Lauren Charles-Johnson, BS, RN, BSN, Miranda Aigeldinger, RN, BSN, PCCN. Lankenau Medical Center
Standardizing nursing care for colorectal surgical patients will enhance recovery by reducing physiologic and psychological stress, improve patient post op pain, expedite bowel function, and decrease cost by a shorter hospital stay and reduced post op complications.
The Enhanced Recovery after Surgery (ERAS) pathway involves continuous teaching and nursing interventions at all stages of care. When a patient comes to the hospital for pre-admission testing (PATs) the nurse discusses with them their plan of care including what to do the night before surgery, realistic postoperative pain expectations, the effects of early ambulation on the healing process, and the negative effects of opioid medication on bowel function. Instructions include drinking a carbohydrate load (12oz) or clear fluids up to 2 hours prior to surgery and taking Entereg the night before. Upon admission, Entereg is administered with a small sip of water if needed, along with Tylenol, Gabapentin, and Celebrex by the preoperative nurse. Teaching done in PATs is reiterated.
Once in the OR the CRNA uses a Clearsite to monitor fluid volumes, propofol to reduce postoperative nausea and vomiting, a ketamine or lidocaine drip are administered for the duration of the case, and a local nerve block using bupivacaine to the anterior abdominal wall is administered once the procedure is complete. The intraoperative goal is euvolemia, defined as having the total fluid volume less than 2L above total losses. In the PACU the nurse assesses pain and administers pain medication as ordered or uses integrative therapy (Reiki, positioning, music, and guided imaginary). The PACU nurse assesses the IV fluid rate, questions the use of an NG tube or Foley catheter, and continues to educate the patient about pain management and the importance of day of surgery ambulation.
Upon arrival to the inpatient unit the nurse maintains the use of multimodel pain management converting to oral medications, uses aggressive antiemetic therapy (Dexamethasone 4-10mg and Ondansetron 4mg), removes the Foley or nasogastric tube, promotes chewing gum, and begins an ambulation schedule. The nurse ambulates the patient as soon as possible the day of surgery setting specific goals.
Since being implemented the average length of stay (5-7 days) is declining with a few patients leaving as early as post op day 2. Many patients have shown enhanced recovery which is a patient who is eating, drinking, and mobilizing well. The newly standardized ERAS pathway is largely the reason for these patients’ success.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93535
Program Number: P298
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster