Preoperative Risk Factors Associated With PACU Pediatric Respiratory Complications: An Integrative Review

PurposeThis article reviews state of the science of preoperative risk factors associated with postanesthesia care unit (PACU) pediatric respiratory complications.DesignAn integrative review.MethodsA search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, Cochrane, and Joanna Briggs Institute databases was performed. Thirty-one articles, published between 2006 and 2018, were appraised for quality and the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice Model.FindingsThese articles were grouped into the following categories: age, American Society of Anesthesiologists status, gender, airway comorbidities, syndromes, anomalies, pulmonary comorbidities, ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities.ConclusionsEvidence identified significant preoperative and anesthesia risk factors that are associated with PACU pediatric respiratory complications. This article reveals the importance for the perioperative team to identify, assess for, communicate, and develop a management plan for pediatric respiratory complications.     

颅脑手术麻醉后恢复室常见并发症

目的调查颅脑手术患者在麻醉后恢复室（PACU）并发症的发生情况。方法对2009年3月～12月进入PACU的颅脑术后患者2166例进行回顾性分析。结果常见的并发症有高血压（14.0%）、心律失常（13.9%）、疼痛(13.7%)、寒战(10.5%)、恶心呕吐(9.3%)、谵妄躁动(8.6%)。低氧血症(3.4%)、呼吸道梗阻(1.9%)、苏醒延迟(1.5%)、低血压(0.5%)的发生率较低。1例患者发生误吸。并发症总的发生率为52.2%。在监测体温及肌松残余的患者中,体温异常和肌松残余的发生率分别为7.2%和22.8%。全部病例经PACU治疗均恢复正常。结论神经外科PACU的常见并发症有其特殊性,需要针对不同的病种、手术严密观察及时处理。     

A Scoping Review of Intravenous Opioid Pain Protocols and Their Dose-Time Intervals in the Management of Acute Postoperative Pain in the Postanesthesia Care Unit

PurposeThis review aims to explore intravenous opioid pain protocols and their dose-time intervals in managing acute postoperative pain in adults in the postanesthesia care unit (PACU).DesignA scoping review using a systematic search strategy.MethodsSixteen articles were identified from MEDLINE, CINAHL, PubMed, Embase, and Cochrane specific to the aims.FindingsThe literature demonstrated several variations on dose-time intervals used for opioid pain protocol administration globally. Furthermore, opioid analgesic pain protocols in the PACU appear to be effective in postoperative pain management. However, the literature did not identify optimal time intervals related to dose administration within these protocols.ConclusionsLiterature gaps were identified regarding the significance of dose-time intervals when using opioid analgesic pain protocols in the PACU.     

Handover Patterns in the PACU: A Review of the Literature

PurposeCurrently, there is no standardized handover pattern for patients undergoing general anesthesia when being transferred to the postanesthesia care unit (PACU).DesignA review of the literature.MethodsIn this study, a review of the literature was conducted to analyze the PACU handover status, factors for poor handover, and commonly used handover patterns.FindingsImportant handover information was often omitted during the handover of PACU patients, and there were many factors influencing postoperative patient handover quality. This study analyzed and compared several commonly used handover patterns for patients. Among these, the Situation-Background-Assessment-Recommendation tool is relatively mature. However, there is currently no unified standardized patient handover pattern, and the validity and applicability of tools still need to be verified.ConclusionsPACU is an important place for the recovery of surgical patients. Anesthesia providers need to provide PACU nurses with complete and comprehensive postoperative handover information. A standardized handover model for clinical nurses is needed to improve patient safety management and work efficiency.     

Achieving the 'perfect handoff' in patient transfers: building teamwork and trust

clarke d., werestiuk k., schoffner a., gerard j., swan k., jackson b., steeves b. & probizanski s. (2012) Journal of Nursing Management  20, 592–598 Achieving the ‘perfect handoff’ in patient transfers: building teamwork and trust Aims To use the philosophy and methodology of Appreciative Inquiry (AI) in the investigation of unit to unit transfers to determine aspects which are working well and should be incorporated into standard practice. Background Handoffs can result in threats to patient safety and an atmosphere of distrust and blaming among staff can be engendered. As the majority of handoffs go well, an alternative is to build on successful handoffs. Evaluation The AI methodology was used to discover what was currently working well in unit to unit transfers. The data from semi-structured interviews that were conducted with staff, patients, and family informed structural process improvements. Key issues Themes extracted from the interviews focused on the situational variables necessary for the perfect transfer, the mode and content of transfer-related communication, and important factors in communication with the patient and family. Conclusions This project was successful in demonstrating the usefulness of AI as both a quality improvement methodology and a strategy to build trust among key stakeholders. Implications for nursing management Giving staff members the opportunity to contribute positively to process improvements and share their ideas for innovation has the potential to highlight expertise and everyday accomplishments enhancing morale and reducing conflict.     

Missed Nursing Care in the Postanesthesia Care Unit: A Cross-Sectional Study

PurposeThis study aimed to investigate the prevalence, activities, and reasons for missed nursing care in the postanesthesia care unit (PACU) and the effect of intensive care unit (ICU) overflow patients.DesignThis is a single-center, cross-sectional survey.MethodsNineteen PACU-registered nurses of a tertiary care hospital participated. Over a 7-month period, participants were asked to complete a validated questionnaire, which included 19 items related to missed nursing care activities and 10 items related to reasons for missed nursing care. χ² test and 1-way analysis of variance were used for data analysis.FindingsQuestionnaires (N = 397) were completed. Prevalence of missed nursing care activities was 78.1% and was significantly higher in cases of ICU overflow patients (P < .001). The three most reported missed nursing care activities were “drug preparation, administration, and assessment of effectiveness," “patient surveillance and assessment," and “care associated with pain”; prevalence was significantly higher in cases of ICU overflow patients (P = .036, P = .003, and P = .004, respectively). The three most reported reasons for missed nursing care were “inadequate number of nursing personnel," “unexpected rise in patient volume or acuity," and “heavy admission or discharge activity".ConclusionsThe findings indicated missed nursing care was common in the PACU and increased in case of ICU overflow patients. Therefore, missed nursing care needs to be identified and minimized, while the number and length of stay of critically ill patients admitted to the PACU should be limited.     

ISBAR as a Structured Tool for Patient Handover During Postoperative Recovery

PurposeThe purpose of this study was to investigate interaction in the handovers between anesthesia and the recovery room and to examine the effect of using the Identification, Situation, Background, Analysis, and Recommendation (ISBAR) instrument as a structured dialogue tool during hand over.DesignA prospective quality improvement project with pre/post assessment.MethodsFifty handovers in the postanaesthesia care unit were observed. Data were collected regarding parameters associated with ISBAR. Both certified registered nurse anesthetists and registered nurses (RNs) from postanaesthesia care unit were subsequently asked about their satisfaction with the handover via an electronic questionnaire survey. After 6 months, the questionnaire survey was repeated, and 50 observations were conducted identical to the baseline observations.FindingsResults showed that from baseline to follow-up, RNs were more prepared to receive the patient (from 84% to 95%), read the patient records more frequently (from 18% to 54%), and were assigned to patients from the start of the day (from 86% to 100%). The content of the oral handover was more structured using the ISBAR, and handovers became more concentrated and undisturbed (from 12% to 86%). At baseline, certified registered nurse anesthetists were more satisfied with the handover than RNs (38% difference). At the follow-up, there was no discrepancy between the two groups.ConclusionsKnowledge and focus on the verbal handover influence communication, team effectiveness, and quality of handovers. The ISBAR structured approach reduced disturbances to handover because everybody involved had a clear expectation of the different items to be reviewed and were less likely to interrupt to question or clarify. Using ISBAR as a structured tool along with organizational changes can improve the quality of patient handover and thereby improve patient safety.     

Use of Long-Acting Reversible Contraceptives Amongst Adolescents: An Integrative Review

Four of 5 pregnancies among adolescents aged 14 to 19 are unintended. Long-acting reversible contraceptives (LARCs) have been found to be the most effective form of birth control. Despite the strong endorsement for LARCs, their use among adolescents remains low. An integrative review was conducted to inform Canadian nurse practitioners about how to effectively implement the use of LARCs in their practice as a strategy to reduce unintended pregnancy amongst adolescents. Nurse practitioners can contribute to the use of LARCs by being proactive, providing accurate, evidence-based information, and reducing or eliminating barriers to contraceptive access.