CBSPANNER. From the President: Volume 11, Issue 4. Winter 2013

Transcription

1 CBSPANNER Volume 11, Issue 4 From the President: Winter 2013 Members of the CBSPAN Executive Board had the opportunity to attend the ASPAN 2013 Leadership Development Institute (LDI). It was a changing experience. We were able to spend the weekend sharing ideas, as well as networking and participating in various activities. Topics included strategic planning, identifying best practices, research opportunities, leadership development and financial stability. The Institute provided the Tools needed for professional and personal success. Even Elvis attended. Guest speakers provided information that all perianesthesia nurses are able to use in all aspects of life.this includes professional guidelines to improve patient outcomes, as well as offering tips for personal success. I would like thank the CBSPAN Baltimore Planning Committee and the Guest Speakers for an excellent educational seminar. (Dr. Shafonya M. Turner and Nikki Price CBSPAN President) As Fall comes to an end and Winter begins, CBSPAN held its 2013 Fall Seminar at Medstar Franklin Square Hospital, Baltimore, MD. The conference theme was Fill Your Toolbox Today for the Challenges of Tomorrow CBSPAN is committed to providing educational resources for our perianesthesia nurses through meetings, newsletters and seminars. Communication and networking are key to promoting our profession. We are here to support You, the Perianesthesia Nurse. In this issue: Page 1! President s Message Page 2! Board of Directors!!!! Mission Statement Page 3! ASPAN News Page 4! Recruiter of the Year Info/Standings Page 5! CBSPAN News Page 6! New CBSPAN Members! Page 7! Member Awards and Honors Page 8! PANAW Seminar Page 9! Governmental Affairs Page 10! Baltimore District Report Page 11! Eastern Shore District Report Page 12! District of Columbia District Report Page 13-15! Research-Patricia Bodine Page 16-19! Research Abstracts-JHH Page 20! Puzzle Page Page 21! ABPANC News Page 22-24! Photo Gallery Page 25! Dates to Remember!! Editor s Note Page 26-27! Scholarship Application!! Page 28! Willingness to Participate Form

2 Page 2 CBSPAN BOARD OF DIRECTORS President: Nickcole Price, BSN, RN, CPAN, CAPA nikkiprice4me@gmail.com Vice President: Vacant Secretary: Kathy Steindl, RN, CAPA kathysteindl@bayhealth.org Treasurer: E Chris Skinner, MSN, RN, CAPA eskinner@christianacare.org Immediate Past President: Diane Swintek, BSN, RN, CPAN dinah613@gmail.com Region Five Director: Sarah Cartwright BA, RN, CAPA scartwright@aspan.org Baltimore District President: Bea Hazzard, MS, RN, CPAN bhazzard@umm.edu District of Columbia District President: Margaret Young, BSN, MDiv, RN, CPAN, CAPA mfy1@gunet.georgetown.edu Eastern Shore District President: Susan Volk, MSN, RN, CCRN, CPAN svolk@christianacare.edu Governmental Affairs: Seema Hussain, MS, RN, CAPA seema_hussain4@yahoo.com Research/EBP Chair Graze Bautista, BSN, RN, CPAN, CAPA grzbautista@gmail.com Ways and Means: Vacant Website Manager and Newsletter Editor: Connie Gull, MPP, BSN, RN, FCN jeeplady@thegulls.com Mission Statement The Chesapeake Bay Society of Perianesthesia Nurses promotes quality and cost effective care for patients, their families, and the community through public and professional education, research, and standards of care.

3 Page 3 ASPAN INFORMATION AND NEWS I M P O R T A N T!!!!! ASPAN Candidate Profiles are now online... your component needs your input! To review the slate of candidates for posi9ons on the ASPAN Board Directors, as well as for Nomina9ng CommiDee members, and to submit a feedback form, click here. You must be logged in to the ASPAN Web site to submit this form. Visit ASPAN's home page: Log- in using your ASPAN username and password Under "Highlights" on the home page, click the Candidate Profiles link and carefully read the instruc9ons. Deadline to vote: February 28, 2014 Full Conference Registration Fees: Note: Pre and post conference offerings are additional costs. Prices below are for the full registration for National Conference held April 27- May 1, If you register before 3/1/14: $ Member $ Non-Member Postmarked after 3/1/14: $ Member $ Non-Member Hotel Information: Las Vegas Hotel & Casino 3000 Paradise Road Las Vegas, NV Hotel Room Rate: Early Bird Room Rate -- must book by January 17, 2014: $85.00 per night plus tax Single/Double Future ASPAN Conference Dates April 26-30, 2015 San Antonio, Texas April 10-14, 2016 Philadelphia, Pennsylvania PeriAnesthesia Nursing Standards, Practice Recommendations and Interpretive Statements is now available from ASPAN All Reservations booked after January 17, 2014: $ per night plus tax Single/Double Click here to make your hotel reservations now!

4 Page 4 ASPAN Recruiter of the Year Award The deadline is December 31, 2013!! Hurry!!!! Encourage a colleague to join ASPAN today! Obtain membership applications by contacting the ASPAN National Office toll free at (877) Request as many copies as you'd like! Campaign Awards The Recruiter of the Year, the individual who has recruited the most new members during the course of the campaign, will win one free year of ASPAN membership, one free 5-day registration* to the 2014 ASPAN National Conference, and a commemorative plaque presented at the National Conference. Additional Awards Ten names will be randomly drawn from all 2013 participating recruiters at the 2014 National Conference. Winners of the drawing will each receive a $75 ASPAN gift certificate. There will be a monthly drawing from all recruiters during The winner each month will receive a copy of the 2010 Redi-Ref for Perianesthesia Practices. Recruit 4-9 new ASPAN members in 2013, and receive a $5 ASPAN gift certificate. Recruit 10 or more new ASPAN members in 2013, and receive a $10 ASPAN gift certificate. *The Recruiter of the Year is responsible for any other conference event that they wish to attend requiring an additional fee (Ex: Development Luncheon, CPAN/CAPA Luncheon, Dream Walk, etc.) CBSPAN Recruiter Standings--October 31, Beatrice M Hazzard, BSN, MS, RN, CPAN 1 - Beth A Garrity, RN, CPAN 2 - Celine Marie Pico, BSN, RN, CAPA 1 - Chris Price, MSN, RN, CPAN, CAPA 1 - Cynthia Voith, BSN, RN, CPAN 1 - Denise Kay Matteson, BSN, RN, CAPA 1 - Diane Swintek, BSN, RN, CPAN 1 - Earl Ryan Ascano, BSN, RN 1 - Elaine Matisko, BN, RN 2 - Elena S Lara, BSN, RN, CPAN 1 - Elizabeth Lada Morse, MSN, RN 2 - Ellen Rombach, BS, RN, CPAN 1 - Eugenia C Judge, BSN, RN, CPAN 1 - Exequiela Oller Sison, BSN, RN, CPAN 1 - Jane Deutsch, RN, AAN 1 - Jennifer M Allen, MSQSM, RN, CPAN 1 - Jessica Pires, RN, BSN 1 - Jo Ann Shelley, RN, MA 1 - Joy E Reece, BSN, RN 2 - Judith A Townsley, RN, CPAN, MN 1 - Judith Pekasiewicz, BSN, RN, CAPA 1 - Maria Annette Morales, MSN, RN, CPAN 1 - Marie Graziela F Bautista, BSN, RN, CPAN, CAPA 1 - Mary G Johnson, RN, CPAN 1 - Maryanne M Tarasco, RN, CPAN 1 - Michele Joynes, BSN, RN, CPAN 1 - Nickcole D Price, BSN, RN, CPAN, CAPA 1 - Patricia T Bodine, BSN, RN, CPAN 1 - Sandra McPherson, RN, CPAN 2 - Seema S Hussain, MS, RN, CAPA 1 - Suellen W Wilkins, MSN, RN, CPAN 1 - Susan G Dorsey, RN 1 - Susan Volk, MSN, RN, CCRN, CPAN 1 - Thea Lynnette Clark, BSN, RN 1 - Victoria Lynn Fisher, RN, CAPA, ADN ASPAN DEVELOPMENT Hail, Honor, Salute A wonderful way to recognize a coworker or colleague Levels of donation: Hail---$750 or above Honor--$250-$749 Salute--$25-$249 All gifts are tax deductible as allowed by law ASPAN 90 Frontage Road Cherry Hill, NJ Toll free

5 CBSPAN NEWS AND INFORMATION Page 5 Treasurer s Report Minutes from the CBSPAN Board Meetings, the Bylaws, Strategic Plan, Treasurer s Reports, upcoming meetings and seminars are available on the new CBSPAN website: Check it out! CBSPAN has 607 members as of October 31, 2013!! CBSPANNER DEADLINES: February 15 May 15 August 15 November 15 Submit all articles by to: Connie Gull Jeeplady@thegulls.com BUSINESS CHECKING : $ BUSINESS CD : $ WESTERN MD SAV : $ TOTAL : $24, Deposits : $ Expenses: BOD mee9ng $ Web Maint $ LDI $ NewsleDer SPG x 2 yrs $30.00 CITRIX Go to Mtg $ $ DIFFERENCE : +$ *Bank accts(check/w. MD) changed to Economy Business Accts secondary to addi9onal monthly charges that would be accrued for lack of minimum balances and lack of Auto Deposit and Payroll Mul9ple scholarships in the amount of $500 are available for the ASPAN Na9onal Conference. CBSPAN would like to send 4 members from each of the three Districts in To apply, submit applica9ons by January 31, The applica9on is available on the CBSPAN.org website. Respeciully submided, Chris Skinner, MSN, RN, CAPA Treasurer, CBSPAN CBSPANNER is written for CBSPAN members. All rights are reserved. Copyright 2013 Do you have something of interest to your colleagues, fellow CBSPAN members? Please send items along so they may be included in the CBSPANNER newsletter Connie Gull, Newsletter Editor Jeeplady@thegulls.com

6 Page 6 New CBSPAN Members Jennifer Anderson Dover, DE Sally Bashaar Towson, MD Karen J. Berisford Wyoming, DE Connie L. Brock Washington, D.C. Mary G. Bullock - Ellicott City, MD Paula L. Casini Elkton, MD Judith Chambers Germantown, MD Danielle A. Coyne Wilmington, DE Kim V. DiCampli Hockessin, DE Dolores A. Donnelly Ellicott City, MD Alexis V. Edwards Silver Spring, MD Tracey Edwards Sparrows Point, MD Sharon M. Gaertner Severna Park, MD Christina Giambra Glen Burnie, MD Tammy Hornick Port Republic, MD Loretta Howard Olney, MD Susan Humphreys Baltimore, MD Debra Jo Jennings Compton, MD Judith L. Long Elkton, MD Leslie Long Woodbine, MD Natalie L. MacIntire Centreville, MD Susan Marcotte Bethesda, MD Alida McDonald Silver Spring, MD Kristin McKee Cochranville, PA Margaret McNeill Frederick, MD Vickie Mills Ijamsville, MD Cecilia Ondoy-Zaballero Newark, DE Drexel J. Aquino Peredo Glen Burnie, MD Marie-Josephine Royall Wilmington, DE M. Elaine Secker Gaithersburg, MD Jean Stark Reisterstown, MD Kimberly Taylor Ellicott City, MD Maryrose Weisman Severn, MD Mary F. Woerner Middletown, DE Tiffany L. Wyttenbach Silver Spring, MD Welcome aboard! We at CBSPAN are happy to have you join our Component. CBSPAN was chartered with ASPAN in1982; last year we celebrated our 30th anniversary. Check for news and information on our website cbspan.org. Thank you for your support of our professional organization.

7 Winner of CBSPAN s Excellence in Clinical Practice Award Page 7 Joanne Kulesh, MSN, RN, CPAN with her nominator, Trish Bodine, BSN, RN, CPAN Shady Grove Adventist Hospital, Rockville, MD Honored by the Washingtonian Magazine Congratulations to Maria Reinitz, BSN, RN, CPAN, who received the Excellence in Nursing Award in the October issue of the magazine!! The magazine annually recognizes nurses who go beyond the call of duty to enhance the well- being of their patients and the community. Each nurse is nominated by their peers and chosen from among hundreds of submissions. Maria is a staff nurse in PACU at the Edwards Surgical Pavillion at Anne Arundel Medical Center in Annapolis. Winners of ABPANC bracelets at CBSPAN Fall Conference CPAN/CAPA dual certification: Nikki Price, DC District CPAN certification: Hope Herd, Baltimore District CAPA certification: Cheryl Seifarth, Western Maryland

8 Page 8

9 Governmental Affairs Page 9 Seema Hussein, MS, RN, CAPA The Institute of Medicine's 2013 Richard & Hinda Rosenthal Lecture will celebrate the three-year anniversary of the IOM's The Future of Nursing: Leading Change, Advancing Health report, which was released on October 5, The event will highlight the impact of the report through implementation of recommendations at both the national and local level, discuss the continued work of the Future of Nursing: Campaign for Action, and chart future directions and priorities for the nursing profession. REGISTRATION NOW AVAILABLE Wednesday, December 11, :00 PM - 7:30 PM Reception to Follow National Academy of Sciences Building 2101 Constitution Avenue NW Washington, D.C Keynote Address: Donna Shalala, Ph.D., FAAN, President, University of Miami; Chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing Panelists: Carmen Alvarez, Ph.D., R.N., NP-C, CNM, Julio Bellber Postdoctoral Fellow at The George Washington University Linda Burnes Bolton, Dr.P.H., R.N., FAAN, Vice President and Chief Nursing Officer, Cedars-Sinai Medical Center; Vice-Chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing Susan Hassmiller, Ph.D., R.N., FAAN, Senior Advisor for Nursing, Robert Wood Johnson Foundation; Study Director, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing Darrell Kirch, M.D., President and Chief Executive Officer, Association of American Medical Colleges David Vlahov, Ph.D., R.N., FAAN, Dean and Endowed Professor of Nursing Education, School of Nursing, University of California, San Francisco Moderated by: Harvey Fineberg, M.D., Ph.D., President, Institute of Medicine For further updates, please visit our meeting webpage. The lecture is open to the public with no costs for registration. Click here to register.

10 Page 10 Baltimore District Beatrice Hazzard MS, RN, CPAN President Bal9more District The Baltimore district has had a very busy fall. Johns Hopkins Medical Center hosted our first meeting in September with a great discussion on the purpose and importance of Journal clubs. In October we hosted the CBSPAN Fall Conference at Medstar Franklin Square Hospital Center. Attended by 81 attendees, we had speakers lecturing on fatigue management, MH, local toxicity, regional anesthesia, integrative therapies, research, and care for the caregivers. I hope you were able to take back to your work new knowledge and shared this with those not able to attend. I was particularly inspired by Felissa Casserta and her passionate lecture on how important it is to take care of ourselves and our coworkers. We must all recognize how challenging our job is and the toll it takes on us physically and emotionally. Only by taking care of ourselves and our coworkers can we assure that our patients will have the best care they deserve. I was also inspired by the many poster presentations from many of our component hospitals showcasing all the Process Improvement, Evidence Based Practice and research being done by our perianesthesia nurses. I hope this encouraged others to consider what projects they may do at work to improve processes and care for our patients. I know many of you do these improvements everyday but we are not always very good at showcasing them and sharing the work we have done with others, either locally or nationally. What I have enjoyed most with my time with CBSPAN is all the knowledge I have gained from others and how important it is to network with those with whom we share a common bond. A great example was our November meeting at University of Maryland St. Joseph Medical Center. The lecture was on OSA in the perianesthesia setting. I know we are all challenged with the implications of patients undergoing anesthesia that are either diagnosed with OSA or identified at risk by a tool. With the imperfection of these tools, our vigilant care for our vulnerable patients becomes incredibly important. The discussion surrounding the different tools and what St. Joseph is doing was a great example of how we can learn from each other. We will restart our winter session at my home, UMMC, with a lecture on Integrative therapies in the perianesthesia setting. Our lecturer is Dr. Reed the Medical Director of our Integrative medicine team. I hope you will consider joining me. Have a great and safe holiday.

11 Page 11 Eastern Shore District Susan Volk MSN, RN, CCRN, CPAN President Eastern Shore District. The Eastern Shore District has had two mee9ngs so far this fall, one in September on the topic of Herbal Supplements and Surgery and in November on Pa9ent and Family Centered Care. The mee9ngs are presented in a conference room and are available for teleconference for par9cipants who want to join from home or another venue. We have mee9ngs scheduled for January, March, May, and June of 2014.! We have begun planning for the Fall Seminar 2014, compiling a list of potential speakers and looking at different venues to hold the function. The seminar will most likely be held in Dover or Newark.! Two of our members attended the Leadership Development Institute in Kansas City in September and found it to be very informative on ways to run the district. It was a wonderful learning environment with many opportunities to network with colleagues from around the country. Kansas City is a very enjoyable and friendly city!! Anita Ruitto, RN from Bay Health Medical Center and a member from CBSPAN passed her CAPA exam! Eastern Shore District extends our congratulations to her on this great achievement!! As we near the end of 2013, it is good to look on back on the year and see what we have learned throughout the year and ponder on what our goals are for It is my hope that we will have more nurses join our meetings and begin networking more with each other so that we can learn more about our practice in perianesthesia nursing!

12 Page 12 Margaret Young, BSN, MDiv, RN, CPAN, CAPA D.C. District President D.C. District Wow! This conference year has really been busy for the nurses in the DC District of the Chesapeake Bay Society of Perianesthesia Nurses. We held our first quarterly half-day seminar on September 28, 2013, at Suburban Hospital in Bethesda, Maryland. I want to congratulate Darlene Gangloff and the nurses at Suburban Hospital for hosting an outstanding seminar. Dr. Andrew Hines, Interventional Radiologist from Suburban, presented a vibrant, animated, pictorial discussion on catheter and needle procedural techniques with interventional radiology. Dr. Hines describes interventional radiology as only two procedures in a hundred costumes. The Clinical Research Coordinator, Mandy Murphy, RN, discussed cardiovascular research at Suburban Hospital with NIH and Johns Hopkins Medicine. Her presentation focused on the NIH Heart Center at Suburban Hospital and the current cardiothoracic surgery research. In October, we joined our colleagues at the CBSPAN Annual Fall Conference hosted by the Baltimore District at Medstar Franklin Square Hospital Center in Rosedale, Maryland. The conference focused on PACU emergencies, new trends and integrative therapies. Bea Hazzard, the Baltimore Chapter President, and her committee, presented a well planned and organized conference that was enjoyed by everyone in attendance. On November 9, 2013, the DC Chapter and the CBSPAN component participated in the Greater Washington Region Heart Walk on the National Mall. We were the CBSPAN Heart Walkers. Thank you Seema Hussain and Lynnae Elliotte for spearheading this great event. Thanks to everyone for your financial donations toward our goal. We had lots of fun for a good cause. If you are not a member of ASPAN, join now and connect with the perianesthesia nurses in the DC and Maryland areas. We need your support. Contact us on our website at Margaret Farr Young BSN, M.Div, RN, CPAN, CAPA DC District President

13 Research Special Needs Pre-Procedure Sedation Protocol Patricia Bodine BSN, RN, CPAN Education Specialist, Department of Nursing Education Shady Grove Adventist Hospital, Rockville, MD Page 13 Our Pediatric Same Day Surgery (PSDS) unit experienced a significant increase in the number of special needs patients as several dentists began doing dental restorations with general anesthesia at our hospital. Special Needs patients, at our hospital, include anyone who has significant difficulty adapting to our environment. Usually this is due to autism. The PSDS staff found it frustrating to care for these patients. There was frequent negotiating between PSDS and the adult pre-op unit who would care for the older teens and young adults with special needs. The anesthesiologists thought the PSDS staff was better able to care for the patients for psychosocial reasons. The PSDS staff was uneasy with caring for adult patients. The adult pre-op unit nurses were opposed to bringing patients to their unit who tended to be disruptive. The patients presented us with more than the usual challenges as many are nonverbal and fearful of all medical environments. We found we were spending extraordinary amounts of time caring for them and maintaining safety for everyone involved, while doing their pre-op assessment. Sometimes the special needs patient would disrupt the whole unit because of their unusual and loud behavior which we understood was an expression of their anxiety. During an especially difficult admission of a young adult male we realized that we needed to change our approach. What routinely was effective for our pediatric special needs patients was ineffective for him and his parents. It was heart breaking to see how frightened he was. His parents and several staff members had to hold him in his stretcher to protect him from hurting himself as he tried to escape after receiving IM sedation. We did a literature search to find out if there were protocols for caring for special needs patients, specifically autistic children and young adults preparing to undergo general anesthesia. Based on this literature search and past experiences, we developed the following protocol. The protocol is put into effect when a pre-op planning nurse makes the initial telephone call assessment of the patient. It is used for any person who might have difficulty cooperating with preparing for and going into the operating room. We utilize the knowledge and experience of the patient s parent or care giver by asking them to tell us what works for the patient. This telephone screening gives the nurse and anesthesiologist valuable information to formulate a care plan for the day of surgery. PROTOCOL FOR SPECIAL NEEDS PATIENTS UNDERGOING ANESTHESIA Developmentally delayed patients have special needs in the perioperative setting. In general, these patients do not tolerate change in their daily routines, are not able to communicate effectively, and therefore can t cooperate well with their care. To provide an early warning system for our department and to consistently sedate our patients in a safe, nontraumatic way, this protocol was developed. Preop Phone Call: 1. As soon as the patient is identified as autistic, make a preliminary phone call to the family and fill out the attached questionnaire and the Department of Nursing Patient History form. 2. Fax copies to Anesthesia and speak to the Anesthesiology Floor Manager about pre-op orders. Complete Pediatric Sedation Pre-op Order form. 3. The Anesthesiologist will order either one or a combination of the following: At least 30 minutes prior to procedure patient will be pre-medicated with Synera patches to 2 potential IV sites Midazolam 0.5 mg/kg orally OR Ketamine 4mg/kg orally AND Midazolam 0.4 mg/kg orally. 4. Develop a plan of care based on the results of the questionnaire and Anesthesia s input including the following possible alterations in our routine management of patients: Have family arrive 1 hour prior to procedure start time. Identify a quiet, non-threatening room that the patient will be admitted to which will have distractions for the patient that the family has identified as effective (ex.: TV, toys, coloring books). This should be in the Pediatric Same Day Surgery Unit whenever space and staffing allows. Assure that 1:1 nursing ratio is available for this patient. Assure that all pre-medications are available in the unit the day before surgery. Assure that the appropriate size stretcher with bumper pads is in the unit prior to patient arrival. If appropriate, notify additional staff or security to be available. (Continued on Page 13)

14 Page 14 (Continued from Page12) Day of Surgery 1. Verify that the patient is ready for surgery (stable vital signs, no recent illnesses, NPO). 2. Apply Synera patches and administer sedation. Techniques to help patient feel comfortable with drinking sedation medications include mixing it with a favorite clear fluid identified by the family on the questionnaire, and offering family member a portion of the same clear liquid at the same time. 3. If patient is not adequately sedated within 30 minutes notify Anesthesiologist or Anesthesiology Floor Manager to prepare for possible administration of intramuscular Ketamine. 4. Post-anesthesia care will be provided in the age appropriate unit After implementing this protocol we found that all except a few patients with special needs did well. For those patients we now have a Special Needs Coordinator, an RN who contacts the family after the initial phone call identifies them at high risk for flight or fight prior to anesthesia. The family or caregiver may report the following to trigger contacting a special needs coordinator: History of fear of medical personnel per family report History of aggressive behavior when anxious Inability to take any oral sedation For these patients the Special Needs Coordinator, in partnership with the anesthesiologist, determines how to safely sedate the patient with as little interaction with our staff as possible. We are able to be quite creative. One example is we have brought the patient into a private waiting area with their caregivers. Another example is that we have met the patient and caregivers at their car (a team of an RN, anesthesiologist, and technician along with all emergency equipment, stretcher and portable monitor were at the curb 20 feet out side of the Department of Surgical Services). In both cases we determined appropriate NPO status, no recent signs of illness, and that appropriate permissions were signed. At that point the patient was pre-sedated with oral versed, or a combination of oral ketamine and versed. When the patient was relaxed enough to have their physical assessment completed we did so. There was an instance when, after the pre-sedation, the assessment showed the patient was not prepared for surgery and it was cancelled. The caregivers knew this was a possibility ahead of time. We held the patient until the sedative wore off adequately, and then discharged home after meeting phase II discharge criteria. Most of the cases are admitted as all patients are, with the exception of shortening the wait time and assuring the admitting area is not agitating to the patient. Again, the patients who require a coordinator are not able to express their concerns and usually have a history of being agitated to the point of self protective aggressive behavior. Since instituting this protocol our special needs patients and their families have a better experience. Time and again we hear comments regarding how smooth the experience has been. The staff knows what the patient s fears are, and what they might be able to cooperate with in our unit. They know what the parents expectations are and the parents are prepared well ahead of time for what will happen with their loved one on the day of surgery. The anesthesiologists are better prepared to pre-sedate and assist each other in those last few minutes before going into the OR. Having a protocol for special needs people has stream-lined the admitting process on the day of surgery for these families. References: Van Der Walt JH, Moran C, An audit of perioperative management of autistic children. Paediatric Anaesthesia 2001; 11: Rainey L, Van Der Walt JH, The Anaesthetic Management of Autistic Children, Anaesthesia Intensive Care 1998; 26: Klein U, Nowak AJ, Characteristics of patients with autistic disorder presenting for dental treatment: a survey and chart review, Special Care Dentistry 1999; 19: Tsang RW, Solow HL, Ananthanarayan C, Haley S, Daily General Anaesthesia for radiotherapy in unco-operative patients: ingredients for successful management, clinical Oncology 2001; 13: Dell, D, Feleccia, M., Hicks, L., Longstreth-Papsun, et al. (2008). Care of patients with autism spectrum disorder undergoing surgery for cancer. Oncology Nursing Forum 35(2) (Continued on Page 14)

15 (Continued from Page 13) Page 15 Special Needs Interview Worksheet When a special needs patient is identified, i.e. with autism, the nurse will call the family, complete the perioperative nursing history and the following interview form. The nurse will inform the family that we will contact them again after we have developed their child s personalized plan of care with the Anesthesiologist. Name DOB MR# Parent s Name (s) Phone Numbers 1. How does patient Communicate? 2. Describe patient s reaction to interactions with medical personnel in the past. 3. What, if anything, might agitate the patient? 4. What, if anything, is patient fearful of? 5. What is the patient s preferred clear liquid? 6. How does the patient do taking medications? 7. What is the patient s approximate height and weight? 8. What can we provide to entertain or distract the patient while he waits for his procedure? 9. What suggestions does parent have to help process of admission go smoothly? *Document responses on the back of Department of Nursing Patient History #

16 Page 16 Four Abstracts accepted for the ASPAN National Conference Chicago, April 2013 By the JHH Weinberg 3 Prep/PACU nurses INCREASING THE EFFICIENCY OF THE USE OF ISOLATION ROOM AND CARTS Team Leaders: Marie Graziela F. Bautista, BSN, RN, CPAN, CAPA and Mary Christina Joy Lazo, MSN, RN, CPAN Johns Hopkins Hospital, Baltimore, MD Team Members: Elizabeth A. Luna, BSN, RN and Regina Dulad, BSN, RN Inconsistencies and poor compliance to HEIC (Hospital Epidemiology and Infection Control) policy on the use of isolation room and carts for patients on isolation precaution was identified during the Comprehensive Unit Safety Program meeting. To address the issue, a team was created to review current unit practice and compare it to existing HEIC policy on Standard and Isolation Precautions. 1 The unit practice revealed that the isolation cart and room supplies are disorganized; overstock and supply bins and carts are not emptied or cleaned after every use. There was inadequate staff knowledge on the HEIC policy and recommended traffic flow in the use of the isolation room. The inconsistencies in practice led to poor compliance, inefficiency in use of supplies and increase in wastage and unit costs. The staff was engaged in identifying items/supplies needed in the care of prep and post-op patients. A list of supplies is created and baskets and bins were reorganized. Traffic flow of personnel going in and out of the isolation room is defined. Staff educated. Compliance was monitored monthly through unit based audits. Standardization of practice in the utilization of isolation room and cart supplies and defining traffic flow improved compliance to HEIC policy. It identified cost efficient measures in the use of supplies and decrease in wastage and unit costs. It promoted safe practice in the avoidance of cross contamination and prevention of spread of infection. 1 HEIC Infec9on Control and Preven9on: Standard and Isola9on Precau9ons Policy, accessed October 15, 2012, hdp://

17 Page 17 MONITORING TIME REQUIRED IN PACU FOR OUTPATIENTS AFTER ADMINISTRATION OF PO OPIODS Team Leader: Laura Kaiser BSN, RN, CPAN The Johns Hopkins Hospital, Baltimore, Maryland Team Members: Mary Christina Joy Lazo MSN, RN, CPAN, Patricia Ryan MSN/MHA, RN, Kimberly Connolly BSN, RN, CPAN, Elizabeth Luna BSN, RN, Marilou Tayag, BSN, RN, Melanie Mallari, BSN, RN, Catherine Desai, BSN, RN, Kristin Zoller BSN, RN, Belle Castro BSN, RN Background/Problem: PACU nurses have questioned the current policy of requiring outpatients to be monitored for 60 minutes post po opiod administration. Different PACUs within the same institution have different practice and policies. Patients and family members have expressed dissatisfaction with the policy that delays the discharge to home. No significant side effects or reactions have been noted during the observation period. Objective/Purpose: To review the evidence using the Johns Hopkins Hospital Evidence Based Practice Model. To determine the minimum safe monitoring period in the PACU post po opiod administration for outpatients. Method/Process: Identified EBP question, defined scope of practice question, identified team members and responsibilities. Telephone survey completed to a sampling of comparable large teaching hospitals in the nation. Literature search conducted and articles reviewed. Significance of Findings: Telephone survey showed that monitoring requirements varied and many institutions do not have a written policy. PACUs in the other hospitals said they would be interested in hearing about the results of our project. Literature search revealed that there is very little research or evidence on this topic. Implications for Perianesthesia nurses and future research: It is a national issue that there are varied practices amongst PACUs and there is little evidence in the literature. Research is needed to come up with standard guidelines.

18 Page 18 INNOVATIVE APPROACH IN PRE-OPERATIVE ORIENTATION PROGRAM Team Leader: Mary Christina Joy Lazo, MSN, RN, CPAN and Maria Talabong, BSN, RN Johns Hopkins Hospital, Baltimore, Maryland Team Members: Debra Harris, BSN, RN, CAPA; Elizabeth Turner, BSN, RN Background Information: Deficits in knowledge, work flow processes, and documentation led to a delay in providing safe and efficient management and care of the pre-operative patient. This was a safety culture in which patients can be placed in harm. Nurses, as the front line care providers, often were the ones identifying potential causes of harm to a patient before it even reaches the patient. Pre-operative nurses serve as the safety nets for patients going to surgery. Objective: To develop a standardized and structured pre-operative nursing orientation program for new staff to promote safe and efficient management of pre-operative patients in a timely manner. Implementation Process: With knowledge of such issues, the Prep team conducted a comprehensive review of Johns Hopkins Hospital (JHH) policies on nursing orientation practices 1, and utilized organizational nursing talent to assist the Prep team in restructuring the pre-operative nursing orientation. Key elements to the standardized and structured pre-operative nursing orientation program were the development of twoweek pre-operative nursing orientation process and a prep workflow diagram that were presented on power point presentation and structured lectures. This process was piloted on ten new staff for a four month period. Successful Practice: Both preceptors and orientees felt more confident, knowledgeable, and empowered by using the new preoperative nursing orientation program which led to safe and efficient management of pre-operative patients in a timely manner. Positive Outcome: Measured and identified qualitative and quantitative outcomes showed improved time management and increased efficiency, prep patient turnover rate, confidence, and satisfaction among orientees. 1 Johns Hopkins Hospital Medical Nursing Operation Manual, Education, Orientation of Registered Nurses and Licensed Practical Nurses accessed October 15, 2012, pdf

19 DECREASING OUTPATIENT SURGERY LEGNTH OF STAY RELATED TO DISPOSITION OF NARCOTIC PRESCRIPTIONS Team Leader: Mary Christina Joy Lazo, MSN, RN, CPAN Johns Hopkins Hospital, Baltimore, Maryland Team Members: Marie Graziela F. Bautista, BSN, RN, CPAN, CAPA; Maria Talabong, BSN, RN; Rudylene Marciano, BSN, RN, CPAN, CAPA; Melanie Mallari, BSN, RN; Dustin Te, BSN, RN, CPAN; and Dina Krenzischek, PhD, MAS, RN, CPAN, FAAN Background Information: Inconsistent issuance of narcotic prescriptions by the providers resulted in delayed discharge and increased length of stay (LOS) of outpatients in the PACU. Providers wrote narcotic prescriptions in the Prep unit and left them in the chart without proper communication with the nurses; a violation to the Hospital Medication Order policy on the management and storage of narcotic prescription. 2 This warranted the creation of a team to address such violation. Objective: To address the management and storage of narcotic prescriptions issued in the Prep Unit. Implementation Process: Workflow and documentation processes: Narcotic prescriptions were directly given to the family by the provider for filling, with patient s approval during the preoperative period. Narcotic prescriptions were stored in the medication station when the families were not present. Narcotic prescriptions were documented by the nurse in the pre-procedure note and on the communication board delineating if given to the family or stored in the medication station. All nurses were educated on the process prior to implementation. Practice initiative was monitored over a six month period. Successful Practice: Standardized process on the management and storage of narcotic prescription for Prep and PACU was created. Narcotic prescriptions were filled while patient surgery was in progress. Page 19 Outcomes: Standardized process on the management and storage of narcotic prescription decreased the LOS and facilitated the discharge of outpatients from the PACU. Eliminating PACU wait time related to narcotic prescription has improved patient, family, and staff satisfaction and has promoted a positive hospital experience. 1 The Johns Hopkins Hospital Interdisciplinary Clinical Practice Manual, Medication Orders, accessed October 15, 2012,

20 Page 20 PUZZLE PAGE!! Las Vegas, Here We Come!! Instructions: Unscramble the letters, spaces and punctuation marks with 3 characters in each box to spell out the phrase. Clue: Las Vegas Come on, Folks! You can do this!!!!! NO ONE has submitted an answer--amazing!!! The answer lies somewhere in this newsletter...hint, hint. The first person to solve this puzzle will receive a $25 credit towards the PANAW Week Seminar with Kim Noble! Send your answer to Connie Gull at jeeplady@comcast.net

21 Page 21 Certification Exam Registration & Administration Dates & Deadlines Spring 2014 Registration Window - Online January 13 - March 10 Registration Deadline - Online March 10 by 11:59pm ET Time period for scheduling exam appt w/ Prometric Upon receipt of ATT letter through May 15 Examination Administration window April 7 through May 17 Deadline for cancelling or rescheduling appt Postmark deadline for requesting withdrawal, refund, rollover from PES 31 calendar days before scheduled test date no charge calendar days before scheduled test date $ Less than 3 days $ On or before last day of examination administration window New Practice Exams available Includes correct answers and references Buy one, get one free New 12-week Study Plan is Available Online is comprehensive 12-week study plan organizes subject matter into topics that can be reviewed in approximately four hours per week. is free guide is ideal for Coaches, small groups or your own personal study plan. Download your copy at: > Certification > Exam Preparation > CPAN/CAPA 12-Week Study Plan For information about finding a Certification Coach or forming study groups, contact zwilliams@proexam.org FAQ's, found under the Certification section of the ABPANC website, answer questions concerning the taking an exam by computer.

22 Page 22 CBSPAN Fall Conference, Medstar Franklin Square Hospital October 26, 2013 Verbal permission to publish granted by all individual in photos.

23 Page 23 LDI Kansas City September 2013

24 Page 24 DC District and CBSPAN Heart Walkers November 9, 2013

25 Dates to Remember: Page 25 December 11, 2013 The Institute of Medicine Richard and Hinda Rosenthal Lecture National Academy of Sciences 2102 Constitution Avenue NW Washington, DC January 11, 2014 CBSPAN Board Meeting via Go To Meeting February 3-9, 2014 PANAW Week February 8, st Annual PANAW Seminar with Kim Noble, PhD, RN, CPAN ASPAN Director for Research February 17, 2014 Nurse s Night in Annapolis February Deadline for ASPAN Officer voting April 27-May 1, 2014 National Conference Las Vegas, NV Editor s Note Here I sit at the last moment, sputtering over how the newsletter is coming together. If I write my thoughts too early, they are too soon out of date, but then I procrastinate and that s not good either. What is good, however, are the incredible opportunities we have for our members, as well as all PACU nurses. The Fall Conference was outstanding. The district meetings are always thought-provoking. And now we are fortunate to have Kim Noble, someone I have always admired for her abilities and her humor, coming to speak to us on Research in February to celebrate PANAW Week!! How great is that??? If you have never heard her speak on her passion, research, you need to plan to attend this seminar on February 8 th. I promise you, you will not go away disappointed!! Connie Gull. MPP, BSN, FCN

26 Page 26

27 Page 24 Page 27

28 Page 28 WILLINGNESS TO PARTICIPATE TAKING THE NEXT STEP TOWARDS BEING AN ACTIVE PART IN THE LEADERSHIP OF CBSPAN AT THE COMPONENT OR THE DISTRICT LEVEL NAME: (include credentials) ADDRESS: (Street/Town, City/State/ Zip code) PHONE wk: home: Fax: POSITION / TITLE: HOSPITAL/SURGICAL CENTER: ADDRESS: (Street/Town, City/ State/ Zip code)) MEMBER OF ASPAN? Y/N Membership # CERTIFIED: Y/N # I am willing to be considered for candidacy for CBSPAN: Vice President/President-elect Secretary Treasurer I am willing to serve on the following CBSPAN committee(s): (may circle more than one) Bylaws (includes policies and procedures) Research Education Marketing and Communications) Ways and Means Governmental Affairs I am willing to be considered for candidacy for my DISTRICT: (circle) Baltimore DC Eastern Shore Vice President/President-elect Secretary Treasurer I am willing to serve on the following DISTRICT committee(s): (may circle more than one) Bylaws Nominating Ways and Means Programs Newsletter/Website Governmental Affairs Scholarship Research Please send information for the duties, functions and time commitment of checked committees I am I am not at this time willing to be the Chairperson of the committee checked Submit the completed to form to the CBSPAN President or appropriate District President.