Collaborative practice patterns cut cancellations
Collaborative practice patterns cut cancellations
Patients, families report high satisfaction
It’s the morning of surgery. You’ve just learned that your elderly patient has no one to take care of her after surgery, and she’s confused about the incentive spirometer that you’re going to give her to take home, even though you discussed both of these points in the preoperative telephone interview.
Don’t throw up your hands in frustration just yet if your preoperative patient education isn’t working. One hospital reports success using patient/family collaborative practice patterns to educate patients and their significant others before the day of surgery. Telling them what to expect and prepare for has helped reduce delays, cancellations, and unplanned admissions by 75%.
On top of that, 88% of patients say the information given to them in the pre-op interview about their upcoming surgery and what to prepare for and expect exceeded their expectations in its usefulness to them.
"It’s much higher than we expected," says Rita Ash-Borden, RN, director of surgical services at Walter O. Boswell Memorial Hospital in Sun City, AZ. Ash-Borden attributes that success to patient/family collaborative practice patterns that are shown to patients and their friends and family members at the preoperative visit, several days before surgery.
The collaborative practice patterns are critical pathways that cover diet; medications; equipment and tubes; treatments and tests; activity; and education and teaching. (See four examples enclosed in this issue of Same-Day Surgery.) The patterns are physician-specific.
Get family buy-in
Patients and their significant others review the practice patterns with a nurse at the preoperative visit. Nurses spend at least 30 minutes conducting the history and reviewing the appropriate collaborative practice patterns.
"It’s a buy-in for the patient and the family," says JoAnne Andrews, RN, coordinator of the outpatient suite.
With the practice pattern in front of him or her, the nurse goes into great detail about what will happen on the day of surgery, including an explanation that, for example, the patient will be changing into a gown and getting into a bed.
"Patients used to come in and say, I have to get undressed? I can’t walk into the operating room?’" Andrews says.
It’s important for the friend or family member to understand all the home care instructions, involving, for example, ice bags, drains, and dressings, Andrews points out. "It’s frightening when you get home, you’re the caretaker, and you don’t know what to do," she says.
Patients and significant others are told what postoperative complications they should report to their doctor, and the nurse ensures that they have the physician’s phone number.
Getting familiar with the equipment
The advantages of reviewing collaborative practice patterns with patients and their significant others are many, Andrews and Ash-Borden say. One is that patients and families can obtain any supplies and equipment ahead of time. For example, patients may need to purchase dressings, medications, or walkers.
"When they get home [from surgery], they’re not running around trying to get the items they need," Andrews says.
In addition, patients and their friends and families can learn how to use equipment ahead of time. For example, patients having a partial mastectomy learn how incentive spirometers and drains work, as their significant others watch. Teaching is reinforced on the day of surgery.
Helping elderly patients learn to use the incentive spirometers preoperatively has increased compliance and improved their lung function, Ash-Borden says. In fact, the outpatient surgery department has completely eradicated atelectasis since the collaborative practice patterns were implemented, she says.
Better preparation means improved outcomes
Another bonus is that patients’ preoperative worry is significantly reduced, Andrews says.
"You’ve got better-prepared patients, better outcomes, and less stress and anxiety," she says.
And the patients aren’t the only ones with less anxiety. Problems that could potentially delay or cancel surgery are uncovered ahead of time. Social services, subacute services, and home health services are contacted, if necessary.
"Often we find they don’t have a ride home," Andrews says. Or the staff may determine that a neighbor was going to check on the patient after surgery, but not stay at the patient’s home to provide postoperative care.
"We’re able to intervene and make arrangements for the nurse to come in the next day," Andrews says.
Previously, such problems might have been uncovered on the day of surgery.
"That’s where cancellations have been eliminated," Ash-Borden says.
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