2015-2017 PeriAnesthesia Nursing Standards, Practice
2015-2017 PeriAnesthesia Nursing Standards, Practice Recommendations and Interpretive Statements Update AzPANA Spring into Summer Conference February 21, 2015 Jacque Crosson MSN RN CPAN 1 Objectives • Discuss the evolution of the ASPAN (American Society of PeriAnesthesia Nurses) Standards. • Describe the ASPAN Practice Recommendations for desirable nursing practice. • Identify ASPAN Position Statements applicable to current challenges in the perianesthesia environment. 2 Evolution of ASPAN Standards ! What is a standard? …the model or example against which we measure the quality, quantity or value of something else. Source of Nursing Standards • • Regulatory • State Board of Nursing • Arizona Department of Health Services • Centers for Medicare & Medicaid Services • Health Insurance Portability & Accountability Act Administrative • Employer / Institution policies, procedures Source of Nursing Standards • Voluntary Examples • The Joint Commission • Accreditation Association for Ambulatory Healthcare • Nursing organizations ASPAN “is responsible for defining and establishing the scope of perianesthesia nursing”. American Society of PeriAnesthesia Nurses. 2015-2017 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements Cherry Hill, NJ: ASPAN; 2014. ASPAN Standards • American Society of Post Anesthesia Nurses founded 1980 • First standards of Post Anesthesia Care published 1986 • • “Periodic” review followed Now published every two years ASPAN Standards • What’s changed over the years? • • • • • 1989 Expanded definitions: Pre-op, Phase II 1991 Data for initial, ongoing, discharge assessment Phase I and II 1995 Definitions: Preanesthesia, Procedural, Phase I and Phase II 1998 Addition of phase III [Extended Observation] 1998-2015- ongoing content additions, deletions, interpretive statements, leveled evidence 7 ASPAN Standards ! How are they developed? Standards are the work of the ASPAN Standards and Guidelines Strategic Work Team ! The Strategic Work Team (SWT) ! Receives input from the Director of Clinical Practice regarding trends in clinical inquiries ! Reviews present standards ! Considers trends > evaluates need for revisions ASPAN Standards • Standards and Guidelines SWT collaborates with other ASPAN committees/SWTs • Clinical Practice • Safety • Evidence Based Practice • Research 9 ASPAN Standards ! Proposed revisions, deletions, additions are presented to ASPAN’s Representative Assembly (RA) for discussion / ratification • RA is the voting body for ASPAN ! Meets annually at NC ASPAN Standards & Practice Recommendations • Latest Edition 2015-2017 • Scope of Practice • Principles of Practice • Standards • Practice Recommendations • Clinical Guidelines • Position Statements • Resources Effective: January 1, 2015 11 ASPAN Standards & Practice Recommendations • Self Assessment ! I have my own copy (and I know what’s inside) ! I know where to find it on my unit (and I have read some of it) ! I’ve never seen this book (but please don’t tell my boss) ASPAN Standards & Practice Recommendations • Part One: Scope of Perianesthesia Nursing Practice • • • • Preanesthesia Phase • Preadmission • Day of surgery/procedure Postanesthesia Phase I Postanesthesia Phase II Extended care ASPAN Standards & Practice Recommendations • Part Two: Principles of Perianesthesia Practice ASPAN & perianesthesia nurses strive to ensure: • • • • • • • Competency Responsibility to patients Professional responsibility Collegiality Research Advocacy Safe practice ASPAN Standards & Practice Recommendations • Part Three Standards of Perianesthesia Nursing Practice • Each standard provides • A framework for care of diverse patient populations in all perianesthesia settings • Included staffing and personnel management • Provide rationale, outcome, criteria ASPAN Standards & Prac.ce Recommenda.ons • Part Four Clinical Practice Guidelines ! Evidence based guidelines for specific care • Promotion of Normothermia • Pain & Comfort Prevention and Management of Post Operative Nausea & Vomiting (PONV) / Post Discharge Nausea & Vomiting (PDNV) • ASPAN Standards & Prac.ce Recommenda.ons • Part Five Practice Recommendations ! ! ! Statements which best describe the desirable and achievable level of performance expected of perianesthesia registered nurses More specific recommendations how to meet criteria of the Standards Interpretive statements for clarity Prac.ce Recommenda.ons ! Patient Classification/Recommended Staffing ! Components of initial, ongoing, discharge assessment ! Recommended Equipment (all phases) ! Recommended Competencies: Perianesthesia RN ! Competencies of Perianesthesia Support Staff 18 Practice Recommendations ! Safe Transfer of Care ! RN Role in Management of Patients Undergoing Sedation ! Fast tracking the Ambulatory Surgery Patient ! Perianesthesia Care Unit Visitation Guidelines for Adult Patients ! Obstructive Sleep Apnea in the Adult Patient ! Unwanted Sedation in the Adult Perianesthesia Patient 19 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines Staffing is based on patient acuity, census, patient flow, physical facility • Preadmission: dependent on patient volume, patient health status, support staff • Day of surgery: patient safety, # and acuity, complexity: time for patient prep, med reconciliation/administration, sedation, procedures, monitoring 20 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines, continued • Phase I: Class 1:1 One Nurse to One Patient • At the time of admission until critical elements* met * Report, questions answered, transfer of care * Stable ** / secure airway * Initial assessment completed * Hemodynamically stable * Pt free from agitation, restlessness, combative behaviors • ** Unstable airway: jaw lift, oral airway, obstruction, respiratory distress Any unconscious patient 8 years and under Second RN must be available to assist • • 21 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines, continued ! Phase I: Class 1:2 One Nurse to Two Patients ! 1 unconscious stable pt, no airway and >8 years and 1 stable conscious pt ! 2 stable conscious pts ! 2 stable conscious pts <8 with family or competent support staff present 22 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines, continued ! Phase I: Class 2:1: Two Nurses to One Patient • One critically ill, unstable, complicated 23 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines, continued • Phase II • 1:3 Over 8 years old; or 8 or younger with family present • 1:2 8 or younger w/o family or support staff; or initial admission of patient post procedure • 1:1 unstable patient awaiting transfer 24 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines, continued • Extended Care • 1:3/5 One Nurse to Three / Five Patients Examples of Extended Care patients may include: • Patients awaiting ride home • Patients without a caregiver • Patient requiring extended observation post procedure • Patients held for inpatient bed 25 Prac.ce Recommenda.ons #1 Patient Classification / Recommended Staffing Guidelines, continued Blended levels of care: ! Perianesthesia units may provide Phase I, Phase II, and/or Extended Care within the same environment. ! This may require the blending of patients and staffing patterns. ! The perianesthesia nurse uses prudent judgment based on patient acuity, nursing observations and required interventions to determine staffing needs. 26 Prac.ce Recommenda.ons ! #1A Patient on Contact Precautions • 1:1 upon arrival of patient • Ratios may advance provided that there is sufficient time to don/remove respiratory precautions, other protective barriers, and wash hands between contact with other patients 27 Prac.ce Recommenda.ons • #2 Components of Initial, Ongoing and Discharge Assessment and Management • Recommended components of assessment and management in all phases of care • Preadmission • Day of Surgery / Procedure • Phase I (Initial & Ongoing Assessment/Management) • Phase II (Initial, Ongoing & Discharge Assessments/Management ) • Extended Care (Initial/Ongoing/Discharge Assessment & Management) 28 Practice Recommendations #6 Safe Transfer of Care The perianesthesia nurse is responsible for the safe transfer of care of patients from each phase of the perianesthesia continuum. • The perianesthesia RN determines the mode, number and competency level of accompanying personnel based on patient needs. • A preanesthesia RN should accompany patients who require cardiac monitoring or evaluation and/or treatment during transfer • Transport personnel remain with the patient until receiving unit staff at bedside to assume care. Position Statements • Support standards of practice; representation of ASPAN’s viewpoint; provide information • 13 Position Statements • DNR • RN Utilization of Unlicensed Personnel • On call/Work schedule • ICU Overflow • Med/surg Overflow 30 Position Statements • Safe Medication Administration • Older Adult • Pediatric • Workplace Violence • Substance Abuse • Social Media • Nurse of the Future • Perinatal Patient Resources • Recommendations for practice based on available evidence, expert consensus, practice guidelines from partnering organizations • American Nurses Association (ANA) Code of Ethics • American Society of Anesthesiologists Standards • Association for Radiologic & Imaging Nursing (ARIN) Clinical Practice Guideline: Handoff communication 32 Resources – ASA Standards • Resource 2C: ASA Standards for postanesthesia care* ! All patients who have received GA, regional, MAC shall receive appropriate postanesthesia management ! Verbal report is provided to PACU RN receiving patient ! Anesthesia provider to remain in PACU until PACU RN accepts responsibility ! Use of an appropriate PACU scoring tool is encouraged ! Policy should exist to assure availability in the facility of MD to manage complications, provide CPR * Reference: ASPAN Standards of Perianesthesia Nursing Practice 33 Perianesthesia Nursing Standards, Practice Recommendations & Interpretive Statements ! How to learn more? ! www.aspan.org ! Answers > Clinical Practice > FAQs to most frequently asked questions submitted to the Clinical Practice Committee 35 36 Questions? 37
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