ERAS protocols empower nurses and improve patient’s journey
Checkered flags line the hallways of Surgical Oncology’s Marburg 2, evoking images of Indianapolis 500 and Grand Prix racers growling across the finish line. It may look whimsical, but the victory symbol serves a patient-centered purpose: helping post-operative colorectal surgery patients measure their ambulatory progress while reminding them that every flag they pass is another triumph to celebrate in a difficult recovery process. It’s just one of a whole host of changes sparked by the implementation of Enhanced Recovery After Surgery (ERAS) protocols.
ERAS, a care pathway aimed at improving and expediting the recovery process for those undergoing major surgery, represents a complete rethinking of the patient’s journey from the time a procedure is ordered all the way through post-operative care. Deb Hobson, BSN, patient safety clinical specialist, remembers attending a session about it at the American College of Surgeons’ Clinical Congress last year with Elizabeth Wick, MD, associate professor of surgery, and Chris Wu, MD, division director in the Department of Anesthesiology and Critical Care Medicine, and pushing the idea for Hopkins. After about six months of research and planning, the program was ready for rollout.
One of the bigger changes was creating an education package that includes a checklist of actions for patients to complete throughout their surgical journey. In a face-to-face meeting shortly after surgery is ordered, a clinical nurse goes through the package with patient and family, reviewing the checklist to make sure all questions are answered and enlist everyone’s participation. “The patient is really the partner now,” says Deborah Baker, DNP, MSN, CRNP, director of nursing for the Department of Surgery. “The family is also able to follow along with the progress tracking and understand it.”
At the same time, nurses are able to identify small adjustments that make a big difference, even as simple as providing a stick of gum. Chewing it provides the same gastrointestinal reflex as eating for patients unable to do so, which can speed recovery from surgery. “The nurse managers told us they were buying gum in the gift shop to have available,” Hobson says. “With executive support, we were able to get it bar-coded and supplied through the pharmacy.”
In the pilot cohort, patient stays have seen a two-day decrease while satisfaction scores have risen. Other units, like Urology and Hepatology, are looking at how ERAS could work for them. Says Hobson, “Patients who have had surgery with us before are particularly enthusiastic about the changes. They’re telling us that their experiences are so much better this time.”
“There are some projects you do that are especially rewarding for nurses, and this is one of them,” Baker reflects. “They’re thrilled to see their patients happier and safer, and they’re teaching and working closely with the patients and families. They’ve been incredibly vocal champions for this work, and they’ve been integral to every step of the process.”