AANA journal
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Information loss can occur during all phases of care. The transfer of care (handoff) from the operating room to the postoperative anesthesia care unit (PACU) is an especially susceptible time. Information loss can lead to an increase in medication errors, sentinel events, and poor patient outcomes. ⋯ As the healthcare industry becomes more complex, it is in the interest of patient safety to develop, validate, and use similar objective procedures as those used in high-reliability organizations. The purpose of this research was to determine if the utilization of a formulated checklist with objective measures during the handoff from the operating room to the PACU decreased information loss, the need for information clarification, and anesthesia providers' time spent in transfer of care, with improved adequacy of the handoff. Specific metrics were monitored before and after implementation to assess for information loss, information clarification, anesthesia providers' time, and to rate the adequacy of the report.
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Postoperative nausea and vomiting is one of the most common complications affecting surgical patients. The glucocorticoid dexamethasone is often used for the prevention of postoperative nausea and vomiting. ⋯ Although the majority of the literature reviewed found no association between single-dose intraoperative dexamethasone and an increase in surgical site infections, the need for a large-scale randomized controlled trial is consistently mentioned. Prudent clinicians should always use the most current evidence with their best clinical judgment when making medication decisions for their patients.
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Forced-air warmers have been used for over twenty years to help prevent and treat inadvertent perioperative hypothermia. One result of hypothermia can be an increased risk of surgical site infection. ⋯ Three reviews have been published and none of these condemned the use of forced-air warmers in the operating room including with patients undergoing total joint arthroplasty. Clinicians must continue to seek information about this problem from peer-reviewed journals and not rely on interpretation by others such as manufacturers.
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Children who present for surgery with undiagnosed sleep-disordered breathing are particularly vulnerable to perioperative respiratory adverse events (PRA Es). Preoperative screening can identify children at increased risk who would benefit from evidence-based perioperative management, reducing serious preventable harm or death. The purpose of this quality improvement study was 2-fold: (1) increase identification of pediatric surgical patients who may be at increased risk of PRAE through the introduction of a validated pediatric screening questionnaire (Snoring, Trouble Breathing, Un-Refreshed [STBUR]), and (2) reduce preventable harm by introducing evidence-based perioperative management guidelines. ⋯ After STBUR implementation, PRAE risk identification increased from 10.5% to 15% (χ2 (1, N = 12,975) = 57.19, z = -7.59, P < .001, odds ratio =1.49). Results of the secondary process measures were mixed. The STBUR screening questions embedded in the medical record significantly improved identification of patients at risk, allowing modification of perioperative management toward safer practices.