Purpose: Enhanced recovery after surgery (ERAs) encourages early mobility of eligible patients to promote improved rehabilitation and facilitate recovery. Immobilization can contribute to post-operative complications such as pneumonia, deep vein thrombosis, and ileus. Seven orange leadership collaborated with the ERAs team to optimize post-op documentation of daily goals through the deployment of a post-op ERAs patient checklist.
Description: A multidisciplinary team was formed which consisted of nursing, advanced practice providers, anesthesiologists, clinical educators, and quality and operational excellence to develop a patient-centered post-op paper checklist to document daily goals in real-time. Seven orange is a 32-bed medical-surgical colorectal unit and is part of the ERAs group. Nursing leadership on this unit and clinical educators oriented staff to the new process. Completed checklists were audited weekly by leadership and disseminated to front-line staff to collect feedback and promote awareness. Anecdotal patient feedback was collected and shared with the project team to help measure and monitor the process. The team agreed to improve both out of bed to chair (OOBTC) and ambulation of post-operative colorectal patients from baseline (OOBTC: 47% and ambulation X3: 35%) on ERAs patients from August 30 to November 31, 2021. Each week leadership communicated data trends and findings to front-line staff by reviewing charts of patients with completed paper checklists. The ERAs team shared results weekly with the nursing leadership team and presented at seven orange staff meetings to discuss updates and collect feedback from front-line staff.
Evaluation/outcome: Documentation of OOBTC and ambulation of post-operative colorectal patients improved during the pilot period (significant at p=.0017). The anecdotal staff feedback suggests the use of the post-op checklist yielded improved nurse/patient communication and document provided a useful roadmap for the patient to look ahead at their plan of care by post-op day. The post-op checklist has been adopted with minor suggested edits to improve readability (e.g., add color, graphics, etc.). One of the major benefits of this checklist was the involvement of the patients and families in the healing process. The checklist helped the patients know they had a specific plan designed for them and that they are collaborating with the physician and nurses in the process of recovery and healing. Due to the success of colorectal ERAs checklist, plans are to roll out to other surgical patient populations.
Evidence-based references 1. Gillis C, Gill M, Marlett N, et al Patients as partners in Enhanced Recovery After Surgery: A qualitative patient-led studyBMJ Open 2017;7:e017002. doi: 10.1136/bmjopen-2017-017002