Neuro Nuances: Standard of Care Implementation Improves Patient Outcomes on a Neurosurgical Acuity Adaptable Unit
Topic of Interest
CNS as Project Manager
Quality Initiatives
Patient Populations
Capture Value of the CNS
Abstract
Objective: Implement neurosurgical standard of care post-operatively for nurses to follow, with a focus on early removal of indwelling urinary catheters (IUCs) and ambulation, to improve post-operative patient outcomes.
Methods: Nurses engaged in research and creation of standards of care for the post-operative neurosurgical patient population. The standards were educated to the new group of nurses that would be caring for the neurosurgical post-operative patient population.
Evaluation: Weekly audits were completed to monitor adherence to protocols. The Plan, Do, Check, Act Cycle was used to continue to evaluate effectiveness of education. New education and interventions were created when inconsistencies were found (such as adding neurosurgery metrics to High Reliability Organization Board, following up with nurses to identify barriers, visual reminders, etc.). The Michigan Spine Surgery Improvement Collaborative (MSSIC) collects data related to post-operative complications for neurosurgical patients, such as deep vein thrombosis, urinary retention, and urinary tract infections. This data was pulled from MSSIC and compared pre and post intervention.
Results: Adherence to early IUC removal by post-op day 1 and early ambulation within 8 hours of surgical case close increased. The increase in adherence to these protocols led to a decrease in the post-operative complications of deep vein thrombosis, urinary tract infection, and urinary retention.
Implications: Implementation of a post-operative neurosurgical standard of care protocol showed a decrease in post-operative complications. This can potentially be applied to other neurosurgical units, as well as other areas caring for post-operative patients other than neurosurgical to decrease complications post-operatively.