December 2012

Volume 27 � Number 6

www.jopan.org

CONTENTS

- Editorial Opinion

Interprofessional Collaboration in the PerianesthesiaSetting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373Jan Odom-Forren

-Guest Editorial

Interprofessional Collaborative Practice . . . . . . . . . . . . . . . . . . . . . . 374Jane Marie Kirschling and Geraldine (Polly) Bednash

-Original Articles

Focused Anesthesia Interview Resource to Improve Efficiencyand Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376Virginia C. Muckler, Charles A. Vacchiano, Edward G. Sanders,Janet P. Wilson, and Mary T. Champagne

In an effort to reduce costs, many hospitals may use registered nurses (RNs) with littleformal education in anesthetic or surgical risk to perform anesthesia preoperativeinterviews (APIs). The goal of this process improvement project was to determine iffidelity to the Focused Anesthesia Interview Resource (FAIR) tool enhanced the abilityof RNs to perform preoperative anesthesia interviews and, if so, to determine if thisresulted in decreased surgical cancellations and delays. After the implementation ofFAIR, significant improvement in identification of patients with hypertension (P, .01)and cardiac disease (P , .05) was noted. In addition, cancellation rates declined from3.33% to 2.31% (P, .05) and first case delays decreased from 7.54% to 6.99%, althoughthis was not statistically significant.

Perioperative Pain Management in the Opioid-Tolerant PatientWith Chronic Pain: An Evidence-Based Practice Project . . . . . . 385Karen M. Dykstra

According to the Institute of Medicine (IOM) report on pain, chronic pain affects anestimated 116 million American adults and costs the nation more than $600 billioneach year in medical treatment and lost worker productivity. Many individuals withchronic pain undergo surgical procedures. Safe and effective treatment of theirpostoperative pain can present a significant challenge to the health care team but isessential to their optimal recovery. This article presents the first phase of an evidence-based practice project that focused on improving the perioperative pain managementin patients with chronic pain who receive long-acting opioids for the treatment ofchronic pain before admission for surgery.

EDITORS 1986-1988

Anne Allen, RN

Tulsa, OK

Marie Darcy, RN

Vero Beach, FL

EDITORS 1989-1993

Denise O’Brien, BSN, RN,

CPAN, CAPA

Ypsilanti, MI

Kathy Carlson, MA, RN, CPAN

Minneapolis, MN

EDITORS 1994-1999

Susan A. Goodwin, MS, RN,

CPAN

Edmond, OK

Joan Bauer, MS, RN, CPAN

Madison, WI

INTERIM EDITORS 2000-2001

Denise O’Brien, MSN, RN,

APRN, BC, CPAN, CAPA,

FAAN

Ypsilanti, MI

Vallire D. Hooper, PhD, RN,

CPAN, FAANAsheville, NC

Postanesthesia Care Unit Discharge Delay for NonclinicalReasons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393Brian Cowie and Petrea Corcoran

Discharge of patients from the postanesthesia care unit (PACU) is often delayed fornonclinical reasons. This prospective study evaluated PACU patient flow and theincidence and reasons behind delayed PACU discharge for nonclinical reasons. Overa 4-month period delayed discharge because of nonclinical reasons was common,occurring in 421 (15%) patients. Themedian time of delayed discharge was 70 minutes(range, 25 to 420 minutes). The most common reasons for delayed discharge over a 4month period were no bed in the designated postoperative ward for the patient foradmittance in 219 (52%) patients, ward nurses being too busy to accept the patient in32% of the patients, and ward nurses’ meal breaks in 10% of the patients. Improveddischarge planning, restructured staffing, and alterations in operating room schedulingmay minimize these nonclinical discharge delays.

Bacteriostatic Normal Saline Compared With Buffered 1%Lidocaine When Injected Intradermally as a Local Anestheticto Reduce Pain During Intravenous Catheter Insertion . . . . . . . . 399Zenaida C. Deguzman, Susan K. O’Mara, Suela Sulo,Therese Haines, Lindsay Blackburn, and Judy Corazza

Pain associated with intravenous (IV) catheter insertion commonly causes fear andanxiety in presurgical patients. The aim of this studywas to determinewhether there isa significant difference in a patient’s pain level after intradermal injection and IVcatheter insertion when comparing intradermally injected bacteriostatic normal salinewith 0.9% benzyl alcohol with buffered 1% lidocaine to numb the IV line site. Usinga double-blinded experimental design, 376 patients were randomly assigned toa bacteriostatic normal saline group or buffered 1% lidocaine group. A statisticallysignificant difference was found in the IV pain scores, with subjects who receivedbuffered 1% lidocaine reporting less pain than those who received bacteriostaticnormal saline (P , .025). However, no significant difference was found in theintradermal pain scores (P , .79). This study determined that buffered 1% lidocainewas more effective than bacteriostatic normal saline in reducing pain during IVcatheter insertion.

- Ambulatory Surgery

Ambulatory Perianesthesia Electronic Documentation—ATwo-Part Series. Part II: Archiving Your Actions. . . . . . . . . . . . . . . 408Sarah M.I. Cartwright and Leslie A. Edney

- Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

- Clinical Clips

Care of Nonsurgical Patients in the PACU . . . . . . . . . . . . . . . . . . . . 412Barbara Godden

- Pathophysiology Corner

Brain Gain: Adolescent Use of Stimulants forAchievement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415Kim A. Noble

- Perianesthesia Culture

The Culture of Nasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420Maureen V. Iacono

- Practice Corner

Ketamine for Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423Theresa Clifford

- Erratum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424

- The Back Page

Meaningful and Useful Measures of Performance: Ensuring anInterprofessional Approach to Measure Development . . . . . . . . . 429Vallire D. Hooper

Articles in this journal are listed in the Cumulative Index to Nursing & Allied Health

Literature and the International Nursing Index.