ORM February 2023 - 22

Ambulatory Surgery Centers
Continued from page 21
Butz. The patient's eyes are open, they
are breathing, and their vital signs are
stable, but they are in a hypnotic state
where they are not experiencing anxiety.
Once they are comfortable, staff separate
them from the parents and bring
them into the OR in this state. " We
certainly have children in our facility to
whom we have had to give an injection
of ketamine prior to going back to the
OR because of extreme anxiety, " says
Dr Butz.
ASCs should also consider ordering
medications in liquid forms and
in smaller doses, he suggests. Many
children cannot swallow pills. Prepare
ahead of time: order narcotics, diazepam
in elixir form, and use Tylenol suppositories
if needed.
" I try to order all my medications in
as small of a unit as possible. Not everybody
needs a 20-mL vial of propofol, "
says Dr Butz. His facility offers doses in
10-mL vials. Sometimes he works with
compounding pharmacies to get emergency
medications in smaller forms.
" We have something that we call dwindle-dose
epinephrine, which is a 10 micrograms
per cubic centimeter dose of
epi, so we don't have to dilute it down
to the pediatric dose if we have to give
it in an emergency, " he explains.
Addressing noise volume in the
OR
Noise level is not something OR staff
often think about, but research suggests
it can make a crucial difference
for young patients.
People are the top sources of noise
in the OR. This is especially true when
multiple conversations take place at the
same time, says Glendyle Levinskas,
BSN, RN, CNOR, a nurse at VUMC who
has researched the effects of noise during
critical surgery times.
A survey of VUMC staff revealed that
people and conversations (87%) were
the key sources of noise, followed by
22
OR Manager | February 2023
music and radio (54%)
and OR equipment and
monitors (50%). " We are
an academic medical
center, so aside from
the regular OR staff, we
have residents, nursing
students, and traffic
going on as well as
nursing staff activities, "
she says.
calls for more research on the impact of
the environment on perioperative outcomes, "
says Dr Uffman.
Glendyle
Levinskas,
BSN, RN,
CNOR
Research specific to pediatrics found
that noise reduction has a direct correlation
to patient behavior following
surgery.
Dr Crockett has led several quality
improvement (QI) studies at Vanderbilt
Children's Hospital at VUMC on distractions
and noise. In one study, interventions
managed to reduce distractions
during general anesthesia induction in
pediatric otolaryngology ORs from 61%
to 10% over an approximate 7-month
period.
Perioperative staff were educated
about distractions for anesthesia providers
and the impact on patient safety,
Noise level is not something OR staff often
think about, but research suggests it can
make a crucial difference for young patients.
One recent study co-authored by Dr
Uffman, presented at the Anesthesiology
2022 annual meeting in New Orleans,
found that reducing the noise
level can impact postoperative behavior
in children.
Researchers at Nationwide Children's
Hospital, Columbus, Ohio, randomized
64 preschool children to a reduced
noise group (33 children) that
had low ambient lighting, muted communication
devices, and reduced OR personnel,
or a control group (31 children).
Participants were 4 to 5 years old
and were administered general anesthesia
for tonsillectomy/adenoidectomy
or dental procedures lasting at least 30
minutes. Children in the reduced noise
group had fewer temper tantrums, were
less fussy about eating, and were more
interested in their environment in the
first 5 days after surgery.
" The study was interesting and really
and OR circulating nurses were trained
to pause any music upon entry to the
OR. The anesthesiologist would ask for
quiet during induction if a distraction
took place.
Crockett et al, in a follow-up study,
used interventions from the first project
along with an audio-visual decibel alarm
meter called the " Yacker Tracker® " to
decrease noise levels in the OR during
emergence from anesthesia.
The device is an audio-visual alarm
meter that looks like a stoplight. " I
would set it at a certain decibel. If the
volume in the room got louder than that
decibel, it would blink yellow. If it got 15
decibels or more above that, it would
blink red and sound an alarm, " says Dr
Crockett. This served as a reminder to
staff that noise in the OR was getting
too loud.
The interventions worked, she adds.
" We were able to go from an average
www.ormanager.com
http://www.ormanager.com
ORM February 2023

Table of Contents for the Digital Edition of ORM February 2023
