Identification of factors increasing length of stay forpatients undergoing lower extremity bypass andlower extremity amputation

Diane Palec, MSN, RNClinical Nurse SpecialistThe Cleveland Clinic FoundationCleveland, Ohio

After vascular surgery, a large proportion of patients have adecline in disposition from home to nursing rehabilitation facil-ities. Predictors of this decline include lower extremity revascu-larizations and amputations, both major and minor (Crouch et al,2001). Length of stay may increase while a postoperative andpostdischarge plan of care is developed, especially for patientsundergoing distal bypass because of the need for multiple pro-cedures and treatment of wound infections. Increased baselineillness, consumer demands, managed care, and government re-imbursement policies necessitate the efficient management ofhealth care dollars. This presentation will focus on findings of a4-month institutional review board-approved chart review ofavailable charts of patients discharged after lower extremityamputation or revascularization. Charts were reviewed for vari-ances from the normal procedure-driven Coordinated CareTrack. Variances were identified and grouped by patient factors,process factors, or system factors. Patient factors included co-morbid conditions, infection, and anticoagulation issues. Processissues included consultation delays, incomplete physician orders,or incomplete implementation of orders. Systems factors in-cluded missed therapies, delays in receiving and administeringmedication, and delays related to postdischarge destination.These findings may be useful to vascular nurses as they developtheir own process improvement projects that involve both qualityof care and length of stay.

Perceived continuing education needs of vascularnurses in caring for patients with peripheral arterialdisease

M. Eileen Walsh, PhD, RN, CVNAdvanced Practice Nurse/Vascular Clinical Nurse SpecialistJobst Vascular CenterToledo, Ohio

Peripheral arterial disease (PAD) affects the lives of anestimated 8 to 12 million Americans annually and is prevalent inat least 20% of the elderly. Persons with PAD require complex

care at most points along the continuum of care. Vascular nursesare well suited to provide care to patients with PAD. Thepurposes of this study were to assess the perceived continuingeducation needs of a national group of practicing vascularnurses, to determine the preferred method of delivery of con-tinuing education, and to identify barriers to obtaining continu-ing education about PAD. A 4-page, 63-item survey was devel-oped: A total of 46 items assessed specific educational needs,and 17 items assessed demographic and background information.A 3-wave mailing technique was used. Of the 605 surveys sent,451 useable surveys were returned, yielding a response rate of74.9%; 425 women and 22 men responded. Seven educationalitems were perceived by at least 30% of the respondents as topicsrequiring extensive or considerably more education. More than50% of the respondents were well versed on 5 continuingeducation items. Three educational items were perceived to benot relevant by 20% or more of the respondents. The preferredmethods of providing continuing education were regional con-ferences, lecture at local meetings, journal continuing-educationoffering, and Internet self-study. The majority of respondentsidentified their work schedule as the greatest barrier to obtainingcontinuing education.

Assisting with tobacco cessation

Elizabeth Cahall, CRNPNurse PractitionerDepartment of Surgery, Temple University HospitalPhiladelphia, Pennsylvania

Tobacco use is the primary preventable cause of morbidityand mortality in the United States today. The consequences ofsmoking are well documented, and it is the responsibility ofevery health care provider to routinely screen and offer treatmentto patients who smoke. Nurses are no exception; they areuniquely qualified to provide practical skills training to patients.Irrefutable data exist that even 3 minutes of counseling can havea positive influence that moves the patient who smokes furtheralong the continuum toward quitting.

The treatment recommendations and strategies that will bediscussed are found in the Agency for Health Care Policy andResearch guideline entitled, “Treating Tobacco Use and Depen-dence.” The algorithms will be broken down into practicalinterview questions and activities that every nurse can imple-ment with patients, regardless of practice setting.

Vol. XXII No. 2 PAGE 63JOURNAL OF VASCULAR NURSINGwww.jvascnurs.net