319 - Caring Lymphedema Surgical Patients: A Team Approach
Description: Issue: This project focuses on improving the care of patients undergoing surgical procedures to treat or to reduce the risk of developing lymphedema. Over the past year, one of our plastic surgeons initiated a comprehensive clinical program for prevention and surgical management of lymphedema in patients at Beth Israel Deaconess Medical Center, Boston MA. The surgical procedures fall into three case types; lymphaticovenous axillary bypass with or without mastectomy and sentinel node biopsy, lymphatico-lymphatic transplant and extremity liposuction for lymphedema. These complex highly specialized case types and the resulting patient care require increased demands on the surgical team. For example, the surgeon uses unique lymphatic specific dyes and devices before almost every case to determine lymph vessels. Our goal was to improve our patient care practices as a team in the operating room leading to the best possible surgical outcomes. Description of the Team: Our team included surgeon, nurse leaders, educators, and clinical staff. Assessment and Planning: We met as a team to review our lymphedema patient care practices in August 2019. Our first action was to determine a project leader to partner with our surgeon. The Unit-Based Educator was invited to lead the project. Next steps were to observe the cases, coordinate the project, and facilitate the implementation of practice changes. After several case observations and discussion with the team (surgeon, nurses, and surgical technicians) we created an Activity Scorecard to assist us in tracking our work. Issues on the activity score card are shared with the project team through-out the process. In addition to our operating room staff, we collaborated and received support of other stakeholders such as central processing department, supply department, and clinical engineering. Implementation: Our project as designed was received well by the care team. Observation and discussion with team members facilitated the improvement process. We focused on lymph specific dyes, case preferences, supplies, aseptic technique, staff training, instruments, unique devices, core team building. General education and orientation improved the competency of the team members. Using the Activity Scorecard we documented the improvements and interventions. Desired Outcome: We have achieved our goal to provide evidence based care to lymphedema patients by improving the care practices in the operating room as a team. The project does not end here. We are and will continue to identify opportunities for improvement as there is a projection for continued growth in this service line in the next year. Implication of Perioperative Nursing: The nurses are participating in a multidisciplinary approach to deliver a safe, competent, comprehensive care to our patients on a highly effective surgical team.
Co-Authors: Charlotte Guglielmi, Elena Canacari, Richard Caswell, Debra Savage, Deborah Tassone, Dhruv Singhal