Can You Pass This Patient Satisfaction Quiz?

1. Patient communication apps can be used in the following situations:

• a. A few days prior to surgery to get patients prepared.
• b. During surgery to keep the responsible caregivers up to date with the progress of the surgery and how their loved one is doing.
• c. To provide post-op care instructions.  
• d. To communicate appointment reminders and help with appointment scheduling.
• e. All of the above.
• Reveal

  • Answer: e
    Brittney Williams, RN, director of surgical services at White Rock Medical Center, a 100-bed, acute care facility in the Dallas area, says that apps and automated text features benefit virtually every area of patient care. “One of the ways that it impacts overall patient satisfaction is through the use of text features to update patient families during surgical procedures,” she says. With the patient’s permission, institutions can send automated text messages to the families letting them know the progress of the procedure. “Automated text messages can also alert the family that the surgery has begun, that the surgery is complete and even discharge readiness,” says Ms. Williams. Automated text messages can also be sent to the patient pre- and postoperatively as reminders of things such as NPO status and important instructions for their post-op care. “All of these things can be beneficial to the patient when implemented with the proper precautions to protect the facility and patients. With the proper safeguards in place to protect patient information, technology can be beneficial to patient care,” notes Ms. Williams.
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2. Cross-training staff not only overwhelms them but can also confuse your patients.

• a. True
• b. False
• Reveal

  • Answer: b
    Despite what many leaders believe, cross-training often reinvigorates staff. If you want to prevent both boredom and burnout, then train your staff on multiple positions and departments, says Carson McCafferty, MSN, RN, CNOR, CSSM, CSRN, clinical director at Eye 35, a busy ASC in Schertz, Texas. “Not only does this help when staff members call out, it also helps keep your facility running on time, which makes patients very happy,” she says.
    To keep the surgery schedule moving, her facility also trained some of its nurses to act as runners for the day. “The runner helps turn over rooms and can even run out and grab an instrument that is needed so that the surgery doesn’t need to stop,” she says, adding that each staff member is equipped with a walkie talkie. “This way, we can communicate more discreetly than a loudspeaker if we need another blanket or another set of hands,” she says. They also rely on a form that they put at the top of every patient’s chart that notes vital details about the patient. “We will note if they are a fall risk, or if the patient has a hearing aid, for example. This helps our staff care for each patient individually and not just as if they are a number,” says Ms. McCafferty.
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3. You should warm patients prior to surgery only if they request it.

• a. True
• b. False
• Reveal

  • Answer: b
    “It is important to keep patients warm throughout their entire perioperative journey for the overall experience of the patient, both in terms of comfort and improved recovery time,” says Amanda Stanley, RN, BSN, CNOR, chief operating officer and chief nursing officer at Advanced CardioVascular Solutions in Oklahoma City.
    When hypothermia goes undetected in the perioperative setting, the risk for incidences of surgical site infections and length of stay increases, and patients are more likely to suffer from cardiac arrythmias, blood loss, altered medication metabolism and pain perception.
    All procedures at Advanced CardioVascular Solutions are under 60 minutes, so the staff monitors a patient’s temperature preoperatively and every 15 minutes post procedure for the first hour. During longer procedures, it is best to monitor each patient’s core temperature during the procedure, because the combination of cold room temperature, cleaning solutions on the skin and anesthetic agents can affect body temperature. Utilizing a consistent temperature measurement practice will ensure reliable readings. Ms. Stanley is an advocate of active warming, which can include the use of forced air warming, an underbody conductive heat mat, a circulating water mattress or radiant warmers. “Active warming measures are more effective because they deliver constant warming to the patient,” says Ms. Stanley.
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TRUST AND VERIFY Patients and family members appreciate clear and constant communication.

4. What are the patient-specific risk factors for postoperative nausea & vomiting (PONV) in adults?

• a. female sex, a history of PONV and/or motion sickness, nonsmoking status and young age
• b. female sex, a history of PONV and/or motion sickness, smoking status and young age
• c. male sex, a history of PONV and/or motion sickness, nonsmoking status and young age
• d. female sex, a history of PONV and/or motion sickness, nonsmoking status and old age
• Reveal

  • Answer: a
    These risk factors are a good starting point to help you determine how to prevent and treat PONV, however, there are plenty of other factors to consider as well. According to the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting (osmag.net/PONVConsensus), which discusses successful strategies that involve a multimodal approach that combines antiemetics with emerging and effective prophylactic modalities for PONV, the guidelines now recommend giving at least two antiemetics to patients with PONV risk factors. Because no provider wants their patients to suffer from PONV, which is associated with longer PACU stays, increased supply costs and staffing burden and decreased patient satisfaction, you must identify the risk factors. “If the only risk factor a patient has is a history of nausea and vomiting, that patient will very likely experience nausea and vomiting if you do not intervene,” notes Tong J (TJ) Gan, MD, MBA, MHS, FRCA, who is a professor and chairman of the department of anesthesiology at Stony Brook (N.Y.) Renaissance School of Medicine.
    Mike Majmundar, MD, a facial plastic surgeon and director of Northside Plastic Surgery, an Atlanta-based plastic surgery center, says he treats all his patients for PONV as a rule. “Our anesthesiologists pretreat nausea and vomiting with a scopolamine patch and preop Pepcid. Then intraoperatively, we treat with steroids. Pepcid is given to all patients with a sip of water whereas the scopolamine patch is usually given to younger patients who are at higher risk of PONV,” says Dr. Majmundar. “Scopolamine in older patients can make them unsteady so it is only offered if there is a strong history of PONV after discussion of pros and cons. Postoperatively, every patient goes home with a prescription for an antiemetic along with their patch. This routine has significantly reduced our nausea and vomiting incidence.”
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5. Which nonpharmacologic prophylaxis shows promise in treating and preventing PONV?

• a. Acupuncture
• b. Aromatherapy
• c. Hydration
• d. All of the above
• e. None of the above
• Reveal

  • Answer: d
    According to the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting, alternative therapies, if used properly, can help decrease PONV. Studies have shown that acupoint stimulation is effective in reducing PONV regardless of whether stimulation is initiated before or after induction of anesthesia, say Dr. Gan.
    He also notes the importance of adequate hydration. While many physicians still expect patients to be NPO after midnight in most cases (children or patients with diabetes can have clear liquids up to four hours prior to surgery), if you keep the patient well-hydrated, you reduce the risk of nausea and vomiting.
    Aromatherapy, which involves patients inhaling essential oils that can contain lavender, peppermint, ginger or lemon, can also assist in decreasing PONV. According to a study that was recently published in the Journal of Holistic Nursing, 384 patients had the option to try aromatherapy before proceeding, if necessary, to antiemetic drugs. “The intervention group demonstrated a statistically significant reduction in the number of unique surgical patients’ need for antiemetics as treatment,” notes the study’s authors.
    In the end, you can quell your patient’s nerves and fears with open and honest communication. “I don’t think there is a perfect formula for preventing PONV,” says Dr. Majmundar, who makes sure his patients are aware that there is always a chance they may experience PONV.
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6. Long-lasting local anesthetics often make even the most painful procedures more tolerable. 

• a. True
• b. False
• Reveal

  • Answer: a
    “The biggest misunderstanding patients have is the idea that they will be in pain the minute they wake up,” says Dr. Majmundar. “With appropriate local anesthesia and nerve blocks, patients can be comfortable for the vast majority of surgeries when they wake. Longer-lasting local anesthetic agents such as bupivacaine have made procedures more tolerable with less reliance on opioids, a major patient-satisfier. “Most patients do not want to take opioids,” says Dr. Majmundar. “We talk to them about local anesthesia and our combination of lidocaine with bupivacaine and how it helps with pain relief for several hours after they leave our center,” he says. 
    Dr. Majmundar says his patients often express their fear of waking up in pain and many are also afraid of addiction. “We explain to patients that it is OK to take an opioid if they are having pain but to switch to acetaminophen as soon as they can. Those who do not want opioids do well with Cox-2 inhibitors such as Celebrex,” he says. OSM
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