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Principles > SCIP/ERAS > Flashcards

SCIP/ERAS Flashcards

1
Q

SCIP stands for….

A

Surgical care improvement project (scip)

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2
Q

Each infection estimated to….(3)

A

↑ hospital stay 7 days
↑ cost $3,000

Complications lasting 30 days decrease median survival 69%

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3
Q

SCIP goal

A

Goal: decrease morbidity and mortality of SSI

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4
Q

SCIP performance measures (3)

A

Proportion of pts who get abx started within 1 hr of incision (no less than 15m minutes before incision)

Proportion given abx regimen consistent with guidelines

The proportion of pts whose abx is discontinued within 24 hrs of surgery stop

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5
Q

Why were the performance measures selected.

A

Based on evidence that abx administered no less than 15 minutes before incision and no more than an hour our= decreased risk of infection. Abx outside 24 hr period = increased risk of bacteria developing resistance to the abx or if gave dose that was inadequate or gave an inappropriate abx.

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6
Q

SCIP abx measures

A

Administration of prophylactic antibiotic within 1 hr of incision

Correct antibiotic choice based on procedure

Discontinued antibiotics within 24 hours of surgery end time unless there is documentation of infection or suspected infection

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7
Q

When vancomycin and clindamycin administered for SCIP

A

2hrs of incision

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8
Q

When are abx dc for cardiac surgery

A

w/in 48 hrs

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9
Q

SCIP Beta blockers measures

A

Beta-blocker must be taken within 24 hours of surgery start for all patients on chronic beta-blocker therapy

Beta-blocker restarted after surgery for all patients on chronic beta-blocker therapy

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10
Q

SCIP hair measures

A

Documentation of appropriate hair removal;
Clippers only
No razor/shaving

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11
Q

SCIP foley measures

A

Urinary catheter removal on or before POD 2 unless an order exists to extend the catheter;
Reason to extend must also be documented
Reason to extend may not be written on postoperative admission orders

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12
Q

SCIP sugar measures

A

Cardiac patients with controlled post-operative blood glucose of </= 200 mg/dl at 6am
180 within 18-24 hours after anesthesia end

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13
Q

SCiP DVT measures

A

SCDs placed during surgery for all procedures >/= 1 hr

Orders for appropriate DVT prophylaxis on the postoperative admission orders.
Unless documentation criteria for not administering pharmacologic and mechanical prophylaxis

RN administration of the appropriate DVT prophylaxis within 24 hours of surgery end

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14
Q

SCIP temperature measure

A

Normothermia or active warming in OR
1st temp in PACU >/= 96.8F within 15 minutes of leaving OR

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15
Q

96.8 F in Celcius

A

37

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16
Q

NPO guidlines

A

clear liquids = 2 hrs
breast milk = 4 hrs
infant formula= 6 hrs
light meal/ non human milk = 6 hrs
fried fatty foods, meat = 8 hrs

17
Q

Toradol ceiling

A

15 mg

18
Q

Pts a risk for PONV (6)

A

young
female
non smoker
duration of anesthesia
postoperative opioid use
hx of PONV/motion sickness

19
Q

ERAS Elements – “The Must-Haves”

A

Pre-Operative- Formal, pre-surgical patient education - counseling
Risk assessment – intervention with standardized optimization

Intra-Operative- Limited fasting, carbohydrate rich drink up to 2 hrs before surgery
Opioid sparing, multimodal analgesia that continues through discharge

Post-Operative- Ambulation w/in 8 hrs of surgery stop time
Formal discharge education that includes incision care and mobility recommendations

20
Q

Formal Patient Education

A

Comprehensive education results in well-informed patients that are more likely to have a better post-operative outcome and realistic expectations

Formal, patient-centered approach that is consistent within the hospital, offered to all patients, and does not vary from surgeon to surgeon

Facilitates dynamic patient participation throughout his/her care

21
Q

Smoking; if quit 2-4 weeks out = increased risk of …….

A

Smoking; if quit 2-4 weeks out = increased risk of bronchospasm and increased sections because the ciliary are mobilizing

22
Q

INtraop phase ERAS protocals

A

Limited fasting and Carbohydrate rich beverage up to 2 hours before surgery
Opioid-sparing, multimodal analgesia (PO premeds)
*Evidenced by order set implementation
*Starts here, goes through discharge

23
Q

Place foleys when sx is how long?

A

> 4hrs

24
Q

What to give to decrease blood loss

A

TXA

25
Q

Effects of surgical stress and NPO on metabolism (7)

A

inc immunospupression and insulin resistance

dec glucose uptake
inc glucogenesis
inc catecholamine surge
inc cortisol, glucagon, GH
inc IL1, IL6
Inc Post op lean tissue loss; strength, mobilization, wound healing, and resp mechanics

26
Q

Post op ERAS protocals

A

Early Ambulation – w/in 8 hrs. of surgery stop time
Formal education at discharge regarding:
*Incision care
*Mobility recommendations

27
Q

what fluid management considerations do we need to add if the pt received bowel prep

A

Subtract 2-3 L from fluid deficit!!

28
Q

Carbohydrate Loading (7)

A

Up to 2 hours prior to surgery
Rate of pulmonary aspiration has not increased
Reduced thirst, hunger, anxiety
Reduced insulin resistance
More muscle strength and lean body mass
Accelerated recovery
Shorter hospital stay

29
Q

Multimodal Pain Management

A

Cox 2 inhibitor or NSAID
Acetaminophen
Ketamine
⍺-2 Agonist (clonidine, dexmedetomidine)
Epidural (local anesthesia +/- adjuncts)
Gabapentin
Corticosteroids
Peripheral Nerve Block

30
Q

Potentially improved pain relief and reduced surgical stress response 30% failure rate

A

Epidural

31
Q

Reduced anesthesia requirements (not just opioids!)

A

a 2 agonists (clonidine/ dexmedetomidine)

32
Q

Opioid sparing effect, can treat opioid resistant pain

A

Ketamine

33
Q

Superior analgesia (vs opioids), reduced PONV, reduced duration of stay
Doesn’t always work

A

Peripheral Nerve Block

34
Q

What is a TAP block

A

Transversus Abdominis Plane

help in area of the diaphgram

35
Q

Erector Spinae coverage

A

provides coverage of 4-6 levels

36
Q

field blocks

A

TAP block, QL and Erector Spinae; field blocks. Putting LA in a fascial plane that the nerve runs.

37
Q

QL blocks compared to TAp blocks

A

QL blocks result inmore extensive sensory blocksthan TAP blocks (T10-L3vs.T10-T12,).
Compared with TAP blocks, the QL block, which is a regional variation of the TAP block, has been suggested to be a more reliable approach for pain after abdominal surgery

38
Q

PONV prophylaxis and treatment strategies

A
  • avoid nitrous oxide and opioids/ volatiles
    • Zofran
    • Decadron
    • Propofol
    • P3 median nerve block (chemo trigger in the body that helps reduce ponv)
    • scolapalamine (placed 2-6 hrs before) (consider SE; dry mouth, confusion)
    • histamine blockers; benedryl
    • Droperidol and Haloperidol; low dose help N/V

Principles (34 decks)

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