192 ASPAN NATIONAL CONFERENCE ABSTRACTS

� Veins are preserved, less patient discomfort from numer-

ous attempts

� Reduced incidence of lost patient belongings

� Use of pre op checklist ensures complete patient prepara-

tion

� Improved safety of ICU patients who used to be trans-

ported by BLS/ACLS certified non critical care trained

OU nurses

Positive Outcomes Achieved:

� Improved efficiency in patient preparation for surgery

� Patient and staff satisfaction

Implications for Perianesthesia Nurses:

� Enhanced patient safety

� Staff satisfaction with streamlined process

NURSING JOURNAL CLUB: BRIDGING THE GAPBETWEEN PRACTICE AND RESEARCHTeam Leader: Sylva L. McClurkin, MSN, RN, CAPA

St. Luke’s Episcopal Hospital, Houston, Texas

Lillian Bailey, BSN, RN, CAPA, Meggie Kwan, BSN, RN, CAPA

With the constant changes in health care delivery and the de-

mands of quality patient care, the professional nurse must con-

tinue to stay abreast of the current evidence-based practices

(EBP) in the provision of care. Keeping upwith new knowledge

can be a difficult task, especially if the staff nurses feel that

resources are limited or there is just no time to assess research

evidence while meeting patient demands. The formation of

a nursing unit journal club is one way of connecting research

to practice.

The journal club in our unit was first implemented at the start of

this year. Among the objectives of the club are to improve nurs-

ing knowledge of current research findings, foster the applica-

tion of clinical research, and best practice models to nursing

practice, and help the participants enhance the development

of systematic critiquing, critical appraisal and evaluative skills.

The initial meeting discussed some of the guidelines and the ob-

jectives. It was agreed that whoever was assigned to bring the

article would have to send it out by e-mail and post copies at

strategic areas of the unit so that the staff will have a chance

to review it. An article review tool was developed that helps

the staff in the appraisal of the article. Since its inception, the

staff has developed a heightened awareness in the critiquing

process. It is the intention of this club that it will generate

new ideas in developing research projects that are focused on

perianesthesia nursing.

PURE SCALE: A VALIDATED TOOL FOR THEPREDICTION OF PERIOPERATIVE PRESSUREULCERSPrimary Investigator: Carol Nicoladis, BSN, RN, CPAN

The Methodist Hospital, Houston, Texas

Co-Investigators: Janet Gilmore, MSN, RN, Michelle Brents,

MSN, RN, CNOR, Art Shumate, BSN, RN, Jocelyn Goffney, MSN,

RN, WOCN, Terry Throckmorton, PhD, RN, David Metz

Pressure ulcers are a devastating complication of surgery aswell

as a non-reimbursable expense for hospitals. Literature review

revealed that there is a need for a pressure ulcer risk evaluation

scale specific to perioperative patients.

The objective was to create a tool that will predict pressure ul-

cers in the perioperative population. The tool, Pressure Ulcer

Risk Evaluation (PURE), was developedwith a multidisciplinary

team including a wound care specialist and dietician.

The scale incorporates two elements from the Braden scale: ac-

tivity and nutrition. The PURE scale mirrors the scoring of the

Braden scale: the lower the score, the higher the risk. The

PURE scale is used preoperatively and intraoperatively to assess

a patient’s risk for developing pressure ulcers during surgery.

Preoperatively the scale evaluates age, activity, malnutrition

risk, skin assessment, previous history of ulcers, diabetes, he-

matocrit, cardiovascular surgery. Intraoperatively the scale eval-

uates anesthesia risk score (ASA), use of a warming blanket

under the patient, use of extracorporeal circulation, hypoten-

sive episodes (diastolic less than 60mm Hg), operating room

time, surgical position and hypothermic episodes (less than

36�C) during surgery.

PURE scale was validated by comparing results of both the Bra-

den and the PURE scales using 40 surgical patients. Results of

the comparison indicated that the PURE tool predicted surgical

patients at risk for pressure ulcer development.

Using the PURE scale, The Methodist Hospital in Houston,

Texas is conducting an Institutional Review Board (IRB) ap-

proved research study of 100 cardiovascular patients to predict

pressure ulcer risk and methods of reducing the development

of pressure ulcers.

EXPANDING THE ROLE OF THE PRE-SURGICALNURSE IN CARING FOR PATIENTS UNDERGOINGEPIDURAL CATHETER PLACEMENTTeam Leader: Stephanie Nolan, RN, MSN, CPAN

Memorial Sloan Kettering Cancer Center, New York, New York

TeamMembers: Lori Gofter, RN, BSN, OCN, Anna Szul, RN, BSN,

Brian Dunbar, RN, BSN, Danielle Silletti, RN,

Inderani Walia, RN, MSN, Joan McKerrow, RN, BSN, MPH, OCN

Background: Epidural catheters were being placed in the Pre-

Surgical Center with limited RN involvement and monitored by

anesthesia. Due to the nature of the oncologic patient, con-

scious sedation was often administered for placement of the

catheter. As the number of pre-op epidurals increased, stan-

dards needed to be established for the care of these patients.

Objective: A process improvement establishing standards and

nursing competencies for the care of the patient receiving

conscious sedation undergoing epidural catheter placement

in PreeSurgical Center.

Implementation: Amulti-disciplinary group including nurses,

anesthesia, nursing assistants and nursing education discussed

current process, conducted literature review and strategized

on methods of improvement. Utilizing the American Society

of Peri-Anesthesia Guidelines, an educational competency pro-

gram was developed and standards were established for caring

for patients undergoing conscious sedation in the pre-surgical

area.

Successful practice: By re-defining the role and competencies

of the Pre-Surgical RN, we havemaintained ASPAN standards for

themanagement andmonitoring of conscious sedation patients.

ASPAN NATIONAL CONFERENCE ABSTRACTS 193

All nurses completed dysrhythmia training for continuous car-

diac monitoring, attended a conscious sedation class and were

required to attend a unit based in-service. The nurse to patient

ratiowas decreased and the Pre-Surgical nursing documentation

revised. In addition, we have increased patient safety in the Pre-

Surgical area, through active involvement of all members of the

health care team in the time out verification process.

Implications for advancing practice: Expanding the role of

the PSC RN provides safe monitoring of patients undergoing con-

scious sedation while advocating for the patient during sedation

and recovery.

SAUK PRAIRIE MEMORIAL HOSPITAL & CLINICSPERIOPERATIVE DIABETES MEDICATIONMANAGEMENT GUIDELINESProject Leader: Lois Oswald, RN, Patient Education

Coordinator/Staff Nurse Joellen Frawley, ANP, BC, Advanced

Diabetes Management

Sauk Prairie Memorial Hospital & Clinics, Prairie du Sac,

Wisconsin

Team Members: Alice Hutter, BSN, Pre-op Coordinator, Joy

Pfeffer, BSN, Staff Education, Tara Mahoney, CRNA, Anesthesia

Department, Terry Zeuske, BSN, CPAN, PACU Staff Nurse

Patients arrived at Sauk Prairie Memorial Hospital & Clinics, for

surgeries and or procedures with uncontrolled hyperglycemia.

An inconsistency in preoperative diabetes medication manage-

ment was identified. Patients were receiving preoperative dia-

betes management instructions that were not evidence-based.

Objectives: Utilize evidence-based guidelines for glycemic man-

agement during theperioperative stay as establishedbyAmerican

AssociationofClinicalEndocrinologists (AACE), andAmericanDi-

abetes Association (ADA). Provide consistent multi-disciplinary

diabetes management for our surgical patients, thus reducing

the incidence of hypoglycemia and hyperglycemia.

Process of Implementation:Diabetes advisory committee re-

viewed and researched current clinical practice recommenda-

tions on inpatient glycemic control with emphasis on AACE &

ADAposition statements. Key leaders approved initiatives to im-

prove inpatient glycemic management. Guidelines were devel-

oped that would provide consistent perioperative diabetes

medication management. Process of implementation included

collaboration with primary care providers, surgeons, anesthe-

tists, nursing staff, staff education department, and diabetes ad-

visory committee members. Multidisciplinary staff education

was included.

Statement of Successful Practice: Our providers and peri-

operative nursing staff have ongoing current evidence based edu-

cation on perioperative diabetes management; multi-disciplinary

teammembers clearly understand their roles. The ability to utilize

evidence-based practice has allowed us to guide our patientswith

diabetes “safely” through their perioperative journey. Patient out-

comes demonstrate improved glycemic control with decreased

hypoglycemia and hyperglycemia complications.

Implications for advancing thepractice of perianesthesia

nursing:Development of evidence-based guidelines, approved

by medical staff and supported by current clinical practice rec-

ommendations of both AACE and ADA, enables nursing staff to

practice autonomously & safely while caring for the surgical pa-

tient with hyperglycemia.

THE USE OF REFLECTIVE PRACTICE TO DEVELOPCRITICAL THINKING IN PERIANESTHESIANURSINGTeam Leader(s): Carol Pehotsky, RN, BSN

Cleveland Clinic, Cleveland, Ohio

Sandy Hossman, RN, CPAN

Patients arrive to the perianesthesia setting with increasing

numbers of co-morbidities and complex needs. A new tool

was needed to help novice nurses learn how to quickly identify,

prioritize, and resolve patient issues through critical thinking.

The objective was to aid the development of critical thinking

skills through the use of a Reflective Practice Exercise based

on Johns’ (2007) work in Reflective Practice. Nurses in orienta-

tion were asked to complete the Reflective Practice Exercise

worksheet based on a patient care situation that did not fit

“the routine.” The exercise included questions about (1) all de-

tails remembered about the situation, (2) what decisions were

made by the nurse and other caregivers, (3) what influenced

those decisions, (4) if the nurse would make those same deci-

sions again, and (5) what learning the nurse believes needs to

be done before encountering a similar situation in the future.

Nurses who completed this exercise were able to identify ap-

propriate patient situations and subsequent learning needed fol-

lowing these instances. They reported qualitatively that this

exercise helped them establish perspective on such challenging

situations. The unit plans to continue using this exercise with

new nurses as well as more experienced nurses who may be

struggling. While many nurses reflect on their day “naturally,”

a guided Reflective Practice Exercise can help guide this habit

into one that generates improved critical thinking skills.

A PREOPERATIVE INTEGRATED APPROACHOPTIMIZES OUTCOMES FOR SURGICAL PATIENTSTeam Leader: Katherine M. Penturff, RN, CAPA

Carilion Roanoke Memorial Hospital, Roanoke, Virginia

Team Members: Michele Berry, RN, Brenda Gilliam, BA, RN,

CAPA

Our national surgical quality data indicated outcomes for surgical

care exceeded national norms. Our preoperative process was

consistentwith best practice andAORN standards, but screening

visits were often scheduled close to surgery, making it difficult to

manage high-risk patients without postponing surgeries.

Our objective was to enhance practice for screening, referral

and appropriate management of preoperative patients in a bud-

get neutral manner.

We benchmarkedwith other facilities and reviewed literature to

identify best practice, but found variations and no common suc-

cessful strategies. An interdisciplinary team of nurses and physi-

cians developed and initiated a screening protocol for high-risk

preoperative health issues. We scheduled preoperative screen-

ings at least 7 days prior to surgery andenhancedour referral sys-

tem. We implemented a process for rapid referrals to specialists

and primary care physicians for patients without PCPs.

Following education of medical office staff, we initiated this

process for pre-surgical visits. Patients are seen in a timely man-

ner with appropriate interventions and coordination of care, for

improved medical optimization. Since initiating the program,

we screened 2,582 patients and identified 1,292 risks. Patients

identified as high-risk were referred for evaluation and/or treat-

ment prior to surgery.