Alma Dirpaul - RN, CPN(C) & Anne Marie DeWeert - RN, BScN
Topic: The Operating Room Team's Experience Responding to the Mass Casualty Event Involving the Humboldt Broncos Hockey Team
On Friday April 6, 2018 a quiet highway intersection in northeastern Saskatchewan ignited global attention. A horrific accident, involving the Humboldt Broncos Saskatchewan Junior Hockey League team became an event that is seared into our memories. In response to this mass casualty event, a “Code Orange” was activated at the Royal University Hospital (RUH) in Saskatoon, Saskatchewan.
The activation of a Code Orange is more than following policy step-by-step. It required the collaboration of diverse team members to devise creative solutions that optimized the care being provided during this crisis. This presentation will provide an overview of the presenters’ (an on-call charge nurse and a nursing manager) experiences during this event. They will each share their perspective of the event, which will include a review of the health region protocol for a mass causality incident, actions taken, and policy changes.
This presentation will conclude with a discussion of the impact the Humboldt Broncos crash has had on the team. Due to the severity of the injuries and the resultant emotional toll, team members experienced varying degrees of post-traumatic stress and have sought the emotional support of their team - as they too heal after this horrific accident. Insight from this experience will be beneficial to others as they prepare to respond to what we all hope never happens.
Anise Barton - MD FRCSC
Topic: Retrospective Chart Review of Wait Times for Breast Cancer Patients, Comparing Two Years Before Our Breast Clinic Opened to Two Years After the Breast Clinic Opened
Assurance of Timely Access to Diagnostics and Treatment by Local Breast Health Clinic
Kaitlin Toplak, BSc*; Anise Barton, MD FRCSC; Elizabeth Ewart, MD FRCPC; Ross Cuthbert, MSN; Andrea Burrows, MSN; Leo Chen, MSc
Breast health clinics (BHCs) allow for centralized care and same-day triple assessment. While Canada lacks consistent standards for BHCs, it does have national guidelines on diagnostic and treatment intervals. This paper provides a critical analysis of pre and post clinic targets, as well as areas for future improvement.
A retrospective chart review was performed on patients with breast cancer (n=540) presenting to a local BHC in Kamloops, Canada, from 2015-2019. Multiple demographic and treatment variables were extracted to evaluate time intervals within both diagnostic and treatment pathways. Results were analyzed using linear
Wait times were significantly reduced after the establishment of a BHC in both women who directly accessed the BHC and others who were treated by traditional means, though more notably in the former. Reduction in time intervals varied from 8, 16, and 24 days for imaging, biopsy, and treatment, respectively.
The BHC, through its significant reduction in wait times, has allowed for more timely access to care.
Bonnie McKechnie - RN & Leenta Nel - RN, CPN(C), RNFA
Topic: Medical Missions: Upholding Our Standards
A Hospital in Antigua, Guatemala depends on volunteers to provide medical services for 48 weeks of a year. A Care-group of 20+ medical staff from Victoria had a shortage of Perioperative Nurses. Three members of PRNABC joined the group of this year. Dr Quon, that oversees the various groups, said that it was noticeable that THIS group held the highest standards - and he thanked us. I think it is directly related to the efforts of PRNABC-members that were there. The proposed presentation includes 60 pictures presented on mirror to apple TV, and/or on a USB. The presentation is estimated to be 35 minutes long and we anticipate 10 minutes for questions at the end.
Topic: Perspectives on Interdisciplinary Collaboration - Strategies to Improve Surgical Care Safety and Prevent Surgical Site Infections
Healthcare professionals must make every reasonable effort to provide safe care to their patients. While healthcare providers, teams and organizations strive to provide safe care, harmful surgical incidents, including wrong site surgeries and surgical items left behind following a surgical procedure, continue to occur. Patient harm as a result of a surgical safety incident damages public confidence in the healthcare system. Effective use of a Surgical Safety Checklist can facilitate communication among teams and help to avoid ‘never events’.
The presenter will discuss the development of the ‘Joint Position Statement on the Advocacy and Support for Use of a Surgical Safety Checklist’ – a collaborative effort in Canada between the Operating Room Nurses Association of Canada and partners: Canadian Anesthesiologists’ Society, Alberta Health Services and the Canadian Patient Safety Institute. With a renewed call for use of a Surgical Safety Checklist, the partners hope to see a reduction in the number of patients harmed as a result of surgical incidents.
It is estimated that hundreds of millions of patients are affected by health care-associated infections (HAI) worldwide, each year. The presenter will provide the history of the development of the ‘WHO Global Guidelines for the Prevention of Surgical Site Infections’ and review the key recommendations for implementation.
Surgical safety incidents and surgical site infections have a human and monetary cost to patients, families, healthcare providers, institutions, and society. Improved collaboration between healthcare providers and patients pays huge dividends by improving patient safety and patient outcomes. The session will close with a discussion of the significance of collaboration.
Cathy Ferguson - BScN, RN, RNFA, CPN(C), ORNAC President
Topic: A Nurse with a Passion
The presentation will focus on the experiences and journey of Cathleen Ferguson, a nurse with a passion to work in the field of perioperative nursing.
Cathleen addresses the specific career decisions she made along the way and the lessons learned that may be of value to others.
The presentation highlights the importance of ongoing education and professional development, the need to engage and network with others, and the value of actively participating in professional organizations.
Christine Kennedy - RN, CPN(C), MA L (Student)
Topic: Nurses on the Move - Supporting Transient Nurses to Provide Care Excellence
This paper will be of interest to those who are curious about travel nursing or who work with travel nurses in their facility. As a travel nurse with Select Medical Connections for the last five years, I have worked at numerous facilities in Canada. I undertook this research as an action research project for my Master of Arts in Leadership and to learn how to support travel nurses to be the best version of themselves as nurses. I will interview travel nurses to discover their unique perspectives of their journey as a travel nurse. I plan to discover what is working, what is not working and where we, as a profession and business, can improve, to better support travel nurses when they are on assignment. My goal is to improve communication between travel nurses and the facilities they work in, to assist nurses to give the best care they can. I will present information to help you understand what travel nursing is, and how you can help to improve the support of travel nurses in your facility. The information may also help you to support new regular staff nurses in your facility. Travel nurses are vital to filling the current staffing gap in so many hospitals. This research touches the surface of the issues confronting nurses in understaffed facilities and the need for innovative recruitment and retention strategies.
Joanne Clark - RN, BScN, CPN(C), Clinical Nurse Educator OR & Jaswant Birk - RN, BScN, CPN(C), Clinical Nurse Educator OR/Endoscopy
Topic: Why Follow Standards?
ORNAC standards, why is it important to follow standards and be a part of the process of writing a standard?
ORNAC standards are guidelines and position statements that are provided for Perioperative Nurses to guide their practice. The ORNAC standards are written by perioperative nurses, allowing them to have a voice in their area of practice.
Role of the standard committee and the process it follows to review, update and write a guideline or position statement.
The ORNAC standards committee in collaboration with the Queen’s University research areas of perioperative nursing. Committee members review, edit and write position statements and guidelines based on the most recent and up to date research studies. The Committee also supports ORNAC members in their practice by answering practice questions through the ORNAC website.
The main changes in ORNAC standards in this edition.
The main changes have been the dress code policy as outlined in the newest edition.
How to become a part of the standards committee?
It is a volunteer position that you can apply for through ORNAC. It builds research and leadership skills through communication and collaboration.
John Filer - RN, Clincial Educator, Clinical Nurse Specialist, Manager
Topic: The Role of an OR RN in Designing a Universal Operating Room for the Future
The operating rooms at Vancouver General Hospital were designed and built over 30 years ago. The infrastructure is ageing and the rooms do not support the needs of modern surgical procedures.
In 2017 we received MOH approval to develop a brand new suite of 16 operating rooms, a 40 bay co-located universal pre and post-op unit (PCU) with offices, education areas and support infrastructure. As an RN from the OR I joined the design team as we embarked on 2 years of design to create a Universal room that would allow “any case, any room”. Using innovative design techniques, including a “dolls house” and full sized mock-ups of the OR and the PCU bays, we involved over 200 clinical staff and representatives from the Community. We achieved our vision of universality by incorporating novel concepts, including walls with e-glass sliding doors in PCU, ceiling lifts in all the ORs, day lockers outside each OR and green initiatives such as anesthetic gas capture, removal of piped nitrous and revision of our HVAC ducting to be more efficient. We are implementing a Real Time Location System for tracking of patients and assets.
We have shared our ideas with many of our Regional colleagues who are in the process of building or applying to build. Our design process was presented at AORN in Nashville and published in the Health Environments Research and Design Journal.
John Just - MD, MSC, FRCSC
Topic: Development of a Surgical Program in a Low Income Country - Co-operative Aprroach in The Gambia in West Africa
We were invited by the government of The Gambia to aid in the development of a surgical training program in 2009. A need for a more basic development of safe surgery in The Gambia was identified and starting in 2010, Medicos en Accion began sending teams to help develop a surgical program at Serrekunda Hospital. This presentation will review the co-operative efforts with the staff of Serrekunda Hospital and the Ministry of Health and Social Welfare to develop the surgical program as well as the National Thyroid Program. I will review the evolution of the program, illustrative cases and discuss the vital role of peri-operative nurses in much of this program.
Kim Savory - RN, BScN, Clincial Practice Lead - BC Transplant
Topic: Organ Donation - Commonplace in BC Operating Rooms
Organ donor referrals from BC hospitals have increased from 180 in 2013, to 512 in 2018. Of the 512 referrals, 122 went to BC hospital operating rooms for organ retrieval surgery, resulting in 502 organs gifted to those in need of life-saving organ transplants. This was an 82% increase in the number of organ retrieval surgeries done in BC from 2013-2018.
With this increase in organ retrieval surgeries occurring in BC, smaller centers that may have rarely or never done retrievals in the past are now also being called on to do them.
Organ retrieval surgeries require the involvement and expertise of Operating Room (OR) Nurses, Anesthesiologists, Anesthesia Aides, Porters and supply staff at the donor hospitals to make sure Organ Donors are treated with respect and their gifted organs are recovered safely to ensure the best possible outcome for the organ recipients.
With more hospitals and OR staff in the province being involved in these surgeries, understanding the donation process from how a potential donor is identified and referred, through to the organs being delivered to the transplant OR’s is important. While BC Transplant staff will always be present in the OR for the surgical portion of the process, a focused understanding of the organ recovery surgery, the OR staff’s roles, the possible emotional challenges staff may face and some tips on how to cope with these challenges are vital for the confidence of the staff, as well as the success of the organ transplants.
Lynn Walters - RN, BSN, CPN(C) (Retired)
Topic: Your Journey to Perioperative Excellence: Healthcare = Self Care
Perioperative nurses waking up our bodies and centering our powerful minds to give us the inner balance, energy and strength to cope with venturing into "uncertain changes" in any OR theatre. Warm up body scan and breath awareness will help us "park our reactions" and be effective and focused on the patient care while the usual organized chaos surrounds us. Lynn Walters, a retired OR Nurse Manager and a current Yoga instructor will provide tips and techniques to make your unique journey to Perioperative Excellence smoother with a full measure of joy. "When you are laughing you do not age"
Sandy Nichol - RN, CPN(C) & Emily Mangum - BScN, RN, CPN(C)
Topic: Why Can't RN's Run the Cell Saver?
Why can't Rn's run the cell saver was the question asked, when in 2014 Fraser Health found itself short of perfusionists. This simple question had a huge impact on Abbotsford Regional Hospital and the patients undergoing surgery where a large blood loss is anticipated. Initially, our focus was on patients having and open AAA repair. With the support of our OR manager, the Vascular Surgeons, our anesthesiologists, and the perfusion group from Royal Columbian Hospital, I was able to research the possibility and in collaboration with Professional Practice, and Don Trostheim, clinical Perfusion Educator at RCH, wrote policies and procedures to allow RN's to operate the Cell Saver.
We started with 5 RN's on the team. Don Trostheim provided both theory and hands on education, he taught us to operate the Autolog machine. Anesthesia also participated in these education sessions. This now means, we at ARH can now provide surgical options to those groups who wish not to receive blood or blood products. We have also eased the burden of the blood bank - we no longer need to access blood banks solely for PRC's, although, this is always remains an option for us. We can give back a unit of the patients own blood for about 25% of the cost of a unit from the blood bank. This results is a significant saving to the Provincial Health Budget.
We started the program in 2014. We have expanded to orthopedics, specifically, hip revision surgery. We have increased our team to 7 members. To date, we have re-infused more than 100,000 mls of the patients own blood.
Stacey Gilmore & Sharon Goodier
Topic: The Current Surgical Safety Checklist (SSCL)
The current Surgical Safety Checklist (SSCL) was implemented by the ministry without input from the user groups and as such was not well received by them. The purpose of the SSCL was to promote communication and patient safety thereby reducing adverse effects and eliminating ‘Never’ events. Over several years, this has not evolved and adverse effects and never events still occur across the province.
Our goal in RMH OR is to streamline the process while maintaining patient safety by incorporating user involvement and FHA audit tool for SSCL. This presentation will examine data, bridged gaps in communication between physicians, nursing and most importantly the patient as well as show the evolution the SSCL”.
Tom Wallace - MD FRCSC FACS
Topic: Preoperative Optimization
Dr. Wallace is a fellow of the Royal College of Physicians and Surgeons of Canada and the American College of Surgeons. He practices colorectal and general surgery at Royal Inland Hospital (RIH). His clinical areas of interest include colorectal and minimally invasive surgery. He is active in patient safety and quality improvement work. He is the Surgeon Champion for the National Surgery Quality Improvement Program (NSQIP) at RIH. He was the team leader for the Enhanced Recovery After Colon Surgery initiative at RIH. He is the site lead at Royal Inland Hospital and the provincial co-chair for the Surgical Preoperative Optimization Collaborative. He is also the Surgical Clinical Lead for the BC Patient Safety Quality Council. He recently completed a fellowship in colorectal surgery at the University of Ottawa. He is currently working on a Masters in Patient Safety and Clinical Human Factors at the University of Edinburgh.
Introduction: Patients who are about to undergo major surgical intervention are at risk of adverse events. Recent developments in perioperative care have attempted to minimize the chance of adverse outcomes while improving the patient experience. To date much energy has been focused on the immediate perioperative period with initiatives such as Enhanced Recovery after Surgery (ERAS) and bundled processes of care to reduce specific complications such as surgical site infection. There is evidence to suggest that post-operative outcomes could be improved for patients if certain aspects of their health were optimized in the preoperative period. This project looks at designing a coordinated, systematic approach to surgical patient optimization.
Methods: The surgical patient’s current journey lacks a systematic approach to identification of elements for optimization and implementation of interventions to address elements that may need to be optimized. The current state (Figure 1) of the patient preoperative journey was determined using process mapping exercises. A provincial collaborative identified 13 elements that could potentially be targeted for optimization. At a community hospital 3 elements were selected for optimization. The initial patient population was colorectal patients. An existing preoperative medical questionnaire was converted into a screening package. The screening package consisted of screening tools to identify elements for optimization. The screening package was assessed by a nurse navigator who identified elements for optimization and initiated appropriate, predetermined interventions (Figure 2)
Results: Compliance with the application of the screening package’s screening tools will be measured. Percentage of patients screening positive for each element was determined. Referral of positive screened patients for indicated optimization interventions was measured. Process measures to assess the efficacy of interventions were monitored. Post-operative patient outcomes were assessed using the NSQIP database.
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