Preoperative Hair Removal Improvement Process

Preoperative Hair Removal Improvement Process

ASPAN NATIONAL CONFERENCE ABSTRACTS outpatient center to Vanderbilt campus. Holding room capacity of 23 beds to support 39 ORs was taxed. The process ...

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ASPAN NATIONAL CONFERENCE ABSTRACTS outpatient center to Vanderbilt campus. Holding room capacity of 23 beds to support 39 ORs was taxed. The process for calling for patients to come to the Holding Room was not standardized resulting in the average length of stay between 2 to 3 hours. The OR Board runner would call for Holding Room to send for the next patient based on different scenarios: surgeon requesting circulator to call OR board for Holding Room to get next patient from admitting, circulator calling OR board with the closing of case to notify Holding Room, board runner notifying Holding Room to send for next patient based on their observation of the electronic OR board queues or anesthesia requesting OR board to send for next patient. Objectives of Project: Create an Anticipatory Model for Holding Room access to increase capacity by decreasing length of stay in the Holding Room. Process of Implementation: Using LEAN methodology, a Kaizen event was initiated bringing stakeholders together to develop a new Anticipatory Model. Holding Room would own and manage access and calling for patients. An algorithm was developed for both short cases (30 to 90 min.) and long cases (.90 min.) with Holding Room calling for next patients 90 minutes before anticipated OR start time. A Flow Coordinator was identified to test the algorithm for four weeks prior to going live. Statement of Successful Practice: Using the Anticipatory Model, the length of stay in Holding Room was reduced to 90 minutes or less in 75% of cases and another 10% were in Holding Room less than 3 hours. No capacity issues were noted during pilot. Physicians state they can better anticipate when their patient will be in the Holding Room. Implications for Advancing the Practice of Perianesthesia Nursing: Ownership of access/throughput in the Holding Room belongs to the Holding Room team utilizing an Anticipatory Model rather than a reactive approach.

PREOPERATIVE HAIR REMOVAL IMPROVEMENT PROCESS Team Leaders: Melissa S. Schmidt, BSN CPAN CAPA VA Portland Healthcare System, Portland, Oregon Team Members: Ginger Chalker-Parker, CNA MBA, Justin Brandt, BA, Christine Valdez, RN MSN CNOR, Christine Beatty, RN, Jennifer Johnson, MS BSN CPAN RN BC

Background Information: The current AORN standards are to remove only the hair that interferes with procedure, and to remove the hair prior to entering the OR with the following precautions:  Hair removal should be performed the day of the surgery  In a location outside of the Operating room  Hair should be clipped using a single-use electric or battery-operated clipper or a clipper with a reusable head that can be disinfected between patients Objectives of Project:    

Create best practice Standardize hair removal process Follow AORN recommendations Remove hair prior to entering the OR

Note: All abstracts are printed as received from the authors.

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Process of Implementation:  Met with Surgical Service chiefs to agree on area to be clipped to create standardization  Train staff in clipping  Create poster with each clipping identified by surgery and number correlated with the surgical procedure  Multiple meetings with the staff to discuss process, updates, and feedback  Address concerns  Create a process to identify which patients need hair removal Statement of Successful Practice: Although hair removal preoperatively is controversial, the literature supports benefit of hair removal prior to entering the surgical suite. There is no current literature to how to implement this practice change. We have reduced the number of patients undergoing hair removal in the OR. Our poster will discuss our process as well as display our educational resources we have created at our facility. Implications for Advancing the Practice of Perianesthesia Nursing: Sharing out process may assist other pre-operative area in instituting this process.

PACU NURSING PROTOCOL FOR SUSPECTED CORNEAL ABRASIONS Team Leaders: Katherine Duncan, MD, Caron Hong, MD, Beatrice Hazzard, RN MS CPAN University of Maryland Medical Center, Baltimore, Maryland Team Members: Laura Haines, BSN RN CPAN, Lynnae Elliotte, MSN RN CPAN CCRN, Michaela Mathews, MD

Background Information: Despite efforts to protect the eyes during the perioperative period, corneal abrasions can occur due to incomplete eye closure during surgery, tape in contact with the eye or the patient rubbing their eyes while awakening from anesthesia. Traditionally, the practice for dealing with a suspected corneal abrasion in the University of Maryland Medical Center (UMMC) adult post anesthesia care unit (PACU) has been to notify the attending or covering anesthesiologist who would arrange an ophthalmology consult. The consults may be delayed, thus leading to prolonged patient discomfort and delayed treatment. Objectives of Project: The primary objective was to develop and implement a Corneal Abrasion Protocol to expedite pain relief and treatment to patients with suspected corneal abrasions. Process of Implementation: The process of developing a protocol to detect and begin treatment of suspected corneal abrasions in the adult PACU was initiated by the ophthalmology service. The director of the ophthalmology consult service and an ophthalmology resident created guidelines to be used for inpatients and outpatients. Several meetings were held to discuss the protocol and obtain input from PACU nurses, the PACU nurse manager and the medical director of the PACU. The protocol went through the hospital approval process and the staff was educated. Statement of Successful Practice: Since the implementation of the PACU Nursing Protocol for Corneal Abrasions, nurses in our adult PACU have been able to initiate timely treatment of