OR Manager - November 2019 - 20

Special Series: ERAS
SPECIAL SERIES
Continued from page 19
and identifying new opportunities for
improving care. Consistent success depends
on having a clinical governance
model that includes surgeons, anesthesia
providers, nursing, and operational
leadership. Additionally, the clinical informatics,
electronic medical record
(EMR), and data analytics must align to
ensure measures are relatively intuitive
to frontline staff.
Role of the OR team
By recognizing that ERAS is a value
stream for the patient, from the time
the patient decides to have surgery
through the return to baseline function
and full recovery, the team can work together
to provide the best possible care
(Figure 2, p 19).
The OR team-surgeons, anesthesia
providers, nursing, techs, and others-must
work together to achieve
sustained change of practice for the
intraoperative period, stressing the importance
of communication and focusing
on treating the whole patient. Good
process is the foundation on which to
build a successful ERAS program in
which the team knows what to do and
when to do it, has access to the resources
needed, and knows what to
expect of others (Figure 3 above).
The role of the surgeon can be divided
into three periods:
* Decision for surgery until day of surgery:
Define the acuity of surgery (ie,
how quickly the surgery must take
place). Participate and be aware of
the need to optimize the patient's
comorbid conditions preoperatively.
* Surgery: Minimize the surgical stress
response, and control the surgical
factors affecting the perioperative
course. Examples include appropriate
choice of antibiotics and preoperative
medications, minimally invasive
approaches where applicable,
and use of separate closure trays in
appropriate cases.
* Postoperatively: Encourage mobilization,
normalization of bodily functions,
and removal of drains.
20
OR Manager | November 2019
Figure 3. Source: Paula Spencer, MSHA, PMP, CPHIMS; Michael J. Scott, MB, ChB, FRCP,
FRCA, FFICM; and Jeanette Amery, MSN, RN, AGACNP-BC.
The role of the anesthesiologist can be
divided into two periods:
* Prior to surgery: Many preoperative
clinics for assessment and optimization
are directed and staffed by anesthesiologists.
This allows them to
coordinate the medical optimization
needed for the planned procedures.
* Day of surgery: Perform the nerve
blocks used to decrease opioid consumption,
and ensure administration
of key perioperative medications
(antibiotics, deep vein thrombosis
prophylaxis, preoperative
non-opioid analgesics) in addition to
the anesthetic plan. For cases with
moderate or significant fluid shifts,
use a flow-based fluid approach to
decrease with over- or under-intraoperative
resuscitation.
The role of nursing can be divided into
six periods:
* Decision for surgery until day of surgery:
Provide guidance for the patient
and family to maximize the patient's
ability to be well prepared and medically
optimized for surgery. Educate
patients about pain management
and early recovery expectations.
* In the preoperative unit: Verify appropriate
carbohydrate loading and
hydration, avoiding unnecessary
fluid infusion. Administer appropriate
premedications to minimize
opioid use for pain management.
Actively warm patients to maintain
normothermia in the OR. Reinforce
education and expectations.
* In the OR: The surgery team manager
ensures the equipment and
supplies are appropriate for the procedure
being done and applicable
infection prevention protocols are
followed.
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OR Manager - November 2019

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