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protecting skin integrity, decreasing length of stay related to
compromised skin integrity, and potentially reducing cost of
care.
STANDARDIZING ADULT CRASH CARTS
Team Leaders: Sarah Barak, RN, BSN, CCRN,
Jacquelyn Pasadyn, RN, BSN, Lonnie Weekley, RN, BSN
Cleveland Clinic Lorain Institute Ambulatory Surgery Centers,
Lorain, Ohio
Background Information: Staff employed by the Cleveland
Clinic Lorain Institute Ambulatory Surgery Centers float be-
tween the three ASCs. The crash carts at all three ASCs were
completely different. One facility had 6 drawer crash carts,
one had 4 drawer crash carts and one had crash carts with 2
doors and once opened, had 4 drawers on the inside as well
as storage inside the doors.
Objectives of Project: Our theme was “Time is muscle and can
be the difference between life and death.” The objective of the proj-
ect was to standardize all the crash carts at all three surgery centers
so they would be the same no matter what facility the staff was
working at. The implications for nursing practice was to reduce
confusion and time it would take to find objects on the crash carts.
Process of Implementation: First, scavenger hunts were per-
formed on the existing crash carts to determine a baseline of how
long it took staff to find a selected list of supplies. The 6 drawer
crash cart was chosen to be the standard crash cart for each facil-
ity and a list of needed supplies was compiled in accordance with
anesthesia and pharmancy. A master list of supplies was created
and divided up by drawer. Once the supplies were organized in
the drawers, color photographs were taken of the drawers. 8 x 10
color photos were printed and laminated with a list of the sup-
plies located in each drawer and kept on top of the crash carts
for reference. Staff was then educated on the new crash carts
and a scavenger hunt was repeated to see if there was an
improvement in the time it took for staff to find the selected
list of supplies as before the crash carts were changed.
Statement of Successful Practice: After ordering new 6
drawer crash carts for all the facilities, re-organizing the
drawers, educating the staff and providing color photographs
of the drawers as well as a list of supplies, the time it took to
do the scavenger hunt was reduced by 50%.
Implications for Advancing the Practice of Perianesthesia
Nursing: The goal for the implications of nursing practice was to
decrease the amount of time it took to search for items on the
crash cart. The goal was achieved when our outcomes showed
a 50% reduction in the amount of time it took to find the listed
items on the crash cart.
POST OP URINARY RETENTION: EVALUATING AND
REDEFINING A COLLABORATIVE PROTOCOL
BASED ON EVIDENCE
Team Leader: Nancy Parvana, RN, BSN, CPAN
Saratoga Hospital, Saratoga Springs, NY
Team Member: Jessica Malloy, RN, MSN, ONC
Background Information: In a collaborative effort to decrease
the rates of Catheter Associated Urinary Tract Infections (CAUTI)
ASPAN NATIONAL CONFERENCE ABSTRACTS
at this Magnet hospital, reducing the number of catheters placed
during total joint replacement (TJR) surgery was an initiative
agreed by the multidisciplinary team who belong to the Orthope-
dic Collaborative Practice Group. The prevalence of CAUTIs in
this patient population was as high as 13%.
Consequently, nurses practicing in the Post Anesthesia Care Unit
(PACU) and Orthopedic Unit identified patients exhibiting signs
and symptoms of urinary retention requiring postoperative cath-
eter insertion. These observations led to the development of an
evidence based practice project.
Objectives of Project:
 Determine TJR patient % exhibiting signs and symptoms
of post op urinary retention (POUR) and needing inter-
vention
 Identify patients at high risk for POUR.
 Develop formal guidelines and standards of care for
bladder management of the high risk TJR patient
 Demonstrate that best practice standards are being met.
Process of Implementation: A data collection tool was
designed based on the risk factors identified in the literature. An
audit of patient records by PACU and Orthopedic nurses was
completed. A convenience sample of 296 patients was used
over a six month period. Data was analyzed using simple statistics.
Statement of Successful Practice: Our project results have
identified an incident rate of 21% for POUR. A practice change
guideline was made for placement of Foley catheter in the OR on
high risk patients for 24 hours. This change resulted in a decreased
rate in the incidence of POUR as well as decrease in CAUTI rates to
6% as shown in quarterly reports. The protocol guideline enhanced
patient safety, satisfaction, and improved outcomes.
Implications for Advancing the Practice of Perianesthesia
Nursing: An organized appraisal of existing protocols, based on
evidence assures quality care is being delivered. Improvement in
nursing practice can be supported through collaborative and
interdisciplinary processes in a shared governance structure
creating an environment of continued clinical excellence.
IMPLEMENTATION OF A PERI-OP PROCEDURAL
SKIN ASSESSMENT TOOL
Team Leaders: Patricia Crosby, RN, BSN, CCRN, CPAN,
Sandra Kim, RN, BSN, CAPA, Donna Benotti, RN, CNOR
Alta Bates Summit Medical Center, Summit Campus, Oakland,
California
Team Members: Jeanne Coney, RN, BSN, Assistant Director
Perioperative Services, Faye Brass, RN, WCC
Background Information:
 The Braden scale and wound/pressure ulcer assessment
tool used as standard policy for all hospital admissions,
are not specific to the perioperative arena which requires
a more appropriate assessment/documentation tool for
our specialty areas.
 A skin-Bar form pilot study is developed as a coordinated
effort among Preop, OR, and PACU as a tool to assess and
document incidence of pressure ulcers or other skin is-
sues. Skin is first assessed in Preop with further documen-
tation noted from OR and later reassessed postop in PACU
with relation to surgical site, position, or other factors.