SCIP & ERAS (Cornelius) Exam II EXPANDED Flashcards
What was the primary goal of the Surgical Care Improvement Project (SCIP)?
a) Decrease accepted standards for surgical procedures
b) To reduce surgical infection rates
c) To extend hospital stays
d) Increase variations in surgical outcomes between facilities
b) To reduce surgical infection rates
Cornelius - what’s an accepted standard for things can include:
* antibiotics,
* patient temperatures.
* Length of hospital stay.
* Infections are a big part of that
Slide 2
Each hospital-acquired infection is estimated to increase the hospital stay by how many days?
a) 3 days
b) 7 days
c) 14 days
d) 10 days
b) 7 days
slide 3
The conservative estimated cost of each hospital-acquired infection is approximately ______.
a) $3,000
b) $10,000
c) $3,000
d) $1,000
c) $3,000
C - it’s very hard to tease out exactly what happened as a result of the prolonged hospital stay or the infection…it’s kinda hard to blame somebody for lack of a better word.
Slide 3
Complications lasting 30 days are estimated to decrease median survival by what percentage?
a) 25%
b) 50%
c) 69%
d) 85%
c) 69%
Slide 3
True or False
As the complication rate and morbidity/mortality rate increase for patients, the payment to the healthcare providers increases as well.
False
C - Payment goes down drastically when complication rates increase, and longer hospital stays are associated with bundled payments
Slide 3
What is the primary goal of the Surgical Infection Prevention (SIP) Project?
a) To reduce hospital costs
b) To decrease surgical wait times
c) To decrease morbidity and mortality of surgical site infections
d) To increase the length of hospital stay
c) To decrease morbidity and mortality of surgical site infections (SSI)
Slide 4
In what year was the Surgical Infection Prevention (SIP) Project initiated by the CDC and CMS?
a) 1995
b) 2000
c) 2002
d) 2005
c) 2002
Slide 4
One of the performance measures for the SIP Project is to ensure antibiotics are started within ______ of incision.
a) 1 hour
b) 2 hours
c) 24 hours
d) 30 minutes
a) 1 hour
slide 4
One of the SIP Project’s performance measures ensures that antibiotics are discontinued within ______ of surgery stop.
a) 12 hours
b) 24 hours
c) 48 hours
d) 72 hours
b) 24 hours
Slide 4
The SIP Project focuses on ensuring that patients are given an antibiotic regimen that is:
a) Based on their medical history
b) Consistent with the surgical team’s preferences
c) Consistent with established guidelines
d) Chosen randomly by the hospital pharmacist
c) Consistent with established guidelines
C - One of the things that really contributes to bacterial resistance is inappropriate use of antibiotics.So people that are getting antibiotics for coughs, colds, fevers, things that are totally inappropriate
Slide 4
Selecting the appropriate antibiotic and timing its infusion correctly has a positive correlation with:
a) Reduction in hospital stay
b) Increased incidence of SSI
c) Decrease in patient satisfaction
d) Improved recovery time
b) Increased incidence of SSI
C - the big things that came out of the initial stuff was timing of the antibiotics selection of the appropriate antibiotics and then how long we continued it for because each of those were tied into increased risk of surgical side infection
Slide 5
In the 2001 retrospective review, what percentage of the 34,133 Medicare inpatients received their antibiotic dose within 1 hour of incision?
a) 40.7%
b) 55.7%
c) 92.6%
d) 70%
b) 55.7%
C - what they figured out was patients weren’t getting antibiotics in the appropriate time period for the most part, they were getting the correct antibiotics, but not all the time
Slide 6
What percentage of patients had the correct antibiotic agent administered according to the 2001 retrospective review?
a) 55.7%
b) 40.7%
c) 92.6%
d) 70%
c) 92.6%
slide 6
Only ______% of antibiotics were discontinued within 24 hours of surgery stop in the 2001 retrospective review
a) 55.7%
b) 92.6%
c) 40.7%
d) 30%
c) 40.7%
C -patient specific factors may come into play..maybe they have an allergy…resistance…you just need to have kind of a good reason for it.
2004 Self-reported data showed hospital compliance increased over 3yrs.
Slide 6&7
Which of the following are key aims of the 2005 Surgical Care Improvement Process (SCIP)? (Select 3)
a) Aligning with other measures like SIP
b) Reducing surgical mortality and morbidity
c) Focusing only on cosmetic surgeries
d) Targeting high-incidence and high-cost complications
e) Increasing hospital readmission rates
f) Extending hospital stays to monitor complications
a) Aligning with other measures like SIP
b) Reducing surgical mortality and morbidity
d) Targeting high-incidence and high-cost complications
Slide 8
The multi year national campaign goal of SCIP was to reduce surgical complications by what percentage by 2010?
a) 10%
b) 15%
c) 25%
d) 50%
c) 25%
C - Starting in 2005, their overall goal was to reduce surgical complications by 25% in five years (2010)
slide 8
What national organization was notably missing from the SCIP steering committee that was initiated by the CDC and CMS?
a) ASA
b) APRN
c) ACS
d) AANA
d) AANA - American Association of Nurse Anesthesiology
C - If we don’t advocate for our profession and we don’t step up on the national level, we lose out on things we don’t have a seat at the table.
Slide 9
Prophylactic antibiotics should generally be administered within what time frame before incision?
a) 30 minutes
b) 1 hour
c) 2 hours
d) 3 hours
b) 1 hour
C - appropriate antibiotics within one hour incision….but no less than 15 minutes.
So you have about a 45 minute window in there where you can give the patient the antibiotics and it needs to be at least 15 minutes before incision.
Slide 10
For which antibiotics is a 2-hour window allowed for administration before incision?
a) Penicillin and Cefazolin
b) Vancomycin and Clindamycin
c) Erythromycin and Gentamicin
d) Ampicillin and Metronidazole
b) Vancomycin and Clindamycin
Slide 10
Antibiotics should be discontinued within ______ of surgery end time unless there is documentation of infection or suspected infection.
a) 12 hours
b) 24 hours
c) 48 hours
d) 72 hours
b) 24 hours
Slide 10
For cardiac surgery, antibiotics should be discontinued within ______ of surgery end time unless there is documentation of infection or suspected infection.
a) 12 hours
b) 24 hours
c) 48 hours
d) 72 hours
c) 48 hours
C -With Cephazolin, they figured out that a lot of the cardiac surgery patients already had some degree of antibiotic resistance.
So we’ll see that a lot of times cardiac surgery patients go on vancomycin and it continues for 48 hours.
Slide 10
Patients on chronic beta-blocker therapy must take their beta-blocker within ____ hours of surgery start.
A. 12
B. 24
C. 48
D. 72
B. 24
Slide 11
Beta-blocker therapy must be ____ after surgery for all patients on chronic beta-blocker therapy.
A. discontinued
B. doubled
C. restarted
D. delayed
C. restarted
Slide 11
According to the guidelines, hair should not be removed by ____ before surgery.
A. Clippers
B. Electric razor
C. Shaving/razor
D. Leaving it untouched
C. Shaving/razor
Use CLIPPERS only
it didn’t get as close to the skin, but it’s still kind of grossly decontaminated that hair. For cleanliness perspective, use a vacuum cleaner or tape to decontaminate the area
Slide 12
A urinary catheter should be removed on or before ____ unless an order exists to extend it.
A. POD 1
B. POD 2
C. POD 3
D. POD 4
B. POD 2
Slide 13
Which of the following are true regarding urinary catheter removal according to Foley measures? (Select all that apply)
A. The catheter must be removed on or before POD 3 unless an order exists to extend it.
B. The reason to extend the catheter must be documented.
C. The reason for extending the catheter may be not written on the postoperative admission orders.
D. No documentation is required for catheter extension.
B. The reason to extend the catheter must be documented.
C. The reason for extending the catheter may be not written on the postoperative admission orders.
Slide 13
Cardiac patients must maintain a blood glucose level of ____ both before and after surgery.
A. ≤ 150 mg/dL
B. ≤ 180 mg/dL
C. ≤ 200 mg/dL
D. ≤ 220 mg/dL
C. ≤ 200 mg/dL
180 within 18-24 hours after anesthesia end
Corn: something for you to think about when you’re writing your preoperative and postoperative orders to make sure finger sticks are in there and then some sort of insulin protocol is needed.
Slide 14
When should Sequential Compression Devices (SCDs) be placed during surgery according to DVT measures?
A. For all procedures ≥ 1 hour
B. For all procedures ≥ 2 hours
C. Only for procedures longer than 3 hours
D. Only for emergency surgeries
A. For all procedures ≥ 1 hour
Slide 15
Which of the following measures are part of DVT prophylaxis in surgery? (Select all that apply)
A. SCDs placed during surgery for procedures lasting ≥ 1 hour.
B. Orders for DVT prophylaxis on postoperative admission orders
C. RN administration of DVT prophylaxis within 48 hours after surgery.
D. Orders for DVT prophylaxis can be skipped if there is documentation for not administering it.
A. SCDs placed during surgery for procedures lasting ≥ 1 hour,
B. Orders for DVT prophylaxis on postoperative admission orders (including both pharmacologic and mechanical methods)
D. Orders for DVT prophylaxis can be skipped if there is documentation for not administering it.
RN administration of the appropriate DVT prophylaxis within 24 hours of surgery end
Corn: you’re using a patient’s leg for a blood pressure because maybe they don’t have arms or maybe that’s the surgical site…just be cautious with an SCD inflating over top of your blood pressure cuff.
Slide 15
Which of the following are common chemical prophylaxis medications used to prevent DVT? (Select all that apply)
A. Heparin
B. Lovenox
C. Warfarin
D. Fondaparinux
A. Heparin
B. Lovenox
Slide 15
What is the required first temperature in the Post Anesthesia Care Unit (PACU) after leaving the OR to meet the normothermia standard?
A. ≥ 95.0°F within 15 minutes
B. ≥ 96.8°F within 15 minutes
C. ≥ 97.5°F within 10 minutes
D. ≥ 98.6°F within 20 minutes
B. ≥ 96.8°F within 15 minutes
Corn: Now, there are obviously some patients that we want to keep cold and then some patients that we can’t warm up as you know as much if somebody comes in with a core temperature of 94, no matter how hard I try, I’m probably not going to get them.
Up to 96.8 within an hour or two.
So just make sure you document that and then document what you did to keep them warm or to make them warm.
Slide 16
Which of the following are reasons to use active warming for patients in the OR? (Select all that apply)
A. To maintain patient comfort
B. To meet core measures for procedures exceeding one hour under general anesthesia
C. To reduce the risk of postoperative infection
D. To ensure a quicker recovery
A. To maintain patient comfort
B. To meet core measures for procedures exceeding one hour under general anesthesia
Normothermia or active warming in OR
Slide 16
A Retrospective cohort study-Stulberg et al. 2010 discovered that when measuring temperature on exposed areas in the OR, there is often ___ and there is a degree of ___ between axillary temperature and core temperature readings.
A. inaccuracy, difference
B. accuracy, difference
C. reliability, variation
D. inconsistency, accuracy
A. inaccuracy, difference
A Retrospective cohort study-Stulberg et al. 2010 discovered that when measuring temperature on exposed areas in the OR, there is often inaccuracy and there is a degree of difference between axillary temperature and core temperature readings.
Corn: So just keep that in mind as well, but for the most part, if possible, we use core temperatures so esophageal bladder probe, nasal probe, those sorts of things.
Slide 17 - END of SCIP
Matching!
Match the ingested material with the correct minimum fasting period (hours)
1 - c
2 - d
3 - a
4 - a
5 - a
6 - b
Slide 5 - START OF ERAS
Which of the following is NOT part of the morning of surgery preop process way back in ancient times in 2002?
a) Performing H&P
b) Ensuring the patient was NPO
c) Administering insulin
d) Explaining general anesthesia and OR expectations
e) Expectations for post op pain control
c) Administering insulin
Slide 6
Which of the following premedications may be used in the morning of surgery in the golden times of 2002?
a) Midazolam with or without fentanyl
b) Aspirin and ibuprofen
c) Acetaminophen with or without fentanyl
d) Morphine only
a) Midazolam with or without fentanyl
Slide 6
What was the problem with the COX-2 inhibitors Vioxx and Celebrex?
a) Headaches
b) Unusual hair growth
c) Liver failure
d) Cardiovascular events
d) Cardiovacular events
C - They were having heart attacks and strokes. They weren’t hurting, but they were dead. Celebrex is still used, Vioxx has been recalled
Slide 6
Which of the following drugs is referred to as a “game changer” in the preoperative setting in 2002?
a) Midazolam
b) Fentanyl
c) Paracoxib
d) Celecoxib
e) Vioxx
c) Paracoxib
Slide 6
Local infiltration by the surgeon is typically done at the ______ to reduce pain. Select 2
a) Peripheral nociceptor
b) Port sites
c) Epidural space
d) Central nociceptor
a) Peripheral nociceptor
b) Port sites
C - laparoscopic cases, their biggest complaints are not the surgery itself. It’s the port sites and then the referred pain from the gas. So use LA and decompress their abdomen
Slide 10
What issue is commonly associated with using epidurals for certain surgeries?
a) Epidurals are typically too expensive
b) There is a high failure rate
c) Epidurals do not provide sufficient pain relief
d) There is a low failure rate
b) There is a high failure rate and difficulty in placing them
C - really the first thing we started doing for cases like this was epidurals.
But the problem we ran into was one we didn’t think about it ahead of time. Lack of experience and of outcome data
Slide 10
Which of the following is the primary benefit of using ketorolac in intraoperative pain management?
a) It reduces nausea and vomiting
b) It reduces opioid requirements
c) It increases sedation
d) It improves cardiovascular stability
b) It reduces opioid requirements
Slide 12
Which of the following is NOT a factor that increases a patient’s risk of postoperative nausea and vomiting (PONV)?
a) Female gender
b) Non-smoker status
c) Young age
d) Use of opioids postoperatively
e) Short duration of anesthesia
f) History of motion sickness
e) Short duration of anesthesia
Slide 13
What are the top two “things” that patients don’t want to experience after surgery?
Select 2
a) Vomiting
b) Pain
c) Nausea
d) ETT gagging
a) Vomiting
d) ETT gagging
Slide 14
True or False
If someone is high risk of PONV you should give them 2-3 different prophylatic agents from different classes
True!
Slide 15
The pre-operative phase begins at the decision for surgery and ends ______.
a) After PACU
b) On the morning of surgery
c) The night before surgery
d) After the patient is discharged
c) The night before surgery
Slide 19
What is a mandatory aspect of the pre-operative phase according to the MSSIC guidelines?
Select 2
A. Smoking cessation
B. Formal presurgical patient education and counseling
C. Nutritional screening (albumin)
D. Implement risk assessments with standardized interventions for optimization
E. Fraility/Delirium
B. Formal presurgical patient education and counseling
D. Implement risk assessments with standardized interventions for optimization
Cornelius - it really continues throughout the whole experience…they also understand what we’re doing for them..so they’re not surprised about how the anesthetic or surgical journey continues.
Slide 21
Which of the following are considered essential preoperative steps according to the Strong for Surgery guidelines? (Select 4)
A. Smoking cessation
B. Eating well
C. Exercise levels
D. Controlling blood sugar
E. Stress
F. Medicines
A. Smoking cessation
B. Eating well
D. Controlling blood sugar
F. Medicines
Cornelius - this is information they’re putting out there for the patients, but it’s also kind of an evaluation in the screening tool…They really need to follow up somewhere to manage that disease process
These tools are FREE
Slide 25
If a patient is a smoker, what is the surgeon’s first recommended action according to the risk assessment flowchart?
A. Refer to endocrinology
B. Counsel the patient on smoking cessation
C. Perform a lung function test
D. Delay surgery for more than 6 weeks
B. Counsel the patient on smoking cessation
slide 26
Which of the following is NOT a preoperative risk factors that should be addressed according to the risk assessment flowchart?
A. Known diabetes or BMI > 35
B. Anemia or hemoglobin <11.5
C. Blood pressure > 160/90
D. Age over 75 years
E. BMI >30
C. Blood pressure > 160/90
Slide 26
If a patient’s HbA1c level is greater than 8, the surgeon should refer the patient to ______.
A. Geriatrics
B. Bariatrics
C. Endocrinology
D. Pulmonology
C. Endocrinology
Slide 26
What is the recommended course of action for a patient with anemia and hemoglobin (Hgb) < 11.5 according to the risk assessment flowchart? Select 2
A. Refer to endocrinology
B. Delay surgery indefinitely
C. Refer to blood management
D. Recommend immediate surgery
E. Administer iron & EPO
C. Refer to blood management
E. Administer iron & EPO
Surgery should be >2wks after consult
Slide 26
For a patient with a BMI > 40, the risk assessment recommends which of the following actions?
A. Immediate referral to bariatrics
B. Administering oral iron and EPO
C. Scheduling surgery within 2 weeks
D. Recommending avoidance of elective surgery
D. Recommending avoidance of elective surgery
Refer to bariatrics if BMI is >30
Slide 26
For a patient older than 75 years, the risk assessment suggests referring to ______ for a frailty assessment.
A. A geriatrician
B. A cardiologist
C. A neurologist
D. A oldologist
A. A geriatrician
Slide 26
What is a mandatory pre-operative requirement before surgery according to the intra-operative phase guidelines?
A. Unlimited fasting
B. Carbohydrate-rich beverage up to 2 hours before surgery
C. Inserting a Foley catheter in all patients
D. Administering general anesthesia early
B. Carbohydrate-rich beverage up to 2 hours before surgery
Slide 27
Opioid-sparing, multimodal analgesia is mandatory intra-operatively and should be implemented ______.
A. Only during the surgery
B. Starting from the surgery and continuing through discharge
C. After the surgery is complete
D. For patients over 50 years old only
B. Starting from the surgery and continuing through discharge
Evidenced by order set implementation
Slide 27
Which of the following are suggested intra-operative management strategies according to the guidelines? (Select 3)
A. Rare Foley catheter use
B. Maintaining normovolemia
C. Inserting a Foley catheter for all patients
D. Minimizing blood loss
A. Rare Foley catheter use - No placement unless surgery > 4 hrs. If foley placed, out in PACU if possible
B. Maintaining normovolemia -(goal directed fluid mgmt.)
D. Minimizing blood loss -MIS, consider TXA
Slide 27
Which of the following are suggested goals during the intra-operative phase? (Select 3)
A. Maintaining normothermia
B. Preventing nausea
C. Avoiding general anesthesia
D. Maintaining normoglycemia
A. Maintaining normothermia
B. Preventing nausea
D. Maintaining normoglycemia
Slide 27
What is a metabolic effect of surgical stress and being NPO?
Select 2
A. Increased glucose uptake
B. Increased immunosuppression
C. Decreased gluconeogenesis
D. Decreased levels of IL-1 and IL-6
E. Increased insulin resistance
B. Increased immunosuppression
E. Increased insulin resistance
slide 28
Which of the following are consequences of the catabolic pathway triggered by surgical stress and NPO status? (Select 3)
A. Decreased glucose uptake
B. Increased gluconeogenesis
C. Increased cortisol, glucagon, and growth hormone
D. Decreased catecholamine levels
E. Decreased IL-1 and IL-6
A. Decreased glucose uptake
B. Increased gluconeogenesis
C. Increased cortisol, glucagon, and growth hormone (GH)
INCREASED IL-1 and IL-6
Slide 28
The catabolic response to surgical stress leads to increased post-operative lean tissue loss, which affects the following:
Select 3
A. Blood pressure regulation
B. Strength and mobilization
C. Respiratory mechanics
D. Kidney function and fluid retention
E. Post-operative memory retention and mobilization
F. Wound healing
B. Strength and mobilization
C. Respiratory mechanics
E. Wound healing
Slide 28
MSSIC
Which of the following are outcomes of CHO loading noted in the systematic review? (Select 3)
A. Improved insulin resistance
B. Improved patient comfort
C. No aspiration events reported
D. Preservation of muscle mass
E. Increased post-operative complications
F. Significant adverse effects on blood sugar levels
A. Improved insulin resistance
B. Improved patient comfort (hunger, thirst, anxiety, malaise)
C. No aspiration events reported
No conclusion on preservation of muscle mass
Slide 29
Which of the following medications are part of the IV/Oral Analgesia in the Penn Neurosurgery ERAS protocol? (Select 4)
A. Gabapentin
B. NSAIDs
C. Acetaminophen
D. Bupivacaine
E. Opioids
F. Dexamethasone
A. Gabapentin (PreOp)
B. NSAIDs (PreOp to Home)
C. Acetaminophen (PreOp to Home)
E. Opioids (PACU to Home)
Slide 30
In the Penn Neurosurgery ERAS protocol, ____ is used for local anesthesia.
A. Lidocaine
B. Bupivacaine
C. Ropivacaine
D. Tetracaine
B. Bupivacaine
Slide 30
Which of the following medications are listed under “Other Adjuncts” in the protocol?
A. Acetaminophen and NSAIDs
B. Dexamethasone and muscle relaxers
C. Bupivacaine and gabapentin
D. IV opioids and NSAIDs
B. Dexamethasone and muscle relaxers
Slide 30
