e40 ASPAN NATIONAL CONFERENCE ABSTRACTS

upper airway. (2008) In the Perioperative setting, patients with

diagnosed or suspected OSA are managed closely due to a po-

tential for complications. The American Society of Anesthesia

(ASA) and the American Society of Perianesthesia Nurses

(ASPAN) have adopted guidelines for the care of the OSA

patient. This institution is in the process of developing guide-

lines for the OSA population.

The purpose of this research was to answer the following

questions: What is the Phase I length of stay for the known

OSA patient with or without a Bipap machine? Were there

any adverse respiratory events in the first 3 post-operative

days?

This descriptive quantative study focuses on 50 randomized

diagnosed OSA patients at a community hospital. The inclu-

sion criteria were: patients with a diagnosis of OSA undergo-

ing surgery and requiring admission. Data was obtained

through current/concurrent chart review. Patients were fol-

lowed for three days postoperatively with a follow up phone

call made one week post discharge. Fourteen patients of the

50 patients had identifiable respiratory events in Phase I peri-

anesthesia unit (PACU). Their oxygen saturations ranged

from 77%-88% on arrival in PACU. To correct hypoxia, nine

required Continuous Positive Airway Pressure (CPAP) and

five required airway maneuvers. For these patients, length

of stay in the PACU was 1-7 hours. Thirteen of the event pa-

tients received general anesthesia. No apnec events were

recorded for any of the patients on 3 consecutive post oper-

ative days. Only 25 patients were able to be reached for the

postoperative phone call. The patients who did not have

CPAP machines, reported nightmares, trouble sleeping and

daytime sleepiness. Only 3 patients used their CPAP when

napping during the day.

Findings of this study maybe used in the development of institu-

tional specific guidelines. OSA patients requiring general anes-

thesia require closer peri-operative monitoring to ensure

adequate respiratory function. A multidisciplinary approach is

needed for the safety of the OSA patient. Nursing staff must

be vigilant for patient complications. Nursing and respiratory

therapy need to encourage patient compliance with CPAP

equipment.

References

Practice Guidelines for the Perioperative management of pa-

tients with obstructive sleep apnea. (2006, May). Anesthesi-

ology, (104), 1543-1563.

Chung, B. Yuan, H. & Chung, F. (2008, Nov.). A systemic review

of obstructive sleep apnea and its implications for anesthesiolo-

gists. Anesthesia and Analgesia. (107), 1543-1563.

Doyle, J. (2009). Obstructive sleep apnea and the surgical pa-

tient. What the anesthesiologist should know. Anesthesiology

News Guide to Airway Management. 7-12.

Ead, H. (2009, April). Meeting the challenge of obstructive sleep

apnea: Developing a protocol that guides perianesthesia patient

care. JOPAN (24), 103-113.

Gali, D. et. al. (2007, April). Management plan to reduce risks in

Perioperative care of the patient with presumed obstructive

sleep apnea syndrome. Journal of Clinical Sleep Medicine.

(6) 1128-1134.

Hwang, D. et. al. (2008, May). Association of sleep disordered

breathing with postoperative complications. Chest Journal.

(5). 1128-1134.

USING PICTURE COMMUNICATION TO ASSESSPAIN LOCATION IN CHILDRENPrimary Investigator: Phyllis J. Mesko, RN, CPN

Akron Children’s Hospital, Akron, Ohio

Co-Investigator: Aris Eliades, PhD, RN, CNS

Introduction/Problem: This study expands on findings sup-

porting that picture communication tools effectively assess

pain location.

Purpose: The study seeks to determine effectiveness of a pic-

ture communication aid, the Mesko-Eliades Pain Area Locator

(PAL) tool, and parent satisfaction with the use of the PAL

among post-anesthesia pediatric patients (ages 3 to 9 years) un-

dergoing a broad range of same-day surgical procedures.

Methodology: Employing a quantitative, comparative design, a

convenience sample of post-operative patients undergoing

same day surgeries was recruited at a freestanding, Magnet

designated pediatric hospital. Post-operative pain location

assessment was performed in the PACU by two individuals: 1)

a PACU nurse completed standard pain assessment; 2) a non-

PACU data collector performed a second pain location assess-

ment with the PAL. Parent Satisfaction was measured through

completion of a ten item satisfaction survey.

Results: To determine consistency between the pain assessment

by the nurse and data collector (using the PAL to determine pain

location), the proportion of agreement, ranging from 0 to 1, was

calculated for41participants. Themeanproportionof agreement

was 0.24 (SD 5 0.435) which is significantly lower than 1, t 5-11.136, p 5 .000. Parent survey responses exceeded historical

data. For the item “Nurses concern for comfort”, the response

of 100% was higher compared to historical data (m 5 93.3%).

For the item “Degree pain was controlled”, the mean response

of 97.3% was higher compared to historical data (m5 93%).

Discussion/Conclusion: Post-anesthesia pediatric patients

undergoing a broad range of same-day surgical procedures

effectively used the PAL to identify location of pain. There

was an inconsistency between the nurse’s assessment of pain

location and the pain location identified by the child using

the PAL. Parents were highly satisfied with the PAL.

Implications for Perianesthesia Nurses and Future

Research: Perianesthesia clinical practice standards are

advanced by the findings that patients undergoing a variety of

pediatric surgical procedures effectively used the PAL post-oper-

atively to identify location of pain and parent satisfaction with

the PAL increased compared to standard pain location assess-

ment. Studies establishing reliability and validity and random-

ized intervention studies on the use of the PAL are indicated.

PERI-OPERATIVE HYPOTHERMIA: ACTIVE VSPASSIVE WARMINGPrimary Investigators: Jenise Rice, MSN, RN, CPAN

UT MD Anderson Cancer Center, Houston, Texas

Co-Investigators: Karen Salinas, BSN, RN, CPAN, Kate

Mask, MSN, RN, CPAN, Elsy Puthenparampil, MSN, RN-BC, CPAN

Identification of the problem: Peri-operative hypothermia

has been associated with a range of adverse effects. During a

ASPAN NATIONAL CONFERENCE ABSTRACTS e41

random chart audit, an inconsistency was discovered in moni-

toring temperatures within 15 minutes of the patient’s arrival

to the Post Anesthesia Care Unit (PACU) per ASPAN standards.

Many newly hired staff were not aware of this standard and

its importance as it relates to the treatment of hypothermia.

This caused a problem in timely recognition and management

of hypothermia in patients admitted to PACU. In order to

achieve the best outcomes for patients with hypothermia, a

literature search was performed to determine the best method

of warming.

EP Question/ Purpose: The EBP team reviewed the literature

for best evidence on the most effective method to maintain

normothermia in adult PACU patients: active or passive

warming?

Methods/ Evidence: A systematic literature review was con-

ducted using key words: perioperative warming, perioperative

hypothermia, perioperative normothermia in electronic data-

bases including PubMed, SCOPUS, CINAHL, Cochrane and

Ovid. The search was limited to Humans, Adult patients, and

English. Thirteen articles were selected.

Significance of Findings/Outcomes: Maintaining normo-

thermia throughout the perioperative environment reduces

the total costs for anesthetic treatment through lower incidence

of mechanical ventilation, reduced intraoperative blood loss,

and shorter PACU stays. Active warming with circulating water

garments and forced-air warming were more effective at

maintaining perioperative normothermia and preventing post--

operative hypothermia compared to passive warming interven-

tions. Circulating water garments were found to be more

effective in active warming than forced-air warming. A unit

wide education using PowerPoint presentation and team

huddles preceded the implementation of the Clinical Practice

Guideline. Clinical leaders in the unit function as resource in

supporting and monitoring the new practice.

Implication for peri-anesthesia and future research: Evi-

dence supports the implementation of Clinical Practice

Guideline to standardize monitoring and management of hypo-

thermia in PACU and the use of forced-air warming to improve

patient outcomes that include decreased rates of surgical site

infection, increased thermal comfort and decreased PACU stay.

Further research on the advantage of active warming with circu-

lating water garments compared to forced air warming is recom-

mended.

EFFECT OF AN INDIVIDUALIZED INSTRUCTIONFORM ON PATIENT KNOWLEDGE OFPERIOPERATIVE ANTICOAGULANT AND/ORANTIPLATELET MEDICATION MANAGEMENTPrimary Investigators: Carolyn Scratchard, RN, MSN-NSA,

Angela Jones, RN, BSN(c), CAPA

Cooper University Hospital e Voorhees Surgical Center,

Voorhees, New Jersey

Introduction:Management of perioperative patients who take

anticoagulant/antiplatelet medications is an important patient

safety issue. The U.S. Joint Commission (2013) identified the

need to decrease patient injury associated with the use of anti-

coagulant therapy as a Hospital National Patient Safety Goal and

suggested practice change. One such practice change is the for-

mation of medication management plans specific to the use of

anticoagulant/antiplatelet medications. It was further sug-

gested that these management plans be a multi-disciplinary

approach (Thachil, 2008).

Problem: While conducting pre-health assessments preadmis-

sion nurses discovered that some patients who take anticoagu-

lant/antiplatelet medications do not understand how tomanage

these medications perioperatively.

Purpose: Evaluation of whether or not same day surgical pa-

tients who take prescribed anticoagulant/antiplatelet medica-

tion and receive individualized education have increased

knowledge on how to manage these medications periopera-

tively compared to patients who received standard care.

Methodology: This randomized clinical trial interviewed sixty

adult patients scheduled for same day surgery who take pre-

scribed anticoagulant/antiplatelet medication. Randomly

distributed into two groups, patients were either given an indi-

vidualized instruction form or did not receive individualized in-

struction and were assessed using the standard interview

practice of the surgical center. Patient knowledge was assessed

by asking both groups identical questions. Data was analyzed

using chi-square to determine p values.

Results: This study demonstrated a significant improvement in

knowledge regarding anticoagulant/antiplatelet medications

among patients who received individualized education. One

hundred percent of the patients receiving this education under-

stood their medication usage compared to 50% who knew

when to stop (, .01) and 7% who knew when to restart

(, .01) following surgery.

Discussion: The multi-disciplinary approach utilized focuses

on promoting high quality patient-centered care and promotes

maximum patient safety throughout the perioperative process.

Conclusion: The use of an individualized instruction form

involving collaboration of the surgeon and the physician pre-

scribing the anticoagulant/antiplatelet medication showed an

increase in patient knowledge on how to manage these medica-

tions perioperatively.

Implications: This improved communication and increased

patient knowledge about anticoagulant/antiplatelet medication

has the potential to decrease unintentional adverse events.

THE ASSESSMENT OF PEDIATRIC POST-OPERATIVE PAIN AND ITS TRANSLATION INTOPRACTICEPrimary Investigator: Kelly Ann Zazyczny, RN, MSN, CPN

Patient Care Manager Pediatric Unit, Bryn Mawr Hospital, Bryn

Mawr, Pennsylvania

Co-Investigators: Kathy Irwin, RN, BSN, Patricia Snyder, RN,

BSN, CAPA, Sara J. Reeder, PhD, RN, Michael Chernick, PhD

Introduction: The American Pain Society created a policy

statement in 1995 coining the phrase “pain-the fifth vital

sign”. Since 2000, there have been guidelines published that

emphasize the need for improved identification and manage-

ment of pain in children.

Identification of the problem: Despite the advancements in

the assessment and management of pediatric pain, it is esti-

mated that pediatric patients are under medicated for pain

relief.