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Pre-Surgical Patients are “In Tune” with Music Program
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Transcript of Pre-Surgical Patients are “In Tune” with Music Program
ANNUAL ASPAN CONFERENCE ABSTRACTS 191
IMPROVING PERIOPERATIVE GLYCEMIC CONTROLPresenter: Nancy Michaelian, BSN, RN, CPAN
SDI Perianesthesia, Pinnacle Health System, Harrisburg, PA
Background: Studies supporting tighter glucose control show that hy-
perglycemia, especially . 200 mg/dl, increases the risk of developing
postoperative infections. Controlling blood glucose may decrease perio-
perative morbidity and mortality in certain patient populations such as
cardiac surgery, but little is known about implementation of a hospital-
wide program.
Objectives: To determine the effectiveness of a perioperative glycemic
control program for diabetic patients admitted on the day of surgery.
Process: Protocols for perioperative education and blood glucose man-
agement were developed. Prior to admission, patients received standard-
ized education about oral medications and insulin. On arrival, patients
with BG levels . 180 mg/dl received insulin based on a sliding scale pro-
tocol, were monitored intra- and post-operatively and received addi-
tional insulin if needed.
Statement of successful practice: Mean blood glucose on arrival im-
proved from 191 to 155 mg/dL (p 5 0.016). Patients with blood glucose
. 180 mg/dL preoperatively improved from 51% to 26%. Mean postop-
erative blood glucose level improved from 189 mg/dL to 168 mg/dL, and
percentage . 180 mg/dL decreased from 59% to 37%. Hypoglycemia
rates remained low.
Implications for Advancing the Practice of Perianesthesia Nurs-
ing: Perianesthesia nurses play an important role in glycemic control
for diabetic patients undergoing surgery. A nursing led protocol which
standardized preoperative education, testing and treatment of elevated
blood glucose safely improves perioperative glycemic control.
IMPROVING SCIP COMPLIANCE THROUGH FLIGHTCHECKEmily Mickelwait, RN, BSN, CPAN, CAPA
Inova Fair Oaks Hospital, Fairfax, VA
The Surgical Care Improvement Project (SCIP) has become an integral
part of Surgical Services across the Nation. At Inova Fair Oaks Hospital,
our initial compliance with SCIP recommendations for almost all mea-
sures was around 70% for over a year. Our objective was to provide ‘per-
fect care’ to our patients on a consistent basis. A multi-disciplinary team
was assembled in 2008 to improve our compliance with these measures
and gain a sustained improvement. We developed a ‘Flight Check’ to go
along with our ‘Boarding Pass’ to make sure every surgical patient gets
perfect care. A lot of education and improved processes have us report-
ing 95-100% compliance in all measures for 2009.
Care of the PeriAnestheisa patient is a multidisciplinary team approach.
Providing ‘perfect care’ is a lofty but achievable goal when all who touch
the patient are in tune with the evidenced based practice of SCIP.
IMPROVING PATIENT FLOW: A HANDOFF SYSTEM FROMTHE PACU TO INPATIENT AREA MEMORIAL SLOANKETTERING CANCER CENTERStephanie Nolan, MSN, RN, CPAN, Jacquelyn Burns, MSN, RN,
Debra Rodrigue, BA, RN, CNS, Glendacy Thom, RN,
Elizabeth Larson, BSN, RN, Colleen Germaine, UA, Eileen Rooney, BSN,
RN, CPAN, Mary Yanolatos, BSN, RN, Wanda Rodriguez, MA, RN, CNS,
CCRN, CPAN
Background: Current telephone handoff report process between PACU
RN and Inpatient RN was frustrating and inefficient. It required multiple
phone calls, taking nurses away from patient care and causing delays in
transfers.
Objective: Handoff report to be given on first phone call attempt
Implementation: Nursing representation from both inpatient unit and
PACU discussed current process, conducted literature review and strat-
egized on methods of improvement. Building on a model developed by
our ASPAN colleagues at Bringham and Woman’s Hospital PACU, a system
was implemented to alert staff in advance via telephone call that the in-
patient RN would be receiving report from the PACU RN in twenty min-
utes.
Successful practice: Data showed enhanced reporting times, de-
creased phone call attempts and improvement in patient flow. Advanced
notification of patient transfer, allowed the inpatient nurse to prepare for
report and the patients arrival, ultimately improving patient safety.
Nurses in both areas reported decreased telephone time led to increased
available time for direct patient care and strengthened relationships be-
tween units.
Implications for advancing practice: The system assists in maintain-
ing an efficient PACU patient flow, facilitating OR efficiency, cost contain-
ment, patient safety, staff job satisfaction and patient and family
satisfaction
PRE-SURGICAL PATIENTS ARE ‘‘IN TUNE’’ WITH MUSICPROGRAMStephanie Nolan, MSN, RN, CPAN, Memorial Sloan Kettering Cancer
Center, New York, NY
Leonore DeLince, RN, BA, BS, Shirley Thevenin, BS, MPH,Unit Assistant,
Betty Kane, RN, Anne Walsh, MS, RN, OCN, Lori Gofter, BSN, RN, OCN,
Frank Morales, III Unit Assistant
Background: Anxiety is common in the Pre-Surgical patient, affecting
both their emotional and physical well being. This can result in increased
vital signs, hypothermia and nausea. Traditional treatments such as med-
ications, warm blankets and soft lighting aren’t always successful. If
these symptoms are not controlled, surgeries can be delayed or even can-
celled.
Objective: To provide comfort and reduce anxiety of the pre-surgical pa-
tient through a music alternative.
Implementation: A music program was introduced in the
Pre –Surgical Center. Patients are offered a Music Menu that lists a variety
CD’s to listen to during their peri-operative experience. The menu’s
choices range from Classical, Relaxation and Subliminal to Popular,
Jazz and R&B.
Successful Practice: Patients have verbalized their pleasure at having
the music available. Nurses report the music program has had a positive
effect on patient’s vital signs and mood. The Peri-Operative Music Pro-
gram not only provides patients with a sense of calm but also a sense
of control since they choose the music they want to listen to.
Implications for the Peri-Anesthesia Nurse: Music is a non-pharma-
cological, non-invasive and inexpensive way to aide patient’s pre-op anx-
iety.