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