Keeping Safety at the Forefront: How to Promote Safety In the Labor & Delivery Post-Anesthesia Care Unit
- Engage a multidisciplinary team in developing and implementing process changes that improve the quality and safety of care delivered for post-surgical patients.
- Revise current guidelines to enforce national standards; in addition to supporting current staffing guidelines.
- Develop a process that will promote quality, patient-centered care and safe passage for the couplet.
The Labor and Delivery nurses at Baylor University Medical Center were inspired to change the care given in the Labor and Delivery Post-Anesthesia Care Unit (PACU) when patient safety concerns came to the forefront. They recognized deficits in the safe passage of the PACU patients and identified several objectives they wanted to achieve during the phase I period of recovery. They wanted to promote bonding of mom and baby, provide appropriate care for the newborn during its transition to extra-uterine life, and provide optimal care for the recovering woman. These challenges, as well as an increase in the high-risk obstetrical patient population, prompted an evaluation of processes in the unit’s PACU.
Proposed change:
A multidisciplinary team identified a need to change guidelines, adjust the nurse to patient ratio, establish a process for continuity of care, and make changes to the current documentation system.
Implementation, outcomes and evaluation:
After benchmarking across the nation, reviewing professional nursing organizations’ standards, and aligning guidelines to the hospital’s main PACU, the team changed the nurse to patient ratio to support the recommended 1 nurse to 2 patients and implemented a process change to support continuity of care for the post-surgical patient. In addition, to support the change in nurse to patient ratio, the recovery period was decreased, meeting requirements set forth by professional organizations and also meeting unit staffing guidelines. To ensure that all components of the discharge criteria were met prior to transfer to the receiving unit, the current documentation system was changed to help guide nursing through all components of the discharge criteria. Prior to implementation of these changes, compliance to the all-or-none bundle for discharge criteria averaged 18%. After implementation of the changes, average compliance was around 68%. Nurses have stated that they have a more nurse-friendly environment that supports continuity of care for the PACU patient and has increased the nurses’ satisfaction.
Implications for nursing practice:
These process changes supported a safer environment for the mother and her infant allowing for optimal care to both patients and allowing the much needed bonding time. In addition, these changes promoted a nurse friendly PACU environment which ultimately promoted safe passage for the patient and her infant.
Keywords: Post-Anesthesia, Safe passage, couplet care, PACU
