The Evolution of a Regional Post Anesthesia Care

Course for the Obstetric Nurse

Poster Presentation

Purpose for the Program

The Central New Jersey Maternal and Child

Health Consortium (CNJMCHC) is a nonpro¢t

organization working to improve the health of women

of childbearing age and infants through the colla-

borative e¡orts of member hospitals, health care

providers, and consumers from ¢ve counties in New

Jersey. Approximately 10 years ago, maternal and

child health directors from the member hospitals

wanted a course that would a¡ord obstetric (OB)

nurses a standard level of competency when caring

for the OB postanesthesia care unit (PACU) patient.

This presentation discusses the evolution of the

CNJMCHC Regional Post Anesthesia Care Course

for the Obstetric Nurse (OB PACU Course).

Proposed Change

The education provided was designed to enhance

the nurses’ knowledge of the standard of care re-

quired for women experiencing Cesarean birth in

the immediate postoperative period. Content in-

cludes standards of care for patients recovering

from anesthesia; anesthesia modalities, side ef-

fects, and nursing implications; review of dynamic

changes in pregnancy and postdelivery; pharma-

cological agents ; principles of cardio-respiratory

monitoring and ECG rhythm interpretation; and

communication skills. Providing a regional course

was proposed to be cost e¡ective, eliminate the

need to provide a program speci¢c to each hospi-

tal, maximize resources and ensure consistent

educational experience. Furthermore, hospitals

would bene¢t from knowing the minimal level of

education most nurses possessed in the region in

light of a high turnover rate.

Implementation, Outcomes, and Evaluation

The course utilizes peer reviewed standardized

presentations and includes information from na-

tionally recognized professional organizations, for

example Association of Women’s Health, Obstetric

and Neonatal Nurses, Association of Perioperative

Registered Nurses, Malignant Hyperthermia Asso-

ciation of the United States, American College of

Obstetricians and Gynecologists, and NJ Depart-

ment of Health and Senior Services Hospital

Licensing Standards. Clinical nurse specialists

(APNs) and educators with expertise in OB care

and/or surgical PACUs from regional hospitals

served on the original and revision curriculum com-

mittees and as taught the course. Overtime, the

course evolved as an e¡ective means to ensure

that nurses working in the OB PACUpractice a stan-

dard of care that is evidence-based and represents

best practices.

Implications for Nursing Practice

Taking a regional approach to nursing education is

cost e¡ective and can facilitate the dissemination of

evidence-based knowledge/best practice to a

wider nursing audience, thus standardizing care

that can improve outcomes. This particular course

curriculum can serve as model for other OB PACU

programs.

Who’s WHO in the Obstetrical Operating Room

Poster Presentation

Purpose for the Program

To discuss the World Health Organization’s

(WHO’s) Safe Surgery Saves Lives initiative of

utilizing a safety checklist for all surgical procedures

to avoid surgical complications. The reported peri-

operative death rate is 0.4% to 0.8% with a complica-

tion rate of 3% to17%. Since it has been determined

by theWHO that half of the surgical complications are

avoidable, the WHO published guidelines including a

safety checklist to ensure safety of the surgical patient.

The checklist is designed to include surgical site in-

fection (SSI) and venous thrombosis event (VTE)

indicators for the obstetric surgical population. Final-

ly, the checklist is a communication tool for the

surgical team that will encourage verbal con¢rmation

Ellen S. Shuzman, PhD, RN,

APN, C, NEA-BC, Education,

Central New Jersey Maternal

& Child Health Consortium,

North Brunswick, NJ

Robyn D’Oria, MA, RNC,

APN, Central New Jersey

Maternal & Child Health

Consortium, North

Brunswick, NJ

Ann Mruk, MSN, Central New

Jersey Maternal & Child

Health Consortium, North

Brunswick, NJ

Charlotte Feeney, AD, RNC,

Central New Jersey Maternal

& Child Health Consortium,

North Brunswick, NJ

Keywordspost-anesthesia care unitobstetric PACU courseregional course

Professional

Issues

Nancy Skinner, MSN, RNC,

Women’s & Children’s Ser-

vices, Christiana Care Health

Services, Newark, DE

Dina Viscount, BSN, RNC-

OB, Labor & Delivery,

Christiana Care Health

System, Newark, DE

S72 JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention

among all team members to share the operative plan,

promote teamwork, and e⁄ciency by developing a

shared understanding of the intended procedure(s)

to reduce preventable harm.

Proposed Change

Utilize a safety checklist designed to meet institu-

tional process and patient population to prevent

surgical complications. The tool designed by the

surgical team members should engage all team

members who will contribute relevant information

to prevent patient harm. The ‘‘Time Out’’ universal

protocol step that is practiced in most if not all surgi-

cal suites is sometimes found to be an event that

needs cognitive engagement. Therefore, incorpor-

ating the WHO checklist into the operative process

would encourage team members to engage in the

‘‘Time Out’’ as well as to contribute relevant informa-

tion to prevent patient harm.

Implementation, Outcomes, and Evaluation

The WHO safety checklist comprises three compo-

nents of the surgical procedure that includes

before anesthesia induction, before incision, and

before the patient leaves the operating room that is

used in conjunction with The Joint Commission

(TJC) Universal Protocol. Implementing the tool in-

volves education and practice designed for the

adult learner. The surgical checklist is individua-

lized for each surgical suite to ensure that

antibiotics and VTE prophylaxis are provided ac-

cording to the American College of Obstetricians

and Gynecologists (ACOG) guidelines to improve

outcomes.Ongoing evaluation of the tool may iden-

tify additional information that needs to be

communicated among team members.

Implications for Nursing Practice

Preventing surgical complications or patient harm

is the ethical practice of nonmale¢cence that drives

nursing practice. Utilizing a surgical safety checklist

allows the health care team to identify opportunities

to improve care to the surgical patient in the obste-

tric operating room.

Simple Infant Simulation: Low Tech Solutions for

Teaching Infant Assessment

Poster Presentation

Purpose for the Program

Nursing students need practice with newborn

and infant assessment. Simulation is a great

teaching tool. Unfortunately, infant simulators cost

thousands of dollars and are too technologically

complicated for the needs of nursing students. Simple

counting of respirations and heart rate are over-

whelming enough for the beginning student. Simple

infant simulation can be developed using low cost

dolls and a bit of creativity. Much of the value of simu-

lation is not technological but psychological. Low

tech infant simulation is an economical and e¡ective

way to enrich nursing education.

Proposed Change

Simulators are expensive and require expensive

training for the faculty. Beginning nurses and

students do not need highly technical infant simula-

tors to learn basic assessment of the infant. Simple

infant simulation allows the nurse to learn from her

mistakes in an atmosphere of safety and to gain

insight into di⁄cult situations. Introducing simple

infant simulation saves educational dollars without

sacri¢cing education.

Implementation, Outcomes, and Evaluation

Attendees will get hands-on practice with using

simple dolls and many simple innovations to create

an infant simulation scenario. The proposed project

is designed to help participants

� Identify cost e¡ective infant simulation strate-

gies to enhance nursing education.

� Recognize the value of innovative teaching

methods in infant simulation.

� Develop simple infant simulation scenarios to

meet students’ needs.

A postsimulationmeeting is used to evaluate the e¡ec-

tiveness of the simulation. Attendeeswill build theirown

simulations in small groups and then evaluate their

own and others performance during the simulation.

Implications for Nursing Practice

Simple infant simulation will allow nurses to learn

the basic assessment skills of the newborn without

KeywordsWHOsafe surgeryobstetric surgery

Professional

Issues

Ruth G. Smillie, MSN, RN,

Nursing, Saint Joseph’s Col-

lege of Maine, Standish, ME

Keywordssimulationinfantassessmentsimpleeducationnursing

Professional

Issues

JOGNN 2011; Vol. 40, Supplement 1 S73

Smillie, R. G. I N N O V A T I V E P R O G R A M S

Proceedings of the 2011 AWHONN Convention