ASPAN NATIONAL CONFERENCE ABSTRACTS e29

poor efficiency. This affects staffing and/or an inability to ac-

commodate physician requests for patient appointments.

Objectives of Project:

� Identify who, when, and why patients do not show up for

appointments

� Analyze results to find themes to determine an action plan

� Discuss improved communication strategies with secre-

taries and office schedulers

� Compare pre and post strategy results for further action

Process of Implementation:No Showswere tracked for a pe-

riod of six weeks prior to and sixweeks after strategies were im-

plemented. A secretary was coached to use scripting for

appointment reminder phone calls. A letter was drafted for of-

fice schedulers describing improvement goals including an ap-

pointment notice for patients with contact information for

appointment cancellation. Communication was recognized as

a catalyst for improvement.

Statement of the Successful Practice: The team leader

learned that both pre and post action plan female patients be-

tween the age of 26 and 49 were most likely to not show up

for a morning appointment. The most common reason to not

show up for an appointment was interferencewith work sched-

ule.

Implications: Pretesting departments should consider women

between the ages of 26 and 49 when scheduling pre-testing ap-

pointments. Flexibility with this patient population may pro-

vide better attendance and improved schedule effectiveness.

Audits will be ongoing after implementation of a plan to meet

the needs of this patient population.

IMPROVING PERIOPERATIVEOUTCOMES FOR THEADULT PATIENT WITH OBSTRUCTIVE SLEEPAPNEA AFTER GENERAL ANESTHESIATeam Leader: Jill Setaro, RN, MSN, CPAN

Stony Brook Medicine, Stony Brook, NY

Carole Capps, RN, BSN, CPAN, Edna Giffen, RN, MSN, CPAN,

Amy Ferrara, RN, BSN, CPAN, Michelle Knipe, RN, Henriette

Lucas, RN, BSN, Karen Wiederkehr, RN, BSN, CPAN

Abstract: Care of the patient with Obstructive Sleep Apnea

(OSA) has proved challenging in the postoperative setting. It

has been observed that this patient population requires a high

level of observation to maintain airway patency and oxygena-

tion. Patients with OSA frequently present with an increased

risk of difficult intubation and an increased sensitivity to seda-

tive and analgesia medications. Postoperatively, patients with

OSA are at risk for apnea, desaturation, and cardiac dysrhyth-

mias. The question of how to effectively manage the patient

with obstructive sleep apnea after surgery emerged while car-

ing for this population in the recovery period. Literature review

supported the need for improved, consistent care of the patient

with sleep apnea. A failure mode effect analysis performed in

the PACU demonstrated several high-risk modes that jeopardize

the safety of patients with OSA. Utilizing the Chronic Care

Model for improving patient outcomes, we examined the pa-

tient experience through the perioperative phase of the health

care system. This resulted in the delivery system design of

a nursing standard of care. Integrating clinical information sys-

tems to improve preoperative screening with the use of the

STOP questionnaire will assist in identifying high-risk patients

early in the surgical process. Intensive postoperative monitor-

ing and discharge planning will provide the resources required

for the patient to return safely to the community after surgery.

Implementing this standard has assisted in producing a proac-

tive multidisciplinary team approach to the management of

surgical patients with obstructive sleep apnea. This com-

prehensive plan results in safe, consistent care, educated pa-

tients and staff and improves patient outcomes after general

anesthesia.

PRE-OPERATIVE ISOLATION STATUS ASSESSMENT:WHAT AN IMPACT WE CAN MAKETeam Leader: Mandi L. Glova, BSN, RN

Johns Hopkins Hospital, Bloomberg Children’s Center,

Baltimore, MD

Background/Problem: Within the pediatric pre-op area at

Johns Hopkins Hospital, pediatric surgical patients are placed

on isolation precautions based upon a positive culture from

a previous date. Although this positive result is not always re-

cent, in many cases, it is more than a year old and lacks accu-

racy. Surgical patients regularly receive antibiotics in the OR

making a post-operative culture swab ineffective. Therefore ini-

tiating the isolation precaution in the pre-op area warranted or

not, ensures compliance for the entire hospital stay. In most

cases, once discharged, communication about isolation follow

up and follow through is neglected. Regardless to the time be-

tween visits or admissions; once the child re-enters the hospital

isolation precautions are implemented andmust bemaintained.

Objective/Purpose: A literature review was conducted to ex-

amine the most current evidence using the Johns Hopkins Hos-

pital Evidence Based Practice Model. The purpose of this study

was to: investigate the preoperative assessment of the isolation

status of children and identify those children on isolation; swab

the patient in the PreOp Unit to rule out multidrug resistant or-

ganism (MDRO).

Method/Process: Preoperatively, all pediatric patients’ isola-

tion status would be identified. The PreOp nurse would obtain

a doctor’s order to swab those children who have been desig-

nated MDRO status in the PreOp Unit before going to surgery.

Significance of the Problems/Findings: This initiative re-

vealed that by assessing isolation status and obtaining a swab

pre-operatively, patients no longer affected by the multidrug re-

sistant organism (MDRO) can be removed from isolation while

allowing those with continued infection or colonization to be

appropriately isolated. The psychosocial impact of isolation

precautions on pediatric patients and their families is a growing

concern. The negative body image that results not only impacts

patient satisfaction but staff as well. Likewise, there is also a sig-

nificant impact on resources related to the cost and waste oc-

curring when unwarranted isolation precautions are taken.

Implications for Perianesthesia Nurses: By creating this

preoperative isolation status assessment initiative that identifies

those patients who warrant continued isolation protocols,

nurses have the power to improve patient & staff satisfaction

as well as lower the cost while reducing waste created by un-

warranted isolation precaution measures.