The purpose of this study was to examine nursing practice in day surgery settings in Sweden. A questionnaire focusing on the routines of the day surgery process of patients in Sweden was administered. Based on these findings, appropriate nursing interventions are outlined and discussed. Day surgery routines were in accordance with general worldwide practice. The study revealed that nursing involvement was rare in the preoperative routine. In addition, the major part of the recovery process, including assessments of discharge eligibility and information about pain management, was managed by PACU nurses. The nurse follow-up revealed a number of subjective queries and symptoms that, in a seemingly easy way, could have been prevented by further perianesthesia/perioperative patient education. There is an obvious place for nursing interventions when the decision for day surgery is taken. These interventions should focus on providing the patient with information before surgery, preoperative patient health screening, and information/education at discharge. Furthermore, nursing interventions should include quality assurance, such as follow-up calls for the evaluation of care, as well as providing information and coaching for the patient at home.
Implementation of an acute pain nurse role and the expansion of the Acute Pain Service (APS) at a newly merged Canadian hospital system led to an evaluation of these programs. A literature review of APSs showed that the services with an APS nurse had improved patient outcomes. As a result, a PACU nurse was added to the APS at all hospitals, and all services were restructured. Surveys conducted one year after this reorganization showed very positive response ratings in the areas of quality of care, but mixed results in other areas including education and job satisfaction. Flow diagrams for the clinical units were developed, and both structured and informal education sessions were provided. The description of the APS nurse's role was also redefined.
Due to the present evidence for reproductive toxicity of nitrous oxide (N(2)O) among female personnel in health care, exposure of 17 female workers employed in two post-anesthesia care units was evaluated. Geometric mean concentration of nitrous oxide for six recovery room personnel was 3.1 ppm versus 1.17 ppm for eleven employees in surgical nursing units. The longest time needed to reach zero concentration of nitrous oxide in postoperative nursing units was 9.5 h. The result of correlation analysis did neither show any association between duration of nitrous oxide exhaled from patients and patient-related factors. It is very unlikely that these low exposure levels can cause any adverse health effect among pregnant PACU employees. However, for those institutions that seek extra protective measures, reassignment of pregnant employees needs to be extended for several hours after a patient is admitted in the PACU units.
Department of Anesthesia, Toronto Western Hospital and Nursing Information Systems, Toronto General Hospital, University Health Network, University of Toronto, Canada.
Postoperative day-case patients are usually allowed to recover from anaesthesia in a postanaesthesia care unit (PACU) before transfer back to the day surgical unit (DSU). Bypassing the PACU can decrease recovery time after day surgery. Cost savings may result from a reduced nursing workload associated with the decreased recovery time. This study was designed to evaluate the effects of bypassing the PACU on patient recovery time and nursing workload and costs.
Two hundred and seven consenting outpatients undergoing day surgery procedures were enrolled. Anaesthesia was induced and maintained with a standardized technique and the electroencephalographic bispectral index was monitored and maintained at 40-60 during anaesthetic maintenance. At the end of surgery, patients were randomly assigned to either a routine or fast-tracking (FT) group. Patients in the FT group were transferred from the operating room to the DSU (i.e. bypassing the PACU) if they achieved the FT criteria. All other patients were transferred to the PACU and then to the DSU. Nursing workload was evaluated using a patient care hour chart based on the type and frequency of nursing interventions in the PACU and DSU. A cost associated with the nursing workload was calculated.
The overall time from end of anaesthesia to discharge home was significantly decreased in the fast-tracking group. However, overall patient care hours and costs were similar in the two recovery groups.
Bypassing the PACU after these short outpatient procedures significantly decreases recovery time without compromising patient satisfaction. However, the overall nursing workload and the associated cost were not significantly affected.
During nurses' shifts, whether they are seven or 12 hours long, breaks are scheduled. The number and time of these breaks varies among institutions but is usually reflected in collective agreements or employment contracts. These breaks are important so nurses can, rest but they need to be scheduled and taken with care. The three cases reviewed below outline the responsibilities of both the charge nurse and staff nurse when scheduling and taking breaks.
The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU).
Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU.
The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU.
Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.
Approximately one to three per cent of pregnant women undergo surgery that is unrelated to their pregnancy. In Canada this represents about 5,000 patients each year that present unique challenges to the perioperative nurse and the entire surgical team. Approximately five to ten per cent of these patients are involved in trauma, which causes 46.3% of maternal deaths. A small percentage of elective procedures are carried out in the first trimester, before the patient herself is aware of the procedure. The majority of procedures are required for urgent and emergent conditions that require surgery despite the risks to the mother and fetus. This article will discuss perioperative care of the non-obstetric pregnant patient and to introduce a nursing care guideline that can be used as a quick-reference tool. The care discussed in the appended Guideline focuses on the pregnant condition and is to be used in conjunction with routine perioperative care practices. Semi-elective and urgent surgery is not contraindicated by pregnancy, although anesthetic and surgical approaches must be modified to promote the safety of mother and her fetus. If possible, the surgery should be postponed to the second trimester. By this time major systems of the fetus are formed and the uterus does not yet infringe on abdominal structures and manipulation may be kept to a minimum. In the first trimester, spontaneous abortion is the greatest risk at 12%. This decreases to less than five per cent in the second and third trimesters. Pre-term labor presents the greatest risk in the second and third trimesters. The most common need for surgery in pregnancy is associated with appendicitis, biliary tract disease, intestinal obstruction, urinary calculi and trauma.
Anesthesiologists are constantly striving for improvement in health care delivery. We assessed the patient flow in the Post Anesthesia Care Unit (PACU) to determine if patients are being transported out of the PACU when ready.
A University student recorded the flow of 336 patients who recovered in our Post Anesthesia Care Unit. The corresponding nursing and orderly complements were recorded. If a delay arose between the time the patient was deemed fit for discharge by the PACU nurse and the time the patient was transported from the PACU, the student determined the duration and cause(s) of the delay.
The number of patients, nurses, and orderlies increased from three to twelve, three to seven, and one to two respectively throughout the elective working day. Seventy-six per cent of patients studied were delayed in transport from the PACU, with 26% of patients waiting 30 min. The average delay in discharge for patients increased during the day from 0 to 65 +/- 54 min from the time of fit for discharge, as determined by the PACU nurse, until transport. Five causes were identified as contributing to the delay: orderly too busy (41%), awaiting Anesthesia assessment (36%), Post Anesthesia Care Unit nurse too busy (15%), receiving floor not ready (6%), and patient awaiting radiographic interpretation (2%).
Our study has shown that system errors unnecessarily prolongs the stay of patients in the PACU.
We performed an experimental single-blind crossover design study in a postanaesthesia care unit (PACU): (i) to test the hypothesis that patients will experience a higher degree of wellbeing if they listen to music compared to ordinary PACU sounds during their early postoperative care, (ii) to determine if there is a difference over time, and (iii) to evaluate the importance of the acoustic environment and whether patients prefer listening to music during their stay. Two groups received a three-phase intervention: one group (n=23) experienced music-ordinary sound-music and the second group (n=21) experienced ordinary sound-music-ordinary sound. Each period lasted 30 min, and after each period the patients assessed their experience of the sound. The results demonstrated a significant difference (p
To evaluate the efficacy of 'the perioperative dialogue (PD)' by analyzing salivary cortisol, in 5- to 11-year-old children undergoing day surgery.
To deal with anxiety prior to investigations and/or procedures, children need to be confident and informed about what is going to happen. Therefore, intervention strategies should be initiated before admission to hospital.
Children (n = 93), 79 boys and 14 girls, scheduled for elective day surgery requiring general anesthesia were randomly recruited into three groups: (i) standard perioperative care (n = 31), (ii) standard perioperative care including preoperative information (n = 31), and (iii) the PD (n = 31). Saliva was sampled for cortisol analysis at specific time points during the pre- and perioperative procedures.
The children who received the PD had significantly lower (P = 0.003) salivary cortisol concentrations postoperatively. Moreover, it continuously decreased during the day of surgery compared with the other two groups (P
