Dina A. Krenzischek

Effect of an automated sink on handwashing practices and attitudes in high-risk units.

OBJECTIVE To assess the effects of an automated sink on handwashing practices and attitudes of staff. DESIGN Quasi-experimental crossover design. SETTING Two high-risk patient care areas, one postanesthesia recovery room (Site 1), and one neonatal intensive care unit (Site 2) in two tertiary care hospitals. PARTICIPANTS All patient care staff on study units; approximately 55 individuals. INTERVENTIONS An automated sink was installed to replace one handwashing sink for about five weeks; the sink was then crossed-over for an equivalent time period to the other location. Handwashing practices of all unit staff were observed in three two-hour observation periods/week. Questionnaires were distributed to staff two weeks after sink installation and at the studys end. RESULTS One thousand, six hundred ten handwashes were observed. Handwashing practices differed significantly by site. For both sites, hands were washed significantly better but significantly less often with the automated sink (all p less than .001). Staff expressed negative attitudes, however, about certain features of the sink, and these negative attitudes increased over the study period. CONCLUSIONS Automated devices must be flexible enough to allow adjustments based on staff acceptance. Application of new technology to improve hand hygiene requires a multifaceted approach to behavior change.

Assessment, Physiological Monitoring, and Consequences of Inadequately Treated Acute Pain

Postoperative pain is a major health care issue. Several factors have contributed to inadequate postoperative pain control, including a lack of understanding of preemptive pain management strategies, mistaken beliefs and expectations of patients, inconsistencies in pain assessment practices, use of as-needed analgesics that patients must request, and lack of analgesic regimens that account for interindividual differences and requirements. Untreated acute pain has the potential to produce acute neurohumoral changes, neuronal remodeling, and long-lasting psychologic and emotional distress and may lead to prolonged chronic pain states. To effectively manage postoperative pain, nurses must be able to adequately assess pain severity in diverse patient populations, understand how to monitor physiologic changes associated with pain and its treatment, be prepared to address the psychosocial experiences accompanying pain, and know the consequences of inadequate analgesia. It is important for nurses to be aware of relevant research and evidence-based guidelines that are available to guide pain assessments and patient monitoring practices.

Perspective on Pain Management in the 21st Century

Pain is a predictable consequence of surgery or trauma. Untreated, it is associated with significant physiologic, emotional, mental, and economic consequences. Despite the vast amount of current knowledge, uncontrolled postoperative pain is reported by approximately 50% of patients. Thus, techniques for effective acute pain management (APM) represent unmet educational needs. The significance of this unmet need is reflected in the number of journal and textbook publications dedicated to disseminating research, evidence-based guidelines, and clinical information. Acknowledging the importance of APM, health care accrediting agencies and professional societies have become increasingly focused on ensuring that patients receive prompt and acceptable pain relief.

An introduction to the ASPAN pain and comfort clinical guideline.

THE JOINT COMMISSION on the Accreditation of Healthcare Organizations (JCAHO) mandates that all individuals have the right to effective pain/symptom management, and this mandate should be a part of basic clinical nursing care. The Agency for Healthcare Research and Quality (AHRQ; formerly the Agency for Health Care Policy and Research [AHCPR]) also states that institutions have the responsibility for pain management and that this responsibility begins with the affirmation that patients should have access to the best level of pain relief that may be provided safely. Despite the availability of effective analgesics and new technologies for drug administration, studies continue to find suboptimal pain management. Health care professionals underestimate pain when performing clinical assessments, and this pain assessment is difficult because of the complex interactions between patient and practitioner. A lack of understanding about basic pain management concepts continues despite more recent efforts to improve nurses’ knowledge of pain management. Inadequate education of nurses in the area of pain concepts fails to prepare them to assess and control postoperative pain effectively.

The perioperative handoff protocol: evaluating impacts on handoff defects and provider satisfaction in adult perianesthesia care units.

STUDY OBJECTIVE To evaluate a new perioperative handoff protocol in the adult perianesthesia care units (PACUs). DESIGN Prospective, unblinded cross-sectional study. SETTING Perianesthesia care unit in a tertiary care facility serving 55,000 patients annually. PATIENTS One hundred three surgery patients. INTERVENTIONS During a 4-week preintervention phase, 53 perioperative handoffs were observed, and data were collected daily by a trained observer. Educational sessions were conducted to train perioperative practitioners on the new protocol. Two weeks after implementation, 50 consecutive handoffs were observed, and practitioners were surveyed with the same methodology as in the preintervention phase. MEASUREMENTS Type of information shared, type and duration of procedure, total duration of handoff, number and type of providers at the bedside, number of report interruptions, environmental distractions, and any other disruptive events. Observers also tracked technical/equipment problems to include malfunctioning or compromised operation of medical equipment, such as the cardiac monitor, transducer, oxygen tank, and pulse oximeter. MAIN RESULTS A total of 103 handoffs were observed (53 preintervention and 50 postintervention). The mean number of defects per handoff decreased from 9.92 to 3.68 (P < .01). The mean number of missed information items from the surgery report decreased from 7.57 to 1.2 items per handoff and from 2.02 to 0.94 (P < .01) for the anesthesia report. Technical defects reported by unit nurses decreased from 0.34 to 0.10 (P = .04). Verbal reports delivered by surgeons increased from 21.2% to 83.3%. Although the mean duration of handoffs increased by 2 minutes (P = .01), the average time from patient arrival at PACU to handoff start was reduced by 1.5 minutes (P = .01). Satisfaction with the handoff improved significantly among PACU nurses. CONCLUSIONS The perioperative handoff protocol implementation was associated with improved information sharing and reduced handoff defects.

Pharmacotherapy for acute pain: implications for practice.

Effective treatment of perioperative acute pain requires that information about the patients goals for pain relief, previous history with analgesics, and type of surgical procedure is used to guide decisions about analgesic regimens. Analgesics are selected based on the location of surgery, degree of anticipated pain, and patient characteristics such as comorbidities, and routes of administration and dosing schedules are determined to maximize the effectiveness and safety of analgesia, while minimizing the potential for adverse events. Pain management therapy is then extended into the postsurgical phase of recovery. To accomplish this, nurses must have a thorough understanding of the pharmacology of analgesics. This article provides useful information for commonly used analgesics, primarily nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and local anesthetics for control of acute postoperative pain.

Toward a better understanding of ASPAN: Its mission for 2000 and beyond

ASPAN is a provider and an approver of continuing education in nursing by the American Nurses Credentialing Centers (ANCC) Commission on Accreditation. The provider and approver sections are separate and distinct, and function independently of each other. The ASPAN Provider Committees provide numerous opportunities for perianesthesia continuing education and include the following: National Conference Committee, Seminars Committee, Workshops Committee, Clinical Practice Forums Committee, and Independent Studies Committee. The ASPAN Approver Committee consists of 17 teams that review and approve programs for contact hours.