e30 ASPAN NATIONAL CONFERENCE ABSTRACTS

team. Howdidwe prepare for such an event? Our PACU received

a “call out” andhadminutes to accept this unexpected admission.

Objectives: To document in a teaching format how such a pa-

tient scenario was managed, and how it impacted our unit. We

found that as nurses in the PACU setting we are often in a “bub-

ble”. We have specialized training, experience and skill sets to

care for complex patients, but lack opportunities to formally

discuss that care with others.

Implementation:We developed a PowerPoint presentation to

share an interesting and challenging case in a forum we called

“Fall into Success”. It encompassed an actual patient case, liter-

ature research and feedback.

Statement of Successful Practice: Staff demonstrated respon-

sibility for their own learning and practice; using PowerPoint

we were able to communicate this patient care experience to

the entire Perianesthesia team, not just those directly involved.

Implications for advancing the practice: Collaboration

with others can be enhanced when we have opportunities to

display and explore our own practices. We are expanding our

forum by posting the presentation on our hospital’s sharepoint

site, thereby allowing us to reach all the patient care areas.

FREON DEGREASER, A NOVEL APPROACH TODECREASE SKIN ABRASIONS DURING SKINPREPARATION IN THE PRE-OPERATIVEDEPARTMENTTeam Leaders: Laurel A. Baker, RN, MSN, CNS, CSRN, Kathleen

Malone, RN, BSN, MBA

Sharp Grossmont Hospital, La Mesa, California

Team Members: Ambulatory Care Center (Pre-op Department)

Abrasions and skin cuts associated with the preoperative skin

preparation of the groin that may increase the likelihood of sur-

gical site infection.

Will preoperative patients who require a groin prep benefit

from improved skin preparation that includes the use of Freon

Degreaser, resulting in a smoother more efficient skin prepwith

a decrease in skin abrasions and cuts?

The pre-op department received approximately two complaints

aweek about skin abrasions and nicks to the groin, which raised

concerns due to possible surgical site infections. After many at-

tempts to correct the problem, we queried the community for

answers to our dilemma. The CNS for SharpMemorial suggested

Freon Degreaser. A chemist was consulted to ensure that the

product would not interfere with the application of Chlorhexi-

dine-gluconate or cause flammability.

The new product allows for a noticeably improved clipper prep

experience for the patient. The patient’s skin is less likely to be

reddened after the procedure, and the patient does not

complain of tugging skin and pulling of hair. Staff completing

the prep also express great satisfaction with the product.

After the use of this product began, there have been no com-

plaints regarding damaged skin in the groin area.

In conclusion this is a novel approach to skin prepping in the

pre-operative environment. It has been well received by staff

and patients due to the safety and ease of clipping patients after

the application of the product. Departments that prepare

patients for surgery should consider using this product to

prep the groin.

SCIP: IT’S NOT PEANUT BUTTER! A PROSPECTIVEREVIEW FOR CORRECT PROPHYLACTICANTIBIOTIC SELECTION, BY THE CLINICAL NURSEIN THE PRE-ADMISSION AND PRE-OPERATIVEDEPARTMENTSTeam Leader: Laurel A. Baker, RN, MSN, CNS, CSRN

Sharp Grossmont Hospital, La Mesa, California

Team Members: Kathleen Malone, RN, BSN, MBA and the

Ambulatory Care Center (Pre-op Department),

Cynthia Brown, RN, BSN and the

Pre Anesthesia Evaluation Services Department,

Marie Yu, PharmD, BCPS

Problem: Fall-out data for our SCIP (Surgical Care Improve-

ment Project) and Outpatient Core Measures reflected

unacceptable rates for physicians ordering the correct prophy-

lactic antibiotic.

Question:Will a new prospective review program by the clin-

ical staff in the PAES and Pre-operative Departments lead to an

increased level of compliance with Core Measures?

Project: The Pharmacist, the CNS, and the Leadership for both

departments met to plan a prospective review process. An ed-

ucation plan and process algorithmwere developed and revised

with the input of the clinical nurses. Since the physician orders

the prophylactic antibiotic for the selected procedure approxi-

mately a week beforehand, there is time to review the selection

appropriateness in the PAES department. There is another op-

portunity for review in the pre-operative department in the

hours before surgery. If the RN finds the selection incorrect,

the MD is contacted for clarification. If the clarification doesn’t

produce a correct selection, or the RN is unable to contact the

MD, then the RN follows up with the Perioperative CNS and

Pharmacist. All nurses were taught and are able to carry out

the instructions of the algorithm.

Results: This prospective review allowed the RNs, CNS, and

Pharmacist several days to track, review, and correct erroneous

or omitted antibiotic selections. This led to fewer fall-outs and

an improvement in this publicly reported core measure.

Conclusions: Leadership in concert with clinical staff were

able to devise a strategy, using a prospective review process

and algorithm, which encourages physicians to increase their

compliance with antibiotic selection.

BETA BLOCKER COMPLIANCE: MAKING ITHAPPENTeam Leader: Linda Beagley, MS, BSN, RN, CPAN

Swedish Covenant Hospital, Chicago, Illinois

Team Member: Ruth Orozco, BSN, RN

The preoperative department struggled with missed beta

blocker documentation and would be notified weeks later by

an outside source who audited the charts. The PACU educator

began to daily audit the surgical schedule for beta blocker

compliance.

What started as a clean-up in the preoperative area turned out to

be a hospital-wide initiative. Approximately 30% of surgical pa-

tients came from the inpatient or emergency department.

When inpatient charts were included in the daily review two

ASPAN NATIONAL CONFERENCE ABSTRACTS e31

problems were identified. First, beta blocker documentation

was inconsistent especially in patients sent from the medical

units and secondly, medication reconciliation was not com-

plete. The objective of this project was to improve beta blocker

documentation to 100%.

An inservice to update staff on hospital formulary beta

blockers was completed along with instructions to document

date and time of last dose. Individual nurses were counseled

when documentation was not complete. Hospital policy states

patients will have medication reconciliation completed within

24 hours. When incomplete documentation was identified the

PACU educator notified the manager via email. The expecta-

tion was the manager would speak to the individual nurse

who admitted the patient. Follow-up education on SCIP mea-

sures was assigned to all nurses who send or receive a surgical

patient.

These initiativeswere labor intensive. Datawas reportedmonthly

to hospital council meetings. Working together throughout the

organization nursing was able to increase beta blocker compli-

ance from 80% to 96%, 16% improvement. Safety is a team effort;

it was a team that turned around beta blocker compliance.

EVERYONE’S SAFETY IS IN YOUR HANDSTeam Leaders: Mary Christina Joy Lazo, MSN, RN, CPAN

Johns Hopkins Hospital, Baltimore, Maryland

Team Members: Marie Graziela Bautista, BSN, RN, CPAN, CAPA,

Maria Liza Anicoche, CNS, MHA, RN, Melanie Mallari, BSN, RN,

CPAN, Elizabeth Turner, BSN, RN, Rollie Asperin, BSN, RN,

Tamara Garey, BSN, RN, David West, PACU Clinical Technician

Background Information: Shift in unit focus, decrease in unit

staffing, and influx of new providers were some of the factors

that led to low hand hygiene (HH) compliance rate in the Pre-

op and PACU for three consecutive months. This posed a

huge risk in the safety and well-being of patients. Hospital-ac-

quired infection (HAI) can cause increase patient hospital LOS

and possibly mortality. Medical experts, CDC, and WHO agree

that HH is the single most important step to prevent the spread

of HAIs. Improving healthcare workers (HCWs) HH compliance

is a healthcare imperative.

Objective: To identify effective strategies to improve and sus-

tain unit HH compliance; and to overcome barriers to change

practice; and ultimately improve patient outcomes.

Implementation Process: With known impact of such issue,

the unit leadership and safety teams, in partnership with Hospi-

tal Epidemiology and Infection Control (HEIC) met with the

goal of immediately increasing unit HH compliance and ulti-

mately sustaining high compliance rate. Literatures were re-

viewed; effective strategies were identified; unit staff was

educated; and results were evaluated.

Successful Practice: With improved communication and

collaborative efforts of the unit safety and leadership teams, and

HEIC, HH strategies to heighten awareness and change practice

were implemented; unit staff was more empowered; and HH

team became more effective and creative. This led to improved

unit HH compliance and safer healthcare environment.

Positive Outcome: Observations showed a dramatic improve-

ment in unit HH compliance for two consecutive months after

the implementation of effective strategies. This has improved

patient outcomes by keeping the patients safe, away from po-

tential harm.

McGurkin, M., Waterman, R., & Shubin, A. (2006). American

Journal of Medical Quality, 21(5), 342e346.Mertz, D. (2010). Effects of a multifaceted intervention on

adherence to hand hygiene among health care workers: a clus-

ter randomized tiral. Infection Control and Hospital Epidemi-

ology, 31(11), 1170.

Rickard, N. (2004). Hand hygiene: promoting compliance

among nurses and health workers. British Journal of Nursing,

13(7), 404-410.

IMPLEMENTING UNIQUE COMPREHENSIVE UNIT-BASED SAFETY PROGRAM (CUSP) INITIATIVETeam Leaders: Myrna Mamaril, RN, MS, CPAN, CAPA, FAAN

The Johns Hopkins Hospital, Baltimore, Maryland

Team Members: Jessica Kalb, BSN, RN, Cheryl Connors, MSN,

RN, CPN

Background Information:

� CUSP is used as a forum to identify safety defects that

impact patient care.

� The multidisciplinary Pediatric PACU CUSP Team investi-

gated a system defect related to nursing and medical re-

sources when a patient’s condition deteriorates in the

postanesthesia period.

� The Rapid Response Team is utilized for early recognition

and intervention in the Pediatric Department at Johns

Hopkins Hospital.

Objectives:

� To identify life threatening patient events that lead to

poor outcomes in the pediatric PACU population.

� To identify the appropriate resources needed to promote

optimal patient outcomes.

� To describe the Rapid Response activation process for

Peds PACU Staff when life threatening events present.

Implementation Process:

� Determine volume projections for this pediatric PACU

population

� Analyzepatient events that takeplace in thePediatricPACU.

� Collaborate with multidisciplinary staff, administration,

and safety leaders regarding care to these pediatric

PACU patients.

� Establish a new standard of care for life threatening pedi-

atric patient events.

� Translate new standard into practice.

Successful Practice:

� Successfully implemented Rapid Response activation pro-

cess by Peds PACU Staff when life threatening events pre-

sent in a critical care setting.

� Elimination of critical delays in care of the deteriorating

pediatric PACU patients

� Getting the right care providers at the bedside in a timely

manner.