Perioperative Care and Operating Room Management最新文献

Background

Productivity refers to the maximum use of human resources in service provision. Due to the existence of advanced equipment and instruments for surgery, the operating room is one of the most complex and income-generating sections of a hospital. Since the improvement of operating room nurses’ productivity can lead to enhanced hospital productivity, this study was done to determine the productivity rate of operating room nurses in Iran.

Methods

This cross-sectional study was done on 533 operating room nurses from 8 metropolises in Iran in 2022. The sampling method in this research was multistage. The data collection instruments were Hersy & Belanchard & Gold.Smith productivity questionnaire and demographic characteristics. After receiving the ethics code, data collection was done for three months. Descriptive and inferential analyses, including independent t-tests and analysis of variance, were used for data analysis. The collected data were analyzed by SPSS 18. P-value < 0.05 was considered statistically significant.

Results

The mean age of the participants was 29.83 ± 5.94 and 421 of the participants were women. The mean and SD for total productivity in operating room nurses was obtained at 60.83 ± 12.78, below average. Data analysis shows that total productivity was significantly associated with marital status (P-value = 0.035) and working experience (P-value = 0.019).

Conclusion

Considering the low mean productivity rate of operating room nurses, researchers recommend that hospital managers pay more attention to the productivity of operating room nurses by knowing the influential factors and implementing proper and high-quality management.

Introduction

In the nursing profession, ethical climate is considered to be an important element of the work environment. Nurses are exposed to moral tension due to the volume and high work pressure; on the other hand, the stressful nature of this profession can have many negative effects on nurses and, as a result, the quality of care. Therefore, improving the conditions and ethical climate becomes very important. In the operating room, due to the special working conditions and the variety of available specialties, team work is of great importance among the operating room staff. Improving teamwork in the operating room reduces stress and anxiety, increases work efficiency, improves the quality of care, and increases the patient safety.

Objective

This study was conducted with the aim of determining the relationship between the ethical climate and the attitude towards teamwork of operating room nurses in hospitals affiliated with Shiraz University of Medical Sciences.

Method

This research was a cross-sectional study conducted in 2022. The study involved a sample of 310 operating room nurses from hospitals affiliated with Shiraz University of Medical Sciences, selected using convenient and purpose-based sampling methods. In order to collect data, the questionnaires of demographic information, Olsan's ethical climate and attitude towards teamwork baker were used. The collected data were analyzed by SPSS V20.

Findings

The average score of the operating room staff from the ethical climate was 94.12±14.96, and that of the overall attitude towards teamwork was 121.92±11.74, which indicates a favorable attitude towards teamwork. There was a significant relationship between the scores of the ethical climate and the attitude toward teamwork among the operating room personnel (r = 0.339,p < 0.0001).

Conclusion

The results showed that there is a significant relationship between the attitude towards teamwork and the ethical climate of operating room nurses. Managers of hospitals and operating rooms can strengthen the spirit of teamwork and create a suitable atmosphere in the operating room by holding training courses and increase safety and productivity there.

Background

Spinal anesthesia (SA) is a popular anesthetic technique for several surgeries; however, it is mostly associated with hypotension. The perfusion index (PI) can predict hypotension after spinal and general anesthesia. We aimed to evaluate the predictability of PI postural change, supine and sitting PI to post-SA hypotension in elderly patients.

Methods

This study was conducted on 68 elderly patients aged >65 years, scheduled for elective orthopedic surgical operations under SA in supine position. PI, arterial oxygen saturation, blood pressure, and heart rate were initially recorded at sitting and supine positions then 5, 10, and 20 min after subarachnoid drug injection (in supine position). ΔPI=PI supine−PI sitting. The relative change in PI (rPI) =ΔPI/PI sitting× 100.

Results

Hypotension occurred in 33.82 % of patients. The Δ PI was 0.53±0.24, and the r PI was 14.18±6.41 %. Δ PI at cut-off >0.6 and r PI at cut-off > 14 %; could predict SA-induced hypotension with a sensitivity of 82.61 and 86.96 %, respectively, and specificity of 88.89 and 77.78 %, respectively. There was an insignificant difference between Δ PI and r PI and between r PI and baseline supine in predicting SA-induced severe hypotension. The prediction of SA-induced hypotension was higher with Δ PI than baseline sitting and baseline supine (P = 0.002 and 0.027) and between r PI and baseline sitting (P = 0.047).

Conclusions

In elderly patients, the Δ PI has a higher predictive value for SA-induced hypotension than baseline sitting and baseline supine with comparable prediction ability between Δ PI and r PI.

Introduction

Patients with known or suspected cervical spine injuries may require either elective intubation for surgery involving neck stabilization or emergency intubation for ventilatory support and airway protection. This comprehensive review summarizes the collective evidences on management of airway when cervical spine injuries are suspected or confirmed.

Methods

Using the patient/population, intervention, comparison, and outcomes (PICO) clinical question and inclusion criteria, a search of the literature was conducted to find articles in electronic databases such as Scopus, Medline, Cochrane, PubMed, Google Scholar, and others. For patients who require emergency or elective airway securing and have or may have cervical spine injuries, a thorough assessment of published studies was carried out.

Results

This comprehensive review comprised seventy three articles from which conclusions were drawn. A number of publications concurred that videolaryngoscopes could lower the rate of unsuccessful intubations, especially in patients who initially arrive with a challenging airway. Videolaryngoscopes may lessen airway/laryngeal damage and enhance the glottic view. Managing the airway of patients with cervical spine injuries requires a multidisciplinary approach, continuous monitoring, minimizing excessive neck extension, applying rapid sequence intubation technique, and manual inline stabilization. These are highlights found in several papers.

Conclusions

Video laryngoscopy is an excellent alternative to direct visualizations techniques, especially for patients who are anticipated to have less an optimal airway view. Awake fiberoptic intubation allows for neurological exam before and after intubation to ensure minimal damage to spinal cord. However, patient selection is key and requires high level of patient cooperation, provider experience, and availability of local anesthetics.

Objective

To enhance adherence to Enhanced Recovery After Surgery (ERAS) protocols and address pre-operative preparation equity gaps, a system was developed to automatically mail chlorhexidine (CHG) and nutritional carbohydrate supplements (ERAS Kits) to surgical patients.

Background

This retrospective observational study focused on adult patients undergoing abdominal surgeries at a large academic hospital, using a pre-post design.

Methods

The study compared adherence to pre-operative ERAS pathways, involving nutritional supplements and chlorhexidine soap usage, before (September 2021-March 2022) and after (September 2022-March 2023) implementing automatic ERAS Kits mailing. A Chi square test analyzed adherence rates.

Results

Post-implementation, adherence to preoperative nutrition rose from 49.6 % to 57.7 % (P = 0.006), and surgical site preparation from 73.8 % to 78.7 % (P = 0.06). Notable improvements were seen among Black patients, Medicaid recipients, and those from lower-income neighborhoods in nutrition adherence, and among younger patients and Medicaid recipients in site preparation.

Conclusion

Mailing ERAS Kits directly to patients significantly enhanced compliance with preoperative protocols, demonstrating an effective strategy to improve care accessibility and reduce disparities for vulnerable groups.

Background

Medication errors (MEs) frequently occur during the execution and administration of anesthesia and are influenced by several factors, such as the experience of the anesthesia staff, the severity of comorbidities, and the technique used. Without pharmacy approval or referral to other staff, anesthesia staff prepare, administer, and monitor powerful anesthetic drugs. This study aimed to evaluate medication errors made by anesthesia staff members working in government hospitals in Sana'a City, Yemen. Methods: A total of 102 anesthesia staff members in government hospitals participated in a descriptive cross-sectional study consistent with the STROBE guidelines was used. The data were collected through a self-administered questionnaire administered during a previous study from March 26th to April 9th, 2022.

Results

A total of 83.3% of the participants were males. A total of 37.3% were aged 25–30 years, 58.8% had 1–5 years of experience, 52.0% had a diploma, and 80.4% were anesthesia technology specialists. In relation to medication errors, 56.9% of them experienced administration errors in their anesthesia practice. There were statistically significant differences in the opinions of preventive measures between anesthesiologists and anesthesia technology specialists.

Conclusion

There was a high occurrence of anesthetic medication errors in Sana'a government hospitals. Syringe labeling practices need to be standardized by policymakers, and future studies should concentrate on the factors that encourage reporting errors in nonpunitive cultures.

Purpose

Since the hospital stay of patients after ambulatory surgery is short, it is important to determine the factors that may cause problems in the early postoperative period. Among these factors, the effects of which are not fully known are active smoking and secondhand smoke exposure. This study aimed to elucidate how active smoking and secondhand smoke exposure effect early outcomes of ambulatory surgery.

Methods

A prospective observational study was conducted with 124 patients (42 active smokers, 40 nonsmokers exposed to secondhand smoke and 42 nonsmokers) who underwent ambulatory general surgery. Patients were closely monitored for cardiac and respiratory complications, as well as pain, opioid use, and nausea and vomiting until discharge from the hospital.

Results

Postoperative complications were observed in 50.8 % of the patients. Hypotension was more common in active smokers compared with nonsmokers and nonsmokers exposed to secondhand smoke. Smokers were more likely to require postoperative supplemental oxygen therapy. Pain intensity at 1st and 4th hours after surgery was significantly higher in smokers (p <  0.005). In addition, nonsmokers exposed to secondhand smoke exhibited more severe pain than nonsmokers (p = 0.001). There were no statistically significant differences between the groups with regard to opioid consumption.

Conclusion

Although smoking and secondhand smoke exposure are not associated with serious complications after ambulatory surgery, patients' comfort and the success of ambulatory surgery may be negatively affected due to severe pain associated with smoking and secondhand smoke exposure.

Objectives

The subcostal transversus abdominis plane (STAP) block has recently been included in the enhanced recovery after surgery (ERAS) protocol for laparoscopic cholecystectomy (LC). In our study on STAP for LC, we compared the effectiveness of adding low-dose magnesium sulphate (MgSO₄) to bupivacaine versus using bupivacaine alone. MgSO₄ was hypothesized to enhance the analgesic effects of bupivacaine and therefore aid in the recovery process.

Methods

Sixty patients, aged 18–65 years, ASA I–II, undergoing LC, were randomly assigned to receive bilateral STAP 15 min before skin incision with 20 ml bupivacaine 0.25 % and either 150 mg MgSO₄ (BM group) or 1.5 ml normal saline (B group). Pain scores, time to initial analgesic demand, overall analgesic requirement, sedation, emetic episodes, time to get out of bed, and patient satisfaction were recorded for the first 24 h following surgery. The Mann-Whitney U test was used to analyze the non-normally distributed data between groups, while the Chi-square test or Fisher^’s exact test was used to test categorical data.

Results

The BM group had statistically significant but clinically insignificant lower pain scores at rest and during coughing in the post-anesthesia care unit (PACU) (P = 0.005 and P = 0.003), at 1 h (P = 0.005 and P = 0.015), 6 h (P = 0.009 and P = 0.003), 12 h (P = 0.017 and P = 0.001), and 24 h (P = 0.001 and P = 0.001) after surgery compared to the B group. Kaplan–Meier curves for times to the first paracetamol and morphine doses showed significant differences (log-rank test) between the groups (P = 0.001 and P = 0.003, respectively). Additionally, the total doses of paracetamol (P = 0.001) and morphine (P = 0.001) in the BM group were significantly lower than those in the B group during the first 24 h after surgery. Sedation and emetic episodes were identical between the groups. The Patient in the BM group ambulated faster (P = 0.001) and were more satisfied (P = 0.026) than those in the B group.

Conclusions

Adding a low-dose (150 mg) of MgSO₄ to bupivacaine in the STAP block for LC was associated with improved analgesic outcomes in the first 24 h after surgery.

Ethical approval

Medical Ethics Committee of Faculty of Medicine, IRB no: 17,100,622 on November 15, 2016.

Trial registration

ClinicalTrials.gov (NCT03612947) on August 2, 2018.

Objective

This scoping review aimed to identify and synthesise existing literature on patient-facing e-health interventions to support self-management and preparation for or recovery from surgery for adult patients.

Introduction

Patients waiting for surgery often experience distress and uncertainty, which can lead to suboptimal surgical preparation and recovery. E-health interventions may provide new models of care to address these issues and maximise value-based healthcare.

Inclusion criteria

Studies were included if adult patients utilised an e-health intervention to support self-management in preparation for and recovery from their surgery, with interventions targeting any perioperative phase.

Methods

The review followed Joanna Briggs Institute methodology and included sources from 2010 onwards in MEDLINE, Embase, PubMed, Cumulative Index for Nursing and Allied Health Literature, Google Scholar and ProQuest. Four reviewers undertook screening and data was presented in tabular and diagrammatic form with a narrative summary.

Results

From 2293 records, 48 papers with a total of 41 unique studies from 15 countries were included. Most interventions supported patients in the postoperative phase only for bowel/colorectal cancer surgery and total hip arthroplasty Quality was generally good to average, with limitations including small sample sizes, single-centre studies, and a failure to include a comparison group. Just 35 % of interventions were codesigned with input from patients during the development process. Development and evaluation methods were workshops (17 %) and unvalidated attitudinal studies (65 %), respectively. E-health interventions showed positive impacts on clinical outcomes (54 %), user satisfaction (65 %), utilisation of the interventions (46 %), and health system outcomes (24 %).

Conclusions

E-health interventions for self-management of surgery preparation and recovery were prevalent in 15 countries, but mostly focused on postoperative support and lacked input from end-users during development. Future studies should address these limitations by creating applications that support patients from all surgical specialities and involving patients and families in the development process.

Elaboration of a consensus document to address perioperative blood pressure (BP) in neurocritical patients, made with anesthesia and resuscitation, and intensive medicine specialists in Spain, by means of a modified Delphi methodology in two rounds with a questionnaire answered by 65 panelists. Consensus was reached in 126 (74.6 %) of 169 statements, with 113 agreements (66.9 %). Consensus was obtained for the use of clevidipine, urapidil, and beta-blockers for acute hypertension in head trauma patients and for brain tumor surgery, among others. The experts considered that the existing clinical studies evaluating the optimal perioperative therapy in neurocritical patients with altered BP are insufficient and that most recommendations are based on clinical experience. Therefore, treatment must be individualized regardless of absolute BP target value and based on occurrence/absence of acute organ damage and the coexistence of other diseases.