PACU Rotation Rotation Director: Dietrich Gravenstein, MD. Curriculum, Goals and Objectives

Transcription

1 PACU Rotation Rotation Director: Dietrich Gravenstein, MD Curriculum, Goals and Objectives 1. Introduction The post anesthesia care unit (PACU) rotation is recognized as a requirement of the American Board of Anesthesiology and ACGME Residency Review Committee. The rotation will be 2 weeks (10 regular week days). Upon successful completion of the PACU rotation, residents shall have learned the clinical, technical, interpersonal and unit management skills needed to safely and competently perform routine PACU and perioperative care to a level consistent with that of a board eligible anesthesiologist. The PACU faculty will serve as your educational resource manager. Outlined below is the UF curriculum including rotation objectives that include lecture, problem-based learning discussion, and patient service requirements. Each objective will be graded (Exemplary, Pass, Fail) according to the mechanisms described below for resident evaluation. 2. Benchmarks by Level of Training This is a two-week rotation for CA-1 residents. They are expected to gain the knowledge and experience during the rotation to demonstrate competency in both the learning topics and the criteria listed in Section 4, Guidelines for Evaluation of Competency. 3. Learning Topics At the completion of this rotation, residents will demonstrate increased knowledge and skill through their ability to: A. Interpret reading that is assigned during this rotation, which focuses on the evaluation and management of common PACU problems including: a. Nausea/Vomiting b. MI and Ischemia c. Hyper/Hypotension d. Airway and Desaturation e. Pain f. Altered CNS g. Fast-Track h. Pediatric i. Shivering j. Hiccups B. Discuss the basics of the following lecture topics: a. Myocardial ischemia in the PACU EKG changes and therapies for MI b. Arrhythmias in the PACU EKG reading with differential diagnoses and treatments c. Cardiovascular instability and Etiologies, diagnosis, therapeutic management in the PACU interventions and outcome evaluation d. Respiratory distress Recognition, differential diagnosis of hypoxemia and hypercarbia and management e. Airway obstruction in the PACU Diagnosis and management f. Post-obstructive pulmonary edema in adults Diagnosis and management g. Weaning patients from a ventilator Ventilator modes and settings (PEEP, CPAP, T-Piece), extubation criteria 1

2 h. Postoperative pulmonary embolism Diagnosis and treatment of a PE i. Delayed emergence Differential diagnosis and management j. Patients with elevated ICP Monitoring and therapy k. Endocrine complications in the PACU Diagnosis and management (diabetic emergencies, acute adrenal insufficiency and thyroid storm) l. Acute and chronic renal failure Diagnosis and management m. Hypothermia in the perioperative period Etiology, risks and management n. Post-op nausea and vomiting Differential diagnosis, high risk patients and surgical procedures, therapeutic interventions o. Acute pain management Treatment strategies, pharmacology of pain medications and techniques for alternative therapies p. Post-op nerve injuries Etiology, risk factors and management q. Nurses may provide topics of particular interest or recent relevance References: 1. ACGME General Competencies: American Society of Anesthesiologist NEWSLETTER.Nov 2002:66; Brett JF, Atwater LE: 360-degree feedback: Accuracy, reaction and perceptions of usefulness. J Appl Psychol 2001; 86: Meng L, Wells C, Metro D, Patel R. Developing a PACU Rotation Curriculum for Anesthesia Residents. University of Pittsburgh 4. Guidelines for Evaluation of Competency In addition to the General Competencies, the following will be evaluated on this rotation. A. Patient Care At the completion of this rotation, residents must demonstrate the ability to competently: a. Perform an accurate assessment of patients post-operative cardiovascular, respiratory and neurological status including hemodynamic stability, airway management, and mental status evaluation; b. Describe the elements contained in the Modified Aldrete Score, as well as acute pain management, recovery from regional anesthesia, fluid management and other co-morbid conditions; c. Manage successful patient care, as reflected by the resident s maintenance of a log with name and date and cumulative numbers of patients 2yo and younger (any surgery), orthopaedic, neurosurgical, general, vascular, ENT and Others, that they evaluated AND discharged (home, to ward, or IMC) from PACU. This log will be provided to the Medical Director B. Medical Knowledge Upon completing this rotation, residents will demonstrate the ability to competently: a. Manage common postoperative complications following a variety of surgical procedures. b. Demonstrate accurate understanding of the underlying pathophysiology of commonly encountered disease processes as well as provide accurate interpretation of the information provided by various noninvasive and invasive monitors. c. Perform proper application of discharge criteria d. Select a topic and prepare a brief min discussion on a topic relevant to the PACU for the PACU nursing staff. i. This lecture will be given to both shifts on a day and time coordinated with the PACU charge nurse. ii. Competency of this skill will require successful completion of the lectures and passing a quiz testing knowledge of common clinical problems and recommended therapeutic strategies. C. Interpersonal and Communication Skills 2

3 Upon completing this rotation, residents will demonstrate the ability to: a. Effectively coordinate appropriate care for PACU patients that may include discussion with the attending anesthesiologist, consultation with the surgical team, Critical Care Medicine or members from other specialties, and communication with PACU staff. b. Maintain appropriate communication with patients and their families. c. Results from 360 evaluations from faculty, patients, PACU nurses, and PACU clerical staff will determine competency. D. Professionalism At the completion of this rotation, residents will demonstrate a commitment to: a. Act with respect and personal integrity in their interactions with patients, PACU nurses, the anesthesia team, and other staff. b. Maintain appropriate appearance, responsiveness to spoken or paged requests and punctuality. c. Manage any interpersonal conflict in a manner which avoids offensive behavior and reflects emotional maturity. d. Protect patient confidentiality under all circumstances. e. 360 evaluations from patients, PACU nurses, and PACU clerks will determine competency. E. Practice-based Learning Upon completing this rotation, residents will demonstrate the ability to: a. Discuss 2 cases and provide up-to-date information based in information researched in recent literature. Discussion dates are to be coordinated with the Medical Director of PACU or designated surrogate. b. Perform patient rounds and communicate topics specific to the patients care daily when care is transferred to the call team. c. Suggest ideas for improvement of post-anesthetic care and outcomes based on their experience. F. Systems-based Practice Upon completing this rotation, residents will demonstrate the ability to: a. Demonstrate a better understanding of patient flow from the OR, through the PACU, and followed by either patient discharge or admission to the hospital. b. Demonstrate an understanding of causes of delays and patient dissatisfaction and act to ameliorate them. c. Facilitate the throughput process by notifying the PACU clerk each time a sign out, including evaluation, completion of Aldrete Score and PACU & Post-Op Note in the chart, has been completed. d. Maintain an average PACU length of stay (LOS - admission to time of clerk notification of discharge) under 90 minutes. This will require an understanding of NaviCare and its icons, color schemes, and timers. A process efficiency report calculating the average LOS will be produced for each rotation. A NaviCare quiz will determine competency. 3

4 Patient Care Medical Knowledge Interpersonal & Comm. Skills Practice-based Learning & Imp Professionalism Systems-based practice Assessment FE=Faculty Eval MCQ=Quiz MO=Mock Oral 360=Nurse/Pt Eval CL=CHecklist Rotation: PACU COMPETENCIES OBJECTIVE 1: Demonstrate learning of required knowledge 1.1 Demonstrate accurate understanding of the underlying pathophysiology of commonly encountered disease processes as well as provide accurate interpretation of the information provided by various noninvasive and invasive monitors. X FE, MCQ 1.2 Demonstrate proper application of discharge criteria. X FE OBJECTIVE 2: Appropriately manage PACU patients 2.1 Demonstrate accurate assessment of patients post-operative cardiovascular, respiratory and neurological status including hemodynamic stability, airway management, and mental status evaluation. X FE, Accurately apply the Modified Aldrete score X FE, 360, MCQ 2.3 Appropriately manage other issues such as acute pain management, recovery from regional anesthesia, fluid management as well as attention to other co-morbid conditions. X FE, Manage a wide variety of PACU patients, maintaining a log book for review X FE, case log OBJECTIVE 3: Prepare patients for discharge from the PACU 3.1 Understand the use of NaviCare; X MCQ 4

5 Patient Care Medical Knowledge Interpersonal & Comm. Skills Practice-based Learning & Imp Professionalism Systems-based practice Assessment FE=Faculty Eval MCQ=Quiz MO=Mock Oral 360=Nurse/Pt Eval CL=CHecklist Rotation: PACU COMPETENCIES achieve competency on a related quiz 3.2 Maintain an average target length-ofstay of under 90 minutes. X X FE of NaviCare chart GOAL 4: Demonstrate professionalism and a responsible work ethic 4.1 Demonstrate the ability to effectively coordinate appropriate care for PACU patients that may include discussion with the attending anesthesiologist, consultation with the surgical team, Critical Care Medicine or members from other specialties, and communication with PACU staff. X X FE, Communicate effectively with patients and their families. X X FE, Demonstrate respect and personal integrity in interactions with patients, PACU nurses, the anesthesia team, and other staff. This includes appropriate appearance, responsiveness to spoken or paged requests, punctuality, and respect for patient confidentiality. GOAL 5: Participate in self-directed learning and scholarly activity 5.1 Prepare a 15-minute talk on a topic from the provided list, for presentation to the nursing staff X X FE, 360 X X X FE, nurse eval 5.2 Using information collected from recent scientific literature, discuss 2 cases and provide up-to-date information. X X MO, FE GOAL 6: Maintain accurate records 6.1 Complete records that are thorough and accurate X FE 5

6 Patient Care Medical Knowledge Interpersonal & Comm. Skills Practice-based Learning & Imp Professionalism Systems-based practice Assessment FE=Faculty Eval MCQ=Quiz MO=Mock Oral 360=Nurse/Pt Eval CL=CHecklist Rotation: PACU COMPETENCIES 6