Preadmission testing in a children's facility

AORN Journal,  Oct, 2003  by Kathleen Sexton,  Michelle Redfearn

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* instituting online scheduling for PAT visits,

* providing education and skill development for support staff members (ie, unit secretaries and care assistants), and

* making staffing adjustments (eg, using care assistants to take patients' vital signs on the day of surgery).

LEADERSHIP. The SDS charge nurses participated in preceptor and mentoring classes offered by the CMHC education department. These nurses learned delegation techniques and communication skills to increase cooperation and receptivity to the PAT concept. The SDS nurse manager incorporated leadership exercises into SDS staff nurse and charge nurse meetings. A job description for a preadmission testing coordinator was written and approved as a permanent position in the SDS unit.

COLLEGIALITY. Before initiation of the pilot program, APNs working in surgical subspecialty sections typically followed patients through clinic visits and completed histories and performed physical examinations on some patients. An SDS nurse called the family on the afternoon before surgery, conducted a telephone assessment, and tried to arrange for all needed interventions, such as a social service consultation, perioperative latex allergy precautions, laboratory orders, prophylactic antibiotics, or other needed medications for the next day.

Many of the surgical APNs work directly with physicians who have heavy patient loads. The APNs believed that time did not allow for preparation other than scheduling the procedure. Members of the quality team set up lunch and breakfast meetings to engage the APNs in the PAT process. Orthopedic and otolaryngology APNs agreed to pilot the program. The role of the APNs changed after they understood and participated in the PAT project. They began to set up PAT visits, write preoperative orders, interpret laboratory test results, and communicate with the SDS nurses. The APNs became excellent ambassadors for the program, as well as patient advocates.

ONLINE SCHEDULING. Surgical procedures were scheduled through the OR scheduling department, which was separate from clinic scheduling or admissions. The SDS nurses visited clinics, studied their online systems, and adapted them to the SDS unit for scheduling PAT visits. They identified problems related to registration and coordinated with the OR and various ancillary areas, such as the laboratory and radiology. A nurse with computer skills and previous clinic experience set up online scheduling for PAT visits.

SUPPORT STAFF MEMBER EDUCATION. The SDS unit secretaries were trained in the PAT online scheduling process. All SDS staff members attended CMHC shared values programs on first impressions and service excellence to enhance their communication skills as their scope of responsibility broadened.

STAFFING ADJUSTMENTS AND ROLE DEFINITION. Patients undergoing PAT visits were in the same physical space concurrently with inpatients and outpatients having surgery that day. Better use of care assistants, student nurses, technologists, and child life specialists relieved the burden on staff nurses. Support staff member roles were expanded to include weighing and measuring patients and taking their vital signs. Child life specialists agreed to teach and perform interventions at the PAT visit rather than on the day of surgery when time is limited.