Valdez-Boyle LS

Purpose: The NMVAHCS is striving for innovation, with the implementation of an enhanced recovery after surgery (ERAS) protocol: best practice.

Background: Literature supports the reduction of intraoperative instability, post-operative ileus and complications, length of stay (LOS), readmission, and an increase in patient satisfaction. LOS is reduced by 2 days, complications decreased by 50%, readmissions reduced by 8%, with an average cost savings of $2,800-$5,900 per patient: depending on ERAS compliance.

Methods: Implementing an ERAS protocol requires engaging a multidisciplinary team comprised of the patient, surgeon, anesthesiologist, and support services. The surgeon/anesthesiologists attended ERAS educational conferences, ongoing seminars educated the teams. Updated patient instructions eased patient understanding. All colorectal cancer patients are enrolled. Ineligibility is due to severe renal dysfunction, or emergency procedure.

Protocols for each of the perioperative phases were created. Preoperative includes pre-habilitation, smoking cessation, pulmonary toilet, and low volume PEG-Gatorade bowel prep with modified Nichol’s prep. Patients drink a clear carbohydrate (CHO) drink 2 hours prior to induction of anesthesia. Intraoperative includes tight glucose and temperature control, goal-directed fluid therapy, pain management with regional and opioid sparing multimodal analgesia, as well as a minimally invasive approach. Postoperative includes avoidance of tubes and drains, early ambulation and pulmonary toilet, CHO drink, narcotics avoidance, and preemptive treatment for nausea and vomiting.

Outcomes are LOS, readmission, opioid use, complications, infection, return of bowel function, and patient satisfaction. Charts are reviewed for compliance and outcomes are recorded.

To sustain the practice, we have templated notes and orders sets to streamline each step of the process: alerting providers to educate patients and staff at each point of the process. Signage has been created to assist the patient and nursing staff in meeting milestones.

Results: From June 2017 to May 2018, 29 patients were enrolled ERAS protocol. PCAs were avoided, reducing ICU stay and overall cost. Patient satisfaction markedly improved with regional pain control, early CHO drink, early ambulation, and removal of Foley. LOS was not significantly affected due to long distance patients and ileostomy teaching, but did decrease by 1 day on average.

Conclusions: Successful ERAS implementation requires an engaged team.

Purpose: The NMVAHCS is striving for innovation, with the implementation of an enhanced recovery after surgery (ERAS) protocol: best practice.

Background: Literature supports the reduction of intraoperative instability, post-operative ileus and complications, length of stay (LOS), readmission, and an increase in patient satisfaction. LOS is reduced by 2 days, complications decreased by 50%, readmissions reduced by 8%, with an average cost savings of $2,800-$5,900 per patient: depending on ERAS compliance.

Methods: Implementing an ERAS protocol requires engaging a multidisciplinary team comprised of the patient, surgeon, anesthesiologist, and support services. The surgeon/anesthesiologists attended ERAS educational conferences, ongoing seminars educated the teams. Updated patient instructions eased patient understanding. All colorectal cancer patients are enrolled. Ineligibility is due to severe renal dysfunction, or emergency procedure.

Protocols for each of the perioperative phases were created. Preoperative includes pre-habilitation, smoking cessation, pulmonary toilet, and low volume PEG-Gatorade bowel prep with modified Nichol’s prep. Patients drink a clear carbohydrate (CHO) drink 2 hours prior to induction of anesthesia. Intraoperative includes tight glucose and temperature control, goal-directed fluid therapy, pain management with regional and opioid sparing multimodal analgesia, as well as a minimally invasive approach. Postoperative includes avoidance of tubes and drains, early ambulation and pulmonary toilet, CHO drink, narcotics avoidance, and preemptive treatment for nausea and vomiting.

Outcomes are LOS, readmission, opioid use, complications, infection, return of bowel function, and patient satisfaction. Charts are reviewed for compliance and outcomes are recorded.

To sustain the practice, we have templated notes and orders sets to streamline each step of the process: alerting providers to educate patients and staff at each point of the process. Signage has been created to assist the patient and nursing staff in meeting milestones.

Results: From June 2017 to May 2018, 29 patients were enrolled ERAS protocol. PCAs were avoided, reducing ICU stay and overall cost. Patient satisfaction markedly improved with regional pain control, early CHO drink, early ambulation, and removal of Foley. LOS was not significantly affected due to long distance patients and ileostomy teaching, but did decrease by 1 day on average.

Conclusions: Successful ERAS implementation requires an engaged team.

Purpose: The NMVAHCS is striving for innovation, with the implementation of an enhanced recovery after surgery (ERAS) protocol: best practice.

Background: Literature supports the reduction of intraoperative instability, post-operative ileus and complications, length of stay (LOS), readmission, and an increase in patient satisfaction. LOS is reduced by 2 days, complications decreased by 50%, readmissions reduced by 8%, with an average cost savings of $2,800-$5,900 per patient: depending on ERAS compliance.

Methods: Implementing an ERAS protocol requires engaging a multidisciplinary team comprised of the patient, surgeon, anesthesiologist, and support services. The surgeon/anesthesiologists attended ERAS educational conferences, ongoing seminars educated the teams. Updated patient instructions eased patient understanding. All colorectal cancer patients are enrolled. Ineligibility is due to severe renal dysfunction, or emergency procedure.

Protocols for each of the perioperative phases were created. Preoperative includes pre-habilitation, smoking cessation, pulmonary toilet, and low volume PEG-Gatorade bowel prep with modified Nichol’s prep. Patients drink a clear carbohydrate (CHO) drink 2 hours prior to induction of anesthesia. Intraoperative includes tight glucose and temperature control, goal-directed fluid therapy, pain management with regional and opioid sparing multimodal analgesia, as well as a minimally invasive approach. Postoperative includes avoidance of tubes and drains, early ambulation and pulmonary toilet, CHO drink, narcotics avoidance, and preemptive treatment for nausea and vomiting.

Outcomes are LOS, readmission, opioid use, complications, infection, return of bowel function, and patient satisfaction. Charts are reviewed for compliance and outcomes are recorded.

To sustain the practice, we have templated notes and orders sets to streamline each step of the process: alerting providers to educate patients and staff at each point of the process. Signage has been created to assist the patient and nursing staff in meeting milestones.

Results: From June 2017 to May 2018, 29 patients were enrolled ERAS protocol. PCAs were avoided, reducing ICU stay and overall cost. Patient satisfaction markedly improved with regional pain control, early CHO drink, early ambulation, and removal of Foley. LOS was not significantly affected due to long distance patients and ileostomy teaching, but did decrease by 1 day on average.

Conclusions: Successful ERAS implementation requires an engaged team.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.