Perianesthesia Nurses Research Articles

The Integration of Smart Goggles into Perianesthesia Nursing Practice

The Integration of Smart Goggles into Perianesthesia Nursing Practice

회복마취 간호사의 그릿, 간호실무숙련도가 간호역량에 미치는 영향

This study was conducted to identify the grit, nursing practice proficiency, nursing competency of perianesthesia nurses and to identify factors affecting nursing competency.
 this study was conducted with 175 participants at a conference of Anesthesia Nursing Society in South Korea at september 12, 2020. Data were analyzed using frequency, percentage, mean, standard deviation, independent t-test, one-way ANOVA, Scheffé test, Pearson correlation coefficient and stepwise multiple regression using the SAS 9.4 program.
 Results of the study Nursing competency was found to have a significant positive correlation with grit (r=.21, =.006) and Nursing practical proficiency (r=.59 <.001). the factors that significantly influenced nursing competency were nursing practical proficiency (=.51, =<.001), educational background (=.17, =.008), and marital status (=-.16, =.011). These variables explained 39.6% of the variance in nursing competency. Based on the results of this study, in order to improve nursing competency by increasing the nursing practice proficiency of perianesthesia nurses, it is necessary to develop a professional practice education program to create a learning environment that can provide evidence-based practice through continuous education.

Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status

PurposeTo describe differences in perioperative RN job satisfaction by specialty certification status. DesignA retrospective, exploratory, cross-sectional design. MethodsWe conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified. FindingsTwelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses. ConclusionsAs job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.

Effectiveness of American Society of Perianesthesia Nurses (ASPAN) on Maternal and Neonates Outcome during Perioperative Enhanced Recovery after Caesarean Surgery (ERACS)

Introduction. Patient comfort is one of the important components that must be considered in providing nursing care, including perioperative nursing services, one of which is temperature comfort. The purpose of this research is to explain or to study the effect of the ASPAN guideline intervention for normothermia (active and passive warming) on ​​maternal and neonates outcomes during perioperative Enhanced Recovery After Caesarean Surgery (ERACS). Method. This research used a quasi-experimental quantitative research design or a quasi-experiment involving a control group and an intervention group. Measurement of the intervention group for prevention of hypothermia in cesarean section patients was performed perioperatively (pre-intra-post-surgery). Results. The mother's body temperature variable in the intraoperative and postoperative phases was higher in the intervention group than the control group. The shivering condition variable in the control group experienced an increase in shivering during the intraoperative and postoperative phases (1.15 ± 0.41 and 2.17 ± 0.80), while in the intervention group there was a decrease in shivering condition (0.22 ± 0, 42 and 0.20 ± 0.41). In the temperature comfort variable after measuring using Thermal Comfort ERACS, the Mean ± SD value in the intervention group when the intra-operative and post-operative phases was in the neutral category (0.44 ± 0.6 and 0.44 ± 0.65). Discussion & Conclusion. Application of ASPAN Guideline for normothermia during perioperative obtained significant results on the variable of the mother's temperature, the baby's temperature.

Positive Healthcare Encounters for Children With Autism Spectrum Disorder: Accommodations During Surgical Procedures

Children with autism spectrum disorder have unique needs during medical procedures involving anesthesia. However, with early patient identification, provider champions can adapt their practice to better serve this population, thereby improving patient satisfaction and outcomes. This article describes a novel protocol developed by an anesthesia resource center to modify care for children with autism spectrum disorder and their families. This information serves as a template for perianesthesia nurses and advanced care providers to implement practice accommodations. Two case examples, based on parent interviews and chart review, are presented to exemplify this protocol.

A Web-based Educational Intervention to Increase Perianesthesia Nurses’ Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids

The purpose of this study was to determine if a web-based educational intervention increased knowledge, attitudes, and intention of perianesthesia nurses regarding opioid discharge education (including safe use, storage, and disposal of opioids). Secondary outcomes were to determine Perceived Behavioral Control, subjective norms, and familiarity with American Society of PeriAnesthesia Nurses (ASPAN) guidance on opioid education. A pre-test, post-test longitudinal design. An email described the study and had a link for those choosing to participate. The intervention was a web-based voiceover module with patient education scenarios focused on information required for patients before discharge home. Responses to the evidence-based pre-survey, post-survey one, and post-survey two were collected. The survey was developed using components of the Theory of Planned Behavior. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. The participants were invited to complete a pre-test survey (n=672), the immediate post-test (n=245), and the 4-week post-test (n=172). The analysis presented is limited to 245 who completed at least the first post-survey. Most were staff nurses (82%), and the majority had a BSN (62%); participants most typically worked in a hospital-based PACU (73%). For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in all but one of the models. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for Perceived Behavioral Control, attitude, and intention, the degree of increase between baseline and week 4 was not significant. In all cases, both the immediate and 4-week post-test scores exceeded the corresponding pre-test score, though, for three of the TPB constructs, the difference between baseline and week 4 was not significant, while nearly all of the increases between baseline and immediately following the intervention were significant. These findings suggest a more intensive intervention, possibly with the inclusion of booster sessions, may be needed.

The Implementation of a Perianesthesia Nursing Orientation for the Newly Licensed Registered Nurse

<h3>Background Information</h3> Historically, nurses were required to have critical care experience prior to transitioning into the perianesthesia areas of practice. Due to complexity of patient care and critical thinking demands of perianesthesia, new graduates are not often recruited. Throughout the United States, there is limited opportunity for new graduate nurses to work in specialty areas, such as perianesthesia, when there is no formal nursing orientation for the newly licensed registered nurses (NLRNs). Perianesthesia nursing encompasses a unique subset of nursing that combines the acute and critical care skills with a comprehensive surgical and anesthesia knowledge base. A perianesthesia specialty nursing orientation for the newly licensed registered nurse could establish a strong nursing foundation and evolve these novice nurses into competent, perceptive, and collaborative perianesthesia nurses. <h3>Objectives of Project</h3> The objective of this project was to create a perianesthesia nursing orientation for the NLRN. <h3>Process of Implementation</h3> An integrative review of the literature was done to synthesize the evidence and understand the impact of nurse residency programs on healthcare organizations. The project leaders then sought out subject matter experts through ASPAN to gain a better understanding of how to operationalize this project. The project leaders then created an orientation plan and business proposal and submitted it to executive leadership, nursing leadership, and perioperative leadership. The business proposal was accepted and the first perianesthesia nurse residency program was started in January 2021. <h3>Statement of Successful Practice</h3> The first cohort was comprised of 2 NLRNs. The two nurses were selected from a candidate pool of almost 100 applicants. The two NLRNs proceeded through a comprehensive orientation plan for 6 months and successfully finished by July 2021. Due to the success of the pilot group, the project leaders were able to successfully justify and recruit for another group of NLRNs, who started in January 2022. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The establishment of a specialty nursing orientation for the NLRN now gives new graduate nurses the opportunity to transition successfully into the perianesthesia setting as a new to practice nurse.

Snapshot Report: A Uniformed Handoff Tool for All Perioperative Services

<h3>Background Information</h3> The Joint Commission reports 80% of serious medical errors are the result of miscommunication during transfer or hand-off and 5 out of 10 sentinel events are directly relate to the perioperative setting. This setting is unique due to large intermittent patient volumes in a brief period, multiple interdisciplinary caregivers, decreased ability for patient engagement due to sedating medications. <h3>Objectives of Project</h3> The handoff process requires a complete understanding of the patient's condition and status to ensure their safety. Bedside handoff is evidence based and is known to reduce errors in patient care, decrease length of stay and improve patient satisfaction. The snapshot tool was created within the EMR to ensure all ASPAN key safety elements were included. The snapshot handoff tool promotes inclusion of important patient details in one report. <h3>Process of Implementation</h3> Assessed and appraised present literature on best practices concerning handoff tools/process. Reviewed present hospital policies. Performance Improvement council members worked with unit staff for input on needs for handoff tool. Final draft sent to our IT department where the tool was drafted. Education of staff prior to implementation. Snapshot tool implemented June 2020. <h3>Statement of Successful Practice</h3> No medication errors reported. Improvement in "overall teamwork between doctors, nurses and staff" patient satisfactions scores. Delay in first case on time starts with "due to nursing" code approximately 5% per month down from 10%. Nurse satisfaction of handoff improved with snapshot tool due to ease and consistency of use at handoff as well as the ability to review a patient case prior to report and admission to the receiving unit. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perianesthesia nurses will understand the benefits and use a uniformed handoff process within all phases of the perioperative service lines. Perianesthesia nurses will understand potential risk factors from lack of communication during handoff. Perianesthesia nurses will be able to apply JACHO and ASPAN best practices in handoff reporting. Perianesthesia nurses will understand and be able to use the seven steps of implementing practice changes.

Simulating LAST to Improve Peri-anesthesia Nursing Knowledge

<h3>Background Information</h3> The use of local anesthetics to improve pain management and patient outcomes during the perioperative experience has been increasing. LAST is a rare, time sensitive, and potentially life-threatening complication of administering local anesthetics to patients. It is important that a LAST crisis is recognized and treated immediately to have better patient outcomes. <h3>Objectives of Project</h3> 1. Increase the perianesthesia nurse's knowledge and comfort level with LAST with an education presentation, simulation case study, and annual competency. 2. Provide resources for treating LAST, which include the American Society of Regional Anesthesia and Pain Medicine (ASRA) checklist for the treatment of LAST and access to lipid emulsion therapy <h3>Process of Implementation</h3> An evidence-based literature review was conducted to develop an educational presentation for the perianesthesia department. After the anesthesiologist reviewed and approved the presentation, a case study was developed for a high-fidelity simulation-based learning with debriefing session, which was mandatory for all nurses. The team partnered with pharmacy to make sure that lipid emulsion therapy was accessible in each department with the necessary supplies. The ASRA checklist was also displayed in the same location near the lipid emulsion therapy. <h3>Statement of Successful Practice</h3> There was 100% participation with the education roll out in the perianesthesia department. There was an improvement in a knowledge-based test and comfort rating scale pre- and post-intervention with an average of 58.4% to 93.8% and 4.8 to 8.4 (scale: 0-10), respectively. Shortly after the education, a patient in PACU presented with mild symptoms of LAST post nerve block with metallic taste, perioral numbness, and progressing to tremors. The nurse recognized the symptoms, notified anesthesia, and initiated treatment, which resulted in a positive patient outcome. The nurse stated that the education helped her recognize the LAST crisis, escalate, and treat the patient. A year later, a case study competency was developed and successfully completed by nursing to ensure sustainability of education. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> By implementing best practice through education and resources, the team was able to improve knowledge and comfort of the perianesthesia nursing staff in recognizing and treating LAST to improve patient outcomes.

On-boarding and Orientation in an Ambulatory Surgery Center—What a Clinical Nurse Educator Can Do For You!

<h3>Background Information</h3> The mission of Copper Ridge Surgery Center is to set the standard for excellence in outpatient surgical services. A closer look at our existing orientation process and training documents brought to light opportunities for improvement. Recognizing that having competent, well-trained staff contributes to excellence and positive patient outcomes, our center instituted a Clinical Nurse Educator (CNE) to elevate staff education and competency to a higher level. <h3>Objectives of Project</h3> 1.To develop the CNE role that would support education in all clinical areas of our ambulatory surgery center. 2.To develop a robust and organized orientation program for new hires. To develop a Preceptor program of dedicated staff wishing to share their knowledge and expertise. 3.To build staff confidence and satisfaction. 4.To create a means to consistently assess and electronically document staff members' competencies and training requirements specific to their practice areas. <h3>Process of Implementation</h3> The CNE job description was written. The position was filled by an internal, certified staff RN with multiple years' experience in perianesthesia nursing. A new-hire general orientation day was implemented where the leadership team spoke on key programs driving our facility's mission and vision. A preceptor program was developed, and preceptor training done. Competencies were written with input from team leaders utilizing a standardized form. An electronic platform for documenting and storing training materials was created. <h3>Statement of Successful Practice</h3> Improving the process of on-boarding and orientation of new-hires through an organized process of training, educating, and documenting success has shown to improve orientee's satisfaction and confidence, while contributing to positive patient outcomes. Preceptor satisfaction increased as they are more prepared to meet the needs of those in training. The CNE has afforded the team leaders more time to round and support staff at the bedside, further improving satisfaction and outcomes. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> A clinical nurse educator brings significant benefits in improving staff competency and expertise, thus increasing positive patient outcomes. Furthermore, this role assists in developing staff who embrace the specialty of Perianesthesia nursing and desire to further advance their knowledge and practice.

Digitalization and Education of Perioperative Surgical Clipping

<h3>Background Information</h3> There is a need for a standardized process in pre surgical clippings, involving clipping sheet preparation and best practice use of techniques and tools. The Association of Perioperative Registered Nurses recommends removing patient's hair before going into the OR to decrease contamination of the operative field. Proper hair removal is an important part of surgical preparation; necessary for surgical site exposure, preoperative skin marking, suturing, and application of wound dressings. <h3>Objectives of Project</h3> Increase the accuracy, accessibility, and efficiency of clipping sheets in the pre anesthesia setting. Standardize and digitalize clipping sheets. Educate preoperative nurses in pre surgical hair removal using a clip vacuum assisted device (ClipVac) opposed to paper tape assisted removal. <h3>Process of Implementation</h3> Clipping sheets were previously filled out by nursing staff by flipping through a resource binder in order to find the correct clipping guidelines for the correct surgery to then personally shade in a poorly anatomically marked model. The process took up valuable nursing time and left room for variation and error in shading based on individual interpretation. Clipping sheets were first redesigned to include a more anatomically correct model. New clipping sheets for each relevant procedure were filled out and sent to surgical primary service nurses for adjustments. Updated clipping sheets were uploaded into an electronic format that are now easily accessed and printed. Staff received thorough education and training on the new clipping sheet process as well as proper use of a ClipVac in place of paper tape. <h3>Statement of Successful Practice</h3> There has been positive feedback with implementation of this project; staff appreciate having a process that is now streamlined and easy to use. Staff feel more competent to perform clippings using a clip vacuum assisted device after hands on practice with a BD rep for ClipVac. These measures combined improve patient outcomes by decreasing risk of infection. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Clipping sheets are one small part of preoperative patient preparation that can largely impact patient outcomes and staff satisfaction. In starting this project, there was not much found in a literature search for enhancing the presurgical clipping process through digitalization. Sharing this project and the success of improving accessibility while decreasing error via digital format promotes the continuation of using best practices in perianesthesia nursing.

Implementation of Acupressure as Adjunct Therapy to Reduce Postoperative Nausea and Vomiting

<h3>Background Information</h3> Postoperative nausea and vomiting (PONV) is a common surgical issue that can result in complications such as, electrolyte imbalance, dehydration, pulmonary aspiration, and wound dehiscence. Additionally, PONV can delay hospital discharge, subsequently affecting hospital costs. Substantial research suggests that utilizing a multimodal approach combining prophylactic pharmacologic antiemetics with non-pharmacological therapies can reduce PONV, therefore decreasing the need to utilize multiple doses of rescue antiemetic therapy. Studies have also demonstrated that acupressure can shorten the time from extubation to "ready for discharge" from PACU. Acupressure can produce additive effects with minimal side effects and without potential for adverse drug reactions. <h3>Objectives of Project</h3> The objectives of the project include: (1) Provide education to nursing staff regarding the benefits of acupressure therapy for patients; (2) Educate nurses on the application of acupressure (3) Reduce patient's nausea by adding acupressure into treatment regimen <h3>Process of Implementation</h3> Six perioperative nurses designated as super-users, were instructed by a licensed acupressure provider on the utilization of acupressure for postoperative nausea and vomiting. Instruction was provided on the application of stimulation to specific points or defined pathways on the body (acupressure) that can relieve nausea. Educational sessions with the licensed acupressure provider were comprised of Zoom interactive web sessions, live in-person training, and evaluation of technique at patient bedside. Once deemed competent, the super-users provided acupressure for ambulatory PACU patients who were identified as being at high risk for PONV or for patients who were reported to be experiencing PONV. Super-users assessed severity of nausea before and after the implementation of acupressure to determine effectiveness by using the Edmonton scale. <h3>Statement of Successful Practice</h3> 45 out of 48 patients who received acupressure stated that "they felt less nauseous after acupressure". The evaluation of their Edmonton scores indicated that acupressure, along with nausea medications, reduced PONV. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Acupressure is a non-invasive nursing intervention that provides a non-pharmacologic alternative in the treatment of PONV. Application of acupressure could be incorporated into new-hire orientation for perianesthesia nurses, in education for the treatment of PONV. Utilization of acupressure could decrease the use of pharmacologic therapy, reduce the postoperative complications, and ultimately improve patient outcomes.

Improving the Patient Experience Through a Preoperative Educational Initiative

<h3>Introduction</h3> Preoperative teaching has the ability to increase patient satisfaction, patient knowledge, and minimize anxiety related to the surgical procedure. Preoperative nurses are in a unique position to provide patients with the educational tools needed to better prepare them for surgery. This project addresses the need for improved patient preoperative teaching to ensure a positive patient experience and improved outcomes for our patients, and their families. <h3>Identification of the Problem</h3> During preoperative admission, we encounter patients that, are ill prepared regarding their surgical procedure. This lack of knowledge leads to increased uncertainty and anxiety. Furthermore, our Press Ganey (PG) scores related to the ‘Information nurses gave you as they helped to prepare you for the procedure', and ‘Nurses response to your concerns or questions' indicate that there is room for improvement. <h3>Purpose of the Study</h3> To evaluate the effectiveness of a preoperative educational initiative to better prepare patients for surgery. <h3>Methods</h3> Provided staff in-service emphasizing preoperative nursing interventions, including clear preoperative call instructions, patients' learning needs assessment, and the use of electronic and printed educational resources. Developed a list of suggested questions with commonly asked questions for patients to ask the perioperative team. After implementation, patients completed surveys over a three-month period of time to ascertain patient preparedness for surgery, which yielded 100 responses. <h3>Outcome/Results</h3> Patient preparedness is measured by the patient survey and PG scores on the indicator questions. Survey results show that 100% of patients received all the information needed to prepare them for surgery from the nursing team during the preoperative call and on the day of the surgery. Post-intervention PG scores on both indicator questions were 92.9 and 94.1, respectively, versus 91.7 and 92.7 pre-intervention PG scores. <h3>Discussion</h3> The preoperative educational initiative in this study proves successful to better prepare patients for surgery, as evidenced by survey results and increased patient satisfaction scores. <h3>Conclusion</h3> Quality patient teaching tailored to the patient needs has the ability to positively impact the patient experience, resulting in greater patient satisfaction and successful patient outcomes. <h3>Implications For Perianesthesia Nurses and Future Research</h3> Perianesthesia nurses are well positioned to ensure that patient education expectations regarding any surgical procedures are fulfilled, leading to optimal patient outcomes, and ultimately patient experience.

Pitfalls in Perioperative Documentation, Compliance with the EMR

<h3>Background Information</h3> In 2018, Perianesthesia nurses at Delnor Hospital embarked on a documentation quality improvement initiative. A team of nurses collaborated to promote consistency in standardized documentation within The American Society of Perianesthesia Nurses (ASPAN) guidelines by enhancing electronic documentation. A workgroup was developed with representation from Pre-op, Phase I, Phase II, Professional Development, and Perioperative Leadership with both surgical areas within Delnor. The team established documentation guidelines based ASPAN standards. Education was developed along with an audit tool to measure compliance. Baseline data from the start of the project in 2018 identified documentation compliance was less than 62% for all areas. A goal was established to improve compliance to 85%. After three months of audits, all three areas achieved the goal and exhibited significant improvement. With continued audits and peer coaching provided by the documentation committee compliance was achieved. However, after the pandemic hit sustainment of the goal decreased in compliance. <h3>Objectives of Project</h3> The committee focused on reeducation of the team and audits to reestablish the expectation, hold staff accountable and get back to the targeted goal. <h3>Process of Implementation</h3> A pre-learning audit was completed to determine baseline data and where reeducation was needed. The education was disseminated to the staff in the three phases of care. The documentation guidelines and education were added to the orientation binder for new staff. Twenty audits were completed monthly per area for three consecutive months. The re-introduction of the project was received positively and the staff felt empowered with knowledge, increased confidence on appropriate assessment/documentation, and improved communication through the Perioperative setting. It was identified that staff who were non-compliant, were the ones who were resistant to the initial project and fell back to old habits. <h3>Statement of Successful Practice</h3> The committee realized that accomplishing the goal is important but identified that sustainment is the most crucial aspect of the project. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The documentation group will continue to monitor documentation, provide additional education for compliance and focus next on case-specific assessment/documentation.

Inspired by the Research Process: Lessons Learned in the Participation of a Mixed Method Randomized Comparative Clinical Trial

<h3>Background Information</h3> Post Anesthesia Care Unit (PACU) nurses met with the clinical nurse specialist to participate in a music-based intervention research study whose purpose was to reduce anxiety and pain in laparoscopic radical prostatectomy patients. One co-investigator was a nursing student whose expertise was in music. The research team chose to frame their study using a mixed method, randomized comparative design between two complementary music interventions: (1) patient-selected music preferences using Spotify; (2) pre-recorded guided breathing relaxation narrative underscored with minimal, hypnotic music. <h3>Objectives of Project</h3> To participate as co-investigators in a mixed method randomized comparative study to determine the effectiveness of music listening interventions in reducing anxiety and pain scores in the PACU; learn about patient experiences through qualitative inquiry. <h3>Process of Implementation</h3> 1.Co-investigators took CITI protection for human subjects 2.Submitted study protocol; approved by IRB 3.IT Department programed music interventions on devices 4.Invitation PreOp phone call night prior 5.Night prior, team collates brown envelope; headset/fully charged i-Pods in plastic bag w/coded randomized group; I-Pods checked fully charged/tested 6.PI/Co-investigators consented patients in waiting room 7.Drew music G-cleft by patient's ID 8.Patient escorted to Prep; listened to music 9.Once awake – patient offered assigned music until discharge 10.Blinded RN records "Post" STAI scores; completes PACU data form 11.RN documents patient's own words to qualitative inquiry 12.RN returns plastic bag/data sheet to LCN desk. All equipment sanitized; placed in locked drawer for recharging; ready for next patient 13.Nurses shared results of their study with nursing leaders and surgeons <h3>Statement of Successful Practice</h3> The PACU nurses successfully completed the research study, authored a music listening manuscript, submitted manuscript for publication, and disseminated results of the study through local and national poster presentations. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Participating in the conduct of research inspires bedside PACU nurses to continue their scientific inquiry by creating new knowledge to improve perianesthesia nursing practice and patient care. Future research should focus on the benefits of PACU nurses participating in research and contributing to nursing theory.

The Development, Feasibility, and Effectiveness of The Pediatric Readiness for Discharge Tool (P-REDI)

<h3>Introduction</h3> There was no standardized validated criteria for discharge to home after pediatric ambulatory surgery. Children's Hospital Colorado (CHCO) created and implemented the P-REDI Tool to assess patient readiness for discharge. This tool was validated using a quasi-experimental retrospective chart review. The results of this study have been submitted and accepted to be published in JoPAN. <h3>Identification of the problem</h3> Historically, discharge practices among CHCO Phase II PACU RNs were inconsistent and assessment of a patient's readiness for discharge varied greatly. This led to varied Phase II times, varied criteria for discharge to home, and potential safety concerns. <h3>Purpose of the Study</h3> The goal of our project was to assess the efficacy of our tool in predicting safe discharge to home of ambulatory surgery pediatric patients. Does the tool decrease the likelihood of adverse patient events at home or the likelihood of hospital readmission, ED, or unscheduled clinic visits? <h3>Methodology</h3> This research project was a quasi-experimental retrospective chart review comparing patient outcomes pre and post implementation outcomes in the 24-hour post-operative period. The chart review included patient variables in relation to patient-readmission, ED visits, and unscheduled clinic visits in the first 24 hours. The data was analyzed using ANOVA and Chi-square statistical analysis. <h3>Results</h3> Our data went through statistical analysis with the Department of Biostatistics at Children's Hospital Colorado. Our manuscript was completed in November 2020. <h3>Discussion</h3> Our data analysis was completed, and we will present the P-REDI tool as an example of successful nursing research. The impact of P-REDI includes improved post-operative patient assessment, increased nursing confidence in readiness for discharge to home, standardized assessment practice in collaboration with anesthesia, and validated criteria for safe discharge. <h3>Conclusion</h3> The P-REDI validation project is the first of its kind in Pediatric Perianesthesia Nursing. With this validation, we now hope to disseminate our findings for use at other institutions. <h3>Implications for perianesthesia nurses and future research</h3> P-REDI could impact RN discharge practices, patient safety, and hospital efficiency and expenses. Standardized assessment for discharge readiness provides a validated model of safety and nursing confidence in predicting safe discharge in the first 24 hours post-op.

Enriching Perioperative Communication Through Family Texting

<h3>Background Information</h3> •Surgeryproduces anxiety for patients families or designated support person. COVID-19 exacerbated this with regulations limiting visitor presence in the perianesthesia area. •The setting for this project was a 171-bed community hospital in the Northeast United States with FY21 surgical volume 11732. Recognizing the need for improved communication during surgery staff and leadership wanted to develop a tool that would improve family communication. •Technological innovations were able to move forward more rapidly during the early stage of the pandemic and were effective solutions for communication challenges. <h3>Objectives of Project</h3> To implement enhanced communication through family texting to alleviate patient family and/or support person anxiety. <h3>Process of Implementation</h3> Following the leadership decision to initiate family texting in the Perianesthesia department a group of interdisciplinary staff were involved in the development of a new process of communication using text messaging. This process was standardized to align with the practices within the larger healthcare system. •Collaborated with leadership and the informatics department to develop standardized messages for texts with time parameters for relaying information to families/support person •Developed process for educating patients/support person about family texting followed by enrollment for those who were interested •Developed process map and other educational resources to support staff •Education provided to all staff throughout the perianesthesia department •Developed process to receive feedback from staff patients families/support person which was then used to improve this new practice. <h3>Statement of Successful Practice</h3> Since August 2020 family texting has been successfully implemented with an enrollment rate of 85% or higher. There has been a decrease in phone calls from families/support person to the perianesthesia unit leading to increased unit efficiency and time for the nurse at the patient's bedside. Anecdotal feedback from patients and support person and patient satisfaction surveys has shown that concerns related to surgery has been reduced. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Family texting is an effective component of perianesthesia communication between clinical nurses and families/support persons. Perianesthesia nurses are essential drivers of development and implementation of innovative technologies to improve care for patients as well as their families and/or support person.

Nurse Led Collaboration and Innovation: Creating Standardized Care for Same Day Joint Arthroplasty Patients

<h3>Background Information</h3> As a Magnet designated hospital, BWFH strives to achieve excellent patient outcomes. Our dedication to provide innovative, high-quality care for patients in a busy 171-bed community teaching hospital in Boston, MA has led to the development of a successful same day joint (SDJ) program. <h3>Objectives of Project</h3> To implement strategies that facilitate the safe discharge of patients undergoing SDJ replacement surgery. <h3>Process of Implementation</h3> After successfully launching a SDJ replacement program, it was identified that nurses needed education and resources to support safe discharge home for this patient population. Identification and education of dedicated resource nurses •Development of SDJ Resource binder that includes tip sheets and checklists opre-discharge medications, hydration and nourishment guidelines, spinal anesthesia recovery protocols, pre-discharge required consultations (PT and Care Continuum Management), and home discharge instructions. <h3>Statement of Successful Practice</h3> Since April 2019, >600 patients have been discharged home the same day as their joint replacement surgery resulting in a reduced hospital length of stay compared with traditional practice. With the identification of dedicated resource nurses and the implementation of a SDJ resource binder, nurses have been able to provide high quality, standardized care. In addition, nurses have been able to identify deviations from the SDJ care pathway that might impede a successful discharge home. Nurses have reported a decrease in anxiety when caring for this population since the addition of these resources. Providers from the orthopedic teams have reported receiving fewer phone calls to clarify post-op orders and instructions. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perianesthesia nurses are collaborative and innovative in designing systems that allow for a successful SDJ program. Standardizing post-op care and having resources such as informational binders and PACU nurse champions play an important role in the safe care and discharge of SDJ patients.

Who's Who in the PACU? Role Designation During Emergencies

<h3>Introduction</h3> There is ample evidence that high performance teams are vital to patient survival during emergency events. Role designation among clinicians is key for high-performing emergency response teams. <h3>Identification of the problem</h3> Poor team dynamics and communication breakdown is often the cause of preventable errors with patient mortality/morbidity occurring more often when team dynamics fail. Lack of role designation may lead to adverse patient outcomes during emergency events. <h3>EBP Question/Purpose</h3> Does role designation strategy impact PACU staff team dynamics during emergency situations? <i>Databases/Resources Utilized</i>: CINHAL PubMed UpToDate ASPAN 2021 Scope and Standards AHA 2020 Pediatric Advanced Life Support Guidelines finding 12 articles and selecting <i>Mayo High Performance Teamwork Scale.</i> Synthesized findings support role designation as an effective strategy for high performing emergency response teams and simulation as a learning tool to improve knowledge confidence and clinical skills. <i>Purpose</i>: Implement and evaluate the effectiveness of an evidence-based role designation strategy for PACU staff during emergency situations with aims to improve staff confidence staff knowledge and team dynamics. <h3>Methods/Evidence</h3> <i>Pre-intervention</i>: Survey distributed to PACU staff to assess knowledge of emergency skill/concepts with 5-point Likert scale measuring confidence of role assumption and skills needed for each role. Team dynamics evaluated using the validated <i>Mayo High Performance Teamwork Scale</i> during unit mock codes. <i>Intervention</i>: Education via skill stations for the following roles/concepts: Effective Team Dynamics Airway Management Crash Cart Compressions & Documentation. Roles and Designation Tool implemented during education. <i>Post-intervention</i>: Repeated survey of knowledge and confidence with staff. Comparative team dynamics evaluated with <i>Mayo High Performance Teamwork Scale</i> during unit mock codes. <h3>Significance of Findings/Outcomes</h3> Implementation of an evidence-based Role Designation Tool with education improved role delineation among PACU staff. Consistency in understanding assumed role during emergencies improved from 0% role-consistency (0/10 simulated events) to 87.5% role-consistency (7/8 simulated events) (p < 0.001). <h3>Implications for perianesthesia nurses and future research</h3> Implementation of a role designation tool in the PACU provides PACU staff with a clear plan for emergencies. This clear plan improves communication team dynamics and comfort among PACU staff during emergencies positively impacting patient outcomes.

Peace in the PACU

<h3>Introduction</h3> Open-bay Post Anesthesia Care Unit (PACU) environments can be loud and overstimulating for patients, caregivers, and healthcare workers. Literature describes noise interferes with the patient's surgical recovery and increases the need for analgesia. In patients and healthcare workers, physiologic (increased heart rate, blood pressure) and psychologic (sleeplessness, stress) changes are associated with increased noise levels as well as medical errors, miscommunication, and surgical site infections. <h3>Identification of the Problem</h3> Reports of a noisy, loud pediatric PACU environment has been identified as an area of improvement by healthcare workers, patients, and caregivers. <h3>Purpose of the Study</h3> Evaluate the effects of noise-reducing curtains on PACU noise level and noise perception by caregivers. <h3>Methodology</h3> Institutional Review Board approval was obtained. A pre/post- intervention study design was employed to evaluate the effectiveness of noise-reducing curtains on noise level and caregiver perception. Noise decibels were measured with calibrated dosimeters. An acoustical assessment was performed and caregiver perception of noise was measured by anonymous surveys. <h3>Results</h3> Following noise-reducing curtain installation no statistical significance in overall decibel levels was observed, however intrusive noise was reduced by 35% - 50%. Additionally, 54.7% of caregivers reported the area around the bay was never quiet before installation compared to 15.5% after noise-reducing curtain installation. <h3>Discussion</h3> This study was done to validate results from a 2019 study in the same PACU where a statistically significant reduction in decibel levels was observed following noise-reducing curtain installation. This study did not validate an improvement in decibel levels likely due to pandemic-related effects such as decreased surgical volumes and an intentional reduction of caregivers and healthcare workers at the bedside. However, this study does validate the use of noise-reducing curtains to improve noise perception. <h3>Conclusion</h3> Noise and sound are multi-dimensional. Though a statistically significant reduction in noise levels was not observed, sound transmission, speech privacy, and reverberation measurements revealed statistically significant reduction in noise perception. Caregiver surveys supported the use of noise-reducing curtains in providing a more therapeutic environment. <h3>Implications for perianesthesia nurses & future research</h3> Literature describes noisy hospital environments lead to negative outcomes for patients, caregivers, and healthcare workers. Noise-reducing curtains are an evidence-based intervention that can improve noise perception in PACUs.