Postanesthesia Care Unit Nurses Research Articles

Pulse Oximetry Understanding and Application: A Survey on Nursing Staff

Introduction: Pulse Oximetry (PO) is widely used for the noninvasive detection of hypoxemia, particularly in the perioperative setting. Research regarding the perioperative assessment of nursing knowledge of PO continues to evolve. Prior evaluations have identified relative knowledge deficits among nurses regarding physiologic principles, data interpretation, and clinical application. Such deficits need identification and targeted education to prevent perioperative patient mismanagement. Aim: To assess nursing knowledge of PO in perioperative and critical care settings of a single center in the United States and to analyse identified knowledge deficits. Materials and Methods: A cross-sectional questionnaire study was conducted in Post Anaesthesia Care Unit (PACU) and Medical Respiratory ICU (MRICU) among 150 participants. The validated questionnaire on surveying PO principle consisted of 21 true/false and 3 open-ended questions. Univariate analysis of nursing Total Knowledge Score (TKS), years of clinical experience, and current practice settings was performed. Significance was set at p<0.05. Results: A total of 51 questionnaires were completed, with a 34% response rate. The mean TKS for the true/false questionnaire was 16.4±2.0. There was no significant difference in TKS between PACU and MRICU nurses (16.5±1.7 vs. 16.2±2.5, respectively, p=0.27). Ninety-eight percent of all nurses scored >50% correct while 13.7% scored >90% (p=0.19 and p=0.74, respectively). The lowest percentages of correct responses (<50%) were seen in questions 3 and 16, which pertained to physiologic principles of PO. There was no significant difference in scoring percentiles between MRICU and PACU nurses, nor was there significant difference in TKS based on clinical experience. Conclusion: The mean TKS of nurses in the study was higher than the mean TKS of nurses in reference studies. There was no significant difference in TKS between PACU and MRICU nurses. Furthermore, clinical experience did not correlate with TKS scores. The authors believe analysing these knowledge deficits may offer educational opportunities in initial and continuing nursing education as well as routine postgraduate assessments.

Development and Deployment of an Intraoperative Clinical Summary Document: A Veterans Health Care Affairs Perspective

Abstract Background Clinical summary documents that abstract details of episodes of care are essential to Advancing Care Information requirements for electronic health records. Few examples exist for intraoperative clinical summary documents (ICSD). Methods We describe the development and deployment of an ICSD at a tertiary hospital within the United States. Development included identification of needs of key stakeholders, evaluation of current clinical and data workflows, iterative development of prototypes with primary stakeholders, i.e., anesthesiologists and evaluation of prototypes with test patients. We deployed the ICSD over 6-months with tracking of (1) usage (number and types of end users and surgery types) and (2) written and oral feedback. Results Current workflows involved accessing a 10 to 40 page document presenting all surgery details with review described as burdensome. The ICSD prototype was a separate one-page summary optimized for viewing on a monitor or paper. The document had four sections: (1) administrative data, allergies, and precautions; (2) medications, infusions, and fluid intake and output; (3) airway assessments and a graphical presentation of hemodynamic trends (blood pressure), and (4) standardized text for events (hypotension) occurring intraoperatively. During the 6-month deployment, postanesthesia care unit and intensive care unit nurses were most prominent users followed by anesthesiologists. While overall well received, our pilot users reported challenges for readability, font size, and the lack of customization. Conclusion While the ICSD was designed for anesthesiologists, postanesthesia care unit and intensive care unit nurses were the most frequent users. Future development will involve customization for different stakeholders.

NURSING PERCEPTIONS OF A NURSE-DRIVEN POINT-OF-CARE ULTRASOUND EVALUATION TO RULE OUT PNEUMOTHORAX FOLLOWING LUNG BIOPSY

SESSION TITLE: Radiology Done by the Nonradiologist SESSION TYPE: Original Investigations PRESENTED ON: 10/23/2019 10:45 AM - 11:45 AM PURPOSE: Pneumothorax (PTX) following flexible bronchoscopy with transbronchial biopsy occurs in up to 4% of cases. Chest radiograph (CXR) remains the standard for detecting post-procedure PTX but delays in performing and interpreting the CXR adds to both patient turn-over time and costs. Lung ultrasound (LUS) has superior sensitivity for ruling out PTX, and has been performed by nurses in prior studies. We explored nursing perspectives regarding the feasibility and desirability of a nurse-driven protocol using LUS to rule out PTX following transbronchial biopsy, to thereby increase diagnostic accuracy and decrease radiation exposure and post-procedural wait-time. METHODS: An anonymous, self-administered survey was developed and given to post-anesthesia care unit (PACU) nurses at a tertiary care lung transplant center during a one-month period. Primary outcomes were nursing perceptions of the time to post-procedural CXR and radiology read as a cause of delay for patient discharge and the feasibility of a nurse-driven LUS protocol. RESULTS: 37 nurses completed the survey, with 36 (97%) identifying the post-procedural CXR or the radiology read as one of the top 3 causes of delay for discharge from the PACU. The next most common was awaiting physician sign off (43%). 86% felt that the delay was greater than 45 minutes. 62% were interested in learning LUS to rule out pneumothorax, but only 40% would be comfortable if the discharge was based solely on their interpretation. However, nurses that were more experienced (p=0.036) or more comfortable with technology (p=0.030) were more likely to feel comfortable performing a scan and interpreting it themselves. Having a physician interpret the examination increased confidence significantly (76%, p<0.001). CONCLUSIONS: PACU nurses believe that CXR is a source of delay in disposition after lung biopsy. The majority would be interested in learning to perform LUS but would be more comfortable if a physician interpreted the images. CLINICAL IMPLICATIONS: A program to decrease length of stay in the PACU should target delays in radiology interpretation. LUS is an attractive target, but PACU nurses are concerned about a program that does not include physician interpretation of images. This information will inform the creation of a curriculum to train select PACU nurses in the use of LUS to evaluate for pneumothorax. DISCLOSURES: No relevant relationships by Cameron Baston, source=Web Response no disclosure on file for Christoph Hutchinson; No relevant relationships by Ryan Sullivan, source=Web Response

Self-Reported Knowledge Levels of Critical Care Nurses in Managing Neuroemergencies: A Survey Based Study

Abstract INTRODUCTION Neurocritical care has become increasingly subspecialized. However, due to a lack of bed availability in neurocritical care units (NCCUs), sometimes patients may need to be boarded in other intensive care units (ICUs). Several academic centers do not have access to dedicated NCCUs. We hypothesized that general ICU and postanesthesia care unit (PACU) nurses may not feel as comfortable managing neurocritical care patients. In this survey-based quality improvement (QI) study, we explored the self-reported knowledge of ICU and PACU nurses at a comprehensive stroke center in recognizing and managing some common neurological emergencies such as stroke, status epilepticus, and raised intracranial pressure. METHODS We engaged the nursing managers of 8 units in this QI project, which included medical, surgical, neurocritical care, cardiac and cardiothoracic units as well as PACU and interventional radiology units. Using institutional RedCap, anonymized surveys were sent to the nurses in January 2019. We collected information on demographic and critical care work experience. All participants answered questions on a Likert-type scale based on their knowledge of several common neurological emergencies. RESULTS A total of 240 nurses (199 females, 41 males) participated in the survey. Out of which, 112 (58%) had been working in an ICU for 3 yr or longer. Their self-reported level of knowledge in managing neurological emergencies have been summarized below. More than half the participants did not feel comfortable managing patients with EVDs, ICH, SAH, raised intracranial pressure, and TBI and traumatic spine injury patients. More than 70% of nurses were not satisfied with their current level of training to deal with neuroemergency and supported the need for dedicated training/study time. CONCLUSION ICU and PACU nurses report gaps in knowledge in recognizing and managing common neuroemergencies. With an increasing cohorting of patients in subspecialized units, it is important to provide ongoing education to ICU and PACU nurses to help them maintain fundamental neurocritical knowledge.

Framework to Explain the Progression of Pain in Obese or Overweight Children Undergoing Tonsillectomy

An estimated 100,000 obese (OB) and overweight (OW) children undergo tonsillectomy each year in the United States. Pain management in this population is particularly challenging because of weight-based dosing, clinician fears, potential for airway obstruction, and genetic differences. A framework is proposed to explain factors involved in the post-tonsillectomy pain (PTP) experience in OB and OW children. The tonsillectomy, the body's inflammatory state, and mechanical stressors comprise influencing factors in PTP progression. Clinician-delivered medication doses, genetic variants of drug metabolism, and soothing factors serve as mediating factors in the progression of PTP. Postanesthesia care unit (PACU) nurses may use this framework to better understand PTP progression in OB and OW children. PACU nurses may manipulate certain mediating factors discussed in this framework to moderate PTP progression in OB and OW children. Researchers may use this framework to support future research to improve PTP management in OB and OW children.

Capnography monitoring of patients with obstructive sleep apnea in the post-anesthesia care unit: a best practice implementation project.

The prevalence of OSA is substantial in North America. Post-operative patients with OSA are at risk for respiratory complications, but about 60% of surgical patients with this condition go undiagnosed. If the presence of sleep apnea is known, non-invasive capnography monitoring can be applied post-operatively to help detect early respiratory compromise during the recovery phase. The STOP-Bang Questionnaire, a validated screening tool to evaluate the risk of OSA, can efficiently be used as part of the pre-surgical evaluation. The aim of this project was to improve safety by averting post-operative respiratory events in patients with obstructive sleep apnea (OSA) through early detection of compromise during recovery from anesthesia. Specific objectives focused on implementing nurse-initiated capnography monitoring of patients with OSA in two post-anesthesia care units and, when indicated, expediently communicating abnormal end-tidal carbon dioxide excursions. Strategies and audit data were organized and evaluated using the Joanna Briggs Institute's Getting Research into Practice (GRiP) and Practical Application of Clinical Evidence Systems (PACES) tools. Medical record review was used for the baseline audit and three follow-up compliance audits of evidence-based practice. Multiple teaching methodologies were employed to reach and engage post-anesthesia care unit nurses. Equipment was maintained at the point of care. Nurses' participation in the project was voluntary. There was nearly full compliance with the new practice of initiating capnography, when indicated. Compliance with escalating abnormal capnography results with associated concerning assessment findings was 100%, but the escalation sample size was only two patients. Patients with known OSA benefited from non-invasive capnography monitoring during recovery from anesthesia because post-anesthesia care unit nurses were empowered to initiate evidence-based technology. Expedient adoption of the new practice was due to comprehensive nurse education, familiarity with a similar capnography monitoring process and the value nurses placed on capnography as another assessment tool to safeguard patients. A larger sample of patients is needed to evaluate compliance with escalating concerning findings to providers. Sustainability will be impacted if the post-anesthesia care unit's standards of care include capnography for patients with OSA.

Nursing Perceptions and Workload Impact of a Standardized Emergence Delirium Assessment Scale in a Postanesthesia Care Unit

Emergence delirium (EDL) is a psychomotor behavioral phenomenon that occurs immediately after emergence from general anesthesia. EDL is nearly 1.5 times more common among military than nonmilitary patients. Indirect delirium scales have precluded understanding of EDL in military patients. This quality improvement project assesses the feasibility of adopting a population-specific scale, the Emergence Delirium in the Wounded Warrior (ED-WW) Tool. Pre-post implementation design. Postanesthesia care unit (PACU) nurses were surveyed on the clinical utility of the ED-WW Tool and its impact on their workload. The incidence of EDL behaviors in a Veterans Administration PACU was also recorded using the ED-WW Tool. PACU nurses agreed the ED-WW Tool was of clinical value to military patients and had a very low workload impact. Twenty-one percent of patients demonstrated at least one behavior associated with EDL. ED-WW Tool adoption is clinically feasible and recommended for practice.

Use of a Checklist for the Postanesthesia Care Unit Patient Handoff

This quality improvement project aimed to evaluate the benefits of implementing a checklist in the postanesthesia care unit (PACU) setting to decrease the omission of health information during the handoff from anesthesia to PACU nurses. Patient handoffs from anesthesia providers were anonymously assessed by PACU nurses before and after the implementation of a handoff checklist with the Situation, Background, Assessment, Recommendation format. PACU nurses recorded use of the handoff checklist and if five items of health information were included in the handoff during the preintervention and postintervention phase. Checklist use increased from 0% to 73% with omitted information decreasing with checklist use: procedure from 19% to 2%, allergies 23% to 4%, input and output 16% to 0%, antiemetic used 21% to 4%, and lines 19% to 11%. Completed handoffs increased from 13% to 82% whereas checklist use remained high, at over 79%, for the 12weeks after implementation. The project was successful in implementing a standardized checklist and echoed the success of the articles reviewed. The use of a PACU handoff checklist can improve transfer of care by ensuring the provider receives more pertinent medical information during these transfers.

Impact of Job Stress, Organizational Culture and Professional Identity on Job Satisfaction of Post-anesthesia Care Unit Nurses

The purpose of this study was to identify the factors affecting job satisfaction of PACU (post-anesthesia care unit) nurses in the context of job stress, organizational culture and professional identity. A total of 149 nurses participated in the cross-sectional, descriptive study suing a structured ...

Evaluation and control of waste anesthetic gas in the postanesthesia care unit within patient and caregiver breathing zones

This study (NCT02428413) evaluated waste anesthetic gas (WAG) in the postanesthesia care unit (PACU) and assessed the utility of the ISO-Gard® mask in reducing nursing exposure to WAG. We hypothesized that WAG levels in the patient’s breathing zone upon recovery would exceed the recommended levels, leading to increased exposure of the PACU nurses, with use of the ISO-Gard mask limiting this exposure. A total of 125 adult patients were recruited to participate. Patients were randomized to receive the standard oxygen delivery mask or the ISO-Gard face mask postoperatively. Continuous particulate concentrations were measured using infrared spectrophotometers placed within the patients’ and nurses’ 6-inch breathing zone. Maximum WAG measurements were obtained every 30 seconds, and the duration of maximum WAG >2 ppm and its proportion relative to the total collection period were calculated. We observed a statistically significant difference in desflurane duration and proportion of maximum WAG >2 ppm in both patient and PACU nurse breathing zones. Therefore, patients and PACU nurses using routine care were exposed to WAG levels >2 ppm during the 1-hour postoperative period, and the ISO-Gard mask effectively reduced the amount of WAG detected in the immediate 1-hour postoperative recovery phase.

Implementation of Physiological Scoring to Determine Discharge Readiness for Patients Undergoing Otolaryngology Head and Neck Procedures

This quality improvement project examined whether the use of a validated physiological scoring protocol to determine discharge readiness for surgical procedures proximal to the airway would decrease the time at which discharge criteria were met and postanesthesia care unit (PACU) length of stay. An observational pre-post design compared preimplementation recovery times to postimplementation recovery times. PACU nurses were trained to use two physiological scoring protocols to determine when patients met discharge criteria and to document when discharge criteria were met. During the postimplementation period, there was a significant decrease in the time it took patients to meet PACU discharge criteria when using the physiological scoring protocols compared with the preimplementation group (P < .001). These results suggest that physiological scoring protocols are safe and appropriate to determine discharge readiness for patients who have surgery proximal to the airway.

The common meanings and shared practices of sedation assessment in the context of managing patients with an opioid: A phenomenological study.

To examine the common meanings of opioid-induced sedation and shared practices in the context of post-operative pain management in expert Post-Anesthesia Care Unit nurses during patient's pain management with opioids. Within the clinical setting, linear pain and sedation scales are not enough to support clinical judgement with acute pain management. Because sedation measurement rests along a fluctuating continuum, it is possible for a patient to be sedated and then shift to increasing alertness, and then to drift back to a sedated state. This potential for acute clinical transition can be challenging to nurses of all levels, even for expert nurses. Interpretive phenomenology. Twenty expert Post-Anesthetic Care Unit nurses, with more than 7years of nursing experience, participated in qualitative interviews regarding their lived experiences. Interviews were analysed using a modified seven-stage process for interpretation by Diekelmann, Allen and Tanner. The manuscript was developed utilising the COREQ guidelines for reporting qualitative studies. Four themes identified through the participant's stories were recognising every patient is different, engaging in iterative knowing, walking a fine line, and looking beyond and anticipating. This study identified a constitutive pattern of interpreting sedation by integrating practical understanding and anticipating beyond. This study indicates a deeper complexity in the way opioid-induced sedation is assessed and balanced with pain management by nurses in the Post-Anesthetic Care Unit. Nurses in the study adapted their practices around pain management with opioids, in response to their patient's level of sedation; incorporating practices such as giving small, incremental doses and changing the drug. Nurses valued the importance of having "eyeballs on everybody" and being ready to meet the needs of their patient. They appreciate the time to watch and wait for their patient to respond, to better judge the result of their interventions.

Ensuring Pediatric Competency for Adult PACU Nurses

Nurses should have good assessment skills; however, post-anesthesia care unit (PACU) nurses must be particularly diligent in monitoring patients and quick to respond in potentially life-threatening situations. Pediatric and adult patients obviously have different needs when recovering from anesthesia and surgical procedures.

Portable X-Ray Radiation Safety Practices in Post-Anesthesia Care Unit Nurses

Portable X-Ray Radiation Safety Practices in Post-Anesthesia Care Unit Nurses

Total Thyroidectomy From A Patient’s Perspective

Total Thyroidectomy From A Patient’s Perspective

Analyses of the phase I postanesthesia care unit baseline capacity and effect of disruptions to its beds or nurse availability on operating room workflow

When there is not a free bed or nurse in the postanesthesia care unit (PACU), the patient recovers in the operating room, preventing the start of the subsequent case(s), until capacity is available in the PACU. We report some real examples of situations in which the capacity of the PACU decreases unexpectedly, and analyse their implications on the operating room workflow. For this purpose, first, different surgical suite sizes are simulated, considering the important factors observed in real time. The baseline capacities of PACU beds and nurses are determined. Then, the characteristics of some situations with less capacity than the baseline are investigated, caused by disruptions of either decreasing the number of beds or nursing hours in the PACU. For example, when the number of PACU beds in 8-OR surgical suites decreases to half of the baseline, the percentage of days with delay increases from 0.22% to 86.79%.

Analyses of the phase I postanesthesia care unit baseline capacity and effect of disruptions to its beds or nurse availability on operating room workflow

When there is not a free bed or nurse in the postanesthesia care unit (PACU), the patient recovers in the operating room, preventing the start of the subsequent case(s), until capacity is available in the PACU. We report some real examples of situations in which the capacity of the PACU decreases unexpectedly, and analyse their implications on the operating room workflow. For this purpose, first, different surgical suite sizes are simulated, considering the important factors observed in real time. The baseline capacities of PACU beds and nurses are determined. Then, the characteristics of some situations with less capacity than the baseline are investigated, caused by disruptions of either decreasing the number of beds or nursing hours in the PACU. For example, when the number of PACU beds in 8-OR surgical suites decreases to half of the baseline, the percentage of days with delay increases from 0.22% to 86.79%.

회복마취 간호사의 셀프리더십, 간호 전문직관, 비판적 사고성향이 임상수행능력에 미치는 영향

본 연구는 회복마취 간호사의 셀프리더십, 간호 전문직관, 비판적 사고성향을 파악하고 임상수행능력에 영향을 미치는 요인을 확인하고자 실시하였다. 서울·경기 지역 회복마취 간호부서에서 근무하는 간호사 193명을 대상으로 자료를 수집하였으며, 임상수행능력은 결혼상태(t=4.627, p<.001), 연령(F=11.092, p<.001), 직위(F=9.302, p<.001), 전체 근무경력(F=10.912, p<.001), 회복마취 간호부서 근무경력(F=9.630, p<.001), 마취전문간호사 자격증 소지여부(F=3.087, p=.002)에 따라 통계적으로 유의한 차이가 있었다. 회복마취간호사의 임상수행능력은 셀프리더십(r=.585, p<.001), 간호 전문직관(r=.394, p<.001), 비판적 사고성향(r=.662, p<.001)과 양의 상관관계로 나타났다. 회복마취간호사의 임상수행능력에 영향을 미치는 요인은 비판적 사고성향(β=.432, p<.001), 전체 근무경력(β=.267, p<.001), 셀프리더십(β=.247, p<.001), 그리고 간호 전문직관(β=.140, p<.001) 순으로 나타났으며, 임상수행능력에 대한 이들 변수의 전체 설명력은 57.7%였다. 본 연구의 결과를 토대로 회복마취간호사의 임상수행능력을 높이기 위해는 셀프리더십과 간호 전문직관을 높일 수 있는 방안이 고려되어야 할 것이라 사료되며, 비판적 사고성향을 갖추기 위한 지속적인 교육과 다양한 전략의 개발 및 운영을 제언한다.The purpose of this study was to identify factors associated with clinical competency of PACU (post-anesthesia care unit) nurses and to examine the relationship among them. A total of 193 nurses participated in this cross-sectional, descriptive study using a structured questionnaire. Self-leadership, nursing professionalism, and critical thinking disposition were positively correlated with clinical competency (r=.585, p<.001; r=.394, p<.001; r=.662, p<.001, respectively). The factors related to clinical competency were critical thinking disposition (β=0.432, p<.001), total clinical career (β=0.267, p<.001), self-leadership (β=0.247, p<.001), and nursing professionalism (β=0.140, p<.001), which accounted for 57.7% of the variance in clinical competency. Critical thinking disposition was the most significant predictor of clinical competency. Thus, in order to enhance the clinical competency of nurses in the PACU, it is necessary to develop and apply an education program that can improve their critical thinking disposition.

Effect of a newly designed observation, response and discharge chart in the Post Anaesthesia Care Unit on patient outcomes: a quasi-expermental study in Australia

ObjectivesThis study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses’ recognition and response to...

Dress Code in the Perianesthesia Setting

QUESTION: DOES THE AMERICAN Society of Perianesthesia Nurses (ASPAN) make any recommendations on whether postanesthesia care unit (PACU) nurses should wear hospital-issued and hospital-laundered scrub attire? Theresa Clifford, MSN, RN, CPAN, CAPA, Perioperative Services, Mercy Hospital, Portland, ME and Former President of American Society of Perianesthesia Nurses from 2009 to 2010.