3-Green
Evergreen Hospital Medical Center
PROFILE
The Surgical Pre-Anesthesia Clinic (PAC) is comprised of a multidisciplinary team who focus on preparing patients for surgery. The PAC staff evaluates pre-surgical patients using anesthesia guidelines from the American Society of Anesthesiologists (ASA) and provides education and information to meet their needs through the surgical continuum of care. PAC is often the first place our surgical patients encounter after being scheduled for a procedure. PAC RN’s initiate the patient’s surgical experience by phone or hospital interview. After indicated tests determined by the patient’s health history, a hospitalist, anesthesiologist or other specialist may also be included in the presurgical preparation and planning.
UNIT FOCUS
The perianesthesia nursing role during the pre-operative phase focuses on assessing the patient and developing a plan of care designed to meet the pre-procedural, physical, psychological, sociocultural and spiritual needs of the patient, family and/or significant other. The nursing roles also focus on preparing the patient, family and/or significant other for his or her experience throughout the surgical continuum. Interview and assessment techniques are used to identify potential or actual problems which may occur. Surgery can be one of the most difficult and stressful events in a patient’s life and our goal is to make this time as easy as possible for our patients.
PATIENT CARE DELIVERY MODEL
The patient care delivery model is highly collaborative and inclusive of all members of the pre- surgical team. A complete pre-surgical evaluation is an important part of the surgical process. Depending on the patient’s condition and type of surgery scheduled, certain pre-operative tests and/or treatments may be indicated. PAC will facilitate the patient evaluation in partnership with the patient’s primary care provider. The patient may also be referred to the Surgical Pre-Anesthesia Clinic for a hospitalist evaluation. The hospitalist team is comprised of internists who provide medical consultations for surgical patients to support the community physician’s needs.
TEAM MEMBERS
The PAC team is comprised of surgical pre-admit nurses who are supported by a health unit coordinators (HUC) and medical assistants (MA’s). The Surgical Services Medical and Nursing Directors are the administrative team for the department. The Pre/Post Anesthesia Care Units Manager and Charge RN are accountable for the nursing practice and daily operations of the PAC unit. Prior perianesthesia/perioperative experience is preferred with a minimum of 2 years of medical-surgical experience required for nursing applicants.
SCHEDULING PRACTICES
Staff schedules are based on, but not limited to, the following criteria: number of patients, number of operating rooms, average time for patient preparation, and patient acuity. We enjoy a variety of shift lengths to accommodate patient appointments. We try to be flexible with scheduling in order to accommodate personal and educational needs.
STAFF ORIENTATION
All new staff members attend the Evergreen Healthcare orientation as outlined by Evergreen Human Resources. The PAC educator and charge RN facilitate the interdepartmental orientation. The nursing staff also attend a skills lab at the time of hire and again annually to ensure competency. The Pre/Post Anesthesia Care Unit Manager and educator provide education and training designed to maintain the knowledge and skill necessary to fulfill the job descriptions and responsibilities of all personnel in the department. Education is determined by ASPAN standards, patient population, type of procedures performed, findings from performance measurement/improvement activities, areas identified in peer/management reviews and staff feedback .
The length of each new hire’s orientation is individually determined based upon past clinical experience in perioperative and/or perianesthesia nursing. Orientation follows ASPAN Competency Based Orientation (CBO) which outlines performance expectations, skills and behaviors necessary for the employee to successfully perform his or her job description. Assessment of performance is obtained from testing scores from CBO and direct observation by the educator, charge RN and preceptor as well as self-evaluation. Additional skills workshops and testing are designed by the educator.
EDUCATIONAL AND DEVELOPMENT OPPORTUNITIES
In addition to the staff orientation, on-going educational opportunities are provided by both general hospital in-services and focused department in-services provided by the PAC educator. Surgery Department Management is committed to the provision of both current and updated education for staff from our physicians, vendors and/or anesthesiologists as well as our department educators. PAC staff (RN’s, HUC and MA’s) also function as preceptors for new employees within the department.
There is also opportunity for staff involvement in process/quality improvement within the unit. The leadership team collaborates with staff to discuss practice and/or process concerns within the unit and develop resolutions to improve future outcomes. We support best clinical practice and continually reevaluate unit practices within the group for improvement opportunities. The nurse manager and staff promote the highest quality nursing practice based upon the American Association of Perianesthesia Nursing Standards of Care as well as community standards.
RN certification with ASPAN for CAPA and/or CPAN is encouraged but is not mandatory.