Enhanced Recovery After Surgery-The Importance of the Perianesthesia Nurse on Program Success

An investigation on the compliance of perioperative practices using ERAS protocols and barriers to the implementation of the ERAS protocols in colorectal surgery

BACKGROUND

Although ERAS protocols have many benefits, there are some deficiencies in their understanding and implementation by healthcare professionals. The present study was conducted to investigate the compliance of the current perioperative practices of healthcare professional with the ERAS protocols and to assess barriers to the implementation of ERAS protocols in colorectal surgery.

METHODS

This cross-sectional descriptive study conducted in the surgical clinics and operating rooms of a training and research hospital between January 2020 and September 2020 included 110 physician and nurse members of surgical teams. Data were collected using the Questionnaire for Evaluating the Use of the ERAS Protocol and Identifying Barriers to Implementation in Colorectal Surgery.

RESULTS

The compliance of the current perioperative practices by healthcare professionals with the ERAS protocols ranged between 15.5% (routinely leaving nasogastric tubes in situ following colorectal resection) and 61.8% (being aware of the concept of balanced analgesia). Variables such as the healthcare professional's profession, title, years in practice and colorectal surgery experience led to a difference between them in terms of their compliance of the practices with the ERAS protocols (p < 0.05). Based on the healthcare professionals' comments about barriers to the implementation of the ERAS protocol, themes such as education, teamwork, communication and lack of resources were created.

CONCLUSION

Healthcare professionals' compliance level of the current perioperative practices with the ERAS protocols was mostly low. Barriers to the implementation of the ERAS protocols had a multi-factor structure that concerns the multidisciplinary team.

Relation of Early Mobility With Gastrointestinal Symptoms and Pain in Patients Undergoing Abdominal Surgery

PURPOSE

The purpose of this study was to examine the relation of mobility with abdominal symptoms and pain in patients undergoing abdominal surgery.

DESIGN

The study has a prospective, correlational design.

METHODS

The study sample included 130 patients who underwent abdominal surgery. Data were gathered with a sociodemographic and clinical features form, the Patient and Observer Mobility Scale, a patient mobility checklist, the Gastrointestinal Symptom Rating Scale, and the Numeric Pain Rating Scale. Higher scores on the Gastrointestinal Symptom Rating Scale show more severe symptoms (max scores: 21 on abdominal pain, 14 on reflux, 21 on diarrhea, 28 on distension, and 21 on constipation). The frequency of mobility and the severity of pain was evaluated from the postoperative first day until discharge. Gastrointestinal symptoms were evaluated on the postoperative seventh day.

FINDINGS

The mean time elapsing till the first postoperative mobility was 22.13 ± 0.57 hours. The mean score was 7.61 ± 0.19 on abdominal pain, 11.94 ± 0.23 on distension, 2.04 ± 0.32 on reflux, 5.02 ± 0.32 on diarrhea, and 4.65 ± 0.24 on constipation. As the difficulty in mobility increased, the frequency of patient mobility decreased, and pain severity increased. As the difficulty in mobility increased, so did the duration of abdominal pain, diarrhea, indigestion, reflux, and time elapsing until the first intestinal gas passed after surgery. As the frequency of mobility increased, abdominal pain, diarrhea, and time elapsing till the first intestinal gas after surgery decreased.

CONCLUSIONS

The results of the study showed that increased mobility had a positive relationship with the reduction of gastrointestinal symptoms and pain. Therefore, interventions directed toward increasing patient mobility should be performed.

The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii

Traditional use of opioids to treat postoperative pain may lead to abuse and overdose. The development of Enhanced Recovery After Surgery (ERAS) protocols has helped to shift pain management from traditional methods to evidence-based best practices involving multimodal analgesia techniques. The purpose of this quality improvement project was to implement and determine the effectiveness of a standardized, evidence-based ERAS pain management pathway for patients undergoing colorectal or gynecology procedures at a medical center in Hawaii. After the intervention, the evaluation of data associated with opioid use, patients' pain scores, time spent in the postanesthesia care unit, and inpatient length of stay showed that most results were not significant. However, the ERAS pain management pathway did reduce clinical practice variations, intraoperative opioid administration, the time that patients spent in the postanesthesia care unit, and length of stay. The ERAS pain management pathway continues to be used and updated at this facility.

Evaluation of a mobile-application educational intervention on the knowledge, attitude, and practice of patients in postoperative care for lumbar disk herniation surgery: A randomized control trial

Objective

We aimed to evaluate the impact of a mobile-based educational program on patients' postoperative care for lumbar disk herniation surgery.

Methods

A randomized controlled trial was conducted at Fayaz-Bakhsh Hospital, Tehran, Iran. Patients with lumbar disc herniation surgery experience were randomized to the intervention and control groups (learning with the LUmbar CAring Training-app). Participants' knowledge, attitudes, and practices of postoperative care for lumbar disc herniation surgery were assessed using a validated questionnaire at three-time points: pre-test (baseline), post-test one (immediately after program completion), and post-test two (8 weeks after program completion). The primary outcome measures were knowledge, attitudes, and practices scores variations. Secondary outcomes were not considered in our study.

Results

In total, 150 patients were enrolled, with 75 patients in each group. Patients in the intervention group demonstrated increased knowledge, modified attitudes, and practice than those in the control group (p < 0.05). The post-test knowledge, attitudes, and practices scores in the intervention group were significantly higher than those in the control group (p < 0.05).

Conclusion

Mobile-application-based education was a practical and feasible approach to improve patients' postoperative care for lumbar disc herniation surgery in Iran.

Determination of Knowledge and Attitudes of Cardiac Surgery Nurses Regarding the Enhanced Recovery After Surgery Protocol

PURPOSE

This study aimed to examine the knowledge and attitudes of cardiac surgery nurses regarding the enhanced recovery after surgery protocol.

DESIGN

This was a descriptive, cross-sectional study.

METHODS

The sample consisted of 50 nurses working in the cardiovascular surgery clinic of a university hospital in the province of Izmir, Turkey. A questionnaire consisting of three sections was prepared by the researchers to collect data. The first section of the form captured sociodemographic and descriptive characteristics; the second section examined the level of knowledge about the enhanced recovery protocol for cardiac surgery; the third section captured the nurses' attitudes regarding the enhanced recovery protocol. The questionnaire was distributed to the nurses and the research data were collected after a certain amount of time. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, and correlation analysis were used in the analysis of the data.

FINDINGS

The mean age of the nurses was 31.26 ± 6.74 (min = 23, max = 47); 78% were female; 76% had a bachelor's degree; 48% were employed in the intensive care unit. The mean score of the nurses regarding their level of knowledge on the enhanced recovery protocol for cardiac surgery was 18.70 ± 5.29 (min = 0.00, max = 28.00); the mean score regarding attitude toward the enhanced recovery protocol after surgery was 30.00 ± 3.86 (min = 12.00, max = 33.00). There was a positive, moderate, statistically significant correlation (r = 0.396, P = .005) between the mean knowledge level score and the mean attitude level score.

CONCLUSIONS

Results showed that nurses' knowledge was at a moderately positive level. Increasing the level of knowledge increased positive attitudes. Recommendations include disseminating protocol information and providing necessary training to increase positive attitudes in an effort to ensure protocol adherance.