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Clinical practice and routines for day surgery in Sweden: implications for improvement in nursing interventions.

https://arctichealth.org/en/permalink/ahliterature154671
Source
J Perianesth Nurs. 2008 Oct;23(5):311-20
Publication Type
Article
Date
Oct-2008
Author
M Warrén Stomberg
M. Segerdahl
N. Rawal
J. Jakobsson
M. Brattwall
Author Affiliation
School of Life Sciences at the University of Skövde, Skövde, Sweden. margareta.warren.stomberg@his.se
Source
J Perianesth Nurs. 2008 Oct;23(5):311-20
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Ambulatory Surgical Procedures
Humans
Pain Measurement
Pain, Postoperative
Postanesthesia Nursing - standards
Preoperative Care
Questionnaires
Sweden
Abstract
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.
PubMed ID
18926477 View in PubMed
Less detail
Source
J Perianesth Nurs. 2002 Feb;17(1):21-9
Publication Type
Article
Date
Feb-2002
Author
Terri Kitowski
Helena McNeil
Author Affiliation
PACU, Perioperative Services, Hamilton, Ontario, Canada.
Source
J Perianesth Nurs. 2002 Feb;17(1):21-9
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Acute Disease
Canada
Humans
Models, organizational
Nurse's Role
Organizational Policy
Pain, Postoperative - nursing
Postanesthesia Nursing - organization & administration - standards
Treatment Outcome
Abstract
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.
PubMed ID
11845421 View in PubMed
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Exposure to exhaled nitrous oxide in hospitals post-anesthesia care units.

https://arctichealth.org/en/permalink/ahliterature163700
Source
Ind Health. 2007 Apr;45(2):334-7
Publication Type
Article
Date
Apr-2007
Author
Ataolah Nayebzadeh
Author Affiliation
McGill University Health Center, Brossard, Canada.
Source
Ind Health. 2007 Apr;45(2):334-7
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Adult
Air Pollutants, Occupational - analysis - toxicity
Air Pollution, Indoor - adverse effects - analysis
Exhalation
Female
Humans
Maximum Allowable Concentration
Middle Aged
Nitrous Oxide - analysis - toxicity
Occupational Exposure - adverse effects - analysis - prevention & control
Personnel, Hospital
Postanesthesia Nursing - standards
Quebec
Recovery Room - standards
Reproduction - drug effects
Time Factors
Ventilation - methods - standards
Abstract
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.
PubMed ID
17485879 View in PubMed
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Fast-tracking (bypassing the PACU) does not reduce nursing workload after ambulatory surgery.

https://arctichealth.org/en/permalink/ahliterature178310
Source
Br J Anaesth. 2004 Dec;93(6):768-74
Publication Type
Article
Date
Dec-2004
Author
D. Song
F. Chung
M. Ronayne
B. Ward
S. Yogendran
C. Sibbick
Author Affiliation
Department of Anesthesia, Toronto Western Hospital and Nursing Information Systems, Toronto General Hospital, University Health Network, University of Toronto, Canada.
Source
Br J Anaesth. 2004 Dec;93(6):768-74
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Ambulatory Surgical Procedures - methods
Anesthesia Recovery Period
Clinical Nursing Research
Electroencephalography
Hospital Costs
Humans
Length of Stay
Middle Aged
Monitoring, Intraoperative - methods
Ontario
Postanesthesia Nursing - economics - organization & administration
Postoperative Care - economics - methods
Recovery Room
Workload
Abstract
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.
Notes
Comment In: Br J Anaesth. 2004 Dec;93(6):756-815533955
PubMed ID
15377581 View in PubMed
Less detail
Source
Can Nurse. 1995 Dec;91(11):39-40
Publication Type
Article
Date
Dec-1995
Author
L. Sanchez-Sweatman
Source
Can Nurse. 1995 Dec;91(11):39-40
Date
Dec-1995
Language
English
Publication Type
Article
Keywords
Adult
Canada
Child
Cholecystectomy - nursing
Fatal Outcome
Female
Humans
Male
Malpractice - legislation & jurisprudence
Middle Aged
Nursing Staff, Hospital - legislation & jurisprudence
Personnel Staffing and Scheduling
Postanesthesia Nursing - legislation & jurisprudence
Abstract
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.
PubMed ID
8713150 View in PubMed
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Nursing workload associated with adverse events in the postanesthesia care unit.

https://arctichealth.org/en/permalink/ahliterature200006
Source
Anesthesiology. 1999 Dec;91(6):1882-90
Publication Type
Article
Date
Dec-1999
Author
M M Cohen
L L O'Brien-Pallas
C. Copplestone
R. Wall
J. Porter
D K Rose
Author Affiliation
Department of Health Administration, Faculty of Medicine, University of Toronto, Ontario, Canada. mmcohen@istar.ca
Source
Anesthesiology. 1999 Dec;91(6):1882-90
Date
Dec-1999
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anesthesia - adverse effects
Canada
Databases, Factual
Female
Humans
Intensive Care Units - economics
Male
Middle Aged
Models, organizational
Postanesthesia Nursing - economics
Postoperative Nausea and Vomiting - nursing
Regression Analysis
Sample Size
Workload - economics
Abstract
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.
PubMed ID
10598633 View in PubMed
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Oh, by the way, the patient is pregnant!

https://arctichealth.org/en/permalink/ahliterature155844
Source
Can Oper Room Nurs J. 2008 Jun;26(2):35, 37-9, 41-2
Publication Type
Article
Date
Jun-2008
Author
Joan Porteous
Author Affiliation
Health Sciences Centre, Winnipeg, MB.
Source
Can Oper Room Nurs J. 2008 Jun;26(2):35, 37-9, 41-2
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Canada
Female
Fetal Monitoring
Humans
Nurse's Role
Nursing Assessment
Operating Room Nursing - organization & administration
Organizational Objectives
Patient Care Planning - organization & administration
Perioperative Care - methods - nursing
Postanesthesia Nursing - methods
Posture
Practice Guidelines as Topic
Pregnancy
Pregnancy Complications - nursing - surgery
Safety Management
Abstract
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.
PubMed ID
18678199 View in PubMed
Less detail

Patient flow in the Post Anesthesia Care Unit: an observational study.

https://arctichealth.org/en/permalink/ahliterature202217
Source
Can J Anaesth. 1999 Apr;46(4):348-51
Publication Type
Article
Date
Apr-1999
Author
M J Tessler
L. Mitmaker
R M Wahba
C R Covert
Author Affiliation
Department of Anesthesia, SMBD-Jewish General Hospital and McGill University, Montreal, Quebec, Canada. mtessler@ana.jgh.mcgill.ca
Source
Can J Anaesth. 1999 Apr;46(4):348-51
Date
Apr-1999
Language
English
Publication Type
Article
Keywords
Anesthesia Recovery Period
Anesthesia, Conduction
Anesthesia, Epidural
Anesthesia, General
Anesthesia, Local
Anesthesia, Spinal
Humans
Length of Stay - statistics & numerical data
Nerve Block
Patient Discharge - statistics & numerical data
Patients' Rooms - organization & administration
Personnel, Hospital - statistics & numerical data
Postanesthesia Nursing - organization & administration - statistics & numerical data
Quebec - epidemiology
Recovery Room - organization & administration - statistics & numerical data
Time Factors
Transportation of Patients - organization & administration
Abstract
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.
PubMed ID
10232718 View in PubMed
Less detail

Patients' perception of music versus ordinary sound in a postanaesthesia care unit: a randomised crossover trial.

https://arctichealth.org/en/permalink/ahliterature95244
Source
Intensive Crit Care Nurs. 2009 Aug;25(4):208-13
Publication Type
Article
Date
Aug-2009
Author
Fredriksson Ann-Charlotte
Hellström Leif
Nilsson Ulrica
Author Affiliation
Dep. Anesthesia and Intensive Care, Malmoe University Hospital, Sweden.
Source
Intensive Crit Care Nurs. 2009 Aug;25(4):208-13
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Anesthesia Recovery Period
Attitude to Health
Chi-Square Distribution
Choice Behavior
Clinical Nursing Research
Cross-Over Studies
Female
Health Facility Environment
Humans
Male
Middle Aged
Music Therapy - organization & administration
Postanesthesia Nursing
Postoperative Care - methods - nursing - psychology
Prospective Studies
Questionnaires
Recovery Room - organization & administration
Single-Blind Method
Statistics, nonparametric
Sweden
Treatment Outcome
Abstract
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
PubMed ID
19446459 View in PubMed
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The perioperative dialogue reduces postoperative stress in children undergoing day surgery as confirmed by salivary cortisol.

https://arctichealth.org/en/permalink/ahliterature132840
Source
Paediatr Anaesth. 2011 Oct;21(10):1058-65
Publication Type
Article
Date
Oct-2011
Author
Berith Wennström
Carl-Johan Törnhage
Salmir Nasic
Hans Hedelin
Ingrid Bergh
Author Affiliation
Department of Anaesthesia, Skaraborg Hospital, Skövde, Sweden. berith.wennstroem@telia.com
Source
Paediatr Anaesth. 2011 Oct;21(10):1058-65
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Ambulatory Surgical Procedures
Analgesics, Opioid - administration & dosage - therapeutic use
Anesthesia, General
Child
Child, Preschool
Female
Humans
Hydrocortisone - metabolism
Male
Morphine - administration & dosage - therapeutic use
Nurse Anesthetists
Pain Measurement
Patient satisfaction
Perioperative Care
Postanesthesia Nursing
Postoperative Care
Postoperative Complications - prevention & control
Saliva - metabolism
Stress, Psychological - prevention & control
Sweden
Treatment Outcome
Abstract
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
PubMed ID
21771174 View in PubMed
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17 records – page 1 of 2.