Evidence-Based Practice Poster Session (Posters #1-#10)
8 - The Green Star Program
Description: Clinical Problem/Significance: Patient’s waking up combative in conjunction with operating room staff’s lack of knowledge on Emergence Delirium placed both patient and staff at risk for harm. When asked about patients with emergence delirium most perioperative staff simply considered it a risk that came along with their job. Patient with Post-traumatic stress disorder (PTSD) are at highest risk for experiencing emergence delirium. Per the National Center for PTSD about 8 out of every 100 people will experience PTSD at some point in their lives, in the military community this percentage is much higher.
Background: Emergence Delirium occurs when a patient wakes up in a state of distress and hyperactivity while emerging from anesthesia. PTSD once called shell shock or battle fatigue is a condition not limited to military men and women and can occur at any age. When a person experiences or witnesses a traumatic or petrifying event where serious harm occurred, threatened to occur or was very frightening they are at risk for PTSD. Traumatic events include, but are not limited to sexual trauma, war/combat events, childhood trauma, a violent event or physical abuse. A person with PTSD relives the trauma over and over again, and can have physical reactions years after the event. PTSD episode can be triggered by something the patient may or may not be aware of. Triggers include smells, sounds, sights, place(s) or thoughts. Clinical Question: How can Perioperative staff help ease or prevent emergence delirium in the surgical setting? Description of Evidenced-Based Protocol: Literature research led to the creation of an emergence delirium screening tool. This screening tool is applied to patients during pre-admissions. A green star stamp is used to inform perioperative staff of the patient's risk for emergence delirium. Implementation of Evidenced-Based Protocol: The Green Star program is adapted to the individual.
Results: Green Star patients comprise between 25 - 40% of operating room cases. Since 2011 only one patient was admitted for behavior management, two staff members received mild harm and zero Code Greens called. Conclusions/
Discussion: It is important to identify patients at risk for emergence delirium, prior to surgery. The Green Star program is a significant means to keep patients and staff members safe. Best practice is to apply the Green Star principles to all waking patients. Decreasing patients' risk for emergence delirium is possible when allowing patients to wake up at their pace and decreasing stimuli. Perioperative Nursing Implications: Annually over 30,000 nurses are injured in the United States. It takes six staff members to assist a combative emergence delirium patient. Even after the combativeness diminishes it takes additional staff at the bedside. The Green Star Program effectively allows one post-operative nurse the ability to recover former combative patient.