Perioperative Care and Operating Room Management最新文献

Operating room nursing and surgical technologist are two disciplines that provide perioperative care in the operating room. However, they have distinct histories, philosophies, curricula, and functions that shape their professional identities and boundaries. This paper critically analyzes the literature on these disciplines, focusing on their historical development, current situation, future directions, and the implications of paradigm shift for their evolution. The findings suggest that both fields are undergoing significant transformations due to technological advancements and changing healthcare needs, and highlight the need for interdisciplinary collaboration and continuous adaptation to ensure high-quality perioperative care for patients.

Background

Due to the equipment used in the health system, drugs, and the need for specialized health personnel, the operating rooms are the most costly, and time is the most valuable resource. From this point of view, the study was aimed to raise awareness about Value Stream Mapping, which is one of the problem-solving practices in nurses, and to practice with a sample VSM study (eliminating non-value-creating activities, creating flow in processes, and avoiding delays due to the preparation of the surgery in the pre-op period with continuous improvement).

Methods

Observational action research. The research, Value Stream Mapping, which is one of the lean methods, was carried out in a private hospital between December 2019 and March 2022. A total of 59 patient flows were observed in three stages. First, the current situation map was drawn. Value-added and non-value-added time was determined. The problems experienced in the current situation were determined and suggestions were developed for their solution, kaizen studies were carried out. Onset time and delays in minutes were monitored for all first cases on a daily basis.

Result

Non-value-added activities were reduced from 102 min to 52 min on average. In particular, the quality increased from 0 % to 36 %. "If patients were not in the operating room within 10 min of the scheduled start time, this was considered a late start". While the rate of starting the surgery on time at the first observation was 0 %, this rate increased to 70 % at the end of the study.

Conclusions

Improving the pre-op preparation process was effective in increasing the percentage of surgery that started on time in the operating room. It is thought that value stream mapping can be a useful method for improving on-time starts in the operating room.

Background

Wide Awake Local Anesthesia No Tourniquet (WALANT) has been accepted safe and effective anesthesia technique for many orthopaedics procedures. Despite growing number of studies, few had described using WALANT in lower extremities with more complexity like the knee. We present a case series of patella fracture fixation using WALANT.

Methods

WALANT was used as a method of anesthesia for five patients diagnosed with patella fracture undergone tension band wiring fixation at Thammasat University hospital during 2021 - 2022. Visual analog scale (VAS) was collected throughout the surgery as primary objective and up to 48 h after the operation. We also evaluated their demographic and clinical data, range of motion, total operative time, amount of WALANT used, blood loss and hospital stay.

Results

Throughout the procedure, all patients reported no pain or discomfort except at wiring step which average VAS was 2.4 ± 1.14. The mean total operative time was 91.6 ± 18.58 min and mean WALANT solution used was 124 ± 12.94 ml. The visualization of surgical field was satisfying with minimal blood loss. All patients were able to walk with weight-bearing as tolerated right after the operation and were discharged in the same day except one due to lack of caregivers at home. Neither local nor systemic complications were found. No conversion to other anesthesia techniques due to failure of WALANT.

Conclusions

This study shows WALANT may be considered safe and effective as an alternative anesthesia technique for patella fracture fixation in ambulatory setting, offering favorable outcome without need for postoperative hospitalization.

Background

Clinical decision-making and self-efficacy levels of operating room nurses are critical for patient care quality and safety.

Objective

This study aims to examine the relationship between clinical decision-making levels and self-efficacy among operating room nurses and to identify factors influencing these two key components of nursing practice.

Methods

A cross-sectional descriptive design was used to survey 94 nurses working in surgical wards at Ankara University Medical Faculty Hospital. Data were collected using the Clinical Decision Making in Nursing Scale (CDMNS), General Self-Efficacy Scale (GSES), and a demographic information form. Data were analyzed using descriptive statistics, correlation analysis, and group comparisons.

Results

A significant positive correlation was found between clinical decision-making ability and self-efficacy (r = 0.355, p < .0001). Nurses with higher education levels demonstrated significantly greater clinical decision-making skills (p < .005). Nurse managers reported significantly higher self-efficacy levels compared to scrub/circulating nurses (p < .05). Age was positively correlated with self-efficacy (r = 0.373, p < .0001) but not with clinical decision-making ability.

Conclusion

The research indicated that self-efficacy levels correspond with clinical decision-making capabilities of the operating room nurses. Higher education levels of the practitioners enhanced their clinical decision-making abilities. Nurse managers had higher self-efficacious beliefs than the scrub or circulating nurses. Age was positively associated with self-efficacy, but not with the scores on clinical decision-making abilities. The results of this study nurse leaders have higher GSES and CDMNS scores because they are experienced nurses with higher education degrees.

Background

Ultrasound-guided supra-clavicular nerve block (SCNB) has regained interest in adults but remains underutilized in pediatrics. This case series aims to evaluate the efficacy and safety of ultrasound-guided SCNB in children undergoing upper-extremity surgery.

Methods

Prospective observational case series, the inclusion criteria were children over one year old who were scheduled for elective upper-extremity surgery. After induction of general anesthesia, an ultrasound-guided SCNB was performed. A dose of 0.2–0.5 ml/kg of bupivacaine 0.25 % or ropivacaine 0.2 % was administered all around the brachial plexus. In case of postoperative pain, 15 mg kg^-1 of paracetamol + 10 mg kg^-1 of ibuprofen were administered. The primary outcome measure was the success and safety of the block. Secondary outcomes were time to first analgesia administration and duration of motor blockade.

Results

Thirty-three patients were included. Median age and weight were 6 [2.75,9.75] years and 24 [16,35] kg, respectively with a sex ratio of 3.1. Bupivacaine 0.25 % was used in the majority of cases (N = 24). The overall duration to complete block performance was 170 [120,300] seconds. A single attempt was sufficient for the majority of children, with a block success rate of 100 %. No incidents were reported during block performance. Postoperatively, time to the first analgesic request was 10 [8,12.5] hours. Twenty-five patients developed a motor block, with a duration of 4 [0.5,5] hours. Bupivacaine 0.25 % was associated with higher incidence of motor blockade (p = 0.002).

Conclusions

Ultrasound-guided SCNB appears to be an effective and safe technique in children. Further studies using lower doses of bupivacaine could help reduce the incidence of motor block.

Background

Patients may feel pain during subcutaneous injection and drug absorption that ranges in intensity. The purpose of this study is to determine the effect of stress ball use on procedural pain due to subcutaneous injection in orthopedic patients.

Method

The randomized controlled study was conducted with the participation of 134 patients (67 experimental group - 67 control group) who underwent orthopedic surgery at a university hospital between January 2023 and July 2023. Participants were randomly divided into stress ball and control groups. Patient Information Form and Visual Analogue Scale (VAS) were used to collect the data.

Results

It was found that the majority of the patients (55.2 %) were women and the mean age was 57.2± 18.7 years. The characteristics of the patients in the experimental and control groups were similar. The Visual Analogue Scale values of the experimental group patients at the time of injection were lower than those of the control group, which was statistically significant (p = 0.011). According to 68.7 % of the patients in the experimental group, the use of the stress ball reduced the intensity of pain during injection. In addition, 71.6 % of the patients were satisfied with the use of the stress ball.

Conclusion

It was concluded that using a stress ball helped orthopedic patients feel less pain during subcutaneous injection procedures. It was found that the experimental group's patients were mainly satisfied with the pain relief provided by stress balls.

ClinicalTrials.gov ID

NCT06023485

Background

High rates of morbidity and mortality would be seen in patients suffering from sepsis and/or septic shock. It has been hypothesised that the Surviving Sepsis Campaign will reduce the morbidity and mortality of individuals who are diagnosed with septic shock and/or sepsis. Improving the surviving sepsis campaign's execution is necessary to reduce these deleterious occurrences. There is currently a lack of local data regarding the management in accordance with the guidelines in the Surviving Sepsis Campaign.Therefore, this study aimed to assess the compliance rate of sepsis resuscitation care bundle in patients diagnosed with septic shock and/or sepsis to the International Surviving Sepsis Campaign among patients admitted to a tertiary and teaching hospital, Ethiopia.

Methods

Hospital based, prospective observational study was conducted from January 1/2023 to December 31, 2023. Consecutive sampling technique was employed to select study participants for a period of one year and the smaple size was found to be 88 participants. A prepared checklist with standards taken from the International Surviving Sepsis Campaign was used to collect the data. Data were collected through direct-observation, interviewing the responsible physician who made the sepsis and/or septic shock diagnosis, and reviewing patient charts. Data were entered and analysed with statistical package for social sciences (SPSS) version-25.

Results

In treating patients diagnosed with septic shock and/or sepsis, the total compliance rate with the International Surviving Sepsis Campaign's (ISSC) sepsis resuscitation care bundle was 38 %. In the initial one-hour care bundle, 100 % of patients received the RECOMMENDED initial fluid resuscitation, 64 (72.7 %) of patients received broad spectrum antibiotics, 12 (14 %) of patients had blood culture before antibiotics.

Conclusions

This study concluded that sepsis resuscitation care bundle practice was subpar. Therefore, we recommend that educational training, increased awareness, and sharing the current and existing evidences are an important measures to improve the utility of the recommendations of the International Surviving Sepsis Campaign's (ISSC). After the sepsis treatment bundle has been fully implemented, a re-evaluation will take place in the summer of 2025.

Background

We investigated the effects of moderate (45°), and extreme (60°) right lateral rotation of the head and neck on the ventilatory performance of Ambu AuraGain Laryngeal mask airway in generally anesthetized spontaneously breathing children.

Methods

Fifty-two children (aged 2–9 years) were randomized in this open-label observational cohort, to receive Ambu® AuraGain either in moderate (45°) (Group I, n = 26) or extreme (60°) (Group II, n = 26) lateral rotation of the head and neck. The oropharyngeal leak pressure OLP (primary outcome), ventilation score, exhaled tidal volume, and fiberoptic glottic view score, were recorded with the head and neck in a neutral position, then in lateral position after insertion by 1,15,30 and 45 min., and at end of surgery.

Results

The mean OLP in group I decreased from 23.81 ± 2.87 cmH2O in the neutral position to 23.77±3.78 cmH2O, (P = 0.941) 1 min. after lateral rotation. Whereas, In group II, it increased from 20.38 ± 4.18 cmH2O to 21.88±3.28 cmH2O, (P = 0.002). Afterward, the OLP was maintained decreased in group I and increased in group II (P < 0.05), with no intergroup differences. The ventilation score did not show significant intra or inter-group differences. After lateral rotation, the fiberoptic glottic score showed a trend towards better values in group II than in group I.

Conclusion

Ventilation with AuraGain LMA can efficiently be implemented while the head and neck are in the neutral and laterally rotated positions in anesthetized spontaneously breathing children. Extreme lateral rotation (60°) was better tolerated than the moderate position (45°).

Background

Hospital supplies are the second largest hospital expenditure after labor cost, and management of inventory is complex. Supply management processes are often manual and reactive, lack clarity, and are overseen by both clinical and supply chain logistics teams where shared responsibilities can be challenging. Not having required supplies on-hand impacts patient safety and can encourage overstocking, potentially leading to waste when those products expire on shelves.

Methods

Our large hospital system noted inconsistent inventory practices leading to operating/procedural room waste, inefficiencies, staff frustration and potential risk to quality of care. A quality improvement initiative was implemented to adopt a clinical supply chain technology to track and report use, non-use, and location of supplies. We provided weekly metrics to both logistics and clinical organizations and reported quarterly progress to leadership.

Results

Across 37 surgical and procedural departments within 11 hospitals, our quality improvement initiative improved our product expiration by 78 % and supply waste by 50 % with an 11 % reduction in owned inventory. It also built strong relationships between clinical and logistics and supported comprehensive patient charge capture for supplies.

Conclusion

Using data-driven strategies we gained visibility and leveraged data to increase efficiency and reduce waste enabling our organization's supply chain to move from reactive to proactive. This case report describes the implementation and optimization of our clinical supply chain technology, and how the combination of people, processes, and technology transformed our supply chain, bridging the gap between our clinical and logistics organizations.

Background

Hemorrhoidectomy is commonly performed under general or regional anesthesia; nevertheless, the underutilization of local anesthesia is attributed to safety concerns. The aim of this study was to compare postoperative outcomes following hemorrhoidectomy using local anesthesia and spinal anesthesia.

Methods

This study was a retrospective cohort study, conducted at the General Surgery Department of the University Medical Center Ho Chi Minh City Branch 2 from January 2018 to September 2023, focused on Milligan-Morgan hemorrhoidectomies for third or fourth-degree hemorrhoids.

Results

A total of 114 patients with third or fourth-degree hemorrhoids were included in the study, with 59 patients in the local anesthesia group and 55 patients in the spinal anesthesia group. Throughout all three time points, average pain scores were consistently lower in the local anesthesia group. The average recovery time for the local anesthesia group was 8.34 ± 6.17 days, and for the spinal anesthesia group, it was 10.50 ± 7.01 days. However, these differences were not statistically significant (p > 0.05). Notably, the local anesthesia group exhibited a significantly lower rate of postoperative complications compared to the spinal anesthesia group (0 % versus 5.5 %, respectively). Additionally, the local anesthesia group had a significantly shorter length of stay (11.07 ± 15.81 h) and lower medical costs (7,793,187 ± 1,835,713 VND) compared to the spinal anesthesia group (32.87 ± 26.06 h and 9,468,098 ± 2,883,630 VND, respectively).

Conclusions

Hemorrhoidectomy under local anesthesia is feasible and safe, and local anesthesia may be considered as an alternative to spinal anesthesia in some cases.