Pre-Procedural Patient Education Reduces Fall Risk in an Outpatient Endoscopy Suite.

The purpose of this article was to determine whether scripted pre-procedural fall risk patient education and nurses' intention to assist patients after receiving sedation improves receptiveness of nursing assistance during recovery and decreases fall risk in an outpatient endoscopy suite. We prospectively identified high fall risk patients using the following criteria: (1) use of an assistive device, (2) fallen two or more times within the last year, (3) sustained an injury in a fall within a year, (4) age greater than 85 years, or (5) nursing judgment of high fall risk. Using a scripted dialogue, nurses educated high-risk patients of their fall risk and the nurses' intent to assist them to and in the bathroom. Documentation of patient education, script use, and assistance was monitored. Over 24 weeks, 892 endoscopy patients were identified as high fall risk; 790 (88.5%) accepted post-procedural assistance. Documentation of assistance significantly increased from 33% to 100%. Patients receiving education and postprocedural assistance increased from 27.9% to 100% at week 24. No patient falls occurred 12 months following implementation among patients identified as high fall risk. Scripted pre-procedural fall risk education increases patient awareness and receptiveness to assistance and can lead to decreased fall rates.

Atuação do enfermeiro na limpeza e desinfecção de materiais de endoscopia digestiva alta / Role of nurse in the cleaning and disinfection of materials for upper endoscopy

Visando descrever a atuação do enfermeiro na Endoscopia Digestiva Alta e no Centro de Material e Esterilização frente ao processo de limpeza e desinfecção de aparelhos endoscópicos, este estudo utilizou-se da visão teórica do enfermeiro, comparando-a com a sua experiência profissional...

Low-dose propofol sedation for diagnostic esophagogastroduodenoscopy: results in 10,662 adults.

OBJECTIVE: The use of propofol sedation during endoscopic procedures has increased in recent years. The aim of this study was to evaluate the safety and effectiveness of nurse-administered low-dose propofol sedation for diagnostic esophagogastroduodenoscopy (EGD). METHODS: We prospectively assessed the outcome and complications of low-dose bolus propofol for endoscopic sedation for diagnostic EGD. Propofol was administered by bolus injection, with a standard protocol of 40 mg for patients <70 years old, 30 mg for patients 70-89 years old, and 20 mg for patients 90 years or older. When required for adequate sedation, additional doses were given, to a maximum of 120 mg. The primary outcome measure was respiratory depression, defined as oxygen desaturation (SpO(2) <90%) that continued for more than 20 s. Secondary measures included successful procedures, full recovery within 60 min of the procedure, and complications. RESULTS: All procedures were successful; 8,431 of 10,662 patients (79.1%) completed diagnostic EGD with a single bolus of propofol. Only 0.26% (28 patients) required transient supplemental oxygen supply; neither mask ventilation nor endotracheal intubation was required. Full recovery occurred in 99.9% of patients 60 min after the procedure. Men and younger patients required significantly higher doses of propofol than did the women and older patients (men vs. women, 46.5+/-19 vs. 42.7+/-15 mg, P=0.0008; age 40-49 vs. age 50-59, 51.5+/-16 vs. 46.3+/-13 mg, P<0.0001). Of the 400 patients, 368 (92%) wanted to drive home or to their offices, and all did so without incident. A total of 99% were willing to repeat the same procedure again. CONCLUSIONS: Low-dose nurse-administered propofol sedation is safe and practical for diagnostic EGD.

Evaluation of the need for endoscopy to identify low-risk patients presenting with an acute upper gastrointestinal bleed suitable for early discharge.

AIMS: To audit the safety of differing protocol-driven early-discharge policies, from two sites, for low-risk acute upper gastrointestinal (GI) bleeding and determine if default early (<24 h) in-patient endoscopy is necessary. METHODS: All patients with low-risk acute upper GI bleeding presenting to two separate hospital sites in Leeds from August 2002 to March 2005 were identified. Both hospitals operate nurse-led process-driven protocols for discharge within 24 h, but only one includes default endoscopy. Relevant information was obtained from patients' notes, patient administration systems, discharge letters and endoscopy records. RESULTS: 120 patients were admitted to site A and 74 to site B. Median length of stay on the clinical decisions unit was 12.6 h at site A and 9.4 h at site B (p = 0.045). Oesophagogastroduodenoscopy was performed on 89/120 (74%) patients at site A compared with only 7/74 (9%) at site B (p<0.001). Six of 120 (5%) patients from site A were admitted to hospital for further observation compared with 6/74 (8%) from site B (p = 0.38). Of the remaining patients, all were discharged within 24 h, and 8/114 (7%) at site A vs 17/68 (25%) at site B were given hospital clinic follow-up (p<0.001). None of the 194 patients had further bleeding or complications within 30 days. CONCLUSIONS: Patients admitted with a low-risk acute upper GI bleeding can be managed safely by a nurse-led process-driven protocol, based on readily available clinical and laboratory variables, with early discharge <24 h. Avoiding in-patient endoscopy appears to be safe but at the price of greater clinic follow-up.

[Management and preparation of endoscopic suite, patients, relatives. Instrumentarium reprocessing]. / Organizzazione e preparazione della sala endoscopica, pazienti, familiari. Reprocessing dello strumentario.

Endoscopic ultrasonography (EUS) investigates the inner side of the digestive tract and the adjacent structures, associating the endoscopic image to the ultrasonographic vision made by a miniaturized ultrasonograph. The technological innovations and a greater attention to the users, have made more complex the organization, the process and the management of the patients. In such panorama, the technical operator of endoscopy, is the competent professional that coordinates the whole necessary organization for diagnostic-therapeutic interventions assuring their feasibility, guaranteeing efficiency and safety of environmental hygiene and strumentario and a specific and competent relief approach to the patients and their relatives.

Aromatherapy and reducing preprocedural anxiety: A controlled prospective study.

The purpose of this study was to evaluate the use of aromatherapy to reduce anxiety prior to a scheduled colonoscopy or esophagogastroduodenoscopy. A controlled, prospective study was done on a convenience sample of 118 patients. The "state" component of the State Trait Anxiety Inventory (STAI) was used to evaluate patients' anxiety levels pre- and postaromatherapy. The control group was given an inert oil (placebo) for inhalation, and the experimental group was given the essential oil, lavender, for inhalation. The STAI state anxiety raw score revealed that patients were at the 99th (women) and 96th (men) percentiles for anxiety. The intervention group and the control group had similar levels of state anxiety prior to the beginning of the study (t[116] = .47, p = .64). There was no difference in state anxiety levels between pre- and postplacebo inhalation in the control group (t[112] = .48, p = .63). There was no statistical difference in state anxiety levels between pre- and postlavender inhalation in the experimental group (t[120] = .73, p = .47). Although this study did not show aromatherapy to be effective based on statistical analysis, patients did generally report the lavender scent to be pleasant. Lavender is an inexpensive and popular technique for relaxation that can be offered to patients as an opportunity to promote preprocedural stress reduction in a hospital setting.

Trained registered nurses/endoscopy teams can administer propofol safely for endoscopy.

BACKGROUND & AIMS: Propofol has advantages as a sedative for endoscopic procedures. Its administration by anesthesia specialists is associated with high cost. Administration by nonanesthesiologists is controversial because of concerns about safety, particularly respiratory depression. METHODS: Three endoscopy units developed programs to train registered nurses supervised only by endoscopists in the administration of propofol for endoscopic procedures. The rate of adverse respiratory events was tracked from the inception of the programs. To estimate whether training nurses to give propofol on a widespread basis might be effective, we evaluated the individual safety records of all nurses and endoscopists involved in propofol delivery at the 3 centers. RESULTS: Among a total of 36,743 cases of nurse-administered propofol sedation (NAPS) at the 3 centers, there were no cases requiring endotracheal intubation or resulting in death, neurologic sequelae, or other permanent injury. The rate of respiratory events requiring assisted ventilation was not significantly different among the 3 centers and ranged from just <1 per 500 cases to just <1 per 1000 cases among the 3 centers. There was no individual nurse or physician for whom the rate of respiratory events requiring assisted ventilation differed from the overall rate of events at the respective centers. CONCLUSIONS: Trained nurses and endoscopists can administer propofol safely for endoscopic procedures. Nurse-administered propofol sedation is one potential solution to the high cost associated with anesthetist-delivered sedation for endoscopy.

Propofol for sedation in the endoscopy setting: nursing considerations for patient care.

Intravenous sedation is routinely administered for endoscopic examinations to help alleviate patient anxiety and discomfort. The goal of moderate sedation is to provide patient comfort to facilitate the completion of the procedure. Nurse administration of intravenous meperidine and midazolam under the direct supervision of the gastroenterologist is the traditional method for achieving this outcome. More recently, physicians have been requesting monitored anesthesia care for the administration of propofol when performing procedures expected to be technically difficult. Propofol is a rapid acting sedative-hypnotic that produces the desired level of consciousness without the residual sedative effect that often persists with the use of benzodiazepines and analgesics. This article reviews current literature regarding the use of propofol for sedation of patients in the endoscopy setting, and highlights the trends in research that may impact future nursing practice.

Teambuilding.

The term "team" is often used in healthcare to describe a work group. But what really makes a team? Three critical elements are involved in the development of a team: goal setting, establishing ground rules, and role clarification. Becoming a "team" will not, however, solve every performance problem or enhance all results. Effective teams can develop in settings where nurses are committed to a common purpose, everyone believes in the goal, roles are clearly defined, and trust is present.

Nurse-administered propofol sedation without anesthesia specialists in 9152 endoscopic cases in an ambulatory surgery center.

Narcotics and benzodiazepines are commonly used for sedation for endoscopy in the United States. Propofol has certain advantages over narcotics and benzodiazepines, but its use is often controlled by anesthesia specialists. This report describes our experience with dosage, safety, patient satisfaction, and discharge time with nurse-administered propofol sedation in 9152 endoscopic cases. The study was performed in a private practice ambulatory surgery center in Medford, Oregon. With the assistance of an anesthesiologist, we developed a protocol for administration of propofol in routine endoscopic cases, in which propofol was given by registered nurses under the supervision of endoscopists or gastroenterologists. We then applied the protocol with 9152 patients. There were seven cases of respiratory compromise (three prolonged apnea, three laryngospasm, one aspiration requiring hospitalization), all associated with upper endoscopy. Five patients required mask ventilation, but none required endotracheal intubation. There were seven colonic perforations (<1 per 1000 colonoscopies), of which three may have involved forceful sigmoid disruption. Of patients who had previously received narcotic or benzodiazepine sedation, 84% preferred propofol. Gastroenterologists strongly preferred propofol. The mean time from completion of procedures to discharge in a sample of 100 patients was 18 min.Nurse-administered propofol sedation in an ambulatory surgery center was safe and resulted in high levels of patient satisfaction and rapid postprocedure recovery and discharge.

[Costs of digestive endoscopy in a level II university hospital]. / Costes de la endoscopia digestiva en un hospital universitario de nivel II.

OBJECTIVES: To establish the criteria that should be considered when analyzing the cost of digestive endoscopy and to determine how the variables studied influence the final results, as well as to determine the relative value unit (RVU) per endoscopic procedure. MATERIAL AND METHOD: Clinical management study relating the cost of endoscopic procedures with their complexity, healthcare activity and direct and indirect countable costs. The endoscopic procedures performed from 2000-2001 (4,982 procedures) were analyzed. We determined the staff costs according to the hours devoted to endoscopic activity, the procedures performed and their complexity, non-amortizable and amortizable materials acquired in the study period, and the cost and amortization of apparatus and equipment. RESULTS: The biannual cost was 392,892.60;. Staff costs were 63%, apparatus and equipment 15%, structural costs 13%, pharmacy 6%, materials 2% and amortizable materials 1%. The least expensive procedure was diagnostic gastroscopy (60.56;) and the most expensive was therapeutic endoscopic retrograde cholangiopancreatography (277.06;). The RVU cost was 52.58;. CONCLUSIONS: Calculation of the cost of any medical procedure should take into account the strict application of direct and indirect costs. In our environment, the cost of endoscopy is lower than might be expected, mainly because the cost of amortization of apparatus and equipment and staff costs were low. Calculation of the complexity index is of considerable clinical and healthcare value. Determination of the RVU is a key element in establishing the cost of a procedure and in relating this cost with other costs, allowing its application as well as comparison among different investigations, services and centers.