Day Surgery Center

RDS Clinical REWARDS Recipient for 2008
Nancy Sallman
Dora Whitehead

RDS Clinical REWARDS Recipient for 2009
Lisa Lewis

Description:

The Regency Day Surgery (RDS) unit is a surgery center providing Gynecologic and Ophthalmologic services to both in- and outpatients.  The unit operates Monday through Friday from 6:00am to 5:00pm with 24-hour on-call availability.  RDS provides care to scheduled C-section patients as well as to emergent OB surgical patients.  All patients are discharged from the department by 5 p.m.—either home or to an inpatient area for extended post-operative care, as indicated and needed.  RDS is located on the first floor of the Regency Medical Center.

Patients

Regency Day Surgery provides perioperative care from pre-admission through discharge. The patient population includes adults and children, age 2 and over.  

 Beds

The unit consists of a pre-operative interview area, 6 pre-op beds, 3 operating rooms, and the post anesthesia care unit.  Registered nurses assess, develop and implement care based on best practice guidelines, as well as collaborate with physicians, coordinate care and oversee the delegation of unit-specific duties to surgical technicians and other non-licensed staff.

Unit Manager:

Lea Herring, RN, CNOR, BS

Professional Standards of Practice

 Regency Day Surgery utilizes the Standards of the American Society of Perianesthesia Nurses (ASPAN), the Association of Perioperative Registered Nurses (AORN), and the American Nurses Association (ANA) as a guide for clinical practice.  Nursing care is based on the Winter Haven Hospital Professional Model of Care and evidenced-based practice.

 Staffing Plan

Regency Day Surgery is staffed by registered nurses (RN), surgical technicians (ST), anesthesia assistants and health unit coordinators (HUC).  Staffing levels are adjusted daily to meet the needs of the patients served. Adjustments are made according to projected and actual patient census as well as patient acuity.  The operating room minimally staffs with 1 RN and 1 Scrub (most often a surgical tech); the post-anesthesia care unit is primarily 1:1 (RN-to-patient) staffing ratio.  Each day emergency call is provided by one OR nurse, One PACU/preop nurse and a scrub tech.  Call is rotated among all staff who works in RDS.

Collaborative Relationships: 

Regency Day Surgery staff collaborate with OR scheduling, materials management, sterile processing, OB & GYN units, pharmacy, lab, radiology, anesthesia and surgeons to provide safe, efficient, & evidenced-based care and services.  Additionally, RDS staff work with social services as needed to prepare patients for discharge from the facility. Patient transfers are coordinated and handled RN-to-RN in collaboration with the surgeon and anesthesiologist.  Interpreters are available onsite for Spanish speaking patients.  A language line is provided for communication with diverse patient populations.  

Typical Patient Diagnosis

The RSD serves patients requiring ophthalmologic surgical procedures including cataracts and retinal surgeries.  Dacrocystorhinostomies are also performed.  Children over 2 years old most commonly require strabismus repair or retinal surgery.  After hour emergencies may include removal of foreign body, repair of eye trauma, or retinal detachments.

 Gynecologic surgeries preformed include D&C’s, tubals, laparoscopies, hysteroscopies, endometrial ablations, vaginal, abdominal & laparoscopic assist vaginal hysterectomies.

Cesarean section patients are admitted to our unit and surgery is coordinated by OB and RDS staff.  After hours emergencies might include D&C’s, ectopic pregnancy, and post partum lacerations.   

Nursing Assessment and Plan of Care:  

As per the Florida Nurse Practice Act, the Preop RN completes an initial assessment on admission, identifying problems within the first hour of admission.  This enables him/her to effectively coordinate care while getting the patient to the OR safely and on time.  The OR  nurse also completes an assessment of the patient upon arrival to the OR and is responsible for positioning the patient and coordinating & documenting care of the patient while in the OR.  The PACU RN assesses and cares for the post anesthesia patient, maintaining stability of airway, vital signs, level of comfort and safety.  ACLS and PALS certifications are required both Preop and PACU RNs.

 The Regency Day Surgery nursing staff collaborates with other disciplines to form a comprehensive plan of care.  Other disciplines include OB/GYN staff, anesthesiology, surgeons, and direct management staff.  The OR RN coordinates care and implements plans based on surgeon-specific procedure and preferences, protocols, and surgeon orders.  The RN is responsible for evaluating clinical progress and adjusting the plan of care to attain desired patient outcomes. The RN coordinates care, delegates tasks as appropriate and oversees the care provided.

 Nursing Documentation:

Regency Day Surgery employees recognize the importance of accurate and complete documentation of work, establishing and practicing meaningful written procedures and managing information effectively.  Documentation is completed on the nursing history form, the peri-operative record and the post-anesthesia record.  Documentation includes initial assessment, medication administration, pre-op teaching, discharge planning, pain assessment and reassessment, treatments, surgical intervention/procedure and discharge teaching. Patient education is documented from admission through discharge.

Most Common Meds:

Anesthesia Inhalational Agents, Proprofol, Muscle Relaxants, Narcotic, Antiemetics, Hypnotics/ Anxieolytics, Antibiotics, Fluid management.

Staff Competency 

In additional to general orientation, registered nurses attend a 1 week nursing orientation.  Unit-specific competencies are satisfied annually through RDS competency based evaluations (CBE’s).

Orientation is individualized for each employee based on learning needs and experience. Area specific continuing education is encouraged through attendance of ASPAN, AORN and Ophthalmology related conferences.

Regency Day Surgery CBE’s are reviewed and updated  annually based on staff in-put, needs, new technology and new surgeons/procedures. 

Performance evaluation is provided on a timely basis utilizing Human Resource guidelines. Staff participate in peer review on a rotating basis.

Certification for Differential:

Certification from ASPAN (CAPA) and AORN (CNOR) are recognized.

Selling Points for the Unit:

• Experienced and supportive leadership.
• Experienced and knowledgeable nursing staff with very low turnover.
• Cooperative and cohesive interdisciplinary team (Nursing, OB/GYN, Ophthalmologists and Anesthesiologists).
• Staff are encouraged to pursue advanced education (BSN, MSN). 
• Shared governance participation.
• Patient safety and satisfaction – high priorities of our unit.
• And we have very high satisfaction scorecards from our patients and families!
• Hospital committee participation encouraged by all staff.
• Monthly staff meetings with unit-based journal club.
• Yearly evaluations include the peer review process.
• Staff participate in interviews of applicants.  

More about Regency's Day Surgery

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