Significance
Myocardial events are the most common medical complication of surgery, occurring in 2% to 5% of patients undergoing noncardiac surgery and 30% for patients undergoing vascular surgery. For patients who suffer cardiac ischemia/infarction during surgery, the mortality rate is nearly 60%.
Description of Practice Change
A multidisciplinary team strategized how to safely and effectively incorporate cardioprotective [beta]-blaocker therapy into practice. [beta]-Blockade was initiated in the preoperative area and continued through discharge.
Purpose
Improve outcomes for surgical patients while preserving safety in practice.
Methods
(1) Computer order entry including (a) guidelines for therapy extended from the immediate preoperative period through dosing after discharge and (b) template orders that included hold parameters and dosing for oral and intravenous therapy. (2) Education including (a) educational sessions and reference material created for physicians and nurses, (b) focused educational offerings included identifying candidates for [beta]-blockade prophylaxsis, rationale of treatment guidelines, monitoring requirements, and antidotes to therapy, (c) patient education materials to assist the nurse with discharge planning and instructions. (3) Safety in practice including (a) cardiac monitoring requirement for intravenous [beta]-blocker therapy and (b) institutional guidelines specifying that physicians must administer intravenous [beta]-blockade therapy outside of and intensive care unit (ICU).
Conclusion
As the scope of nursing practice continues to grow, the CNS becomes even more integral to the development of change processes that are focused on patient and clinician safety. Future work will look at outcomes associated with prophylactic [beta]-blocker therapy, obstacles to administration of the medication, and possible expansion of nursing practice in the administration of intravenous [beta]-blocker therapy to RNs outside of the intensive care unit (ICU).
Section Description
This year's annual NACNS conference is planned for Orlando, Fla, March 9-12, 2005. Over 300 clinical nurse specialists (CNSs) are expected to attend, and as with past conferences, attendees will also include graduate faculty from CNS programs, nurse administrators, and nurse researchers. The theme of the conference, CNS Leadership: Navigating the Healthcare Environment Toward Excellence, was selected to showcase the many ways CNSs acquire and disseminate knowledge and innovative practices in their specialty areas. Two preconference sessions are scheduled. One session, sponsored by NACNS Legislative/Regulatory Committee, targets information for CNSs interested in understanding the legislative/regulatory process as it deals with the practice of nursing, and will also help build skills CNSs need to engage in the process. The second session, sponsored by NACNS Education Committee, focuses on CNS education issues, and as with the education preconferences of past years, anticipates informative dialogue and much sharing among CNS educators around curriculum design, teaching strategies, and indicators of quality in the curriculum that link to the NACNS education standards to program review and excellence. The conference planning committee is proud and pleased to have Jeanette Ives Erickson, MS, RN, CNA, Senior Vice President for Patient Care Services and Chief Nurse Executive of Massachusetts General Hospital as the opening keynote speaker. She will begin the conference by highlighting the importance of CNS practice on patient safety. The planning committee is equally proud and pleased to have NACNS past-president Rhonda Scott, PhD, RN, Chief Nursing Officer of Grady Health System as the closing speaker. Dr Scott will challenge attendees to use the information from the conference to shape quality care delivered in a safe environment and to advance the profession of nursing through direct care to clients, influencing standards of care delivered by other nurses, and influencing the healthcare delivery system to be to support innovative, cost-effective, quality nursing care. A total of 64 abstracts for podium and poster presentations were selected in addition to graduate student posters. The abstracts address the 3 spheres of CNS practice with a strong emphasis on clinical practice improvements. As you will note from the abstracts published in this issue of the journal, specialty practice areas represented in the abstracts include children, adults, and gerontological patient groups; hospital, outpatient, and home care settings, and community health. In addition, a wide variety of specialty topics including smoking cessation programs, end-of-life care issues, and protocols outlining nursing approaches to improved diabetes, cardiovascular and ventilator management. A number of the abstracts described hospital and healthcare system level innovations that resulted from CNS practice. Collectively, these abstracts reflect the breadth, depth, and richness of CNS contributions to the well-being of individuals, families, groups, and communities. The following abstracts are from those presenters who elected to have their work published in the journal so those who are unable to attend this year's conference can share in the knowledge of the conference. As you read each abstract, consider the talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to improved outcomes for patients and healthcare organizations. You may want to contact individual presenters to network, collaborate, consult, or share your own ideas about these topics. Watch for next year's call for abstracts and consider submitting an abstract for presentation at NACNS's next conference in Salt Lake City, Utah, March 15-18, 2006.