Implement a Standardized Anesthesia Order Set in the PACU

Background: Incomplete physician orders are a significant cause of interdisciplinary miscommunication, patient treatment delays, inconsistent patient care, medication irregularities, and medication errors in the Post Anesthesia Care Unit (Kandaswamy et al., 2019; Park et al., 2018; Wells & Loshak, 2019). Communication breakdown occurs during transitions of care, handoff procedures, and medication ordering processes (Cierniak et al., 2018). Local problem: The Post Anesthesia Care Unit at the level two trauma hospital has faced challenges with physician-nurse communication during anesthesia handoff and nurses being equipped with comprehensive orders to provide quality patient care and minimize patient treatment delays. Methods: Customized order sets (COSs) were replaced with a standard order set (SOS) in the PACU at a level two trauma hospital. Investigator-designed surveys using ten five-point Likert scale questions were used to assess PACU nurses' satisfaction, feasibility, and usability of the (COSs) compared to the (SOS). Descriptive statistics were used to draw inferences from qualitative and quantitative survey data and a retrospective chart review. Interventions: A pre-implementation survey assessed nurses' experience and satisfaction with the customized order sets. A comprehensive analysis was conducted with each anesthesiologist to gauge their comprehension of SOSs and their relevance in various clinical environments. A multidisciplinary team designed the SOS. It was then implemented and trialed the SOS for six weeks. Nurses were given a post-implementation survey to gauge their satisfaction with the SOS. A retrospective review of the order sets within the electronic health records (EHR) analyzed occurrences of irregularities or incomplete orders. Results: An overwhelming majority of nurses (n=21) were highly satisfied with the SOS and unanimously agreed it improved patient care. 76.2% (n=16) agreed or strongly agreed that they needed to contact the anesthesiologist one or more times for additional orders with the COSs compared to 4.8% (n=1) with the SOS. The frequency of medications ordered significantly increased with the SOS compared to the COSs. Most anesthesiologists agreed that the SOS was easy to order and applicable to PACU patients. Conclusion: This project successfully addressed the need to enhance interdisciplinary communication between anesthesiologists and nurses with comprehensive orders in the PACU. The pre-implementation survey revealed substantial dissatisfaction among nurses with the existing COSs. The post-implementation survey presented compelling evidence of the SOS's positive impact, with a significant reduction in phone calls to anesthesia, improved focus during handoffs, and an overall enhancement in patient care. The positive feedback from anesthesiologists and nurses, coupled with the increased frequency of medication orders, suggest a promising path for future implementation in similar healthcare settings.