OR Manager - November 2019 - 3

Editorial
www.ormanager.com
EDITOR
Elizabeth Wood * 301-354-1786 * ewood@accessintel.com
CLINICAL EDITOR
Judith M. Mathias, MA, RN
CONTRIBUTING WRITERS
Janet M. Boivin, BSN, BSJ, RN
Iris Llewellyn
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Cynthia Saver, MS, RN
Catherine Spader, RN
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Vol. 35, No. 11 November 2019 * OR Manager (ISSN 87568047)
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O
ur series on Enhanced Recovery
After Surgery (ERAS), which
began last month with an
overview of its history and perioperative
pathway, continues in this issue
with examples of improved outcomes
and the roles played by perioperative
team members (see p 18).
ERAS, known to speed recovery
and increase patient satisfaction, has
been adopted for many types of procedures.
Yet Henrik Kehlet, MD, PhD,
who came up with the concept of
" fast-track surgery " from which ERAS
evolved, sounded a cautionary note
early in 2019. In a JAMA Viewpoint, Dr
Kehlet and his colleagues stressed the
importance of conducting scientifically
rigorous studies to support the adoption
of ERAS protocols, noting that " ERAS
recommendations for one surgery may
not be directly translatable to another. "
They lament the shift in focus from
reducing complications and improving
recovery to reducing length of stay
(LOS). " Although it is likely that most
patients would prefer a shorter hospital
stay, a focus on inpatient LOS ignores
the full process of rehabilitation since
much of recovery is shifting from hospitals
to other acute care settings such
as skilled nursing facilities, " they say.
Another caveat: Be wary of adding new
or inadequately studied drugs and interventions.
For example, intravenous acetaminophen
or liposomal bupivacaine
may work well in one procedure but may
be unsafe in another.
Dr Kehlet and his colleagues want
to ensure that ERAS, which began
as a patient-centered science, is not
replaced by " uncertain scientific approaches
that seek to replace true
measures of recovery such as complications,
readmissions, or quality of life
with LOS. "
Cardiac surgery protocols
The authors of recent ERAS recommendations
for cardiac surgery appear
to have used the kind of rigor advocated
by Dr Kehlet et al. Their multidisciplinary
group of cardiac surgeons,
anesthesiologists, and intensivists experienced
in ERAS researched the literature
and ultimately agreed on 22
interventions across preoperative, intraoperative,
and postoperative phases
of recovery. Each recommendation required
a minimum of 75% agreement
on class and level for consensus.
The strongest recommendations
have benefits that greatly outweigh
risks and are based on evidence ranging
from randomized clinical trials to
non-randomized or observational studies.
Examples include:
* delirium screening at least once per
nursing shift
* using forced-air warming blankets,
raising the ambient room temperature,
and warming irrigation and
Continued on page 5
Certified Surgical Services Manager
This CE meets eligibility requirements to recertify the Certified Surgical
Services Manager (CSSM®
for the CSSM®
) credential, and eligibility requirements to apply
exam. Surgical services leaders interested in improving patient
care and advancing the performance of their departments seek the CSSM®
credential, administered by the Competency and Credentialing Institute
(CCI). CCI is a leader in credentialing and nursing competency assessment,
certifying over 35,000 CNOR®
more at cc-institute.org/CSSM.
, CSSM®
, CRNFA®
, and CNS-CP®
Excellent
teamwork and
education are
the hallmarks of
successful ERAS.
nurses. Learn
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3
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OR Manager - November 2019

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