Congress Education Sessions provide diverse learning opportunities: Saturday, March 10, to Thursday, March 15, 2007

AORN Journal,  June, 2007  by Lynn J. Hayne,  George E. Brandon,  Liz Cowperthwaite,  Christine Ferrill,  Rebecca L. Holm,  Annie Lenth

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Attendees at the 54th Congress in Orlando, Fla, had the opportunity to attend a variety of education sessions presented throughout the week. Following are synopses of a few of the sessions offered this year.

AMBULATORY EDUCATION

The ambulatory education track addresses issues specific to ambulatory, hospital-based, free-standing, and office-based surgical practices. Ambulatory education sessions are designed to educate and support the many nurses working in this growing segment of the health care community.

POSTOPERATIVE AMBULATORY SURVEILLANCE. There are many more opportunities for surveillance in an inpatient setting than in an ambulatory setting, Catherine "Kate" Moses, RN, CNOR, CPHQ, pointed out during the session, "Out of Sight, Not Out of Mind: Postoperative Surveillance in the Ambulatory Setting." In addition to observing the patient during postoperative care, staff members in inpatient settings can rely on documentation, review records, and track readmissions to determine whether any postoperative problems exist.

In most ambulatory surgery centers (ASCs), especially free-standing ASCs, personnel typically rely on a 24- to 48-hour postoperative telephone call with the patient and hope that the physician will report any problems. Retrospective record review is limited, and surgical case review, tracking, and trending usually take place at the physician level. It is important, therefore, to make the most of the postoperative telephone call and to explore other ways to obtain postoperative patient data for quality improvement.

Moses engaged in a role-playing exercise of a postoperative telephone call; she played the role of a patient while a member of the audience acted as the nurse. After the exchange, Moses gave the nurse some constructive feedback. "You did well, but I suggest you slow down. Patients may be elderly or have a language problem," she said. She also pointed out that the nurse used the word "complications" but had not given specific examples, such as swelling or nausea, so the patient might not have understood what she was asking. She recommended not making the call a question-and-answer session. "Make it a conversation. Make the patient feel you truly care. You're not just calling to fill out a questionnaire because you have to."

Valuable information can be gained from asking the right questions during these telephone calls, and patient problems can be addressed. For example, if the patient is experiencing pain, the nurse can determine what medications were prescribed and call the physician to request a different prescription. Patients often do not want to bother the physician by making a call, so it is important for the nurse to make sure that the physician's office has checked in with the patient. Any problems should be reported to the nurse manager. If the issue can be addressed and resolved, the nurse should report back to the patient.

Several audience members shared their difficulties with postoperative follow-up. In response to an audience member's concern about patient privacy, Moses stressed the importance of verifying the contact telephone number before the patient leaves the facility and asking the patient if it is okay to leave a message. Another said her staff does follow up calls during patient care hours. It is hectic, and if they cannot reach the patient, they do not make a second attempt. Moses explained that at her facility, the person who makes follow-up calls is not a nurse but a person well trained to ask structured questions. She suggested that making follow-up calls could be a perfect job for a retired nurse or a volunteer.

A 14- or 30-day follow-up telephone call or survey can probe more deeply into the patient's surgical experience. Important questions to ask include:

* Did we take care of your safety and comfort?

* Is there something we could have done or done better?

* Were you warm enough?

* What was your overall experience?

* Do you feel the surgery was successful?

* Did the surgery meet your expectations?

Information obtained from calls and surveys can be compiled into a database that allows staff members to examine trends and problems. Data also can show whether organizational goals are being met. Moses gave the example of a goal to have all patients discharged within two hours after surgery. If this is not occurring, then the causes should be determined (eg, nausea, sleepiness, pain, no one there to drive the patient home). Identifying the problem allows staff members to explore ways to improve the process.

In addition to determining what could be done better, data can identify what is being done well or has been improved. Reporting positive results to all stakeholders (eg, nurses, physicians, board members) can help boost morale. Additionally, advertising and marketing the positive results can help attract physicians and patients to the practice and improve community relations.

CLINICAL EDUCATION