ANNUAL ASPAN CONFERENCE ABSTRACTS 187

THE HEALING GARDEN WAITING AREA, ACOMPREHENSIVE VISITATION PROGRAM FOR PATIENTSAND THEIR FAMILIES DURING THE PHASE 1 LEVEL OFCAREGladys Fields, BSN, RN

University of Maryland Medical Center, Baltimore, MD

Background Information: A perioperative customer service team was

developed to create a visitation system for the Adult PACU that executed

the ASPAN position statement.

Objectives: Develop a program which provides the patient’s families

with updates during the all phases of postoperative care.

Implement a comprehensive and structured visitation system for pa-

tient’s families.

Process of Implementation: A team including an RN and Hospitality

liaison was developed to coordinate communication between the pa-

tient’s families and health care providers while providing visits to the

Adult PACU.

Statement of Successful Practice: Patient and family satisfaction

scores have increased to the 90th percentile in regards to postoperative

visitation.

Implications for Nursing Practice Advancement: Educating staff to

ASPAN position on visitation, providing emotional support and educa-

tion for the patient and their families and enhancing communication be-

tween surgeons, ASCU, OR and PACU nurses.

PACU OXYGEN DELIVERY EBP SAVES $$$ ANDEMPOWERS STAFFBetsy Garton-Park, BSN, RN, CPAN, Mimi Brado, BS, RN,

Sara Lacava, BSN, RN, CPAN

Highland Hospital an Affiliate of the University of Rochester Medical

Center Rochester, NY

Applying humidified oxygen mask sets on our post-operative patients

was accepted practice. Whose practice? Why were we using a system

that required time to assemble bulky tubing and occupied valuable cubi-

cle storage space? Simultaneously, couldn’t we reduce our contribution

of waste into our landfills? Couldn’t the PACU engage in cost cutting?

We set about finding out the best practice.

The literature and evidence led us to redefine our supplemental oxygen

delivery. Replacing a humidified mask system with a one piece oxygen

mask was tested in other studies and found to be effective and safe.

We made the switch and collected our own data that showed no change

in oxygen saturation levels. We were equally pleased when our patients

complained less about the ill fitting humidified oxygen mask. With over

6,000 masks needed per year, replacing the costly humidified mask as-

sembly with the simple oxygen mask saved us one dollar per mask or

at least $6,000 per year. It also allowed our support technicians more

time to help with patient care. Increased use of regional anesthesia

has also played a role in our ability to become more cost effective. Oxy-

gen saturation levels for the majority of these patients can be safely main-

tained on nasal cannula.

Our PACU is empowered after this trial, as we define our own practice.

We learned a lot about EBP and research and are anxious to tackle other

practice questions.

SURGICAL CANCELATIONS: A SIX MONTH REVIEW OFEXTENDED STAY CANCELATIONSMary Gibson, BSN, RN, CPN, Susan Boudreau, MSN, NP-C, RN

Children’s Hospital, Boston, MA

PICO Question: Are there potential nursing practice changes in

the Pre-Op Clinic that may influence the overall cancelation

rate? (P) Pediatric surgical patients anticipating a postoperative inpa-

tient stay. (I) Prospective chart review of scheduled and canceled cases

over a six month period. (C) Total number of scheduled cases was com-

pared with the number of canceled surgical cases. (O)To identify poten-

tial nursing practice changes in the Pre-Op Clinic that may influence the

overall surgical cancelation rate.

Significance to Nursing Practice: Surgical cancelations can be costly

not only to the institution, but also to families and patients who have

carefully coordinated surgical dates with other important commitments.

It is critical for Pre-Op Clinic nursing staff to constantly analyze practice

in an attempt to provide optimal pre-operative assessments which min-

imize the potential for surgical cancelations.

Scientific Merit: Review of the Literature: Few studies have exam-

ined overall surgical cancelation rates and no studies reviewed surgical

cancelations in the pediatric population.

Interpretation: No surgical cancelations were attributable to omissions

in nursing pre-operative work-up or follow-up.

Outcomes/Desired Outcomes: Illness (49%) was responsible for the

majority of surgical cancelations between the time of the pre-op visit

and the day of surgery; NPO status 4.5%.

Nursing Practice Implemented: Specific health promotion teaching

has been incorporated into a Family Education Sheet which is discussed

and distributed during the preoperative visit. A read back-feedback pol-

icy for teaching/documenting NPO guidelines has been implemented.

MEETING THE CHALLENGE: A COLLABORATIVE TEAMEFFORT TO PROVIDE OFF-SHIFT POST-ANESTHESIA CAREFOR PEDIATRIC PATIENTSLucille Graboff, BSN, RN, CAPA, Nursing Care Coordinator

Jeanne Prota, RN Level III, CAPA, Robert Boebert, RN, Director of

Perioperative Services Patricia Schiavi, BSN, RN, Patient Care Manager

Saint Raphael Healthcare System, New Haven, CT

All post-anesthesia pediatric patients are recovered in the Ambulatory

PACU. The hours of operation for the Ambulatory PACU are Monday –

Friday 6:00 a.m. – 7:00 p.m. These limited hours created a problem in

caring for pediatric patients. If a pediatric patient had surgery after

hours, they would need to recover in the in-house PACU. However,

the in-house PACU nurses lacked the competency to care for pediatric

patients. A solution was required to provide coverage to post-anesthesia

pediatric patients on a 24/7 basis.

Provide competent and safe post-anesthesia care for the pediatric popu-

lation. A) Developing an ‘‘on-call’’ system for the ambulatory nurses. B)

Provide PALS certification for all post-anesthesia nurses.

In order to meet the ASPAN standard, two licensed nurses must be pres-

ent to care for any patient. This caused a major staffing/scheduling pro-

cess change between the two PACU units. The primary nurse is the

Ambulatory PACU nurse and the in-house PACU nurse is the back-up.

This necessitated ‘‘on-call’’ scheduling for both nursing staffs. Overall,

the major goal of this project was achieved as the hospital was able to

provide competent, PALS certified nurses to care for the post-anesthesia

pediatric patient when the Ambulatory PACU is closed.

Expanded knowledge base of all PACU nurses to care for the emergent

pediatric post anesthesia patient. By requiring PALS certification we en-

hanced our daily practice by increasing our competency level in all post-

anesthesia care units.

Improved the quality of care for the pediatric PACU patients. ASPAN stan-

dards for nurse/patient ratio were met. Increased collaboration between

Short Term Surgery and Main PACU nursing staffs.