References: Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (Eighth Edition). St. Louis, MO: Elsevier Mosby.…
“The Veterans Health Administration: NSQIP Program” (Ball, Weaver, Kiel; 2004) was a physician-driven comparison study initiated by senior surgeons between 1991 and 1997, in which mortality and morbidity rates were “risk adjusted and compared to observed-to-expected ratios”. They studied data in order to determine the efficacy of surgical procedures from the pre-operative- through 30-day post-operative periods. This study was intended to improve the quality of care provided to patients throughout the Veterans Administration Medical Centers (VAMC) nationwide during the operative periods stated above by utilizing the National VA Surgical Risk Study (NVASRS). The information technology (IT) system, VISTA, is an electronic medical record system developed by the VHA which uniformly connects the entire VAMC system and was utilized in the compilation of the necessary data. They intended to show that the quality of care provided for the patients was equal to the outcomes produced within the study and initiated solid evidenced-based practice (EVP) protocols to ensure improvement of outcomes.…
Objective 4: Notify the Surgery scheduler of any problems or questions. Measureable outcomes: Assisting patient’s family in 4 hours every week for 3 months, total of 48 hours contact time. Working in the surgery department for helping family and friends of surgery patients by informing…
Perioperative routine practices vary from state to state and even facility to facility. It is important for the surgical nurse to be well versed in perioperative procedures and constantly question the effectiveness and positive/negative outcomes related to each one. Several preoperative procedures take place on the surgical unit of my hospital, and after research and discussions with surgeons, I discovered a preoperative procedure that could be tweaked in order to improve post-op results.…
During the initial pre-op assessment, the nurse reviewed the patients past surgical history, medical chart, lab test results, and physical report as well as performing a physical assessment on the patient of her own. The nurse also performed duties such as: taking vitals, starting the IV, ensuring consent forms and all necessary paper work is filled out; making sure the patient has all belongings and jewelry taken off and put in a belongings bag, keeping the patient calm and comfortable, assisting the patient to the bathroom, and perform the blood sugar check. The patient had a history of an appendectomy for a ruptured appendix in 2002, a bowel resection in 2002, and a ventral hernia repair in 2010. None of these past surgeries will affect the current…
Anything abnormal needs to be reported to the doctor. These findings need to be documented as well. Document allergies according to facility policy. Accurate measuring and recording of height and weight are important for proper dosage of anesthetic agents. Ensure that the results of all laboratory, radiographic, and diagnostic tests on the chart. Document any abnormal results, and report them to the surgeon and the anesthesia provider. If the pt. is an autologous blood donor or has had directed blood donations made, those special slips must be included in the chart. Record a current set of vital signs within 1 to 2 hours of the scheduled surgery time, and document any significant physical or psychosocial observations. Report special needs concerns, and instructions (advance directives) to the surgical team, as required by The Joint Commission’s NPSGs. For example, advise the surgical team if the pt. is a member of Jehovah’s witnesses and does not accept blood products or if the patient is hard of hearing and does not have his or her hearing aid. This information assists the surgical team in providing continuity of care while the pt. is in the surgical area.…
The patient was discharged on postoperative day number 3 after having had a normal bowel movement. She was discharged without complaints on no medications. She understood her instructions regarding followup, incision care, and limitation of activities.…
ERAS is an acronym for enhanced recovery after surgery. The acronym is commonly used to describe a multimodal perioperative care program. The term enhanced recover after surgery can be and often is substituted for terms like enhanced recovery programs (ERP) or fast-track surgery, but ultimately the meaning is the same. Every program of ERAS is composed of several evidence-based perioperative care aspects that have been proven to be effective; however, when each aspect is put together into a protocol, they have been shown to result in substantially improved surgical outcome. The number of aspects in each ERAS protocol is different, but a common number is approximately twenty. Enhanced recovery after surgery protocols in major…
Lewis, S., Dirkson, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby.…
The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU).…
According to Kennedy, Bakir & Brauer (2012) measuring heath systems quality is rapidly becoming a priority for the government, the public in addition to the private sector. Surgical complications continue be on the rise in both adult and pediatric populations and health system improvements within our government have become a priority to ensure a safer environment for our patients. Surgical complications are said to cost the public billions of dollars; in 2004 alone it was noted to have cost Canadians 19.8 billion dollars for both intentional and unintentional surgical injuries (2012). Quality Indicators have mandated the evolution of surgical performances over the past decade, adult surgical procedures have been the main focus, however; the shift has been moving towards pediatric surgical procedures in more recent years (2012). “Quality Indicators refer to clear, measurable items related to outcomes” (2012). The Quality Indicators established and supported by the Agency for Healthcare Research and Quality are one response towards the need for multidimensional, accessible quality measures that can…
The Battle of Gettysburg was by far the bloodiest battle in American History and ultimately changed the outcome on the Civil War. During the first year and a half the Confederates succeeded with many major victories against the Union Army. However, the Battle of Gettysburg became a great turning point of the war. The battle itself lasted for three days and decisions made by both the Confederates and the Union led to one of the highest casualty wars in history.…
* Planning admission and discharge individually ensures that patient and carers know what to expect facilitating earlier post operative care at home…
satisfaction and staffing, complications such as urinary tract infections and pressure ulcers. The National Database…
Postoperative care is an essential role in nursing practice. It prevents postoperative complications that may arise due to surgeries. Postoperative care includes a pathway of healing and recovering leading to prophylaxis of many pulmonary complications. Postoperative pulmonary complications include respiratory failure, pneumonia, and atelectasis. Preventing such complications is important in the clinical setting because it avoids a decline in patients’ well-being. I chose this topic for it is a common set of complications that arises postoperatively. Preventing these complications will avoid longer hospital stays and will also speed up the recovery time. The…