By Pamela K. Ginex, EdD, RN, OCN®, and Kerri Moriarty, MLS
For many patients with cancer, surgery is an integral part of the treatment regimen and offers a chance for a cure.
This is especially true for patients with pancreatic cancer, where surgery is currently the only potential cure for the disease and a predictor of long-term survival.
Pancreaticoduodenectomy (PD, also known as a Whipple procedure) is the current standard operation for patients with resectable pancreatic cancer. PD is a complex surgery with postoperative morbidity rates from bile leak, bleeding, cardiac dysrhythmias, delayed gastric emptying, and other complications as high as 30%–40%. Enhanced recovery after surgery (ERAS) guidelines—evidence-based practice (EBP) guidelines for perioperative care that have the potential to reduce inappropriate variations in practice and promote the delivery of high-quality, evidence-based health care—can help institutions standardize care for patients receiving PD.
Exemplar of Using Evidence to Standardize Care
ONS member Cesar Aviles, DNP, ANP-BC, and a team from Carolinas Medical Center in Charlotte, NC, implemented an EBP project using ERAS guidelines starting with preoperative education and standardizing intraoperative and postoperative procedures. Because the ERAS guidelines crossed multiple care settings, Aviles noted the importance of having leadership buy-in, calling it “essential” to the program’s success. He said that “changing culture in a complex healthcare environment can be a difficult task, but leadership buy-in can expedite the process of culture change.” Hospital leadership was instrumental in advocating for an ERAS nurse who coordinated data collection, helped to identify barriers in implementing the program, and was integral to the program’s sustainability.
Aviles also highlighted having an electronic standard order set as a key component in the program’s success, which helped to facilitate workflow across settings and increase compliance to ERAS guidelines. The goal of standardizing workflow with the order set was to increase staff knowledge, which would lead to an engaged staff that was empowered to be more involved in patient care decisions. The ERAS team was careful to draft the electronic order set in accordance with ERAS guidelines, bearing in mind that the simpler for the end use, the better. The team also ensured the order set didn’t interrupt workflow, that they performed pilot and user testing, and that they continuously monitored compliance to the protocol.
Aviles and his team found the ERAS protocol to be feasible and safely implemented. Outcomes included decreased length of stay without increasing readmission rate.
Evidence-based practice projects can be complex, cross multiple practice areas, and involve many healthcare professionals. Involving leadership from the start and having a clear data collection and monitoring plan can increase your chances for success.