Interpreting Arterial Blood Gases Successfully.

Arterial blood gas (ABG) analysis is a crucial skill for perioperative nurses, in particular the RN circulator. This article provides the physiological basis for assessing ABGs perioperatively and presents a systematic approach to blood gas analysis using the Romanski method. Blood gas sample data allow the reader to practice ABG interpretation. In addition, four case studies are presented that give the reader the opportunity to analyze ABGs within the context of surgical patient scenarios. The ability to accurately assess ABGs allows the perioperative nurse to assist surgical team members in restoring a patient's acid-base balance.

Time motion study in a pediatric emergency department before and after computer physician order entry.

STUDY OBJECTIVE: To determine the effect of computer physician order entry on pediatric emergency department (ED) care providers allocation of time. We seek to determine whether the increase in time by ED care providers on the computer will decrease time spent with patients. METHODS: This was a before-and-after observational time-and-motion study conducted at an urban pediatric ED. Observers recorded how caregivers allocated their time during 180-minute observation periods at 30-second increments the summers before after computer physician order entry introduction. Time on the computer was recorded in seconds. Observations were placed into 3 categories (direct patient care, indirect patient care, other), each with its own subcategories. RESULTS: For attending physicians, median computer time increased from 5.0 minutes before computer physician order entry to 9.5 minutes after computer physician order entry (P=.01). For resident physicians, median computer time increased from 5.5 minutes before computer physician order entry to 14.3 minutes after computer physician order entry (P=.001). For nurses, time on the computer was not significantly different before and after computer physician order entry (P=.15), although it appears there was still some change in time allocation. After computer physician order entry, nurses' talking with staff about patient care decreased from 24.5 minutes to 13.3 minutes (P=.01). Computer physician order entry did not decrease time with patients for any of the caregiver types. CONCLUSION: The addition of computer physician order entry to a pediatric ED increases time spent on the computer by both attending and resident physicians but not for emergency nurses. This additional time on the computer is allocated from nonpatient care activities. The addition of computer physician order entry decreases nurses' time talking with other staff for patient care.