STONY BROOK, N.Y. – Nurses at Stony Brook University Hospital’s Ambulatory Surgery Center have pioneered a new way of performing peripheral nerve blocks for patients undergoing outpatient orthopedic surgical procedures that reduces pain, nausea and vomiting, the risk of errors and the amount of time patients spend in the operating room.
Expanding on the role of the Registered Nurse as outlined by the New York State Board of Nursing Education, the nurses can now inject medications under the direction of an anesthesiologist. The medications used during peripheral nerve blocks continue to be drawn up and labeled by the anesthesiologist.
Amelia Williams, MSN, RN, ANP, Clinical Nurse Specialist at the Ambulatory Surgery Center, spearheaded the initiative along with Helen Kurtzke, BSN, RN, Nurse Clinician, who presented their work at the national conference of the American Society of Perianesthesia Nurses (ASPAN) in Seattle, WA, in April 2011. Now it is being featured as the cover story for the June 25 issue of Advance for Nurses magazine.
“These nurses are well deserving of this recognition for their incredible initiative and foresight to create an expanded nursing role that changes how these nerve blocks are administered,” said Lee Xippolitos, RN, PhD, Chief Nursing Officer, Stony Brook University Hospital, and Dean of the Stony Brook University School of Nursing. “Their efforts will improve our operating efficiency while also improving satisfaction for our patients.”
“This new model allows the orthopedic surgeons to perform major reconstructive procedures, such as rotator cuff repairs and anterior cruciate ligament reconstructions of the knee, while advancing clinical practice for nurses, enhancing patient safety and shortening operating room times,” Williams said.
Because there were no clinical practice guidelines or policies for nurses to assist with regional blocks, the ASC nurses took the initiative to develop a clinical model that ensured safe and efficient clinical practice. The staff first researched what role the nurse would play under the scope of practice allowable by the State Board of Nursing. Then they identified a set of critical elements that the nurse would address to ensure patient safety. Those elements included:
• Ensuring that an informed consent to perform the regional block is completed
• Participation by the nurse in a timeout procedure to verify the correct block site
• Development of a specific form to document vital signs during the procedure
• Development of a process to confirm that all medications drawn up by the anesthesiologists were properly labeled
• Development of competencies in ultrasound machine and nerve stimulator
• Credentialing of registered nurses in moderate sedation, allowing nurses to sedate the patient under the direction of an anesthesiologist
• Development of in-services on regional blocks and associated annual competencies
The nurses in the pre-operative holding area all received education to prepare them to assist with the nerve blocks by the anesthesiology team, Williams said. The nurses also developed and implemented a policy to provide a framework to support the pre-operative nurse assisting the anesthesiologists with regional blocks. The nurses check proper placement of the nerve catheter via ultrasound and inject the block medications under the direction of an anesthesiologist.
This model has provided many benefits for patients at the Ambulatory Surgery Center. “As a result of the regional nerve blocks, post-operative pain is decreased since the peripheral block can last up to 24 hours,” Williams said. “With nerve blocks, there are less opioids given with general anesthesia, and post-operative nausea and vomiting is virtually eliminated. This allows the patient to eat and drink sooner, thereby preventing a delay in discharge. The process greatly reduces the potential for wrong-site errors due to the new policy and procedure changes that have been implemented.”
Performing the regional blocks in the holding areas has also decreased the time the patient is in the operating room, which ultimately improved patient turnaround time in the OR, Williams said. This allows more cases to be done in the OR, allowing the facility to be more cost efficient.
The ASC nurses have created a patient teaching video regarding the regional nerve blocks, which helps patients make informed decisions before consenting to the procedure and highlights safety measures for patients upon discharge. The DVD is provided to patients prior to the day of their surgery, or it can be accessed via the ASC web site.
Williams says the procedure is just one reason why the Ambulatory Surgery Center consistently ranks at the 99th percentile nationwide for patient satisfaction compared to other ambulatory facilities participating in the University HealthSystem Consortium (UHC) of academic medical centers nationwide.
About Stony Brook University Hospital:
Stony Brook University Hospital (SBUH) is Long Island’s premier academic medical center. With 597 beds, SBUH serves as the region’s only tertiary care center and Level 1 Trauma Center, and is home to the Stony Brook Heart Institute, Stony Brook Cancer Center, Stony Brook Long Island Children’s Hospital, Stony Brook Neurosciences Institute, and Stony Brook Digestive Disorders Institute. SBUH also encompasses Suffolk County’s only Level 4 Regional Perinatal Center, state-designated AIDS Center, state-designated Comprehensive Psychiatric Emergency Program, state-designated Burn Center, the Christopher Pendergast ALS Center of Excellence, and Kidney Transplant Center. It is home of the nation’s first Pediatric Multiple Sclerosis Center. To learn more, visit www.stonybrookmedicine.edu.
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