Protecting Brain Health: A Call to Action for Nursing Leaders

As research continues to uncover the effects of surgery and anesthesia on the older patient’s brain, more is being understood about the short-term and long-term cognitive impairment these patients face.

Physician anesthesiologist Lee A. Fleisher, MD, says perioperative nursing leaders play a critical role in advancing knowledge and education about perioperative neurocognitive disorder (PND) to empower frontline staff nurses, patients, and their families in identifying at-risk patients and planning care accordingly.

“We now know that surgery can trigger inflammation in the brain of older adults and anesthetics can also impact brain function, creating a spectrum of delirium and other cognitive symptoms (“brain fog”) that can delay a return to baseline cognition for three to four months,” Fleisher explains. He is chair of the department of Anesthesiology and Critical Care at the University of Pennsylvania in Philadelphia and chairs the American Society of Anesthesiologists (ASA) ad hoc committee on the Perioperative Brain Health Initiative.

Fleisher is speaking out to healthcare professionals across disciplines to encourage a focus on perioperative brain health in all phases of perioperative care as part of a national campaign the ASA and AARP are jointly supporting.

The goal of the campaign is to engage perioperative partners in raising awareness around best care strategies for addressing postoperative cognitive impairment in older patients.

Shed Light on Perioperative Brain Health

AORN has signed on to this national campaign as a demonstration of commitment for the important role perioperative nurses play in supporting the cognitive health of the older adult perioperative patient—a focus AORN has long supported.

Fleisher says knowledge is key across the phases of perioperative care, starting with preoperative education shared by perioperative nurses in partnership with surgeons and anesthesia professionals and continuing through the postoperative recovery period, when perioperative nurses can take simple actions such as returning eye glasses and hearing aids to older adult patients recovering from anesthesia to help them reorient.

He also stresses the importance of understanding the varied forms of postoperative cognitive impairment.

Know the Signs

Postoperative cognitive impairment takes two primary forms after surgery, including:

• Postoperative delirium: seen commonly on the day of or day after surgery as difficulty with attention and hyperactive, hypoactive or mixed affects to motor symptoms.
• Delayed cognitive recovery: seen as a decline in mental acuity days or even weeks after surgery. Certain procedures such as cardiac surgery could increase the risk for this type of cognitive dysfunction in certain patients.

When these forms of cognitive impairment occur, a range of implications are possible, including patient complications and a delayed return to function that can prolong hospital stay, increase care costs and effect the patient’s quality of life.

Fleisher encourages perioperative nursing leaders to revisit care strategies surrounding perioperative brain health to identify high-risk patients as early as possible in order to assure cognitive care support before and after surgery, especially to prepare caregivers at home about the possibility of delayed cognitive recovery.

To perioperative nursing leaders, he suggests a few tips to increase perioperative patient brain health outcomes in their respective perioperative settings:

• Share the data—Think about sample patient scenarios you can share, as well as other data on perioperative brain health in older adults that will remind your team members to discuss brain health with their older patients.
• Generate team ideas—Take time to talk to different staff groups and understand the issues preventing improvement surrounding recognition of older adult cognitive concerns after surgery such as lack of knowledge, failure of recognition, or fear of giving anti-psychotic drugs.
• Partner with patients and families—Patients and caregivers are becoming more aware of the incidence of postoperative confusion and delirium. Consider forming a patient advisory council for your delirium reduction project, get patients and their families input on your ideas, and ask for their suggestions.

As activities around the Perioperative Brain Health Initiative continue to ramp up, Fleisher expects a greater focus and potential accreditation or regulatory requirements to address older patient cognitive health during perioperative care.

“We hope to convene as many groups as possible in this initiative to target all providers who work with surgical patients during all phases of the perioperative period,” he says.” In doing so, we all have the opportunity to make our individual care environments safer for older adults.”

Share these recent publications and other tools and resources from the Perioperative Brain Health Initiative to improve brain health management in your practice setting.

Post these infographics from the Perioperative Brain Health Initiative to remind your team members to consider the risk of cognitive impairment in older patients.

Additional Resources

• Position statement on Care of the Older Adult in Perioperative Settings
• Care of the Older Adult Video

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