OR Manager - November 2019 - 5

Editorial
Editorial
Continued from page 3
intravenous fluids to avoid hypothermia
in the early postoperative period
* the use of tranexamic acid or epsilon
aminocaproic acid during onpump
cardiac surgical procedures
* the use of acetaminophen, Tramadol,
dexmedetomidine, and pregabalin
or gabapentin for multimodal
opioid-sparing pain management
* the use of biomarkers for early identification
of patients at risk for acute
kidney injury complications.
" Cardiac surgery involves a large
clinician group working in concert
throughout all phases of care, " the authors
say. " Patient and caregiver education
and systemwide engagement
(facilitated by specialty champions and
nurse coordinators) are necessary to
implement best practices. A successful
introduction of ERAS protocols is
possible, but a broad-based, multidisciplinary
approach is imperative for
success, " they conclude.
Putting ERAS into practice
Similar conclusions were drawn in a
review of studies on health professionals'
experiences of ERAS. The authors
narrowed down a qualitative literature
review to eight studies in the US,
UK, Canada, Denmark, Norway, and
Australia focusing on ERAS applied
to colorectal surgery, gastrointestinal
surgery, abdominal hysterectomy, and
orthopedics.
Like other standardized care initiatives,
successful implementation of
ERAS depends on a multidisciplinary
team that communicates effectively,
is willing to collaborate, overcomes resistance
to change, understands each
team member's role, and understands
ERAS protocols. Some of the studies
found that giving new staff a " thorough
introduction " about ERAS principles and
ADVISORY BOARD
Kathryn Adamson, MBA, RN, Independent
Consultant, Salt Lake City, UT
Amy L. Bethel, MPA, RN, NE-BC,
Clinical Education Specialist,
UnityPoint Health, Des Moines, IA
Mark E. Bruley, CCE, FACCE,
EIT, Vice President Emeritus,
Accident & Forensic Investigation,
ECRI Institute, Plymouth Meeting, PA
Ellen Carpenter, BSN, RN, Assistant Director
of the OR, Long Island Jewish Medical
Center, New Hyde Park, NY
Michael A. Hofmann, BSN, RN, Regional
Director of Perioperative Services, Ascension
NE Wisconsin St Elizabeth Hospital/Fox
Valley Region, Appleton, WI
Natasha Luster, MSN, RN, CNOR, Nurse
Manager, Surgical Services, Premier
Health-Miami Valley Hospital, Dayton, OH
Casey Orth-Nebitt, BSN, RN, Director of
Surgery, Buena Vista Regional Medical
Center, Storm Lake, IA
www.ormanager.com
Kaye Reiter, MSN, RN, NE-BC, Regional Vice
President, Surgical Services, University
of Colorado Hospital, UC Health Metro
Denver, Denver CO
John Rosing, MHA, FACHE, Executive Vice
President and Principal, Patton Healthcare
Consulting, Naperville, IL
Patricia C Seifert, MSN, RN, CNOR, FAAN
Independent Cardiac Consultant, Falls
Church, VA
Diane Skorupski, MS, RN, CNOR, NE-BC,
Vice President, Surgical Services,
Tampa General Hospital, Tampa, FL
Dawn Vocke, MSN, MBA, RN, CNOR,
Clinical Director, Surgical Service,
UPMC St Margaret, Pittsburgh, PA
David E. Young, MD, Medical Director,
Preanesthesia Testing, Advocate Lutheran
General Hospital, Chicago, IL
using a " bottom-up " rather than a " topdown "
approach were helpful in engaging
staff.
Three of the eight studies found that
staff generally favored use of ERAS,
but all of the studies cited challenges
such as worry about other team members'
perceptions and possible secondguessing
of decisions. In one study, for
example, researchers noted: " Where
nurses anticipated that some surgeons
might resist ERAS recommendations,
surgeons thought that the nursing culture
and lack of nursing time would
present a problem. Anesthetists, meanwhile,
were concerned that patients
would not understand ERAS guidelines
and procedures. "
The authors conclude that even
when staff are on board with ERAS, it
can be a complex and challenging process
to implement. " We suggest that
the provision of comprehensive, coherent,
and locally relevant information to
health professionals would help to improve
the implementation and delivery
of ERAS pathways, " they say.
This is the intent of our ERAS series:
to provide a comprehensive picture of
the people, processes, and improved
outcomes that are possible with this
model of patient care. We hope you find
these articles illuminating. ✥
-Elizabeth Wood
References
Cohen R, Gooberman-Hill R. Staff
experiences of enhanced recovery
after surgery: Systematic review
of qualitative studies. BMJ Open.
2019;9:e022259.
Engleman D T, Ali W B, Williams J B,
et al. Guidelines for perioperative
care in cardiac surgery: Enhanced
Recovery After Surgery Society
recommendations. JAMA Surg.
2019;154(8):755-766.
Memtsoudis S G, Poeran J, Kehlet H. Enhanced
Recovery After Surgery in the
United States: From evidence-based
practice to uncertain science? JAMA.
Published online February 28, 2019.
OR Manager | November 2019
5
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OR Manager - November 2019

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