AACN News—February 2009—Practice

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Vol. 26, No. 2, FEBRUARY 2009

Practice Resource Network

Q: Patients are now being brought directly to our ICU from surgery, without spending time in the postanesthesia care unit. Are standards of care different for patients recovering in the ICU?

A: Patients need to receive the same standards of care no matter where they are taken care of in the hospital – that is, transferring the responsibilities of the PACU (post anesthesia care unit) to the ICU means the patient would be managed the same way as in the PACU. The nurses’ competencies must include understanding post op phase I (immediate post anesthesia) and the assessment and monitoring requirements, including criteria for transitioning the patient to routine ICU care. This also includes having policies in place and a valid measurement tool to help determine the transition from Phase I to ICU care.


PeriAnesthesia Nursing Core Curriculum: Preoperative, Phase I and Phase II PACU Nursing
Editor: D. DeFazio Quinn, L. Shick
Product #128730
Member Price: $78.80 (Nonmember: $82.95)

This one resource provides practicing perianesthesia nurses with the complete scope of practice in line with and as defined by ASPAN. It focuses on ASPAN’s full scope of perianesthesia nursing practice regardless of the practice setting, and provides core content necessary to demonstrate competency as a perianesthesia nurse. It includes a section on life span considerations to help the nurse understand the full scope of perianesthesia care from pediatrics through older adult life.

Claudia P. Barone, Carmelita S. Pablo and Gary W. Barone
Postanesthetic Care in the Critical Care Unit
Crit. Care Nurse, Feb 2004; 24: 38 - 45. ASPAN Web site www.aspan.org

Beacon Corner

The Surgical and Cardiac ICUs at Oregon Health & Science University Hospital, Portland (OHSU) merged to form the Cardiac-Surgical ICU (8CSICU). After this merger, 8CSICU’s Unit-Based Nursing Practice Council (UBNPC) worked to update and revise the unit’s standards of care. As a result of this process, the council identified specific areas that deserved attention in order to promote staff excellence and improve patient care. Specific standards were chosen by a Standard of Care subcommittee that included UBNPC quality co-chairs as well as volunteer staff. A Standard of Care Peer Review Survey was developed, in coordination with OHSU’s Quality Department, so that every RN could complete an online Zoomerang survey to evaluate whether the RN they followed had provided care per the unit’s standards. The survey was completed for every shift worked over a four-month period.

The survey included questions about whether or not correct doses, Ks (calculation constant for dosing of titratable drips) and rates were calculated and documented on the pump, whether IV bags and tubing were current and documented, whether the IV flow sheet had been completed, whether ETT care was provided per protocol, and whether tracheostomy care had been provided and documented.

The Quality Department collected the results of nearly 400 surveys. In addition to being provided with the unit’s overall results, each nurse received a report on how their peers evaluated the care they provided. During the time period of the survey, results showed that completion of many of the standards improved. However, results from the last two months, compared to the first two months, did show some decline. The lesson UBNPC learned from this trend is that the optimum benefit period from a survey is likely shorter than four months. Overall, though, results showed high completion rates for many of the standards, evidence of the nursing staff on 8CSICU providing excellent patient care.

We recently revised all our standards of care as part of a transition to electronic nursing documentation and will use this opportunity to create a modified standard of care survey. This process will allow us to reinforce the importance of the standards of care and assure that staff understand the relationship between old and new standards and correct documentation in the electronic system.

For more information, contact Cyndi Perez, 8CSICU nurse manager, at (503) 494-8062, or perezc@ohsu.edu.
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