Newsletter of the Texas Association of Perianesthesia Nurses · TAPAN Mission Statement “The...

2007 National Newsletter Award Winner

Newsletter of the Texas Association of Perianesthesia NursesNewsletter of the Texas Association of Perianesthesia Nurses

WINTER EDITION 2007 VOLUME 19, NUMBER 4

O ur Nation celebrated Thanksgiving on No-

vember 22nd this year. As I look back over 2007, I reflect on the changes this year brought to my life, the “constants” which grounded me, and the surprises I did not anticipate. Dynamic change challenges and invigorates the spirit. Never one to make small changes, I took on the role of TAPAN President while simul-taneously starting a new job. My Safety Net is the TAPAN Board. In this Season of Thanksgiving, I want to tell them how much I value and respect their input and their selflessness as I transitioned into my new roles. As Board members, our service to TAPAN gives us the opportu-nity to network with other pro-fessional nursing organizations, to exchange ideas, to dream, and to plan. No compensa-tion? I am rich beyond measure in the friends I have made and the wisdom those friends have imparted. I thank the mentors who encouraged me, figuratively held my hand, gave me advice, and kept be-lieving in me when I faltered.

As I said goodbye to my Seton Northwest co-workers in Sep-tember, I encouraged them to “do something that scares you, just a little.” I thank the peri-anesthesia staff at Seton Northwest Hospital for accept-ing my decision to resign, for encouraging me as I moved on, and for their dedication to safe perianesthesia nursing practice. Every experience changes us. My years at SNW afforded me numerous oppor-tunities for growth and devel-opment as a professional. SNW served as my “research” laboratory for changes that will shape and improve my current practice. Safe nursing practice in the perianesthesia environment is one of the challenges many of

Dynamic Change Challenges and Invigorates the Spirit

Susan Russell, RN,JD,CPAN,CAPA

TAPAN President 2007-2008

us face daily. Smaller institu-tions, those without adequate staffing, and those overbur-dened by the sheer volumes of patients who pass through their units all feel the pressure to do more with fewer quali-fied nurses. We work with travelers, agency personnel, and new graduates. Our ad-herence to ASPAN’s standards for nurse to patient ratios and safety concerns may fall short of the mark. We must be creative in the way we address these issues in order to meet our employers’ expectations without compromising patient and staff safety. We must be advocates for our patients and ourselves. I challenge every member of TAPAN to do something that scares you, just a little. Translate this challenge in some form in your own life. Will you take a certification exam to be a CPAN or CAPA? Will you run for a TAPAN State or District office? Will you write an article for the Eyeopener , Breathline or JoPAN? Will you speak at a local, district, or State conference? Will you join a committee and work to

Inside this issue:

ASPAN Update: A Busy Time of Year; TAPAN Board of Direc-tors Contact Information

2

President’s Message con-tinued; Keep Your Cards and Letters Coming

3

Governmental Affairs: Issues That Affect You

4

Spotlight Across Texas: District News

6

2008 National Conference… Texas Style

8

Anesthesia Awareness: Recall

10

Research: The Question of PACU Visita-tion

12

We Want You! To Be a TAPAN Officer

14

www.tapan.org Continued on page 3

THE EYEOPENER

Twilla Shrout, RN, BSN, MBA, CAPA, Region 2 Director

ASPAN Update: A Busy Time of Year

T his has been a busy time of year—so many of the Region 2 seminars

are held in the Fall. I have been to Texas (TAPAN), Missouri/Kansas (MO KAN PANA), and Nebraska (NAPAN). The Component Development Institute was held in Albuquerque, New Mexico the first weekend of September. The attendees left with information that should help with the transition of leader-ship in the components. Please ask your component representative to share the information or I can send the power point presentation from the Regional Directors. We now have over 13,000 members of ASPAN—but remember the member-get-a member campaign as a way to re-cruit for your component. Your name will be placed in a drawing with the other recruiters (one chance for each member recruited) to win registration for the next National Conference. The re-cruiter of the year will win one free regis-tration and a year of ASPAN member-ship. Go to the ASPAN website for the power point presentation held during confer-ence in 2007: Pain Management Essen-tials: Strategies for Implementing Opti-mal Pain Control in the PACU. Also, under the ASPAN Issues Agenda-The State of Postoperative Pain Manage-ment: A Need for Improvement. You can download in PDF form or request a hard copy. ASPAN is in the stage of compiling data on the issue of fatigue in the workplace

it and will be presented to the ASPAN members at a later date. Also, ASPAN and the Council on Surgical and Pe-rioperative Safety are working on a posi-tion statement on alarms and workplace violence. The newly revised book with practice test questions and rationales, Review for Certification, should be out later this year. The Competency Orientation for Unlicensed Personnel is finished and available. The Competency Based Orien-tation for the RN should also be avail-able by the end of the year. The Core Curriculum will be due for review next year with Lois Schick and Pam Windle as the co-editors. The President of each component has received Sue Fossum’s ASPAN update in a power point presentation, as well as the ASPAN 101 that I have updated specific to each component. These pres-entations would be a way to share at a district or component meeting for the members. I have sent each President and President Elect the proposed strate-gic plan for Region 2, please ask for this to be e-mailed to you for review. I would ask any ASPAN, or potential ASPAN member, to e-mail me at [email protected] with any questions or concerns that you may have. I will try to answer the question myself, or for-ward the information to someone else for clarification.

TAPAN Board of Directors

President Susan Russell RN, JD,

CPAN, CAPA Austin, TX

[email protected]

1st Vice President/President Elect

Linda Allyn RN,CPAN,CAPA

Elgin, TX [email protected]

2nd Vice President

Susan Norris RN,CAPA Houston, TX

[email protected]

Treasurer Herminia Robles BSN,RN,CPAN

Houston, TX [email protected]

Secretary

Olga M. Ramirez-Rodriquez, RN, CAPA El Paso, TX olgamargari-

[email protected]

Immediate Past President Lori Sanders

BSN,RN,CPAN Trophy Club, TX

[email protected]

ASPAN Mission Statement

“The American Society of PeriAnesthesia Nurses advances nursing practice through education, r e s e a r c h , a n d standards.”

VOLUME 19, NUMBER 4

make your district or State conference a success? Perhaps you will write a letter to an elected State or National official asking for support on healthcare or nursing is-sues. Learning to accept change, to embrace challenge, and to educate perianesthesia nurses keeps TAPAN alive as a professional specialty organization. Without the commitment to change through nursing research and evidence based practice, we cannot continue to set the standards for perianesthesia nursing. Without advocacy, ASPAN and TAPAN will not inform the Nation and the World about the nursing profession, the state of our specialty and the future safety of healthcare we face both as healthcare providers and as consumers. I am thankful for our ASPAN Board’s leadership in encouraging individual nurses to speak out for changes in healthcare and funding for nursing education. In February, we celebrate PeriAnesthesia Nurse Awareness Week—PANAW. I encourage every perianesthesia nurse to remind administrators, physicians and con-sumers that our specialty advocates safe nursing care for patients at their most vul-nerable. Plan something special to highlight what you do that sets perianesthesia nursing apart from other nursing specialties. Celebrate how far the field of Peri-Anesthesia Nursing has come in the thirty one years since TAPAN was founded. If we do more with less these days, let us be thankful that we have a professional or-ganization which supports our efforts to make a difference in healthcare and advo-cates for safety and quality in our work environment.

President’s Message cont.

TAPAN District Presidents

District 1: Houston

Deborah Davis djdavis@texaschildrenshospital

.org

District 2: Fort Worth Sharon Thorwald, RN

CAPA [email protected]

District 3: Dallas

Les Rodriguez [email protected]

District 6:

Austin/San Antonio Leonard Allen, ADN, RN

Leonard.allen@ Mhshealth.com

District 7: El Paso

Olga Ramirez-Rodriguez, RN, CAPA

[email protected]

District 9: San Angelo Jackie Clinkinbeard

[email protected]

District 11: Lubbock Vern Pharr

[email protected]

TAPAN Mission Statement

“The Texas Association of PeriAnesthesia Nurses, as a component of the American Society of PeriAnesthesia Nurses, advances nursing practice through education, research, and standards.”

Keep Those Cards and Letters Coming

T hanks to all of you that have already responded about getting your Eyeopener reminder online. I do seem to have a few missing people that did not receive

their notices in the mail. If anyone has a current address for any of the following people please let me know at [email protected], so we can keep our lists accurate. Our list of MIA's is as follows: Clifford Alston, Cynthis Bass, Houston Carr, Thomas Hicks, Linell Nixon, Deb-orah Ost, Jane Redmond, Jennie Riley, Damon Watkins, and Shannon Weck. Remember, if you haven't responded yet please do so if you want a reminder. I haven't counted it, but I know I haven't gotten 900+ responses yet.

Linda Allyn, RN, CPAN, CAPA, 1st Vice President/President Elect

THE EYEOPENER

T he political arena is a very busy place these

days. Following are excerpts of information that is continu-ally flowing from various or-ganizations. Our ASPAN

Governmental Affairs Committee Chair, Maureen McLaughlin, sends updates related to legislative issues that affect nursing frequently. There isn’t enough room in our newsletter to print all of the issues. I would like to reiterate that if anyone is interested in placing their name on my list for contacts, please send your e-mail ad-dress to me at: [email protected]. It makes the flow of information much more fluid when many of us are communicating with each other when important pieces of legislation are up for vote! I hope you all have a blessed holiday season. Merry Christ-mas & Happy New Year! Title VIII- The Nurse Reinvestment Act The House of Representatives passed H.R. 3043, which would appropriate $165.6 million for Title VIII. Included in this amount:

$57 million for Advanced Nursing Education

$37.3 million for Nurse Education, Practice, and Retention

$16 million for Workforce Diversity

$44 million (a $13 million increase) for Loan Repayments and Scholar-ships

$7.7 for Nurse Faculty Loans (a $3 million increase)

$3.4 million for Comprehensive Geri-atric Education

Mandatory Overtime Senators Kennedy (D-MA) and Kerry (D-MA), along with 14 other co-sponsors, have reintroduced legis-lation to prohibit the use of manda-tory overtime as a staffing tool. The bill is titled ‘The Safe Nursing and Patient Care Act’ and is numbered S.1842. If enacted, the legislation would prohibit health care facilities that receive Medicare funding from requiring a registered nurse (RN) or licensed practical nurse (LPN) to work more that an agreed to, regu-larly scheduled shift. The language also limits the nurse from working more than 12 hours in a 24-hour period and for more than 80 hours in a two-week period. Exemptions to this include local, state, or national emergencies. Any voluntary overtime is permissible under this regulation. The bill also protects nurses who refuse overtime or who cooperate with authorities regarding the use of overtime by prohibiting employers from penalizing or retaliating in any manner towards a nurse who avails himself or herself of this protection. Currently, there are thirteen states that have enacted legislation either banning or limiting the use of man-datory overtime. However, there is no federal protection in place. (http://www.capitolupdate.org/newsletter/)

State Children’s Health Insurance Program (SCHIP) Both the House of Representatives, the Senate, and the White House, have been in debate over reauthori-zation for this program that provides

The bill would also fund the NIH’s National Institute of Nursing Re-search at $140 million, an increase of $2 million. On October 23rd, the Senate passed its FY 2008 Labor-HHS-Education (Labor-HHS) ap-propriations bill (H.R. 3043) by a veto-proof margin of 75-19, with a total of 29 Republicans voting in favor of the bill, and five Democrats not present for the vote. The Sen-ate-passed bill includes $169.7 mil-lion for Title VIII (13.4% increase), while the House-passed bill provides $165 .6 mi l l i on (10 .7% in -crease). Staff report the Labor-HHS subcommittee allocation will split the difference between the House and the Senate bills. The Senate bill is $1.9 million less than the version of the bill passed by the House on July 18. The President has indicated that he will veto both versions of the bill because they exceed his budget re-quest. UPDATE – 11/15/07 The U.S. House of Representatives fell two votes short in an attempt to override President Bush's veto of the Labor, Health, and Education spend-ing bill for the 2008 fiscal year. This important bill provided an $18 mil-lion increase in federal funding for Nursing Workforce Development Programs. By a 277 to 141 vote, the House just missed the two-thirds m a j o r i t y t h r e s h o l d n e e d e d to override the President's veto. (http://www.capitolupdate.org/newsletter/)

Governmental Affairs: Issues That Affect You Cindy Hill, RN, CPAN, CAPA , Governmental Affairs Chairperson

VOLUME 19, NUMBER 4

tact their Member of the House of Representatives to urge them to vote against the Wicker amendment. In a great victory for nursing, these ap-peals worked! Nurse's active opposi-tion ultimately led Rep. Wicker to withdraw his amendment. ANA will carefully watch this bill as it moves through the Senate and into confer-ence to make sure that this amend-ment does not re-appear. In addi-tion, the House voted to reject the Wicker amendment. (http://www.capitolupdate.org/newsletter/) Preventable errors According to the Bush administra-tion, Medicare will no longer cover the extra costs required to treat pre-ventable medical errors, injuries, and infections that occur in hospitals. It is estimated that this could save Medicare thousands of dollars and hopefully also save hundreds of lives. Private insurers are also considering a similar initiative. Under the new rules, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been pre-vented”. These include bedsores or pressure ulcers, injuries caused by falls, and catheter related infections (infections caused by extended use of catheters in either the bladder or blood vessel). In addition, Medicare also states that it will not pay for the treatment of other preventable er-rors, such as treatment to remove a retained object following surgery or any treatment related to an incom-patible blood transfusion. (Boston Globe, August 19, 2007, p. A7 )

ance and those currently in the SCHIP program would be allowed to continue. Funding for the $50 billion would come from an additional ciga-rette tax as well as reduced payments to Medicare managed care plans, hospitals, skilled nursing facilities and home health agencies. It is ex-pected that the President will veto both the House and the Senate measures. Debate is expected to be on going until the Sept 30th deadline. (http://www.capitolupdate.org/newsletter/) UPDATE: As expected, this meas-ure was vetoed by the President. It is an ongoing issue at this time. I will report further information as it becomes available. Wicker Amendment During the Appropriations Commit-tee meeting to discuss funding for the Department of Health and Hu-man Services (HHS), Rep. Wicker (R-MS) again presented his amend-ment to remove the annual fit-testing requirement for respirators. This amendment, if enacted, would pro-hibit the Occupational Safety and Health Administration (OSHA) for enforcing annual fit testing for respi-rators used in health care settings. Health care workers, including nurses, utilize these masks to pre-vent/reduce the risk of contracting and transmitting infectious, airborne diseases such as TB, SARS, and the pandemic flu. Since OSHA recom-mends proper, exact fit of these masks for them to be effective, many institutions perform annual fit testing for their employees who are consid-ered at risk. ANA Government Af-fairs swung into action, and appealed to nurses across the nation to con-

health care coverage to children of low-income families that earn too much to qualify for Medicaid and are unable to afford private health insur-ance. Funding for the program comes from both Federal and State governments, although it is adminis-tered by each state. Each state deter-mines the design of the program, eligibility requirements, benefits packages, etc. In 2006, 6.6 million children received health insurance through SCHIP. President Bush has proposed a funding increase of $4.8 billion over the next five years. However, many children who are currently covered by SCHIP would be dropped under this proposal. Maintaining the cur-rent SCHIP program is projected to cost $25 billion over the next five years. In July, the Senate Finance Commit-tee passed a bi-partisan reauthoriza-tion bill, the Children’s Health Insur-ance Program Reauthorization Act of 2007 that would increase SCHIP funding by $35 billion over the next five years. This bill maintains cover-age for all of the children who are currently receiving health insurance through SCHIP and provides enough funding for an additional 3.3 million low-income, uninsured American children. The House version of SCHIP fund-ing, titled the Children’s Health and Medicare Protection Act of 2007, or CHAMP Act, H.R. 3162, would in-crease funding for SCHIP by $50 billion over the next five years and would also allocate $40 billion on Medicare improvements. Under the CHAMP Act, an additional 5 million children would receive health insur-

Spotlight Across Texas: District News District 1: Houston /

Gulf Coast Marjorie Mira, RN, BSN, CAPA

D istrict 1 is getting ready for a fantastic year ahead! We in-

stalled new officers during our Sep-tember meeting. They are: President, Deborah Davis; President-elect, Meg-gie Kwan; 2nd Vice President, Amelia Pacardo; 3rd Vice President, Tula Epling; Recording Secretary, Videlyn Ilacio-Uy; Corresponding Secretary, Marjorie Mira; Treasurer, Aida Ca-dorna; and Historian, Leslie Hale. A board meeting was held on September 22nd where the outgoing officers turned over their responsibilities to the new incoming officers, as well as planned for activities for the year. The CPAN/CAPA Review, last Oc-tober 6-7, was very successful! Our speaker, Myrna Mamaril, was excel-lent and very dynamic. This seminar was co-sponsored by District 1 and ASPAN, and coordinated by Deborah Davis, Lillian Bailey, Sylva McClurkin, Meggie Kwan, and Tessie Santiago, who worked tirelessly to ensure a good turnout. At the recent state conference in El Paso, District 1 was well represented. Our district received the Bluebonnet Award as well as the Outstanding District Award. Special thanks to last year’s officers, especially Sylva McClurkin, Immediate Past President, for their efficiency, unsurpassed drive, and volunteering their time far and beyond. They provided district mem-bers with wonderful educational of-ferings, seminars, and community outreach activities.

District 1 meets monthly except in January and July. Last October 2nd, our speaker, Dr. Khatta presented “Skin Cancer and Prevention.” No-vember 3rd was a quarterly Saturday meeting and Dr. Dhotter spoke on “Regional Anesthesia.” On Decem-ber 4th, Dr. Tae Kim will prsent “Malignant Hyperthermia”. We are also actively planning a district semi-nar in January 2008. For members who want to host a speaker in their facility for our quarterly Saturday meetings, please contact Tula Epling at 832-355-3270 or Meggie Kwan at 832-355-3270. If you are a District member and have not been receiving our quarterly “Snooze News” newsletter or e-mail announcements, please update us with your current mailing address and e-mail address. We want to serve you more efficiently and ensure that you enjoy the benefits of being a TAPAN member. Please send your current information to [email protected] or call Marjorie Mira at 832-641-2083.

District 2: Fort Worth

Kathleen McCauley, RN, BSN

D istrict 2 hosted Donna Ber-tram, RN at Harris Fort Worth

on October 13th. Her motivational lecture,"5 Steps to a Successful Life", stressed the importance of a positive attitude and self affirmation. We all left the meeting feeling rejuvenated! The December meeting will be hosted by John Peter Smith Hospital. Save the date, December 8th, for a morn-ing meeting.

In October, District 2 was saddened by the death of Cathy Headen, RN. A for-mer District Historian and a respected nurse at Arlington Memorial Hospital, Cathy’s sunny smile and infectious laugh will be re-membered always.

District 3: Dallas

Prudence Nietupski, RN, BSN

O ur October meeting was held at UT Southwestern Medical

Center - St. Paul. David Wilson, a sleep consultant with Respironics Inc., spoke on the current hot topic, “Obstructive Sleep Apnea”. District 3 is in need of a secretary and we would be thrilled if there is anyone who would step up to assume this position. Several of our current board members have served in this capacity in the past and we would be delighted to help you with the duties. A new e-mail address has been cre-ated for District 3 communication. If you haven’t been receiving e-mails announcing our meetings please send us your e-mail address at [email protected]. District 3 board members recognize our district covers a large geographical area. We would like to offer the out lying areas the opportunity to develop their own chapter which could pro-vide educational meetings. Contact us at the above e-mail address if you would like more information.

THE EYEOPENER

TTUHSC presented a one hour edu-cational offering, "Regional Anesthe-sia". This offering was well received and attended! On November 3rd we had several RNs sit the certification exam held here in Lubbock. All are anxiously awaiting results.

Status of TAPAN District 4, Amarillo

The TAPAN Executive Board hereby notifies former officers and members of District 4, Amarillo, that District 4 is on probation in accordance with the Bylaws of the Association. This status is effective immediately. Ac-cording to Article VI of the Bylaws, any District which fails to declare a slate of officers at the Annual State Conference will be placed on proba-tion. Failure to present a slate of offi-cers at the next Annual State Confer-ence will result in dissolution of the district and reassignment of district members per policy. District 4 failed to present officers at the 2007 TAPAN State Conference business meeting in El Paso in Sep-tember. If District 4 is able to pro-duce officers by January 1, 2008, the probation will be lifted. Please contact TAPAN's President, Susan Russell, immediately at [email protected]. All members who live or work in the Amarillo area are encouraged to con-tact the TAPAN Board with ques-tions or concerns.

PAGE 7 VOLUME 19, NUMBER 4

District 6: Austin - San Antonio - Corpus Christi - South Texas

Lucinda Pfeifer, RN, BA, BSN

G reetings from District 6! Sev-eral of us had the good fortune

to attend the 2007 TAPAN State Conference in El Paso this past Sep-tember. If you did not attend this event then you really missed an out-standing time. Our West Texas col-leagues organized a conference full of outstanding entertainment, buckets of hospitality, and stimulating presenta-tions. It was a pleasure to attend. At State Conference our District was recognized in several ways. First, our territory, along with Houston, was recognized as District of the Year. Second, Leonard Allen, District 6 President, won Recruiter of the Year Award. Finally, Sandra Rodriguez was named District Star for her out-standing contributions to District 6. During the months of September and October, the District was very fortu-nate to have two really outstanding educational seminars. The first semi-nar, “A CPAN Review”, was excellent and provided a comprehensive review for certification. The second seminar, “A System Review of Pathophysiol-ogy”, presented by Kim Noble was also an excellent preparation for our colleagues taking the certification test. Certification Testing for CPAN/CAPA took place on November 2nd. Participants are anxiously awaiting the results. Once the results are an-nounced, we will post the successful candidates on the District 6 Website. You get a breather for the rest of No-vember and December! The holidays

are almost upon us. Since this is such a busy time of the year, there are no educational seminars or other activi-ties planned for the rest of the year. TAPAN District 6 will host the 2008 Texas Association of PeriAneshesia Nurses Annual Conference to be held here in San Antonio, Friday, Septem-ber 19th – Sunday, September 21st, 2008. Suzanna Feliciano and Sandra Russell, Co-Chairs for this event, are working diligently to organize this monumental project. They need your help and expertise. If you have any ideas or can volunteer some time please contact them at [email protected] or [email protected]. To kick off the New Year, Kerrville is offering a seminar entitled “Safety Begins With Us” on January 26, 2008. Pamela Windle, ASPAN Past Presi-dent, will present several safety topics ranging from “Medication Errors” to “Why Do Professionals Make Mis-takes”. Plan to attend this most im-portant seminar. Details on the Dis-trict 6 Website.

District 7: El Paso

Carolyn Prentice RN CPAN,CAPA No News Reported District 9: San Angelo

Susan Hinson, RN No News Reported

District 11: Lubbock

Margaret Rosson, RN

O ur District has seen quite a bit of activity over the last couple

of months! On October 22nd, Dr. Bettina Schmitz, Anesthesiologist

THE EYEOPENER

B y now, you have had the oppor-tunity to browse through the

2008 ASPAN National Conference Brochure, hopefully trying to decide

which of the educational sessions you want to attend. With so many interesting topics and excellent speakers, it may not be an easy choice! For those of you for whom this will be your first ASPAN conference, I highly recommend that you attend one of the two First Timers’ Orientation sessions. National Confer-ence can be a little overwhelming, and the orientation ses-sions will help you navigate the syllabus and pocket guide, explain the evaluation forms, preview the social activities, and give you an opportunity to meet the ASPAN Regional Directors, who will be happy to answer your questions about conference and ASPAN. If you are coming to con-ference by yourself and would be interested in sharing a hotel room to help keep down expenses, there is informa-tion below that can help you find a roommate. Also in the brochure, you will find the Optional Tour booklet. If this is your first time to visit the Dallas-Ft. Worth area, and don’t want to rent a car to see the sights, let someone else do the driving and sign up for one of the tours which showcase area museums and attractions, shop-ping venues, and historic sites. The roadside highways will be resplendent with spring wildflowers such as Bluebon-

2008 National Conference… Texas Style Susan McDonald, RN, CPAN, CAPA , National Conference Committee

nets, Indian Blankets, and Brown-Eyed Susans, so the drive down to Fossil Rim, a world renowned wild life con-servancy area, should be a treat. In addition to offering the Certification Examination on Sunday, May 4th, ABPANC will offer several sessions to help you certify, re-certify, promote certification, and write questions for the exam. Monday, May 5th is CPAN/CAPA Day, so if you are a certified nurse, set your alarm and join your colleagues for CPAN/CAPA Celebration Breakfast. You have the opportunity to earn 40-50 contact hours dur-ing the conference. In addition to the regular sessions, con-tact hours are awarded for participating in the Research Poster Grand Rounds on Tuesday, and Celebrate Success-ful Practices on Wednesday. At the 2007 National Confer-ence, several of your peers participated in a Speaker Devel-opment Workshop. After formulating, researching, and developing an educational presentation, they are ready to hone their skills as speakers in front of an audience. Sup-port them by attending the presentation sessions, and earn extra contact hours. Seating is limited, so come early. The National Conference Strategic Work Team has worked hard to bring you an outstanding conference. We are eager to welcome you to Grapevine!

Call for Hosts/Hostesses

Y’all come and join us at the Gaylord Texan in Grapevine, Texas for the 27th National Conference. Consider getting involved in AS-PAN by taking an active role during the National Conference. Hosts/hostesses are needed for all educational sessions, social events, pre-conference preparation, registration, silent auction, and the ASPAN Shoppe. ASPAN offers reimbursement for time worked which will be paid post-conference. Please contact Cindy Hill, for more information or to volunteer: 6510 22nd Street, Lubbock, TX 79407; (806) 793-1797 (H); E-mail: [email protected]

Room Sharing for the 27th National Conference

Come to Texas next May and make a new friend! If you would like your name placed on the “Willingness to Share a Room” list, please include the following information: name, complete mailing address, home and work phone numbers, and e-mail address. Indicate a preference for smoking or nonsmoking room and your preferred notification location (home, work, e-mail, etc.). The “Willingness to Share a Room” list will be distributed by postal mail on February 28, 2008. Your name, address, phone number, and e-mail will be circulated to all others on the list. Participants must directly contact others on the list to coordinate room share arrangements. The deadline to request a room share is February 11, 2008. Late inquiries will be answered by e-mail only. Please mail or e-mail your request to: Cindy Hill, 6510 22nd Street, Lubbock, TX 79407; E-mail: [email protected]

The National Conference host hotel room reservation deadline is April 1, 2008 .

Reservations made beyond this deadline are based on a space and rate availability basis only.

VOLUME 19, NUMBER 4

The Metroplex The Dallas-Ft. Worth metropolitan area, known locally as the “Metroplex,” is larger than the state of New Jersey! Encom-passing 9,200 square miles, the Metroplex is home to 6 million people. Each city within the metroplex has its own unique flavors; sample them all! Texas Fun: Grapevine Area Attractions Just minutes from the Gaylord Texan, your entire family can enjoy first-class attractions such as Six Flags Over Texas amuse-ment park and state-of-the-art sporting venues. Watch major league sports action, including Texas Rangers (baseball), Dallas Mavericks (basketball), Dallas Stars (hockey), and auto racing at the famous Texas Motor Speedway.

Grapevine Vintage Railroad Turn back the hands of time with a ride on the Grapevine Vintage Railroad. The excursion train will take you round-trip from the Cotton Belt Depot on Main Street to the Fort Worth Stockyards. Giddy-up in Grapevine Enjoy a truly Western experience by seeing the area’s natural beauty and wildlife by horseback. Austin Ranch, minutes from the Gaylord Texan, offers trail rides around Lake Grapevine. Rides are led by an experienced trail boss and no riding experi-ence is necessary. To saddle up, call 817-410-6860

The Grapevine Opry Just try to sit still during the Grapevine Opry’s Saturday evening Country Music Showcase! Every Saturday night, musicians, singers, and dancers perform in the historic Palace Theater. This restored theatre, located in downtown Grapevine, was fea-tured in the movie Tender Mercies.

Fort Worth A mere 30-minute drive from the Gaylord Texan, Fort Worth is home to numerous historic attractions. Settled in 1849 as an army outpost, this flourishing town was the last major stop on the legendary Chisholm Trail and became known as the city “Where the West Begins.” Today, Fort Worth is a major metropolitan city with a vital downtown area. Visit the Bass Per-formance Hall, Cowboy Hall of Fame, National Cowgirl Museum, Fort Worth Modern Art Museum, Kimball Museum of Art, Fort Worth Museum of Science and History, Fort Worth Zoo, and the Stockyards National Historic District. Sundance Square Back in the “Wild West Days,” Butch Cassidy, the Sundance Kid, and the rest of the Hole in the Wall gang visited Fort Worth. All posed for a now-famous photograph, which allowed law enforcement officials to track down the gang! Sundance Square, named for the Kid, offers exceptional shopping, top-notch entertainment, and world class cuisine all in a vibrant, downtown setting. Billy Bob’s Texas The world’s largest honky-tonk is in the heart of the Stockyards National Historic District in Fort Worth. Two-step the night away or enjoy a favorite adult beverage in one of Billy Bob’s several bars. Watch live bull-riding in the rodeo arena. The less adventurous might try to ride the mechanical bull instead. Enjoy live entertainment in the theatre, shoot pool in the pool hall, or just observe the many cowboys, cowgirls… and wannabes!

Grapevine, Texas Tidbits...

THE EYEOPENER

Policy and survey was done by: 1. Having a passion to learn. 2. Developing a plan. 3. Formatting a questionnaire (See next page). 4. Interviewing 20 people, explaining the purpose of the

survey. Choosing nurses from throughout the hospi-tal and doctors, both anesthesia and surgeons.

5. Provide an up to date article on Anesthesia Aware-ness.

6. Listen to each person’s knowledge of the subject; truly listen to their stories.

7. Tally the results. 8. Write a draft of the policy using P&P format: State the title of the policy Definition Purpose Procedure Questions If awareness if present Reportable conditions 9. Present the draft and survey results to anesthesia and

PACU, and then to Policy and Procedure committee for approval.

10. Make final Policy and Procedure and In-service. See the following information enclosed: 1. Survey (this page). 2. Policy and Procedure final copy (see next page). 3. Results of Survey.

Anesthesia Awareness: Recall

By Carolyn Prentice, RN, CAPA, CPAN

Anesthesia Awareness Survey Name: ______________________________ Date: _______________________________ Work Area: __________________________ RN: ________________________________ Years as a Nurse: ______________________ LVN: _______________________________ Other: ______________________________ 1. What is “recall”? 2. Have you experienced recall? If yes, explain. 3. Have you had a patient who says he/she remembers * his surgery? * the conversations in OR? * being unable to move? Explain: 4. What was done for the patient for his “recall”? A. Counseling by anesthesia, surgeon, or other. B. Medications such as Versed or other C. Other D. Nothing 5. Where was the “recall” identified? A. OR B. PACU C. Floor / Unit D. Home Please let anesthesia and surgeon know of any “recall” event, give support. Please use one page for each recall event.

VOLUME 19, NUMBER 4

Recall Survey Results

Anesthesia Awareness

Results of survey of 23 Doctors and Nurses

• 9 patients experienced recall • 22% recalled surgery • 78% recalled conversations in OR • 22% were unable to move Patients were post op heart, post op bowel surgery, and an unstable ICU patient. Care after recall discovered

• 67% were counseled by Anesthesia or Surgeon. • 3% received medication. • 33% received professional counseling. • 11% nothing was done. Outcome

• Education and handout given. • Rapport and respect increased. • Importance of recognizing recall, and follow up

stressed, • Policy and Procedure would increase knowledge

of what to do,

Policy Awareness under Anesthesia, recall, is a possibility that can occur under anesthesia. It is more often seen in patients who are hemodynamically unstable as in trauma cases, heart surgery, and in obstetric cases in which higher doses of anesthesia are avoided prior to delivery of the baby. Staff must be aware of the possi-bility of awareness under anesthesia occurring and how to support these patients. Purpose 1. To reduce anxiety of patients having recall and

have patients arouse more easily. 2. To assist staff in identifying patients more at risk

for “Awareness Under Anesthesia”. 3. To provide staff with a protocol to support pa-

tients who have awareness under anesthesia. Procedure 1. Staff shall be in-serviced on the potential for

“recall,” especially in Perioperative areas, post sur-gery areas, ICU, Telemetry, and Obstetrics.

2. Any history of postop awareness stated by the pa-tient, preop or postop, will be reported to the An-esthesiologist

3. To learn of postop awareness, questions can be asked:

A. What is the last thing you remembered be- fore going to sleep? B. Did you dream? C. What was the first thing you remembered when you woke up? D. What was the worst part of the operation? 4. If awareness is present A. Listen to the patient. B. Sympathize for the recall memories.

C. Explain to the patient what happened if a reason can be given, have anesthesia talk to the patient.

D. Report to the patient’s surgeon. E. Provide medication as ordered. F. Provide follow up that day, next day, one

week, one month. G. Professional counseling may be required as

post traumatic stress syndrome may occur. H. Changes in behavior as noted by family or

friends should be reported.

Reportable Conditions 1. Recall conversations. 2. Feelings of not being able to move in surgery.

ASPAN Seminars In Texas

Ambulatory PeriAnesthesia Practice: Beyond the Basics 2008. March 29, 2008 Fredericksburg, Texas Speaker: Nancy Stryzewski PeriAnesthesia Care: Beyond the Basics 2008. June 21, 2008 Corpus Christi, Texas Speaker: Myra Mamaril

THE EYEOPENER PAGE 12

A ttendees at the Texas Associa-tion of PeriAnesthesia Nurses

(TAPAN) Annual State Conference were surveyed on their perception of family visitation in the Post Anesthe-sia Care Unit (PACU). A review of the literature revealed articles written on family visitation in the PACU as early as 1987.1 Today family visitation remains a challenge for the PACU nurse. Many have strong personal opinions regarding the effects of visitation on the pa-tient’s privacy, confidentiality, quality of care, timing of the visits, and con-trol of visitors at the bedside. Further more, most PACUs have a very strict visitation policy. The purpose of the Research Survey: (1) Identify family visitation practices in the PACU setting in hospitals across the state of Texas and (2) Attain the nurse’s perception of family visitation in the PACU. The aim of the survey was to acquire information about hospitals’ practices and nurses’ perceptions of family visi-tations in the PACU and publish the findings in the Eyeopener. Methodology A questionnaire, developed by the immediate past Research Chair (Herminia Robles) and Committee, to collect data from a convenience sam-ple of 101 perianesthesia nurses. A survey questionnaire was selected due to the accessibility of the nurses from different hospitals and cities across Texas who attended the TAPAN Annual State Conference held in Lubbock, September 2006.

Certification Status Certified 56% Not Certified 37% No response 8% Since only scoring of the Survey Questionnaire could be obtained, descriptive statistics were used to present the data. Question #1 inquired about the PACU open family visitation pro-gram in place at the facility where the participant was employed. 74% stated that no PACU open visitation program was in place at their facility. 17% responded yes and 7% selected other. Question #2 was in reference to the facilities having developed guidelines prior to implementing family visita-tion in the PACU. 55% stated they had not developed guidelines at their facilities. 41% responded yes and 4% selected other. In Question #3 the participants were asked to select from a specific patient population; Same Day Ad-mission (SDA), In-patients, Post Operative Patients (Post Op), Inten-sive Care Unit (ICU), and Pediatric Patients only, that were allowed fam-ily visitation in the PACU. The nurses responses were; a. SDA 33% b. In-patients 35% c. Post-Op 17% d. ICU 36% e. Pediatric Patient’s only 50% f. Other 19%

The questionnaire consisted of 12 questions. Questions 1-4 focused on hospital visitation program, guide-lines, and the availability of Nursing Support/Resources to assist the staff with family visitation in the PACU. Questions 10-12 requested the par-ticipant’s demographics to include age, years of nursing experience, and National Professional Nursing Certi-fication status. Each participant was instructed to return the questionnaire to the designated box at the Registra-tion Desk after completion. Results A total of 101 completed question-naires were returned. The partici-pants’ demographic information re-vealed that the years of nursing ex-perience range from one year to over twenty years. Their ages were be-tween twenty-one to over sixty-five years and 56% of the nurses were certified by a National Nursing Certi-fying Agency. Years of Nursing Experience < 1 year 2% 1-5 years 3% 6-10 years 9% 11-15 years 6% 16-20 years 8% Over 20 years 65% No response 8% Age Under 21 years 0% 21 - 30 years 5% 31 - 40 years 8% 41 – 50 years 32% 51- 65 years 45% Over 65 years 2% No response 9%

Research: The Question of PACU Visitation Elizabeth Martin, MSN, RN, CPAN

VOLUME 19, NUMBER 4 PAGE 13

TAPAN Operations Eyeopener Editor

Cyndi Mocek, ADN, RN [email protected]

Policy and Procedure Coordinator Susan McDonald, RN, CPAN, CAPA

[email protected]

Governmental Affairs Chair Cindy Hill, RN, BSOE, CPAN, CAPA

[email protected]

Research Chair Elizabeth Martin, MSN, RN, CPAN

[email protected]

ASPAN Region 2 Director Twilla Shrout, RN, BSN, MBA, CAPA

[email protected]

anesthesia nurses in Texas. Replicate the study with a larger sample of PACU nurses to obtain sufficient data. There is a need for facilities to develop guidelines for implementing family visitation in the PACU. • Family visitation is an important aspect of PACU nursing. PACU nurses are concerned that open visi-tation would compromise patient privacy/confidentiality in the PACU. There is a need for Evidence-Based Practice research and sharing of best practices between perianesthesia nurses regarding family visitation in the PACU. Family visitation in the PACU decreases patient/family anxi-ety and improves patient outcome.

Reference Vogelslang, J. (1987). “Nursing Interven-tions Reduced Patient Anxiety: Visitors in the Recovery Room,” Journal of Post anesthe-sia Nursing 2: 25-31.

Question #7 asked the participants if they believed that open PACU visitation would compromise patient privacy/confidentiality. 67% an-swered yes. 19% selected no and 14% replied other. Question #8 inquired if the partici-pants believed patient care workflow would be disrupted with the family at the bedside. 55% responded yes to the question. 27% stated no and 18% selected other. In Question #9 the nurses were asked if they believed family visita-tion contributed more to patients’ anxiety and pain, therefore increasing patients’ length of stay in the PACU. 30% stated yes, 51% responded no, and 29% selected other. Conclusions

• The Survey sample was small and did not adequately represent the majority of the hospitals and peri-

Question #4 asked the participants to identify Nursing Support/Resources available to the staff to assist with PACU family visitation. The available resources to the staff identified were: a. Nurse Manager 36% b. Liaison Nurse 25% c . Volunteers 53% d. Others 12% The participants were asked in Question #5 if they believed family visitation in the PACU would de-crease patient/family anxiety and improve patient outcome. 54% re-sponded yes, 29% answered no, and 17% chose other. In Question #6 the nurses were asked if they believed open visitation in the PACU would improve overall patient satisfaction. 49% stated no, 36% responded yes, and 17% se-lected other.

Attention ASPAN Members: We are currently trying to establish an

Integrative Medicine Specialty Practice Group. Everyday more of our patients are trying and

using various complimentary therapies. It is time to embrace these modalities and find ways to

incorporate these therapies into our daily perianesthesia practice.

We hope to have this Group established prior to the 2008 National Conference. If you are interested please contact:

Barbara Ochampaugh BSN RN CPAN [email protected]

or Blanca Marichal BS RN CPAN CAPA

[email protected]

THE EYEOPENER

TAPAN is coming to you! TAPAN on the Road is a new project which the Executive Board is excited to share with you. We plan to hold mini TAPAN Seminars in smaller cities all over Texas where it is not feasible to do our Annual State Confer-ence. Our goal is to provide low-cost educational offering and the opportunity for members to meet and collaborate with TAPAN Leadership. It is also our hope that this project will inspire members to become our future leaders. We sincerely believe someone out there is cut out to be our future TAPAN President. We are looking and calling for the enthusiasts. We will work with you to plan and coordinate a half-day or one day seminar in your district. If you are willing and able to give your time, knowledge and dedication, we need to hear from you. Please e-mail me at [email protected] for more informa-tion, or contact any Board member. We are also asking all of you to watch out for announcements and flyers. Please support this endeavor and plan to attend the seminars. We hope to meet all of you.

TAPAN on the Road: Traveling Around Texas Hermie Robles, RN, CPAN Treasurer

Susan Norris, RN 2nd Vice President

Photos Needed

T he new year is well underway. I’d like to

congratulate the Districts who participated in the Bluebonnet and Outstanding District Award competitions this past year. I’m hoping that more districts will accept the challenge in the coming year. Appli-cations for both awards were distrib-uted at the State Conference in El Paso. If you need another copy, please c o n t a c t m e v i a e - m a i l a t [email protected] ASAP. Now is the time to start collecting the data needed for next year’s application. Documentation for the awards covers the year from August 1, 2007 through July 31, 2008. If at any time you have questions concerning the application process, please let me know. Anyone with photos from the past year including District, TAPAN and ASPAN events is encouraged to submit copies to be included in the TAPAN historical record. Photos can be digital or prints and will be used to compile an elec-tronic scrapbook.

H ave you ever wondered what it would be like to be a TAPAN officer or committee member? Have you decided against it

because you thought you were unqualified? Chances are, you are just who TAPAN has been looking for! The only qualifications to be a

TAPAN officer or committee member are to have been an active TAPAN member for at least two years and to mail in a Willingness to Serve Form. Willingness to Serve Forms are found at the TAPAN website www.tapan.org under the Forms tab. Mail the form to me, Lori Sanders, 313 Village Trail, Trophy Club, TX 76262 by April 1. You would also need to travel at least four weekends a year to different Texas cities for Board meetings. This is a fun and exciting way to meet more of your Perianesthesia peers as well as make decisions that shape our practice in Texas. It has been several years since TAPAN has been able to have an officer election because only one person has applied for the positions. We would really love to give our TAPAN members a choice in their leadership so we want everyone to consider applying! If an election is needed, it will be held at our State Convention in San Antonio this September. We will be electing a new Vice President/President Elect and Treas-urer this year. We will also need to fill appointed positions such as Research Chair-person (The Research Committee Chairperson is required to have a Master's De-gree), Governmental Affairs Chairperson, and Education Coordinator, as well as committee members to help support these positions. To be on a committee, a Will-ingness to Serve Form should be sent in by September 1st. There is not a large time commitment needed for serving on a committee and it is a great way to be-come involved with TAPAN and learn more about our organization. I hope you will all give some serious thought to applying for TAPAN office next year. I know that we have some amazing untapped talent out there and we want to see you all shine and make TAPAN a better organization.

We Want You! To Be a TAPAN Officer! Lori Sanders, BSN, RN, CPAN, TAPAN President 2006-2007

VOLUME 19, NUMBER 4

From the Editor

The Eyeopener is the official publication of the Texas Association of PeriAnesthesia Nurses (TAPAN).

All rights reserved. No part of The Eyeopener may be copied or reproduced in any form without prior writ-ten permission from TAPAN. Contact the editor for further information.

Eyeopener submissions:

Members are encouraged to write to the editor with comments, suggestions, and/or articles of interest to PeriAnesthesia Nursing. Submissions must be typed and double spaced. It is the responsibility of the author of items submitted for p u b l i c a t i o n i n T h e Eyeopener to verify the accuracy of information and provide appropriate refer-ences. The editor and the TAPAN Board reserve the right to edit or reject submitted material.

Submission Deadlines: February 15: Spring Edition May 15: Summer Edition August 15: Fall Edition November 15: Winter Edition Send comments, suggestions and/or submissions to: Cyndi Mocek, RN 6002 Kenilworth Drive Arlington, TX 76001 [email protected]

W e are proud to announce that 2008 is the year that TAPAN Dis-

trict 6 will host the 2008 Texas Associa-tion of PeriAnesthesia Nurses Annual Conference to be held here in San Anto-nio Friday, September 19th through Sun-day, September 21st, 2008. The planning committee is organizing an exciting event filled with an engaging host of topics for the PeriAnesthesia Nurse. We are anticipating speakers in the area of Pediatrics, Sedation Analgesia, PACU Emergencies, Pharmacology, Therapeu-tics, and Evidence Based Practice. Other areas of interest include: Ambulatory/Day Surgery, Care of the Elderly, Pain and An-algesia and a host of topics that are of concern to the PeriAnesthesia Nurse. Since we want this to be an event for nurses that practice and have an interest in these areas, we are writing to appeal to the hidden talent in your work environment and BRING FORTH the hard earned research, process improvement project, publication and best practice initiative that

Respecting our Past & Embracing the Future

Suzanna Feliciano, BSN, RN, CCRN & Sandra Russell, MSN, RN CPAN Conference Co-Chairs

have been performed by or co-authored by the PeriAnesthesia Nurse. This would be a wonderful forum to bring that talent out into the practice arena and showcase it to the Nurses who understand and value this expertise. We are a small but committed specialty area that impacts a vast patient population and we often go unrecognized in our de-votion and hard work. So, the TAPAN State Conference Committee invites you to come forward and make this a Peri-Anesthesia Forum to remember and chal-lenges you to continue to grow in our re-spective practice. We want to make this your conference & we would love to hear from you! Contact us at [email protected] or [email protected].

the revised policies and ask for a vote to accept, prior to the next Board meeting. If there are further discussions or clarifica-tions needed, these policies will be added to the agenda for the next meeting. It is the goal of the P&P Coordinator to have the manual available to all district presi-dents in CD format at the next annual con-ference.

T he schedule for 2007 –2008 Policy and Procedure review was distributed

to all Executive Board members at the Oc-tober meeting. In an effort to maximize meeting time, it was agreed that P&P re-view would be done electronically this year. Board members will submit suggested revi-sions to the P&P Coordinator, who will then reconcile the changes, redistribute

Susan McDonald, RN, CPAN, CAPA Policy and Procedure Chair

Electronic Policy & Procedure Review

Newsletter of the Texas Association of Perianesthesia Nurses · TAPAN Mission Statement “The...

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