References: Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (Eighth Edition). St. Louis, MO: Elsevier Mosby.…
“The Veterans Health Administration: NSQIP Program” (Ball, Weaver, Kiel; 2004) was a physician-driven comparison study initiated by senior surgeons between 1991 and 1997, in which mortality and morbidity rates were “risk adjusted and compared to observed-to-expected ratios”. They studied data in order to determine the efficacy of surgical procedures from the pre-operative- through 30-day post-operative periods. This study was intended to improve the quality of care provided to patients throughout the Veterans Administration Medical Centers (VAMC) nationwide during the operative periods stated above by utilizing the National VA Surgical Risk Study (NVASRS). The information technology (IT) system, VISTA, is an electronic medical record system developed by the VHA which uniformly connects the entire VAMC system and was utilized in the compilation of the necessary data. They intended to show that the quality of care provided for the patients was equal to the outcomes produced within the study and initiated solid evidenced-based practice (EVP) protocols to ensure improvement of outcomes.…
Perioperative routine practices vary from state to state and even facility to facility. It is important for the surgical nurse to be well versed in perioperative procedures and constantly question the effectiveness and positive/negative outcomes related to each one. Several preoperative procedures take place on the surgical unit of my hospital, and after research and discussions with surgeons, I discovered a preoperative procedure that could be tweaked in order to improve post-op results.…
Currently Scripps does not have a hybrid suite and to stay competitive with the competition and offer the best care for the community Scripps may want to take the necessary steps to consider hybrid technology. With the addition of a hybrid suite Scripps can secure a foothold in a shifting medical model of providing excellent multi-modal care in one visit. With a shift to minimally invasive surgery it is paramount to consider a hybrid in the early stages so that the competence level of the surgeon and staff are equal to or better than that of the community. If Scripps does not embrace this new type of surgical suite it may lose a valuable referral base that will be actively seeking for this type of modality. The addition of a hybrid suite is also in alignment with the new shift in medically treating patients from a “sickness model to a wellness care model” (Fitzhugh, 2012, p. 2) that is more holistic and encompassing.…
Anything abnormal needs to be reported to the doctor. These findings need to be documented as well. Document allergies according to facility policy. Accurate measuring and recording of height and weight are important for proper dosage of anesthetic agents. Ensure that the results of all laboratory, radiographic, and diagnostic tests on the chart. Document any abnormal results, and report them to the surgeon and the anesthesia provider. If the pt. is an autologous blood donor or has had directed blood donations made, those special slips must be included in the chart. Record a current set of vital signs within 1 to 2 hours of the scheduled surgery time, and document any significant physical or psychosocial observations. Report special needs concerns, and instructions (advance directives) to the surgical team, as required by The Joint Commission’s NPSGs. For example, advise the surgical team if the pt. is a member of Jehovah’s witnesses and does not accept blood products or if the patient is hard of hearing and does not have his or her hearing aid. This information assists the surgical team in providing continuity of care while the pt. is in the surgical area.…
In chapter 5 we have reviewed major elements of ambulatory (outpatient) care and discussed changes supported by the Patient Protection and Affordable Care Act (ACA) and American Reinvestment and Recovery Act. Ambulatory care encompasses a diverse and growing sector of the healthcare delivery system. Ambulatory surgery is a continuously expanding component of ambulatory care, as new technology allows an increasing number of procedures to be performed safely and efficiently outside of the hospital. In addition to new diagnostic and treatment tools available in outpatient setting, financial mandates also have driven services into the ambulatory arena. This new development pushed more hospitals to shift procedures and services amenable to outpatient delivery from more expensive inpatient environment to less expensive. For profit, free standing facilities providing primary, specialty, and surgical services have been increased (Sultz & Young, 2014, p163-199).…
The patient was discharged on postoperative day number 3 after having had a normal bowel movement. She was discharged without complaints on no medications. She understood her instructions regarding followup, incision care, and limitation of activities.…
ERAS is an acronym for enhanced recovery after surgery. The acronym is commonly used to describe a multimodal perioperative care program. The term enhanced recover after surgery can be and often is substituted for terms like enhanced recovery programs (ERP) or fast-track surgery, but ultimately the meaning is the same. Every program of ERAS is composed of several evidence-based perioperative care aspects that have been proven to be effective; however, when each aspect is put together into a protocol, they have been shown to result in substantially improved surgical outcome. The number of aspects in each ERAS protocol is different, but a common number is approximately twenty. Enhanced recovery after surgery protocols in major…
Lewis, S., Dirkson, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby.…
The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU).…
According to Kennedy, Bakir & Brauer (2012) measuring heath systems quality is rapidly becoming a priority for the government, the public in addition to the private sector. Surgical complications continue be on the rise in both adult and pediatric populations and health system improvements within our government have become a priority to ensure a safer environment for our patients. Surgical complications are said to cost the public billions of dollars; in 2004 alone it was noted to have cost Canadians 19.8 billion dollars for both intentional and unintentional surgical injuries (2012). Quality Indicators have mandated the evolution of surgical performances over the past decade, adult surgical procedures have been the main focus, however; the shift has been moving towards pediatric surgical procedures in more recent years (2012). “Quality Indicators refer to clear, measurable items related to outcomes” (2012). The Quality Indicators established and supported by the Agency for Healthcare Research and Quality are one response towards the need for multidimensional, accessible quality measures that can…
* Planning admission and discharge individually ensures that patient and carers know what to expect facilitating earlier post operative care at home…
References: Bare, B., Cheever, K., Hinkle, J., & Smeltzer, S. (2010). Textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.…
satisfaction and staffing, complications such as urinary tract infections and pressure ulcers. The National Database…
Postoperative care is an essential role in nursing practice. It prevents postoperative complications that may arise due to surgeries. Postoperative care includes a pathway of healing and recovering leading to prophylaxis of many pulmonary complications. Postoperative pulmonary complications include respiratory failure, pneumonia, and atelectasis. Preventing such complications is important in the clinical setting because it avoids a decline in patients’ well-being. I chose this topic for it is a common set of complications that arises postoperatively. Preventing these complications will avoid longer hospital stays and will also speed up the recovery time. The…