SCIP & ERAS (Exam II) Flashcards
Complications lasting 30 days decrease median survival rate by ____%.
69%
nice
What are the antibiotic performance metrics associated with the SIP (Surgical Infection Prevention Project)?
- ABX started within 1 hr of incision
- ABX regimen consistent w/ guidelines
- ABX d/c within 24hours of surgery stop
What did compliance with three metrics of SIP project look like?
When was the Surgical Care Improvement Project (SCIP) implemented?
What was the intended result?
- Aimed at reducing surgical mortality and morbidity.
What national organization was notably missing from the SCIP steering committee?
AANA
What are the three antibiotic measures associated with the SCIP?
- ABX within 1 hour of incision
- Correct ABX based on procedure
- D/C ABX in 24 hours unless documented reason.
What are the two antibiotics that can be given within 2 hours of incision?
Vancomycin and Fluoroquinolones
When must ABX be discontinued after Cardiac Surgery?
Within 48 hours of cardiac surgery
What are the β-blocker measures associated with the SCIP?
- β blocker within 24 hours of surgery start for all patients on chronic β blocker therapy.
- β blocker restarted after surgery for all patients on chronic β blocker therapy.
What is the hair removal measure associated with the SCIP?
- Documentation of appropriate hair removal w/ clippers only (no razors).
What is the foley catheter measure associated with the SCIP?
Urinary catheter removal on or before POD 2 unless order for extension exists.
What is the blood sugar measure associated with the SCIP?
Cardiac patients need a controlled post-operative blood glucose of ≤ 200 mg/dL prior to surgery and after.
What are the DVT measures associated with the SCIP?
- SCDs placed for all surgeries unless under 1 hour.
- Orders for DVT prophylaxis on post-operative admission orders.
- RN administration of DVT prophylaxis within 24 hours of surgery end.
What are the temperature measures associated with the SCIP?
- Normothermic or active warming in OR
- 1st temp in PACU ≥ 96.8F within 15 minutes of leaving OR.
What are the new ASA guidelines for preoperative fasting?
What pre-medications are typically given in the pre-operative area? 2
Midazolam (and/or fentanyl)
COX-2 Inhibitor (Paracoxib, celecoxib, etc)
A 70kg patient was NPO for 8 hours. What is this patients calculated fluid deficit?
40ml + 20mL + 50mL = 110mL/hr
110 x 8hrs = 880 mL deficit
How much of a fluid deficit occurs due to bowel prep?
2-3L
What type of insensible losses might be seen in a patient?
4-8 mL/kg/hr
This doesn’t pass the sniff test. For a 50kg patient this would be 2400 mL per day on the low end.
What drugs are used for intraoperative pain management? 6
- Opioids
- Local LA infiltration by surgeon
- Epidural
- Ketorolac
- Dexmedetomidine
- Ketamine
What benefits do opioids provide for intraoperative pain control?
Cardiovascular stability
What risks are associated with Ketorolac (Toradol) use?
Bleeding & kidney injury
What is the intraoperative dose of ketamine?
0.25 - 0.3 mg/kg
What are risk factors for PONV?
- Female gender
- Non-smoker
- Young
- Duration of anesthesia
- Post-operative opioid use
- Hx of PONV or motion sickness
