August2009

August 2009

Orthopaedic Nursing Evidence-Based Initiative. Reflecting on one's practice is critical to providing high quality patient care. The clinical reflection of several CVMC orthopaedic nurses resulted in the realization that a greater number of postoperative patients were arriving on the unit in a deeper state of sedation. These patients required more oxygen to maintain an appropriate oxygen saturation level. Some of the patients required the use of medications to reverse the effects of anesthesia/analgesia after arriving to the unit from post-operative recovery. Questions raised by these astute nurses revealed that patients, who had undergone knee or hip replacement, were the ones experiencing these issues. It was then learned that orthopaedic surgeons were intraoperatively injecting a “Mitka Cocktail,” a synthetic narcotic and anesthetic mixture for pain control, into the muscle surrounding the newly introduced prosthetic. The cocktail, followed by narcotics given during recovery, appeared to be the sources of the over-sedation problem.

alt Because the nurses noticed that these patients were more comfortable post-operatively and required less analgesia, they did not want to interfere with the use of the cocktail. Rather, they searched for a solution after arrival in the postoperative unit. Kelly Yang, BSN, RN (left) and Rose Cook, BSN, RN, ONC (right) brought these concerns to the attention of their nurse manager and shared governance council. Next, they consulted with their course instructor at Western Carolina University and the CVMC Department for Research and Evidence-Based Practice for assistance with research on the topic. The literature search and review confirmed that these issues were common in patients receiving the cocktail, however; literature also revealed these patients tended to be better able to ambulate and more fully participate in their physical therapy regimen. Armed with the evidence in the literature and their own clinical observations, the nurses brought together a multidisciplinary team of orthopedic nurses, surgeons, PACU nurses, and pharmacists. The team developed an order set, based on published guidelines, which addresses standardized medication treatment, nursing care, monitoring, and emergency treatment.

For the first three months following the implementation of the standardized postoperative care protocol in the orthopaedic unit, no code purples were initiated. In contrast, during the three months preceding the evidence-based practice change, 3 orthopaedic code purple events occurred in a single month. The use of continuous pulse oximetry has improved patient outcomes as evidenced by the absence of code purple occurrences. In addition to improved patient outcomes, the EBP initiative has reinforced the value of collaboration and teamwork. The order set facilitated improved hand-off between the OR, PACU, and orthopaedic units.

alt What do Rose and Kelly say about the evidence-based nursing practice change? “At first we were nervous about an EBP project, but in the end, it was very rewarding. The project led to a set of orders that prints automatically. Before, the nurse often had no idea which patients had the cocktail in the OR and wasn’t aware of the potential issues until they happened.” The two agree that communication between the nurses in PACU and the unit has increased. “The quality of care we give now is so much better for these patients.” They also touted the benefits of working as a team and having physician support and encouragement for this initiative. Rose and Kelly presented the EBP project at the Medical/Surgical Journal Club in April, and at Western Carolina University to both BSN and MSN students in spring of 2009. Following the presentation at WCU, the nurses stated that the audience was very impressed with the Research and Evidence-Based Practice program at CVMC. What is next on the horizon for Rose and Kelly? “Our plan is to continue the EBP project to determine cost effectiveness of the cocktail injections vs. pain management with PCA and PCEA. We look forward to our next EBP success”. §

Clinical expertise, one component of evidence-based practice, is enhanced when a nurse earns an advanced degree and/or speciality certification. We tip our hats to these individuals recently furthering their professional training.

Certified Nurse Operating Room: May Lee, BSN, RN, CNOR

Donna Smith, RN, Carla Keaton, RN, Cortney Godfrey, BSN, RN and Terrill Davis-Coulter, BSN, RN-BC recently passed the Oncology Nurses Society Chemotherapy/Biotherapy course.

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The Votes Are In. Hosptial staff cast 408 ballots in the Evidence-Based Practice Logo Contest. The image shown here at left, submitted by Robyn Ison, CRNA, garnered the most votes. Robyn (left) is pictured with Anita Herman, BSN, RN, CEN, Co-Chair of the Research & EBP Council (right), which sponsored the contest. The Council wishes to thank each staff member who submitted a logo image: Kimberly Rudisill, RN (1st runner up) and Shannon Hefner, BSN, RN, CNOR (2nd runner up) Operating Room; Monique Robinson, BSN, RN (3rd runner up) and Suzanne Bradshaw, RN, Psychiatry; Sheree Yoder, ED/DS Out Patient Registration; Brian Smith, CPhT, Pharmacy; Gail Settlemyre, BSN, RN, CPAN, Day Surgery. §

TheCarolina Foothills Chapter of the Emergency Nurses Association (ENA) elected Anita Herman, BSN, RN, CEN to represent the chapter at the upcoming 2009 ENA Annual Conference in Baltimore, MD in October. Congratulations, Anita. §

2009 Research Theatres. Mark you calendar for the 21st or 29th of September to enjoy good food while taking in research presentations by CVMC nurses. Back by popular demand, the Dinner Theater is scheduled for 21 September 2009 from 1730-1830. Showing of the Morning Theater will occur from 0800-0900 on 29 September 2009. Registration is limited due to seating capacity for both events. Participation in the complete educational activity, including evaluation, entitles the participant to one contact hour. To reserve your seat, call Organizational Learning at Extension 3386 and register. §

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Robyn Ison, CRNA, Director of Anesthesia

Robyn joined Catawba Valley Medical Center in 2005. She came from a family of nurses; both of Robyn’s grandmothers were nurses. Initially, Robyn had interests of either being a lawyer, chemical engineer, or nurse. She finished her degree in chemical engineering and before graduation had already applied to a nursing program. She then entered an Associate’s Nursing Degree program, which she completed in 1999. Her first job offers included cardiac catherization and neonatal intensive care.

Robyn began her nursing career in the cath lab. As an RN she worked at Charleston Area Medical Center in Charleston, WV, second only to Duke Medical Center in volume for cardiac caths. One day when Robyn was at the time clock she saw a flyer recognizing “Nurse Anesthetist Week,” she decided it was now or never to pursue her nurse anesthesia degree. She began the 27-month anesthesia program in May 2002, completed her Masters in Health Care Administration in August 2004, and worked as a CRNA for a year prior to coming to CVMC. When asked how she came to CVMC, she explained that she had a “chance” meeting with Vance Lowery, CRNA in Gatlinburg. Vance worked at CVMC at the time and had so much enthusiasm for his job here it sparked a great interest.

Robyn became involved in EBP at the hospital in January 2009 after receiving an invitation from Dr. Tart. The council did not have representation from the Advanced Practice Nurses until Robyn joined. Robyn was very familiar with Journal Clubs, Research, and EBP from grad school, but she admits that EBP at the bedside was foreign to her in the beginning. She is excited to see “fingers reaching out beyond nursing.” Robyn says, “EBP is guiding your practice for a reason, not on a whim.” She has learned that no change occurs quickly and if it does, it is usually not good.

Robyn has been the Director of Anesthesia for three years. She is actively researching, attending classes, and networking with other directors to improve anesthesia, including moderate sedation at CVMC. She is tired of hearing, “Well, we have always done it this way.” We are very excited to spotlight Robyn Ison as a member of the Resarch & Evidence-Based Practice Council, representing our Advanced Practice Nurses. §

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