birth control when comparing the preintervention group to the postintervention group (26.7% vs 60%, P=.123). The findings suggest that providing a standardized presentation about aprepitant may improve the PACU nurses' ability to verbalize key information about aprepitant, including the need for patients to use a secondary form of birth control. This increase in nursing knowledge and confidence, along with improved written discharge instructions, may have led to improved patient comprehension of aprepitant discharge education. Additionally, there was an increase in the percentage of patients who were able to recall the need to use a secondary form birth control for 28 days, to reduce the likelihood of an unintentional pregnancy.

Collaborative approach to the emergency management of post-thyroidectomy haematoma

Background: The risk of haemorrhage after thyroid surgery is 1–5%. Our local incidence at Royal Surrey Hospital over the past 2 yr is 2%. As haematoma develops, pressure in the neck increases leading to impaired venous return from the head, causing progressive laryngeal oedema. Opening the neck wound allows immediate release of pressure, which should prevent worsening of the oedema and help optimise intubation conditions. Difficult Airway Society (DAS), British Association of Endocrine and Thyroid Surgeons (BAETS), and Ear, Nose and Throat UK (ENT UK) developed consensus guidelines for early recognition and management of haematoma after thyroid surgery, along with a series of recommendations that would ‘improve patient safety by identifying key areas in clinical management, training and institutional preparedness’.1 Methods: Initially we wanted to assess our local policies and awareness of the guidelines, and any specific issues related to post-thyroidectomy haematoma management in our hospital. We surveyed the multidisciplinary team (MDT) including PACU nurses, anaesthetists, and ENT (ear, nose, throat) surgeons, to assess their knowledge of the clinical signs of impending airway compromise secondary to haematoma development and the key steps in its management. We also reviewed the postoperative areas for the presence of appropriate equipment to manage a post thyroidectomy haematoma. Results: Our hospital does not currently have a specific ‘post-thyroidectomy haematoma management’ box in any of the postoperative areas or wards, nor does any equipment accompany the patient out of theatre for this eventuality. Most members of the MDT involved with these patients had not received any formal training in post-thyroidectomy haematoma recognition or management and were not aware of any guidelines covering this scenario. The PACU nurses knew the most important symptoms of impending airway compromise, but not all were aware of the more subtle signs (e.g. anxiety). More ENT surgeons (85%) were aware of the guidelines than anaesthetists (33%). Of the anaesthetists, 75% were aware that part of the management includes releasing the sutures/clips; however, only 25% knew where to find the appropriate equipment to carry this out. All ENT surgeons were aware of the appropriate management; however, they highlighted the importance of formal teaching given that often only the skin was opened and not the deeper tissues, which would not necessarily treat the problem. Conclusions: Going forward, we plan to introduce printed guidelines (DESATS [Difficulty swallowing; Early warning score; Swelling; Anxiety; Tachypnoea; Stridor] for monitoring plus management of suspected haematoma) to accompany the patient from theatre to PACU and the ward. We will also bring in an emergency box with the SCOOP (skin exposure, cut sutures, open skin, open muscles, pack wound) guideline included in the postoperative areas. Finally, we are arranging appropriate MDT education/training sessions on the guidelines and the role of the emergency box. We aim to then re-survey the MDT to ascertain their confidence managing these cases, and to identify any problems with the use of the guidelines or the box. 1.Iliff HA, El-Bogdadhly K, Ahmad I, et al. Anaesthesia 2022: 77; 82–95

Implementation of a PACU Pause in a Pediatric Post Anesthesia Care Unit

<h3>Background Information</h3> Effective communication between the surgical team and the PACU nurse is essential to delivering safe postoperative care. Distractions during anesthesia/OR team hand-off to PACU results in gaps in information and leads to adverse patient outcomes. The PACU Clinical Practice Council (CPC) completed an observational survey on the arrival of pediatric patients from OR to PACU. The observations indicated the PACU nurse was distracted during the hand-off because anesthesia/OR team gave report while the PACU nurse placed the monitors and attempted to assess the patient's respiratory status. Additionally, the audit found that the anesthesia/OR team report did not follow a consistent communication structure. Both observations showed the PACU nurse is not receiving/processing all information needed to safely care for the patient. Distraction and lack of standardization during hand-off may result in information gaps, leading to adverse clinical outcomes. <h3>Objectives of Project</h3> The goal of this nurse led project is to increase patient safety by improving communication between the perioperative teams and provide a safe transition from the OR to PACU. <h3>Process of Implementation</h3> The CPC surveyed the PACU nurses to obtain baseline information on their perception of the current process. Most nurses reported feeling distracted during the arrival and report process of the patient to PACU. They also felt they did not receive all the information needed to safely care for the patient. The CPC completed a review of best practices and collaborated with nursing leadership and the anesthesiologists to implement an evidence-based hand-off protocol and "PACU Pause." Checklists were created and placed at each bay to facilitate standardized report. The CPC provided education to all nurses and anesthesiologists involved in hand-off and audited the process to evaluate protocol adherence. <h3>Statement of Successful Practice</h3> Implementation of the standardized perioperative protocol has enhanced safety during the transition of care from OR to PACU. Nursing satisfaction increased with the patient arrival process and hand-off from the anesthesia/OR team. Serious safety events related to communication failures decreased. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Results are consistent with the literature suggesting that implementing a PACU Pause increases patient safety and facilitates undistracted communication of vital information to safely transition the pediatric patient from the OR to the PACU.

Ensuring Successful Practice Using a PACU-Track-Specific Nurse Residency and Fellowship Program

<h3>Background</h3> Nurse residency and fellowship programs are designed to help nurses transition into new practice settings. Our PACU nurse residency is designed to prepare nurses with less than 12 months of experience, while our PACU nurse fellowship is aimed to equip experienced nurses to master new clinical settings. By nurturing them with the knowledge, skills and attitudes for professional success, these programs can improve their critical thinking, communication and problem solving skills thereby increasing nurse retention and satisfaction. <h3>Objectives of Project</h3> This project evaluates the degree to which PACU nurse residents and fellows apply what they learned during a PACU Track Specific program. <h3>Process of Implementation</h3> Our PACU Track-Specific program was initiated in 2016 and has aided 24 nurses to transition to functioning members of the PACU team. A post-residency post-fellowship survey was developed using Kirkpatrick's Evaluation Model: Level 3. This survey was distributed to PACU nurse residents and fellows within 1 year of completing the program. Respondents were asked to report positive behavior change, identify significant reasons for the change and provide a specific example that helped them achieve positive result. <h3>Statement of the Successful Practice</h3> Every respondent provided commendable feedback regarding their experience during the program. Two respondents noted that being precepted by experienced PACU nurses was the most valuable aspect of the program. The responses revealed that 75% of the respondents strongly agree that they are successfully applying what they learned from the program and 87% of them attributed help from their colleagues as the most significant reason. <h3>Implications for advancing the practice of perianesthesia nursing</h3> This provides compelling evidence that our PACU track-specific nurse residency and fellowship led to positive behavior change among nurses who transitioned to PACU clinical setting. Other perianesthesia departments can model our PACU track-specific nurse residency and fellowship program in leading positive behavior change for nurses transitioning to PACU.

Initiating a Validated Pediatric Post-Anesthesia Emergence Delirium Scale in the Pediatric Post-Anesthesia Care Unit

<h3>Introduction</h3> Emergence Delirium(ED) is a frequent occurrence in the pediatric PACU. The PAED scale is a research validated tool that has been shown to help nurses and anesthesiologists recognize and appropriately treat ED. <h3>Identification of the problem</h3> OurPACU was currently not using a measuring tool. After learning about the scales already in place at a national conference, I discussed with the unit manager and she agreed that a PAED scale would be a valuable tool. The anesthesiologist that agreed to be physician support recommended that we carry this out as a research project. <h3>Purpose of the study</h3> The aim of this study is to assess our PACU nurse's current knowledge of delirium, implement education, as well as encourage documentation of the PAED score. The potential benefits of the study include benefiting future pediatric patients and their nurses by improving how our institution approaches pediatric post-anesthesia delirium. <h3>Methods</h3> IRBapproval was obtained. A survey was constructed to measure 2 things: 1) nurses knowledge of PAED pre and post education and implementation of a PAED scale 2) nurses confidence and satisfaction with several aspects of PAED pre and post education and implementation. An invitation email with a link to the online survey was sent to all nurses who worked in the pediatric PACU. Consent was in the email. The prospective participant can elect to participate in the survey or not participate. The consent described the anonymity of the survey by including the statement "Identifiers will be removed and the de-identified information may be used for future research without additional informed consent from the subject." Pre-interventiondata was collected via survey answers. Training for the PAED scale was implemented in concurrence with pediatric emergence delirium training by anesthesia. One month post intervention, the survey was re-sent. A final six-month post intervention survey was repeated. Each survey knowledge question was scored and results were analyzed using the T-test. <h3>Outcomes/Results</h3> A total of 15 PACU nurses participated. 14 responded to the one month survey and 7 responded to the 6 month survey. The most significant increase was knowledge of the PAED scale (↑ 58.3%, p < 0.0001)) as well as knowledge about patient risk factors (↑ 13.3%, p = 0.01) and dispelling common myths surrounding PAED (↑ 14.6%, p = 0.01). It is unclear at this time if the education initiative was ineffective in regards to the other goals of PAED knowledge, or if our pediatric PACU nurses simply pre-possessed much of this knowledge prior to implementation. Nursing confidence and satisfaction also increased with the largest gains being seen in their satisfaction with the tools they have at their disposal (↑28.8%) and the responsiveness of anesthesiologists (↑26.5%). The anesthesiologists were not included in the education sessions; therefore the increase in satisfaction is likely due to either a change in nursing perception or a change in anesthesiologist behavior due to nurses reporting the PAED score. A six-month follow-up survey was distributed to see how these gains change over time. The complete results are pending analysis. <h3>Discussion</h3> ThePAED scale is a research-validated tool that is easy to use to quickly identify and discern if emergence delirium is present. The nursing education initiative and implementation was successful in increasing knowledge of the PAED scale as well as increasing knowledge about patient risk factors and dispelling common myths surrounding PAED. The documentation piece has taken several months to get built as we have 3^rd party vendors to develop most of our screens. Currently we are waiting for the screen to be included in our assessment options. During the study, a verbal reporting of the score was provided to the anesthesia provider. Further studies to determine documentation compliance would be helpful. <h3>Conclusion</h3> The findings have demonstrated that the pediatric PACU nurses are more confident in identifying true ED. Additionally, it showed that they are more aware of the tool used to score delirium and what intervention(s) are the best to implement. <h3>Implications for perianesthesia nurses and future research</h3> The PAED scale chosen for this study promotes quick and easy scoring. Identifying emergence delirium quickly in pediatric patients is crucial to implementing the appropriate intervention(s). Future research desired is to determine if having the parent at bedside before onset of delirium would decrease the intensity and/or longevity of ED.

PACU Education Standardization for PACU Protocols

Background Information New PACU staff nurses are assigned two preceptors for a three-month orientation. It was noted that a lot of variation existed in the education of orientees regarding various protocols in the PACU. Pre-survey results showed that 47% of staff felt as though there were inconsistencies from preceptor to preceptor. Furthermore, we discussed with new staff and orientees areas where they felt discrepancies existed in their orientation, which included documentation and checking of patient-controlled analgesia (PCA), frequency of vital signs, documentation of assessments, and various competencies, such as arterial lines. Objectives of Project The objective of this project is to streamline the education and orientation process so that each new PACU staff nurse receives consistent information from both preceptors. By standardizing education, the PACU staff nurse would be able to improve workflow and compliance with PACU policies, also allowing for consistent documentation throughout the duration of their time in PACU. Process of Implementation A ten question anonymous survey monkey was sent out to all staff regarding PACU policies and documentation to evaluate which areas re-education was needed for PACU nurses. All PACU nurses were then in-serviced on PACU policies and documentation on the topics highlighted in the survey results. We educated on six different topics and then conducted a post-education survey to determine the effectiveness of the in-services. Statement of Successful Practice On pre-survey there was a large gap in the knowledge surrounding various protocols utilized in the PACU. On average nurses answered 64.7% of the questions correctly prior to in-services. After education on protocols, post-survey results showed an improvement to 89.2%. Implications for Advancing the Practice of Perianesthesia Nursing Standardization of the practices and implementation of hospital wide protocols allows for consistent and streamlined care of patients throughout their hospital stay, beginning with their arrival to the PACU and then transitioning to their destination. This allows for consistent and specific care for the large variety of disciplines and acuity of patients seen in this and other similar PACUs. New PACU staff nurses are assigned two preceptors for a three-month orientation. It was noted that a lot of variation existed in the education of orientees regarding various protocols in the PACU. Pre-survey results showed that 47% of staff felt as though there were inconsistencies from preceptor to preceptor. Furthermore, we discussed with new staff and orientees areas where they felt discrepancies existed in their orientation, which included documentation and checking of patient-controlled analgesia (PCA), frequency of vital signs, documentation of assessments, and various competencies, such as arterial lines. The objective of this project is to streamline the education and orientation process so that each new PACU staff nurse receives consistent information from both preceptors. By standardizing education, the PACU staff nurse would be able to improve workflow and compliance with PACU policies, also allowing for consistent documentation throughout the duration of their time in PACU. A ten question anonymous survey monkey was sent out to all staff regarding PACU policies and documentation to evaluate which areas re-education was needed for PACU nurses. All PACU nurses were then in-serviced on PACU policies and documentation on the topics highlighted in the survey results. We educated on six different topics and then conducted a post-education survey to determine the effectiveness of the in-services. On pre-survey there was a large gap in the knowledge surrounding various protocols utilized in the PACU. On average nurses answered 64.7% of the questions correctly prior to in-services. After education on protocols, post-survey results showed an improvement to 89.2%. Standardization of the practices and implementation of hospital wide protocols allows for consistent and streamlined care of patients throughout their hospital stay, beginning with their arrival to the PACU and then transitioning to their destination. This allows for consistent and specific care for the large variety of disciplines and acuity of patients seen in this and other similar PACUs.

Increasing PACU Certification and Recognition During COVID-19 Pandemic

Background InformationHigh certification rates can represent skilled registered nurses' commitment to nursing professionalism. Research has shown that higher specialty certification rates are associated with better patient outcomes and a higher sense of nursing empowerment. NYU Langone Orthopedic Hospital has a goal of 51% nursing certification for Magnet re-designation. In 2018, the PACU nursing certification rate was 43%. Limitations to obtaining certification include costs, inadequate incentives, weak interest, poor access to resources, and stressors.Objectives of ProjectTo increase the certification rate in the PACU and achieve a goal of 60% by March 2022.Process of ImplementationIn 2018, a survey was distributed to PACU nurses on barriers and motivators for achieving certification. Based on the results, leadership, certified nurses, and nurse educators used a team approach and implemented strategies to increase certification rates. Certification coaches mentored eligible nurses throughout the certification process and formed study groups. Pertinent information about certification was shared through flyers and resource tables. To increase their knowledge, nurses received peer-to-peer education or presentations from content experts during in-services, special event, and conferences. Newly certified nurses were recognized during a pinning ceremony. Due to the restrictions during the COVID-19 pandemic in 2020, strategies were modified to comply with social distancing guidelines. For example, pinning ceremonies and in-person events had limited participants. Nurses embraced technology by distributing certification information via email, video conferencing educational presentations, and using phone-based application learning platforms. Certified nurses were recognized on the hospital website, newsletters, emails, and a photo wall.Statement of Successful PracticeDespite the challenges, nurses remained motivated to continue to study, become certified, and celebrate their peers. The PACU certification rate increased by 18.3% due to the implementation of informational, celebratory, and supportive strategies. As of October 2021, the PACU certification rate is 61.3%.Implications for Advancing the Practice of Perianesthesia NursingImplications for advancing the practice of perianesthesia nursing by increasing the number of certified nurses is the use of certification coaches, certification information sharing, obtaining study resources, educational opportunities offerings, and nursing recognition. Continued support is essential to a culture that values life-long learning and professional development.

Score that Snore: Proactive Nursing Identification of Obstructive Sleep Apnea in Surgical Patients

<h3>Introduction</h3> Surgical patients with undiagnosed Obstructive Sleep Apnea (OSA) are at an increased risk for post-operative complications of respiratory distress and over sedation. Early identification of undiagnosed OSA can mitigate future risks of post-operative adverse events. <h3>Identification of the problem</h3> In2020, 22% of RRT events occurring within 24 hours of transfer from PACU to inpatient units were related to over sedation and respiratory issues. Retrospective assessment of these patients indicate 50% would have a STOP BANG score of ≥ 3 (moderate to severe OSA risk) while 88% of these patients had no prior OSA diagnosis. Current practice excludes preoperative screening for OSA risks among surgical patients. <h3>EBP Question/Purpose</h3> <b>PICOquestion -</b> In adult surgical patients does a preoperative STOP BANG assessment to identify undiagnosed OSA compared to no assessment reduce post-operative rapid response (RRT) events of respiratory distress and over sedation? <b>Databases utilized</b> - PubMed, CINHAL <h3>Methods/Evidence</h3> Preoperative nurses assess patient risk for OSA using the STOP BANG questionnaire. Moderate to high-risk patients (STOP BANG score ≥ 3) are identified. Nurses notify providers prior to surgery. Post-operatively, PACU nurses implement interventions such as oxygenation, patient positioning, multimodal pain relief, and, if needed, extended monitoring in these moderate to high risk OSA patients. <h3>Significance of Findings/Outcomes</h3> Resultsare pending. Anticipate reduction in RRT events of respiratory distress and over sedation in postoperative patients transferred within 24 hours from PACU to inpatient units. Introduces new perioperative practice of proactive identification of pre-surgical patients with moderate to severe OSA risk which allows for intra-and post-operative interventions that prevent adverse events. Standardizes best practices in perioperative services across multi-hospital healthcare system. <h3>Implications for perianesthesia nurses and future research</h3> Proactive early identification of high risk undiagnosed OSA patients by preoperative nurses can ensure coordinated medical and nursing interventions at all stages of the perioperative process.

Letter Regarding "Prevalence and Factors Affecting Postoperative Delirium in a Neurosurgical Intensive Care Unit".

Questions or comments about this article may be directed to Fu-Shan Xue, MD, at [email protected]; [email protected]. F.-S.X. is an Anesthesiologist and a Professor, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China. Ying-Gang Xiao, RN, is PACU Nurse and Anesthetist Nurse, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China. Liu-Jia-Zi Shao, MD, is Anesthesiologist and Attending Physician, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China. The authors declare no conflicts of interest. Author Contributions: All authors had carefully read the manuscript of Kose et al and analyzed their methods and data. Y.-G.X. suggested the comment points and drafted the manuscript. L.-J.-Z.S. revised the comment points and the manuscript. F.-S.X. critically revised the comment points and the manuscript, and authored the manuscript. All authors had seen and approved the final manuscript.

Increasing the Utilization of End Tidal Carbon Dioxide (EtCO2) Monitoring in PACU

<h3>Background Information</h3> Literature shows that monitoring end tidal carbon dioxide (EtCO₂) in at-risk patients can facilitate early detection of ventilatory compromise. Perceived lack of knowledge about how to identify patients in need for monitoring and how to interpret EtCO₂ data contributed to underutilization of this valuable monitoring tool by our PACU nurses. <h3>Purpose and Objectives of Project</h3> The purpose of this project was to increase EtCO₂ monitoring in patients who meet established criteria. Specific aims were to: a) Increase PACU nurses' awareness of value of capnography monitoring; b) Increase nurses confidence in their ability to interpret EtCO₂ waveforms and values; c) Increase the number of EtCO₂ monitored patients by at least 50% compared to 2019; and d) Document the number of ventilatory events detected by capnography, and were treated, before any changes in SpO₂ were detected <h3>Process of Implementation</h3> This was a two-phase project. In phase one, we collected baseline data from the electronic medical record (EMR) and documented the number of patients who were monitored using EtCO₂ over the past 12 months. We also documented the number of at-risk patients who did not receive EtCO₂ monitoring. Before implementation, all PACU nurses took a pretest to determine baseline knowledge. PACU nurses were educated on EtCO₂ monitoring criteria, identifying at-risk patients, interpreting and documenting EtCO₂ monitoring values/waveforms. Phase two of the project included daily data collection on all patients monitored with EtCO₂. Results showed that EtCO₂ monitoring increased from 0.4% (n=30) of patients in 2019 to 5.4% (n= 203) of patients during the study period. In 95% of the reported respiratory events, the PACU RN intervened based on the EtCO₂ reading prior to any change in SpO₂. <h3>Statement of Successful Practice</h3> This practice change promotes safety by providing an evidence-based, objective tool to assist in early detection of post-operative ventilatory compromise. Monitoring EtCO₂ may reduce transfer to a higher level of care and may reduce PACU/hospital length of stay. PACU nurses were able to intervene earlier based on ETCO₂ readings/waveforms. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> EtCO₂ monitoring enables advanced assessment capabilities and assists the perianesthesia nurses to safely manage patient care while optimizing ventilatory status.

Mobilizing PACU Nurses to Provide Critical Care during the Covid-19 Pandemic

Background InformationIn March 2020, a New York State mandate required our institution place a moratorium on elective surgery for an unknown period of time to ensure adequate Covid-19 surge hospital bed availability. This resulted in extremely low patient volumes for perioperative services. Conversely, critical care was experiencing an influx of patient volume and acuity, necessitating additional nursing support.Objectives of ProjectOur aim was to bolster the hospital's critical care service line by pooling available nursing resources. The perioperative and critical care leadership teams further identified this initiative as an opportunity to strengthen relationships between nurses that share a common skill set.Process of ImplementationHospital command center meetings to address surge bed capacity reinforced the partnership between perioperative and critical care services. Team nursing models were reviewed collaboratively. The PACU nurse manager requested volunteers to staff critical care based on a team model. Five highly experienced PACU RNs and five newer PACU RNs without prior ICU assignments volunteered, with goals to expand knowledge, improve critical assessment skills, and help a service in need. The ten PACU nurse volunteers were assigned into five pairs, consisting of one experienced RN and one newer RN. The five teams of two were consistently matched with their partner, and worked every shift in the ICU as a pair.Statement of Successful PracticeThis collaborative effort between the perioperative and critical care nursing services achieved the goal of providing safe and competent care to a population in dire need during the height of the Covid-19 pandemic. This initiative also strengthened relationships between the services, thereby promoting improved communication and increased efficiency.Implications for Advancing the Practice of Perianesthesia NursingThe future implications of Covid-19 are largely unknown, and this initiative mobilized nursing resources in a systematic fashion to provide necessary specialized care. A framework was established that could be easily replicated, thereby strengthening our ability to collaboratively approach emergency preparedness moving forward.

The Johns Hopkins Evidence-Based Practice (EBP) Model: Weinberg Perianesthesia Interventions for a Healing Environment

<h3>Introduction</h3> Weinberg Perianesthesia Unit has 28 Prep/PACU bays divided by curtains. In this unit, diverse surgical patients are prepared/recovered from anesthesia and surgery. Patients/families described the unit as congested, cluttered, dim, noisy, and unfriendly. This Prep/PACU is the busiest adult unit in this Mid-Atlantic academic medical center and has been compared to "Grand Central Station." <h3>Identification of the problem</h3> After participating in the Weinberg EBP Competency Program in 2017, the staff identified the need to conduct EBP Healing Environment Project that focused on therapeutic nursing interventions. <h3>EBP Question/Purpose: PICO question. Databases utilized</h3> What are the best therapeutic nursing interventions to create a safe, caring, healing environment for perianesthesia patients being prepared and recovered from their surgeries? P = Prep/PACU patients having surgery; I – Therapeutic healing nursing interventions; C = Compared to standard Prep/PACU nursing care; and O = Safe, caring, and healing environment. PubMed, CINAHL, and Scopus databases identified 43 key articles relating to complementary techniques to promote relaxation, music therapy, guided imagery, massage therapy, noise reduction, light therapy, aromatherapy, and clean, uncluttered environment. <h3>Methods/Evidence</h3> Nineteen articles were appraised and leveled using Johns Hopkins Nursing EBP Model that revealed: 8 Level I's, 6 Level III's, and 5 Level IVs with a 19 Quality "A" rating for strength of the evidence. <h3>Significance of Findings/Outcomes</h3> Evidence revealed: Promoting filtering light correlates with higher satisfaction, decreased opioid use; decreasing noise during agitated emergence reduces anxiety; providing music listening reduces anxiety, improves pain management and easy to administer; offering relaxation therapy with guided imagery decreases anxiety and reduces pain; providing massage therapy and therapeutic touch are beneficial for relieving pain and anxiety. <h3>Implications for perianesthesia nurses and future research</h3> Increased lighting, decreased noise, relaxation techniques, guided imagery and music therapy improved the perianesthesia healing environment as well as patient care outcomes. The project raised staff awareness of the importance of using EBP to change practice by motivating staff to use complimentary techniques to improve the healing environment of the PACU. Currently, the PACU nurses are conducting randomized comparative clinical research study with music listening interventions to determine if patients' anxiety and pain are alleviated.

Active Shooter Workshop

<h3>Background Information</h3> Active shooter situations are dynamic and evolve rapidly, demanding immediate response by the community and immediate deployment of law enforcement resources to stop the shooting and prevent further harm to the community. Clinical nurses expressed concern that the PACU is an open unit. This means anyone who has access to the hospital premises was able to enter the unit. At night and on the weekends, the entire third floor of the hospital, where the G3 PACU is located, may only have two nurses working. Clinical nurses also affirmed their lack of confidence to handle an active shooter incident. <h3>Objectives of Project</h3> To increase confidence of G3 PACU clinical nurses in managing an active shooter incident. <h3>Process of Implementation</h3> The PACU nursing leadership team, in partnership with the security department developed an active shooter education plan. The active shooter workshop was an hour-long session focused on how to cope and respond to an active shooter situation. The session included strategies on how to run, hide, and fight during an active shooter incident or any other workplace violence. PACU nurses had expressed appreciation on how the NYP/WC leadership team made employee safety an utmost priority. Pre and post surveys were taken by all participants. The following questions were asked: "I know what steps to take to barricade against the active shooter" and "I feel prepared to protect myself from an active shooter while at work". <h3>Statement of Successful Practice</h3> The active shooter workshop demonstrated positive outcomes as shown in the pre and post-survey results. On the question "I know what steps to take to barricade against the active shooter", only 9% of the nurses responded "Strongly Agree" prior to the workshop. Immediately following the workshop, 45% of the nurses responded "strongly agree". <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Active shooter incidents have been on the rise in public settings including hospitals. It is imperative that nursing leadership ensure that their teams are as prepared as possible in the event of an active shooter. Active shooter workshops are now available for all New York Presbyterian Weill Cornell employees.

Enhance RN Initiated Family Update in PACU During the Covid Pandemic

<h3>Introduction/Background</h3> ML PACU is a fast-paced unit. In order to meet both patient and family members' emotional need and decrease patient/family anxiety, prior the Covid pandemic, our PACU usually offer a brief family visitation without disrupting PACU workflow. Literature shows that the highest need from both patient and family perioperatively is the information and communication from healthcare provider. <h3>Identification of the problem</h3> During the Covid pandemic, the PACU visitation has become highly restricted. Therefore, the timely PACU family update via texting message or voice/video call has been becoming crucial to reduce patient/family's anxiety. <h3>QI question/Purpose of the study</h3> <i>Does education on strengthening communication between PACU nurses and patient's family during the Covid pandemic would impact timely PACU family update and patient/family's satisfaction?</i> The purpose of this project is to enhance RN initiated family update during the Covid pandemic. <h3>Methods</h3> All data were collected monthly from April 2020 to July 2020, which matched to baseline and 3 post data sets. Each month thirty surgical cases were randomly selected from three working days and nurses were recommended to follow a special time frame - texting family within 30 mins PACU arrival and phone/video call within 60 mins PACU arrival. A variety of focused RN education was conducted monthly. The QI data on patient/family satisfaction was retrieved from the hospital data dashboard quarterly. <h3>Outcomes/Results/Discussion</h3> Through a variety of educational implementations, the PACU family update either via texting or voice call was significantly increased from pre-implementation month 46.7% to 66.7%, 86.7% and 86.7% post-implementation months consecutively and the update within time frame was improved from pre-month 20.0% to post-months 36.7%, 30.0% and 33.3% consecutively. The survey result on patient/family satisfaction was improved from 50% to 62.5%. <h3>Conclusion</h3> RN initiated in time family update is an important way to enhance communication with patient's family and improve patient care during the Covid pandemic. <h3>Implications for perianesthesia nurses and future research</h3> With actively update family via texting message and voice/video call, continuing staff education and multidiscipline team coordination, we could strengthen nurse and family communication, decrease patient/family postoperative anxiety, optimize PACU patient care and increase patient/family's satisfaction.

Implementing a Medical Emergency and Rapid Intervention Team

<h3>Background Information</h3> Failure to rescue accounts for approximately 60,000 deaths each year in Medicare patients under the age of 75. In a large outpatient oncology facility that encompasses an infusion center, multimodality procedure unit, radiation treatment center & multidisciplinary clinic, the need to implement a rapid rescue team was identified to mitigate the risk of failure to rescue. <h3>Objectives of Project</h3> The goal of this initiative was to implement a Medical Emergency and Rapid Intervention Team (MERIT) service to care for patients undergoing chemotherapy, blood transfusions, procedures, radiation and other oncology treatments. A standardized process was developed for MERIT activation by healthcare providers within the facility. In-Service all employees in the facility and empower them to activate MERIT for identified patients. <h3>Process of Implementation</h3> The current MERIT policy for inpatients was reviewed and collaboration was formed with institutional leaders to revise it for an ambulatory center. A needs assessment was conducted and knowledge deficits were identified. The skill mix of PACU nurses was reviewed to identify those with a high acuity background to be a core member of the MERIT team. An orientation and competency check-off was developed, which included requiring members to have Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and High Acuity Training. A post-implementation survey was conducted to assess needs and knowledge gaps. <h3>Statement of Successful Practice</h3> The assessment survey indicated 83% of staff were able to identify all the correct situations to call MERIT, 9% of staff were not sure what situations require MERIT and 25% of staff did not know the correct extension to request MERIT. Post implementation of MERIT service, the building team members indicated 84.4% of the staff were able to identify correct situations to call MERIT, and 98% of the staff knew the correct extension to request MERIT. Post education survey was done 2 weeks after go live and showed improvement in knowledge and comfort level in calling MERIT. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Providing a MERIT service in an outpatient facility could mitigate the risk of failure to rescue, and improve patient outcomes.