ANNUAL ASPAN CONFERENCE ABSTRACTS e11

PAIN MANAGEMENT: ACUTE PAIN IN PACUMarsha Craig, RN, MN, CPAN, Ian Wright, MD, Sundeep Malik, MD,

Mary Ersek, RN, PhD, FAAN

Swedish Medical Center, Seattle, WA and Medical Director of Anesthesia

and Chief of Anesthesia and Pain Specialist

There is a lack of research-based protocols for pain management in the

PACU. At our 600 bed facility, anesthesia PACU orders included three opi-

oids for pain management without sequencing or guidelines for alternat-

ing between them. Our PACU nurses chose which IV opioid was to be

administered based upon pain scores and physiological response. Learn-

ing that nurse-determined choice of opioid was ‘‘prescriptive’’ and out-

side scope of practice, our objective was to develop medication-

sequenced anesthesia orders with best-practice nursing protocol for ad-

ministering short and longer-onset opioids. Additional objectives in-

cluded implementing a standardized approach to pain management

and gaining regulatory approval.

Implementation:

� review of pain management literature, discussions with national

experts and consensus with our anesthesia and PACU staff

� in-services with PACU nurses and anesthesia to gain feedback and sup-

port for practice change

� review by administrative ‘‘scope of practice’’ committee

Medication-sequenced anesthesia orders and an acute PACU pain proto-

col were implemented in March 2008. We standardized opioid adminis-

tration and discontinued ‘‘prescriptive’’ practice. CMS auditors granted

approval of our orders and protocol.

Perianesthesia nursing implications include discussion locally and na-

tionally regarding best practice for PACU pain management, opioid ad-

ministration and increased pain management research.

THE IMPACT OF UNIT DESIGN AND THE NEED FORPATIENT ADVOCACYBonnie Crumley Aybar, RN, CPAN, Sheila Swenson, RN, BSN, CAPA

Concord Hospital, Concord, New Hampshire

PACU staff recognized the impact of environmental stressors that di-

rectly correlated to poor unit design and created daily frustration. Provid-

ing quality nursing care in an outdated architecturally designed

department lead to growing concerns for patient safety and privacy, an

inefficient unit flow, and an unprofessional environment of care we

felt reflected on nursing. Administrative allocations for redesign had

been delayed over several years. Staff determined their concerns must

be taken directly to the hospital CEO and proactively planned a meeting

to present their case. Peer input was compiled and a summary of con-

cerns was formulated. The presentation incorporated ASPAN Standards

of Care, JCAHO requirements, HIPAA regulations, PeriAnesthesia Nurs-

ing literature, specific Press Ganey results, including patient safety con-

cerns, new requirements for design and research studies finding’s on

effect of noise on staff and patient outcomes. The meeting was strategi-

cally held in the PACU to allow an enactment of nurse-patient interac-

tions. Following the presentation the CEO requested staff to report

any other safety concerns immediately to the Day Surgery Committee,

and a new unit could be realized within 18 months. A positive outcome

was achieved by presenting our concerns as a group with written, verbal

and visual tools promoting patient advocacy.

WHO YOU GONNA CALL?Brenda Ballard, RN, BSN, Project Leader, Cindy Hinds, RN, BSN,

Amy Newland, RN, ASN, Jenny Willis, RN, BS, ASN

St John’s Health System, Anderson, Indiana

Purpose: To develop a way to meet the safe staffing/call time guidelines

issued in AORN, ASPAN and ISNA (Indiana State Nursing Association).

Method: Developed a creative plan to provide call team coverage while

remaining cost neutral.

Implementation: Prior to implementation of a dedicated call team all

staff rotated through call nights. Each night 4 RNs and 1 CST were on

call for OR and PACU. By cross training RNs to PACU and surgery and add-

ing a CST the hospital was able to decrease the number of call staff

needed. The call team was made salaried staff and was supplied without

addition of FTEs (full time equivalents). Two additional staff members

were placed on back up call in the event of a second case. In meeting

the cost neutral piece of the goal it was decided that call team members

would work 8 hours each week during normal operating hours. This

served to allow the call staff to stay current on changes within the depart-

ment, to attend staff meetings and educational offerings.

Results: The call team was successful in eliminating the fatigue of work-

ing a normal schedule with the addition of call hours. Staff satisfaction

improved as they were no longer working over twelve hours/day. The

plan not only met the goal of cost neutral but resulted in a $100,000 ex-

pense savings in the labor budget. As a result of the weekday call team,

the hospital is looking at the implementation of a weekend call team.

GETTING EVERYONE ON THE SAME PAGE: THE CREATIONOF A MULTIDISCIPLINARY PRE-PROCEDURE CHECKLISTDeidre Devaux, MSN RN, Cynthia Engel, RN, Maureen MacDonald, RN,

Roberta Bernard, BS AD RN, Katrina Bickerstaff, BSN, RN, CPAN, CAPA,

Ellen Sullivan, BSN, RN, CPAN

Brigham and Women’s Hospital, Boston, Massachusetts

The Perianesthesia leadership convened a group of frontline nurses and

ancillary staff to look at process improvement in our Perianesthesia

areas. One area identified was the need for a pre-procedure multidisci-

plinary checklist to verify that all required elements are present in the

patient’s medical record. Identification of missing elements early in the

pre-op process helps to prevent or minimize delays into the Operating

Room. This checklist has brought the attention of Nursing, Anesthesiol-

ogy and Surgical staff to one form with the goal of patient safety being at

the core of our process improvement.