Streamlining the Preoperative process for the Open Heart Surgery PatientWritten by Cynthia Havrilak, RN, MSN
Open heart surgery is considered to be a major event for patients, their families, and hospitals. Delays in surgery cause emotional distress for patient and their family and are costly to hospital. For these reasons, it is beneficial for all organizations providing open heart surgery services to review their processes that prepare patient for open heart surgery. Investing time to detail patient flow processes involved in preoperative preparation will assist in eliminating process gaps and identify opportunities to improve organizational communication, patient care and satisfaction. This can be accomplished by instituting a task force/ committee to assist in this area. It is advisable to include departments involved with patient entry points into open heart process. These departments are usually inpatient medical cardiac units, registration area, cardiovascular surgeon office, and cardiac cath lab. Development of standardized preoperative open heart surgery orders help to create common practice routines that can reduce errors, improve staff education, and reduce organizational costs by eliminating unnecessary tests and improving staff efficiencies. These benefits outweigh challenge of standardizing preoperative physician orders. The orders set should be approved by appropriate organizational committees, explained to staff, and then distributive to appropriate departments for implementation. Included in these order sets should be preoperative lab tests, patient testing (CXR, EKG), medications, consults including anesthesia, and surgical prep. Input from medical staff is essential to this process. The administrative leader should be well versed on latest clinical techniques and cardiovascular research ensuring best practices are addressed and not overlooked. Some of most common causes of delays are from inaccurate completion of blood bank procedures, long turnaround times for patient reports, a lack of chest film or lateral view, scheduling delays for patient testing, and lost pieces of patient’s medical record. Addressing these topics during patient flow planning is essential in expediting presurgery process. Once process gaps are identified it is important to develop a workable solution and education plan. Ongoing continuous quality management can evaluate effectiveness of changes and identify any additional needed areas of improvement. The outpatient preadmission process should be flow charted to facilitate a smooth patient transition through appointment schedule. This is patient’s introduction to your heart program and efforts should be directed at providing patient with a good first impression. The following issues should be addresses in planning sessions for preadmission appointment: •What time of day is best to schedule preadmission appointments •Where should patient report •Who will educate patient on post operative care, incentive spirometer, skin prep, family waiting, and discharge needs •Who will be involved in preadmission process Due to need for a number of tests and significant clinical education it is recommended to schedule preadmission appointment prior to day of surgery. This provides time to review test results and provide comprehensive education for patient. The preadmission process can be accommodated in a same day surgical appointment but more opportunities are present for process delays. Frequently included with diagnostic testing are a listing of consults for anesthesia and other services, an insurance assessment, and completion of history and physical by a physician assistant /certified nurse practitioner if this has not been provided by physician office. A standardized patient education session is a major component to patient surgical preparation. One of first steps should be to determine who will be involved in education process. Cardiac care coordinator, clinical nurse specialist, or cardiovascular unit staff nurses are good choices to provide postoperative education. When multiple patient care providers are providing patient education it is recommended to script education ensuring all topics are consistently presented. Many hospital heart programs are now offering preoperative cardiovascular patient education online through their website. This is another educational opportunity that compliments individualized approach. The patient education session should be brief as to not frighten patient, but should review major care components such as monitoring, invasive lines, tubes, and alarms. Most patients are interested in knowing when lines and tubes are inserted and how long they remain. Ambulation protocol should be explained so they can anticipate getting out of bed shortly after they awake from surgery. Skin prep and other medications such as Bactroban (if they are a part of night before prep) should be provided with written instructions and explanation for use. The educational session is also a good time to review specific discharge issues like expected length of stay and need for someone to stay with them first few days following discharge. A tour of post op recovery unit allows patient and their family to visualize high level of care that will be provided. The committee should plan for how sequence of appointments will flow to reduce wait times for patients and all disciplines involved. This attention given to improving preadmission process can increase level of confidence patient and family has in your program. It starts their surgical experience off on a favorable note.
| | Why You Absolutely MUST Keep A Food Diary Or FAIL!Written by Tony Tass
When starting a fat loss and/or fitness program, most people neglect one very important step...... ......keeping track of what you eat. Keeping a Food Diary, a meal by meal record of everything you eat, can often times mean difference between success and failure on a fitness program. You absolutely MUST, MUST, MUST keep a food diary if you are to succeed in losing weight. I cannot stress that enough! Most people have NO CLUE what they are eating or even how much. Most people guess as to what they're eating and vast majority of time, they're WAY OFF! Unless you write down EVERYTHING YOU EAT in a food diary, you will NEVER, EVER be able to accurately and consistently plan your weight loss. Don't fool yourself. And you WILL FAIL.... It's a fact. I did not get a handle on losing weight UNTIL I finally started to log everything I ate in a food diary on a meal-to-meal and day-to-day basis. This does not have to be difficult. You can do it manually or use software for it. You can use a simple binder to keep track or even use your Palm Pilot. I also recommend you buy book "The Complete Book of Calorie Counts" by Corrine Netzer. It's one of best I've found that tells you exactly what's in food you eat, even ethnic foods.
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