Evidence-Based Practice Poster Session (Posters #21-#28)
28 - ERAS: Improving Surgical Experience in Colorectal Surgeries
Description: Clinical Problem or Significance:Post-op Infections and other complications in Colorectal Surgeries.
Background: Colon surgery is one of the most frequently performed surgical procedures in the operating room each year. Complications from these procedures such as infections, pneumonia, and DVT, not only endanger patient’s lives and cause prolonged patient/ family suffering but also lead to financial losses/ reimbursements to the facility/ institutions involved.Clinical question:The purpose of this study therefore, is to identify if implementation of ERAS protocols in Colorectal Surgery will lessen, if not eliminate post op infections and other complications in post surgical patients at Stamford Hospital.Description of Evidenced Based protocol:Enhanced Recovery After Surgery (ERAS),a.k.a, Fast Track Surgery, is an evidence-based paradigm shift in perioperative care, focused on stress reduction and the promotion of a return to function, proven to lower both recovery time and postoperative complication rates, while being cost-effective at the same time.Implementation of Evidenced Based Protocol:A multidisciplinary team / committee consisting of representatives from hospital management, anesthesia, general and colorectal surgeons and residents, nurses,pharmacists, and infection control was formed to develop the ERAS pathway to be implemented. In- Service trainings for surgical staff and pre-op teachings and booklets for patients were given to reinforce knowledge and foster cooperation in the program’s protocol.Furthermore, ERAS preset orders and nurse’s checklist were made to guide nurses and boost their confidence in carrying out their responsibilities to fast track patients.While progress was monitored by the periop ERAS team of nurses and residents, a nurse abstractor/ representative collects and coordinates results regarding infection rate and other variables encountered by patients following colorectal procedures, be it laparoscopic,robotic or open.
Results: Post project data shows a significant decrease in post op infections, DVT, length of stay, morbidity and mortality, etc., on post colorectal patients in Stamford Hospital.Conclusions/ Discussions:Enhanced Recovery after Surgery protocols are a challenge to carry out. Though several research have proven its effectiveness and success, the traditional medical routines to which disciplines were used to will continue to impede its universal application/ acceptance. However, continued education of the medical team,dedication and support of the implementing organization and through the collective effort between the patient and the periop team,it is possible to make it work and yield impressive outcomes.Nursing Implications:ERAS program needs dedicated members to follow up its implementation.Patient should also be educated to make them understand that active participation in their care and strict adherence to follow protocols will lead to faster recovery and uneventful discharge.