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- Brattwall, Metha, 1952, et al.
(author)
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What can a mobile App add to improve quality of care, with focus on ambulatory surgery?
- 2018
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In: European Journal for Person Centered Healthcare. - : University of Buckingham Press. - 2052-5656 .- 2052-5648. ; 6:1, s. 20-24
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Journal article (peer-reviewed)abstract
- Rationale, aims and objectives: Many surgical procedures are nowadays performed as ambulatory or short stay procedures, reducing hospital length of stay. Patient safety and quality of care remain imperative especially when adopting enhanced recovery pathways. Patients should be adequately informed and prepared prior to admission. Recovery is to a major extent dependent after discharge on self-care and thus techniques to follow the post-operative course after leaving hospital are warranted. Telemedicine has grown tremendously over recent years and the incorporation of mobile telephone app technology for the pre- and post-operative coaching of the ambulatory surgical patient may represent an effective means of assisting patients. The present paper presents a feasibility study of a mobile telephone app providing pre-operative information and following the post-operative recovery following day surgery. Method: Patients scheduled for elective day surgery were asked to participate, testing the app and to assess its usefulness on visual analogue scales. Results: Sixty-nine patients aged 18 to 73 years tested the app. Patients aged 30 to 50 where the most frequent users and patients < 30 less frequent. The app was in general assessed as useful and most users expressed an interest in the option of having an app as a source of information before undergoing a scheduled procedure. General pre-operative information was assessed as the most important. A willingness to submit follow-up information decreased rapidly, only 26 and 16 responded at day 10 and 30, respectively. Conclusion: A mobile telephone app is a feasible and appreciated tool for pre-operative information and coaching as part of person-centered healthcare, but its use for follow-up after discharge is challenging and requires further investigation.
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| 4. |
- Sellbrant, Irene, et al.
(author)
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The choice between surgical scrubbing and sterile covering before or after induction of anaesthesia: A prospective study
- 2017
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In: F1000Research. - : F1000 Research Ltd. - 2046-1402. ; :6
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Journal article (peer-reviewed)abstract
- Background: Day surgery is increasing, and safe and effective logistics are sought. One part of the in-theatre logistics commonly discussed is whether surgical scrub and sterile covering should be done before or after induction of anaesthesia. The aim of the present study was to compare the impact of surgical scrub and sterile covering before vs. after the induction of anaesthesia in male patients scheduled for open hernia repair. Methods: This is a prospective randomised study. Sixty ASA 1-3 patients scheduled for open hernia repair were randomised to surgical scrub and sterile covering before or after induction of anaesthesia; group “awake” and “anaesthetised”. Need for vasoactive medication during anaesthesia was primary study objective. Duration of anaesthesia and surgery, theatre time, recovery room stay and time to discharge, patients and theatre nurses experiences and willingness to have the same logistics on further potential surgeries, by a questionnaire provided before discharge was also assessed. Results: The duration of anaesthesia was shorter and doses of propofol and remifentanil were reduced by 10 and 13%, respectively, in the awake group. We found still no difference in the need for vasoactive medication during anaesthesia Time in recovery area was significantly reduced in the awake group 39 (SD 15) vs. 48 SD 16) (p<0.05), but time to discharge was not different. There was further no difference in the patients’ assessment of quality of care, and only one patient in the awake group would prefer to be anaesthetised on a future procedure. All nurses found pre-anaesthesia scrubbing acceptable as routine. Conclusion: Surgical scrub and sterile covering before the induction of anaesthesia can be done safely and without jeopardising patients’ quality of care and possibly improve perioperative logistics. Further studies are warranted assessing impact of awake scrubbing and sterile covering on quality and efficacy of perioperative care.
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| 7. |
- Brattwall, Metha, 1952, et al.
(author)
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Safe Perioperative Practice, How Can We Further Improve Clinical Every Day Work?
- 2016
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In: Journal of Perioperative & Critical Intensive Care Nursing. - : OMICS Publishing Group. - 2471-9870. ; 1:2, s. 1-4
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Journal article (peer-reviewed)abstract
- Anaesthesia has become reassuringly safe. All modern anaesthetic agents are effective and associated to only minor side effects, anaesthetic machines and monitors helps delivery and closely in real time observation of vital signs. Anaesthesia practice has expanded and includes today perioperative care, preoperative assessment and optimisation, anaesthesia and postoperative care. Following the postoperative course up to day 30 after surgery is today of increasing interest and importance to document value based perioperative. Interprofessional care where the perioperative nurse has a major commitment will help to further improve the perioperative process.
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| 8. |
- Brattwall, Metha, 1952, et al.
(author)
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Upper extremity nerve block: how can benefit, duration, and safety be improved? An update
- 2016
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In: F1000Research. - : F1000 Research Ltd. - 2046-1402. ; 5:907, s. 1-9
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Journal article (peer-reviewed)abstract
- Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality.
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| 9. |
- Sellbrandt, Irene, et al.
(author)
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The choice between surgical scrubbing and sterile covering before or after induction of anaesthesia: A prospective study
- 2017
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In: F1000Research. - 2046-1402. ; 6:1019
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Journal article (peer-reviewed)abstract
- Background: Day surgery is increasing, and safe and effective logistics are sought. One part of the in-theatre logistics commonly discussed is whether surgical scrub and sterile covering should be done before or after induction of anaesthesia. The aim of the present study was to compare the impact of surgical scrub and sterile covering before vs. after the induction of anaesthesia in male patients scheduled for open hernia repair. Methods: This is a prospective randomised study. Sixty ASA 1-3 patients scheduled for open hernia repair were randomised to surgical scrub and sterile covering before or after induction of anaesthesia; group “awake” and group “anaesthetised”, respectively. Patients and theatre nurses were asked about their experiences and willingness to have the same logistics on further potential surgeries, through a survey provided before post-surgery. Duration of anaesthesia, surgery, theatre time, recovery room stay and time to discharge was studied. Results: There was no difference in the patients’ assessment of quality of care, and only one patient in the awake group would prefer to be anaesthetised on a future procedure. All nurses found pre-anaesthesia scrubbing acceptable as routine. The duration of anaesthesia was shorter and doses of propofol and remifentanil were reduced by 10 and 13%, respectively, in the awake group. Time in recovery area was significantly reduced in the awake group (p<0.05), but time to discharge was not different. Conclusion: Surgical scrub and sterile covering before the induction of anaesthesia can be done safely and without jeopardising patients’ quality of care.
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