enhanced recovery after surgery from nursing … · 2019. 10. 28. · 10/28/2019 1 enhanced...

10/28/2019

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ENHANCED RECOVERY AFTER SURGERY FROM NURSING PERSPECTIVE

KAROL MONNET, RN

PUNS 2019

DISCLOSURES

▸ None.

PUNS 2019

GOALS

▸ Make case for why ERAS is important

▸ Describe nursing role in ERAS protocol

▸ Review key implementation materials

▸ Future efforts

▸ Q & A

Families can be overwhelmed by surgery.

ERAS offers holistic, evidence-based paradigm shift in perioperative care.

EnhancedRecoveryAfterSurgery

Caring for patients with complex conditions is challenging.

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PUNS 2019

ERAS OPERATIONS

▸ Reconstruction

▸ Bladder augmentation, channels, bladder neck procedures

▸ Ureteral surgery

▸ Reimplant, ureteroureterostomy

▸ Pyeloplasty

▸ Oncologic resections

▸ Nephrectomy, RPLND

PUNS 2019 ERAS CHCO PROCESS MAP

PUNS 2019 ERAS CHCO PROCESS MAP PUNS 2019

CLINIC VISIT - DECISION FOR SURGERY

▸ Preliminary ERAS education

▸ ERAS handout

▸ ERAS preop checklist

▸ Arrange to see in multi-disciplinary preop clinic (as needed)

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PUNS 2019

BEFORE SURGERY

▸ Repeat ERAS education (usually by phone)

▸ ERAS handout

▸ ERAS preop checklist

▸ Preop clear liquid carbohydrate drink instructions

▸ 10 mL/kg up to 350 mL

▸ Drink between 3 and 2 hours prior to scheduled start time

▸ Diet / pain control / drain expectations

▸ Document in EMR (allows us to track)

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PUNS 2019

AFTER SURGERY

▸ For reconstruction patients

▸ Remove catheters, teach CIC

▸ Arrange home supplies

▸ Review patient questionnaire (quality of recovery 9)

▸ Higher score = back to baseline

▸ Lower score = Difficulty with day to day tasks

PUNS 2019

OTHER ERAS IMPLEMENTATION TOOLS

▸ REDCap database (managed by research team)

▸ Automated EMR → REDCap data to capture processes

▸ ERAS order set (residents/fellows)

▸ ERAS pocket guide (residents/fellows)

PUNS 2019

FUTURE EFFORTS

▸ Create a multidisciplinary preop clinic

▸ Simplify preop workflows

▸ Use Epic / EMR tools to assist

▸ Patient questionnaires can beelectronic

▸ Keep patient handouts short and few in number

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Thank you!

Q &

karol.monnet@childrenscolorado.org

kyle.rove@childrenscolorado.org

A