Postanesthesia Care Unit Nurses Research Articles

Evaluation of nurse‐reported missed care in a post‐anesthesia care unit: A mixed‐methods study

AbstractBackgroundNurse‐reported missed care (NRMC) is considered as any significant delay or omission in provision of nursing care.Aim(i) Evaluate the frequency, types, and reasons for NRMC in the Post‐anesthesia Care Unit (PACU). (ii) Evaluate associations between nurse demographic and workload factors with NRMC. (iii) Explore nurses' perception of NRMC in the PACU.MethodsA cross‐sectional study was conducted in the PACU in a tertiary acute care hospital over 3 months. Full‐time PACU nurses were conveniently sampled to complete an anonymous survey after their daily shift over different shifts. It contained three sections: (i) nurse demographics; (ii) elements of NRMC; and (iii) reasons for NRMC. Qualitative interviews employed a semi‐structured guide to explore perceptions and experiences of NRMC. Descriptive, inferential statistics, and thematic analyses were applied.ResultsSixty‐six survey responses were collected. 48.5% of respondents indicated at least one NRMC activity. Activities more clinically sensitive were less missed. Eight nurses were interviewed. Four main themes were identified: (i) communication with patients; (ii) communication and teamwork with colleagues; (iii) dual role of documentation; and (iv) staffing inadequacy. Language barriers made communication challenging. Staff shortage exacerbates workload but effective teamwork and documentation facilitates nursing care.ConclusionCommunication and staffing concerns aggravate NRMC. Teamwork and personal contentment were satisfactory. Nurses' turnover intention may worsen staffing.Clinical RelevanceTimeliness and quality of nursing care is impacted by elements such as manpower, allocation of resources, work processes, and workplace environmental or interpersonal factors such as culture and language fit. Re‐evaluation of nursing resources and work processes may assist post‐anesthesia care unit nurses in fulfilling their role, decreasing the prevalence of nurse‐reported missed care.

Pain Catastrophizing and Impact on Pelvic Floor Surgery Experience

ABSTRACT Duration, intensity, and management of pain and discomfort may all be affected by experience, personality, and medical and psychosocial comorbidities. A negative cognitive-affective response to actual or anticipated pain, which impacts the pain experience, is called pain catastrophizing. The scale utilized for identifying individuals who magnify, feel helpless to manage, anticipate, or ruminate on pain is known as the Pain Catastrophizing Scale (PCS) and is composed of a 13-question validated measure and 3 subscales. The scale's score ranges from 0 to 52, where scores of 30 and greater indicate pain catastrophizing (30 points is the 75th percentile for PCS score distribution in patients with chronic pain). Pain catastrophizing is associated with increased pain severity, pain persistence, and opioid consumption following surgery, as well as poorer response to endometriosis treatments. Approximately 300,000 prolapse surgical procedures are performed in the United States annually, and because little is known about pain catastrophizing on perioperative pain, pelvic floor symptom distress/impact, and voiding trial (VT) performance following urogynecologic surgery, the authors' primary aim was to assess baseline pain catastrophizing on preoperative pelvic floor symptom impact and distress. The secondary aims included assessing the impact of pain catastrophizing on voiding function and postoperative pain following pelvic floor surgery. The patients for this prospective cohort study included self-identifying female patients undergoing surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse from March 2020 to December 2021. Inclusion came following completion of appropriate surveys and subsequent surgery. Exclusion was merited through surgery for reasons besides SUI or prolapse. At the baseline patient visit, a PCS score of 30 or greater was defined as pain catastrophizing. The initial visit also included recording data such as body mass index, age, benzodiazepine use, chronic opioid use, anxiety and depression diagnoses, postoperative prolapse stage, bothersome urgency urinary incontinence, and preoperative postvoid residual volume. Charts were used for abstracting surgical data, such as operative time, estimated blood loss, type of pelvic reconstructive surgery performed, and midurethral sling placement. Surgeries were all performed by fellowship-trained reconstructive pelvic surgery providers. Postanesthesia care unit (PACU) nurses and clinic staff were masked to preoperative PCS scores obtained in the PACU and postoperative clinic visits. A standardized void trial was performed. Of 320 participants in this cohort, 46 had a pain catastrophizing score of ≥30. Mean age was 60.0 ± 12.8 years. Bivariate analysis indicated that the pain catastrophizing group had higher average body mass index and greater preoperative use of benzodiazepines. Variants such as SUI rates, urgency urinary incontinence, or prolapse stage had no significant differences between groups, yet preoperative pelvic floor symptom distress and impact scores were clinically and statistically significantly higher in the catastrophizing group. Higher PACU pain scores were associated with pain catastrophizing, but not first postoperative VT failure. A significant association between pain catastrophizing and symptom distress remained following multivariable analysis, as well as a relationship between high PCS scores and symptom impact. All quality-of-life subscales maintained the significant associations. This study, although unique in describing pain catastrophizing in this setting, includes various limitations such as its single-institutional nature, which may limit external generalizability. Furthermore, generalizability may also be limited for those electing nonsurgical management, as the study selected for women choosing surgery. Study strengths include its large number of patients cared for by fellowship-trained providers in a similar manner with uniform surgical practice and timing of measures for assessing pelvic pain and pelvic floor symptoms. Also, a relatively standard VT method was utilized. Although further investigation is warranted for describing pain catastrophizing and its role with pelvic floor symptoms and pain postoperatively, the results of this study support other investigative findings, which indicate the importance of understanding pain catastrophizing and its potential effect on patients undergoing pelvic floor surgery. Future studies around this relationship can potentially enable health care providers to tailor perioperative care for individuals with pain catastrophizing.

Acupuncture as a Complementary Treatment Modality in the Post-Anesthesia Care Setting: A Feasibility Study.

Introduction: Postoperative pain management and postoperative nausea and vomiting are a persistent challenge for both health care providers and patients. Acupuncture is an effective and safe modality for the management of pain and nausea, and has the potential to play a key role in postoperative pain management. This study explores the utility and feasibility of acupuncture in the immediate postoperative setting. Methods: In a retrospective case-control study, 22 patients who underwent elective surgeries and received acupuncture in the post-anesthesia care unit (PACU) were compared with 88 case controls. Indications for acupuncture therapy included persistent pain, nausea, or anxiety. Patient satisfaction and symptom improvement after acupuncture were assessed. PACU nurses and patients were queried on their perspectives on using this therapy. Demographic data, perioperative opioid consumption, pain score in the PACU, incidence of postoperative nausea, PACU length of stay, and unintended hospital admission were assessed. The groups with/without acupuncture were compared using Wilcoxon rank sum test or Fisher's exact test as appropriate. Results: A total of 78.9% of patients receiving acupuncture felt improvement in their symptoms. 94.7% of recovery nurses who cared for patients who received acupuncture felt that it was helpful and 78.9% did not believe it was disruptive. Patients who opted for acupuncture had a statistically significant higher overall median (interquartile range) pain score in the PACU (7.0 [5.2, 9.5] vs. 5.0 [3.0, 7.0], p = 0.009) and higher postoperative opioid consumption (22.5 [9.8, 44.8] vs. 15.0 [0.0, 30.0], p = 0. 03). There was no difference between total perioperative opioid consumption between groups (p = 0.94). Conclusions: Most patients who received acupuncture therapy in the PACU were satisfied with their therapy and would recommend it to future patients undergoing surgery. Most recovery nurses felt it was helpful, was not disruptive, and would like to see it utilized in the PACU.

General anesthesia techniques reducing the time to satisfy phase I post-anesthesia care unit discharge criteria: Narrative review of randomized clinical trials and cohort studies studying unit bypass, supplemented with computer simulation

We performed a narrative review of bypass of the phase I post-anesthesia care unit (PACU) following general anesthesia to gain insight into ways to reduce the time until patients are ready for PACU discharge following general anesthesia. Web of Science and PubMed literature searches were performed. Publications’ references and citations were examined. The Scale for the Assessment of Narrative Review Articles’ six components were satisfied. The 14 articles included 17 studies, with nearly all patients being adults. Most studies’ patients underwent outpatient surgery with an average surgical duration of less than 100 min . The studies applied several different, but similar, criteria to choose if patients bypass the PACU. Notably, 13 of 17 studies and all five with the largest observed bypass rates used some version of the White-Song fast-track bypass criteria. Propofol was used uniformly for induction of general anesthesia. Most studies included at least one antiemetic prophylactically, a local anesthetic administered by the surgeon, and a non-opioid analgesic. The six studies with the largest observed bypass rates used remifentanil or restricted use of intraoperative opioids. We then considered economics. While achievable PACU bypass rates are insufficient to reduce healthcare costs, reducing mean PACU time markedly can lower the nursing labor costs, the total time until the last patient exits the PACU, and the incidence of patients recovering in operating rooms because of unavailable PACU nurses or beds. We examined probability distributions of brief patient recovery times by using Gas Man, an uptake and distribution software program, simulating times until reaching constant incremental reductions (0.1 %) in vessel-rich concentrations of desflurane and sevoflurane once the vaporizer was set to zero. Results showed that simulated recovery from volatile anesthetics can have recovery times appearing log-normal, as seen empirically. Thus, patients already meeting discharge criteria upon PACU arrival can be the far-left fraction of one population of patients. The implication is that the narrative review results for PACU bypass provide insight into how to have more patients with very brief times to recovery. Therefore, future studies should quantify the effectiveness and economic benefits of anesthesia practitioners aiming not for PACU bypass, per se, but rather that the patients meet PACU discharge criteria by the 5–10 min after unit arrival when the practitioner has completed PACU handoff and finished documentation in the anesthesia record.

Implementation of Electronic Postoperative Nausea and Vomiting Assessment and Best Practice Advisory Tools to Improve Patient Care.

Postoperative nausea and vomiting (PONV) affects 30% of surgical patients undergoing anesthesia. PONV is a substantial cause of increased length of stay, cost of care, and unanticipated patient admission and readmission. Seventy percent of patients received PONV prophylaxis; PONV assessment was performed in only 63% of patients in this hospital system. A standardized PONV preoperative assessment checklist and a best practice advisory (BPA) were implemented in our electronic medical record (EMR) and charting system. Anesthesia providers and postanesthesia care unit (PACU) nurses completed training on patient management for PONV, including preoperative assessment and BPA use. The PONV preoperative assessment achieved high adoption, and providers followed its recommendations in more than 90% of cases. During the 6-month implementation phase, PONV rates decreased from 56% to 43.6%. Implementing a standardized, electronic PONV preoperative risk assessment checklist and a BPA effectively reduced PONV rates in this hospital system.

Documentation of Assessments and Interventions Using a Pediatric Preoperative Risk Assessment Checklist in the Postanesthesia Care Unit: A Quality Improvement Initiative

PurposeDescribe the impact of the implementation of an evidence-based pediatric preoperative risk assessment (PPRA) checklist on the frequency of postanesthesia care unit (PACU) nursing assessments and interventions in children at risk for respiratory complications during emergence from anesthesia. DesignProspective pre-/postdesign. MethodsPediatric perianesthesia nurses assessed 100 children preintervention according to current standard. After nurses received pediatric preoperative risk factor (PPRF) education, another 100 children were assessed postintervention using the PPRA checklist. Pre-/postpatients were unmatched for statistical purposes due to two different groups. Frequency of PACU nursing respiratory assessments/interventions was evaluated. FindingsDemographic variables, risk factors, frequency of nursing assessments/interventions were summarized in pre-/postinterventions. Significant differences (P < .001) were noted between pre-/postintervention groups with increased frequency of postnursing assessments/interventions that correlated with increased risk factors and weighted risk factors. ConclusionsBy identifying total PPRFs, PACU nurses used their plan of care to frequently assess and pre-emptively intervene with children who had increased risk factors to prevent or mitigate respiratory complications on emergence from anesthesia.

Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals’ experiences after 3 years, including the COVID-19 pandemic period

ObjectivesUnsafe medical care causes morbidity and mortality among the hospital patients. In a postanaesthesia care unit (PACU), increasing patient safety is a joint effort between different professions. The Green Cross...

MP06-16 PERCEIVED NURSING BARRIERS TO IMPLEMENTATION OF ENHANCED RECOVERY AFTER SURGERY PATHWAYS

You have accessJournal of UrologyCME1 Apr 2023MP06-16 PERCEIVED NURSING BARRIERS TO IMPLEMENTATION OF ENHANCED RECOVERY AFTER SURGERY PATHWAYS Akshay Thaper, Melinda Z. Fu, Kevin Chua, Hiren V. Patel, Raeesa Islam, Thomas L. Jang, and Saum Ghodoussipour Akshay ThaperAkshay Thaper More articles by this author , Melinda Z. FuMelinda Z. Fu More articles by this author , Kevin ChuaKevin Chua More articles by this author , Hiren V. PatelHiren V. Patel More articles by this author , Raeesa IslamRaeesa Islam More articles by this author , Thomas L. JangThomas L. Jang More articles by this author , and Saum GhodoussipourSaum Ghodoussipour More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Enhanced recovery after surgery (ERAS) protocols are evidence-based multimodal perioperative care pathways that have shortened hospital stays, optimized pain control, led to earlier mobility and recovery, and reduced rates of postoperative complications across several surgical specialties. However, adherence to and implementation of ERAS protocols is not universal. Our study aimed to identify barriers nursing staff face in implementing ERAS protocols in patients undergoing radical cystectomy. METHODS: A survey was sent to preoperative, post-anesthesia care unit (PACU), and surgical oncology med/surg nurses about the effectiveness, ease, and frequency of ERAS implementation in the preoperative and early postoperative phase of care. Respondents rated each statement on a 5-point Likert scale and were able to provide narrative responses. RESULTS: The survey was completed by 31 nurses (8 preoperative, 10 PACU and 13 surgical oncology nurses). The majority (80%) of surgical oncology nurses had prior ERAS training and 100% knew where to find additional resources about ERAS. Only 50% of PACU nurses and 33% of preoperative nurses reported they had received ERAS training. Approximately half of nurses surveyed agreed that ERAS improves workflow by standardizing care and setting clear expectations for staff. On POD 0, 21% of nurses reported chewing gum as slightly effective or not effective at all, with 36% never implementing it. Daily weight was seen as slightly effective or not effective at all by 17% of nurses. For at least 85% of nurses, it was somewhat or extremely easy to administer a standing pain regimen, bowel regimen, and antiemetics on POD 0. 75% of nurses believed ERAS improves patient experience, citing faster recovery time and better pain control. Lack of personnel (79%), time (68%), and resources (68%) were commonly identified by nurses as barriers to implementing ERAS (Figure 1). CONCLUSIONS: Consensus on the effectiveness and ease of implementation of ERAS protocols remains varied. Equipping nursing staff with sufficient resources, education and training is necessary for widespread successful implementation of ERAS. Source of Funding: Grant from the National Cancer Institute (P30CA072720) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e59 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akshay Thaper More articles by this author Melinda Z. Fu More articles by this author Kevin Chua More articles by this author Hiren V. Patel More articles by this author Raeesa Islam More articles by this author Thomas L. Jang More articles by this author Saum Ghodoussipour More articles by this author Expand All Advertisement PDF downloadLoading ...

Spanish version of the Pediatric Anesthesia Emergence Delirium scale: translation and cross-cultural adaptation

BackgroundEmergence delirium (ED) is a mental disturbance in children during recovery from general anaesthesia. The Pediatric Anesthesia Emergence Delirium (PAED) scale is the only validated scale that assesses ED in paediatric patients undergoing general anaesthesia. The aim of this study was the translation and cross-cultural adaptation of the PAED scale into Spanish (Chile). MethodsA five-stage translation and cross-cultural adaptation process was carried out. The reliability of the Spanish version of the PAED scale was evaluated in paediatric patients independently by a set of two raters (anaesthesiologists or postanaesthesia care unit nurses) in the postanaesthetic period after major outpatient surgery. ED was defined by a cut-off level of ≥ 10 points on the PAED scale. ResultsThe PAED scale was evaluated in 353 consecutive children. Patients had a mean age of 7.4 ± 3.22 years. The preoperative ASA Physical Status class was 62%, 37%, and 1% (ASA class I, II and III, respectively). The distribution of patients by service was as follows: 45% of patients underwent paediatric surgery; 33% underwent otorhinolaryngological surgery; 11% underwent orthopaedic surgery; 10% underwent ophthalmological surgery; and 1% underwent other types of surgery. The interrater agreement ranged from 96.9% to 97.9%, with Kappa values ranging from 0.59 to 0.79. The Cronbach’s alpha value was 0.91. The ED global incidence was 9.1% and was higher in the younger age groups (3–10 years).ConclusionsThe translated and cross-culturally adapted Spanish version of the PAED scale is a reliable instrument to measure ED in the postanaesthetic period in Chilean children.

The Thai version of the nursing delirium screening scale-Thai: Adaptation and validation study in postoperative patients.

BackgroundThe Nursing Delirium Screening Scale (Nu-DESC) is an effective instrument for assessing postoperative delirium (POD). This study translated the Nu-DESC into Thai (“Nu-DESC-Thai”), validated it, and compared its accuracy with the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).MethodsThe translation process followed the International Society for Pharmacoeconomics Outcome Research guidelines. Recruited participants were ≥ 70 years old, fluent in Thai, and scheduled for surgery. The exclusion criteria were cancellation or postponement of an operation, severe visual or auditory impairment, and patients with a Richmond Agitation Sedation Scale score of –4 or less before delirium assessment. Post-anesthesia care unit (PACU) nurses and residents on wards each used the Nu-DESC to assess delirium in 70 participants (i.e., 140 assessments) after the operation and after patient arrival at wards, respectively. Geriatricians confirmed the diagnoses using video observations and direct patient contact.ResultsThe participants’ mean age was 76.5 ± 4.6 years. The sensitivity and specificity of the Nu-DESC-Thai at a threshold of ≥ 2 were 55% (95% CI, 31.5–76.9%) and 90.8% (84.2–95.3%), respectively, with an area under a receiver operating characteristic curve (AUC) of 0.73. At a threshold of ≥ 1, the sensitivity and specificity were 85% (62.1–96.8%) and 71.7% (62.7–79.5%), respectively (AUC, 0.78). Adding 1 point for failing backward-digit counting (30–1) to the Nu-DESC-Thai and screening at a threshold of ≥ 2 increased its sensitivity to 85% (62.1–96.8%) with the same specificity of 90.8% (84.2–95.3%).ConclusionThe Nu-DESC-Thai showed good validity and reliability for postoperative use. Its sensitivity was inadequate at a cutoff ≥ 2. However, the sensitivity improved when the threshold was ≥ 1 or with the addition of backward counting to Nu-DESC-Thai and screening at a threshold of ≥ 2.

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.

Post Anesthesia Response Unit: Development of an Intensive Care Unit within a Post Anesthesia Care Unit

Background InformationDuring the COVID-19 pandemic, the bed availability in Intensive Care Unit's (ICU) at Strong Memorial Hospital was limited. The Post Anesthesia Care Unit (PACU) was able to help load balance the intensive care units (ICU's) by caring for 6 ICU patients utilizing a team nursing model.Objectives of ProjectThe goal of the Post Anesthesia Response Unit (PARU) development was to utilize a team nursing model successfully caring for ICU patients. Because not all of the nurses who work within the PACU are traditionally trained to care for ICU patients, perioperative services leadership wanted to provide comprehensive ICU care by pairing the few ICU trained nurses with added support staff for safe patient care.Process of ImplementationThe PACU converted the extended recovery area into separate areas to care for ICU patients indefinitely. Leadership identified items that were critical in caring for ICU patients, worked alongside the hospital supply chain on creating a supply room, and built a code cart specifically for the PARU. The PARU scheduler paired an in-patient PACU RN who had prior knowledge working in an ICU with an assistive RN creating a buddy pairing. This paring was maintained throughout the entirety of the PARU and had a patient ratio of two patients to one pairing. Focusing on the PACU RN's skillset and knowledge base, leadership was able to identify staff member to care for individuals either receiving surgery or the chronic ICU population.Statement of Successful PracticePARU leadership found by having an ambulatory nurse or nurse anesthetists paired with a PACU nurse, a team nursing model approach was successful. The PACU nurses delegated tasks appropriately to their supportive staff member for safe patient care. PARU was open for total of 46 days caring for chronic surgical ICU patients. There was a total of 26 patients: 11 patients transitioned to floor level of care. 2 patients transitioned to comfort measures only. 2 patients were discharged to long term ventilator care units. 6 patients returned to the ICU's. Through collaborative efforts, ICU patients were able to be cared for by a nurse pairing in a safe comprehensive manner.Implications for Advancing the Practice of Perianesthesia NursingThe second surge of the COVID-19 pandemic caused an influx of critically ill patients. Perioperative leadership recognized the opportunity to help load balance the patient population by having 6 patients be cared for within the PACU setting. We learned that PACU nurses can successfully and confidently care for a two patient ICU assignment by utilizing a team nursing model.

Implications of Peri Operative Cannabis Use in Adolescents and Young Adults

<h3>Introduction</h3> Massachusetts legalized cannabis use for both medical and recreational use in 2014. Since then, adolescent recreational and medicinal use of cannabinoids has increased. <h3>Identification of the Problem</h3> There were increased requests by surgical patients post-operatively regarding resuming cannabis use post-operatively. <h3>EBP Question/Purpose</h3> <b>PICO question. Databases utilized.</b> The purpose was to understand best practice regarding post-operative pain management for patients who frequently use cannabis using the PICO question ‘<i>In adolescence and young adults (AYA), does the habitual use of marijuana versus no use increase the need for pain management interventions post-operatively?',</i> and the CINAHL, PubMed, Google Scholar, and Cochrane databases. <h3>Methods/Evidence</h3> The initial search returned 20 articles, which were critically appraised using the Johns Hopkins Evidence-Based Practice Appraisal Tool. One post-operative pain management expert opinion was obtained. In five articles, patients who reported using cannabinoids had higher pain scores, required more narcotics, and exhibited a poorer quality of sleep in the early post-operative period. Three articles found no difference in pain scores, narcotic use or length of stay for post-operative patients reporting cannabis use. These articles focused primarily on the orthopedic population, making it difficult to determine its' effects in other patient populations. Additionally, small sample sizes and older patients make the results difficult to interpret for a pediatric population. Four articles identified the multisystem effects of cannabinoids and its interaction with anesthetic agents, which may lead to serious complications for the patient. <h3>Significance of Findings/Outcomes</h3> There are conflicting findings regarding the use of cannabis as an effective post-operative pain management strategy and no practice change is currently recommended. However, the current available evidence can assist nurses caring for post-operative patients that utilize cannabis. Limited high quality studies were found, possibly due to the lack of federal research funding as cannabis is considered an illegal substance at the federal level. <h3>Implications for perianesthesia nurses and future research</h3> The evidence is useful to educate post-anesthesia care unit (PACU) nurses about how to screen for cannabis use and post-operative care considerations in the PACU setting. Considerations include the importance of eliciting and quantifying a history of cannabis use, consideration of cannabis weaning, additional post-operative nausea, vomiting prophylaxis, anticipated increased post-operative analgesic requirements, and maintaining vigilance for cannabis withdrawal syndrome. Adolescent-specific research is needed.

Early Ambulation of Patients with Post Transfemoral Arteriography with Vascular Closure Device (VCD): A Quality Improvement Project

<h3>Introduction</h3> Post Transfemoral Arteriogram (PTFA) is a minimally invasive diagnostic interventional procedure using venous closure device (VCD) to achieve hemostasis. Post procedure patient discomfort arises due to restrictions in position and prolonged bedrest. The postanesthesia care unit (PACU) nurses conducted an evidence-based practice (EBP) project that recommended early ambulation for PTFA with VCD between May 1, 2021 and December 1, 2021. <h3>Identification of the problem</h3> IR PACU patients' 120 minute supine positioning and 180 minute total bedrest time causes patient discomfort and PACU to go on hold – not allowing the operating room patients to be transferred. <h3>QI question/Purpose of the study</h3> Can supine positioning be reduced from 120 minutes to 60 minutes and total bedrest time be reduced from 180 minutes to 120 minutes without incidence of bleeding or trauma after PTFA with VCD? <h3>Methods</h3> This project compared current practice of IR patients that requires three-hour bedrest while maintaining supine head of bed (HOB) in flat position for two hours then elevating the HOB to 30 degrees for one additional hour vs implementing two-hour bedrest while maintaining supine HOB in flat position for one hour then elevating the HOB to 30 degrees for an additional hour. Data collection involved monitoring BP, HR, RR, femoral pulse check, femoral groin site check, pain score and patient satisfaction. <h3>Outcomes/Results</h3> Data showed reducing the total supination time from 120 minutes to to 69.95 minutes and total bedrest time from 180 minutes to to 108 minutes showed no increased risk for bleeding or trauma in the patient and overwhelmingly increased patient satisfaction related to decrease in back discomfort while supine and ability to void out-of-bed and/or without assistive devices. <h3>Discussion</h3> Cardiac Prep/PACU nurses recover interventional cardiac patients with the early ambulation protocol for one hour and progressively elevate HOB every thirty minutes. These patients safely ambulate after two hours. Further evaluation of this protocol could be cost effective due to decreased utilization of resources, manpower, and length of hospital stay. <h3>Conclusion</h3> PTFA with VCD patients can safely reduce their flat bedrest and ambulation time frames by one hour after PTFA with VCD. <h3>Implications for perianesthesia nurses and future research</h3> The science revealed ten years of research recommending safe ambulation within 120 minutes PTFA with VCD. Dissemination of these findings will advance the IR recovery process and improve patient satisfaction.

Music Listening as a Postanesthesia Care Unit (PACU) Nursing Intervention for Laparoscopic Radical Prostatectomy Patients: A Mixed Method Randomized Comparative Clinical Trial

<h3>Introduction/Background</h3> Laparoscopic radical prostatectomy surgery patients have reported severe pain post operatively and experienced psychological distress for potential urinary incontinence and sexual dysfunction. Over this past year, PACU nurses identified anxiety and pain management as the primary cause of these patients' increased length of stay in PACU. <h3>Identification of the problem</h3> Patients undergoing major cancer surgery frequently express increased anxiety about how severe their pain will be as well as their oncology surgical outcomes. Mid-Atlantic academic teaching hospital's postanesthesia care unit (PACU) Standards of Care Committee met to discuss investigating complementary music listening methods to enhance pharmacologic pain management to address concerns in this surgical population. <h3>Purpose of the Study</h3> To compare two methods of music listening interventions on anxiety, pain, heart rate, blood pressure, and oxygen saturation among post anesthesia care unit (PACU) patients who are recovering from laparoscopic radical prostatectomy surgeries: a) patient-preferred music listening via Spotify selections; and b) relaxation breathing narrative over minimalistic hypnotic music. <h3>Methodology</h3> Randomization of participants by computer-generated table of random numbers for effective balance between the two groups. A power analysis was calculated to have 77 male participants: Group I (n=37) and Group II (n=40). Inclusion criteria/exclusion criteria established. Nurses blinded to study interventions. The study started in December 2019 and concluded in December 2020. Data collection began in PreOP and continued through discharge. <h3>Results</h3> Both Groups I and II had reduced pain scores at discharge as compared to PACU admission; both groups had significant reduction (p=0.046 Group I, and Group II (p=0.002), but changes for comparative groups (I and II) were not significant between the two groups (p=0.53). <h3>Discussion</h3> Both interventions reduced State Trait Anxiety Inventory scores and pain scores to a similar degree; this reduction was clinically and statistically significant. Pain medication use did not differ between the two groups. Notably, three study participants did not require any pain medication throughout their entire PACU stay. Qualitative inquiry question on discharge revealed significant relaxation, distraction, pain relief, and comfort when listening to music. <h3>Conclusion</h3> Study revealed both relaxation/breathing track and personally selected music can meaningfully improve patients' anxiety and PACU pain scores. <h3>Implications for perianesthesia nurses and future research</h3> Future multicenter studies of music listening methods should be studied in other surgical/procedural patients recovering in PACU.

Improving PACU Throughput Using an Electronic Dashboard: A Quality Improvement Initiative

PurposePatients boarding in a 14-bed postanesthesia care unit (PACU) impacted throughput in a large university hospital in West Virginia. The PACU and operating room (OR) boarder rate in 2019 was 12% (n = 1241) and 5% (n = 503), respectively. The purpose of this initiative was to improve PACU throughput by developing an efficient and evidence-based handoff communication process between the PACU and the medical-surgical floors. DesignThe design of the project was evidence-based quality improvement. MethodsAn interprofessional team created a nursing patient dashboard in the electronic medical record to be used during handoff communication between the PACU and medical-surgical floor nurses. The dashboard displayed real-time vital signs, patient history, medications, and laboratory results. When the patient met Aldrete score requirements for transfer, PACU nurses notified the floor that the patient was ready for transfer. After allowing 20 minutes for the floor nurse to view the dashboard, the PACU nurse and floor nurse spoke on the phone to discuss any outstanding questions. PACU and OR boarder rates were obtained from the electronic medical record 12 months before and after implementing the nursing patient dashboard. User feedback was gathered via plan-do-study-act cycles, posters, and interviews. FindingsThe electronic dashboard was a successful strategy to improve handoff communication between the PACU and receiving units. The dashboard was accepted by the staff with 70% (n = 24) of the comments being positive. A significant decrease in the number of PACU (χ2(1, n = 20,608) =122.63, P < .00001) and OR boarding (χ2 (1, n = 20,283) =14.55, P = .000136) of patients was found in the C-year compared to 2019. For patients who were boarded in the PACU, no significant difference in PACU delay duration was found (t(11) =1.49, P = .149) with the mean in 2019 of 166.96 (SD = 68.38) and the C-Year mean 132.84 (SD = 39.74). For patients who boarded in the OR, there was a significant difference (t(11) =15.590162, P <.00001) between groups for average duration of boarding with the mean in 2019 of 19.06 minutes (SD = 3.72) compared to 1.62 (SD = 1.1) in C-year. However, in July 2020 the PACU intermittently opened 2 flexible beds when the PACU was full, suggesting that OR boarding was not a reliable measure, but PACU boarding remained an accurate measure. ConclusionsThe findings of this evidence-based quality improvement project demonstrated the usefulness of an electronic dashboard tool combined with verbal report to improve patient throughput by decreasing the number of patients boarding in the PACU.

Understanding the use of tympanic thermometry in the Post Anaesthesia Care Unit: A discussion paper

Inadvertent perioperative hypothermia (IPH) is an uncomfortable, dangerous and costly but preventable complication of surgery. For perioperative nurses to treat this condition, they must first have an accurate means of detecting it. In making clinical decisions based on patients’ temperature, an important vital sign, nurses must understand how different thermometers work and be competent in their use. It is vital that patients have accurate core body temperature recorded when admitted to the Post Anaesthesia Care Unit (PACU). Infrared tympanic thermometers are a non-invasive tool regularly used by PACU nurses and provide a quick and easily obtained measurement that is a reflection of core body temperature. Despite this, uncertainty remains about the accuracy of tympanic thermometer readings and their ability to accurately estimate core temperature, leading to questions being raised about their acceptability in clinical use. This discussion paper will evaluate the use of tympanic thermometers within the PACU and identify their benefits, limitations and alternatives, as well as the competency requirements of the nurse. Clinical trials give varying results and more research is needed into both the use of tympanic thermometers in the PACU and the competence of the user.

Nursing Practice Combined with Scene Simulation Teaching Mode in Standardized Training and Teaching for Newly Recruited Nurses in Post Anesthesia Care Unit

Background:To explore the application of nursing practice combined with scene simulation teaching mode in standardized training and teaching for newly recruited nurses in Post Anesthesia Care Unit (PACU) and its impact on their emergency response ability and competence.Methods:From Jan 2019 to Jan 2020, a total of 120 PACU nurses with professional qualification certificates in West China Hospital Sichuan University, Chengdu, China were enrolled and randomized into group A (n=60) and group B (n=60). Conventional standardized PACU training and teaching was applied in group B, and nursing practice combined with scene simulation teaching mode was applied in group A. After training for 12 weeks, the examination scores, competence and emergency response ability in the two groups were compared.Results:After training, the scores of theoretical examination, comprehensive scene simulation and nursing document in group A were conspicuously higher than those in group B (P<0.001). After training, the competence and emergency response ability in group A were significantly higher than those in group B (P<0.001).Conclusion:With a better training effect, nursing practice combined with scene simulation teaching mode can enhance the emergency response ability and competence for nurses in PACU, which should be promoted in practice.

Feasibility, implementation, and outcomes of in situ simulation-based curriculum to manage common emergencies in the pediatric post-anesthesia care unit

PurposeStudies have shown that most critical events that occur in the post-anesthesia care unit (PACU), including cardiac arrests, are preventable and respiratory in origin. Admission to the PACU necessitates transfer of care from anesthesiology staff to PACU nurses. The aim of the study is to assess a) feasibility in implementing an in-situ curriculum for PACU nurses to manage common pediatric emergencies, b) the effectiveness of the curriculum in improving self-confidence of the PACU nurses in performing essential skills c) nurses’' perception of such an offering. Design and methodsThis was a single center curricular evaluation study. Anonymous surveys were used to assess curriculum effectiveness by comparing self-reported confidence in the execution of key technical skills and application of knowledge in a real clinical environment at three time points: baseline, immediately post-simulation, and 3 months later. ResultsOf 50 PACU nurses, 80%, 98% and 58% responded to the targeted needs assessment, post-simulation and follow up (at 3 months) survey respectively. Self-reported confidence levels for most of the essential skills were significantly increased immediately after simulation and at 3 months. Most of the participants responded that the simulation training helped them improve care of hypoxic (83%) and hypotensive (62%) patients in the PACU. ConclusionImplementation of in situ curriculum for PACU nurses was feasible. The self-reported confidence in performing essential skills increased significantly and the nurses could apply these skills in real clinical environment. Practice implicationsInterprofessional simulation should be implemented in all high risk units to optimize safety of children.

Documenting urine output for pediatric urology patients in the post-anesthesia care unit: A quality improvement initiative

Close monitoring and documentation of urine output (UOP) after urologic surgery is a nursing standard of care in the post-anesthesia care unit (PACU). UOP is a critical piece of information for surgeons and anesthesiologists to provide safe quality patient care. The electronic medical record (EMR) is used to communicate this information between members of the care team. Initial review at our institution confirmed only 31.3% of children recovering in the PACU after urologic surgery had a numerical value for UOP documented in the EMR. The aim of this project was to improve compliance of UOP documentation in the EMR for pediatric urologic patients in the PACU from 31.3% to 80% by August 2021, using quality improvement methodology. Patients undergoing urologic surgery with planned post-operative hospital admission were identified in the EMR by admission status and Current Procedural Terminology (CPT) code. UOP documentation data during the patients' PACU stay was retrieved from the EMR. Traditional QI methods were used to develop a key driver diagram, identify barriers, and implement targeted interventions. Statistical process control charts tracked the outcome measure (percentage of patients with UOP documented in the PACU) and balancing measure (average PACU length of stay). The project began in July 2019, and four interventions started between July and October 2019. These interventions resulted in a centerline shift of our outcome measure, UOP documentation rate, from 31.3% to 76.2% (p<0.001). Patient volumes were stable with the exception of March, April, and May 2020 during the Covid-19 pandemic. An X-bar chart tracked PACU LOS, the balancing measure, in average minutes per patient without any trends. This quality improvement initiative sought to improve urine output (UOP) documentation for pediatric urologic patients during the immediate post-operative period. Targeted interventions leading to this improvement included educating nursing staff, establishing direct communication expectations for the surgical team, and improving the availability of UOP measurement tools. Limitations include reliance on education and behavioral change, only including urologic surgery patients, and our institution's robust focus on quality improvement work. This performance improvement initiative successfully increased the rate of UOP documentation by PACU nurses for pediatric urology patients through a combination of interventions. The next phase is to expand these interventions throughout the hospital to improve UOP documentation for all post-operative patients.