Purpose

1. PediatricUrology Perioperative Process Improvement (PUPPI) Project THE PUPPI PROJECT Authors Sue M. Hadden, RN, BSN, Janet Malhoit, RN, BSN, Carla Garwood, RN, BSN, Sandra Ratliff, RN, BSN, Pediatric Urology and Mott PACU, University of Michigan, Ann Arbor, MI Purpose Results Methods • A FIGS grant enabled us to update handouts and purchase hands on teaching items. We transitioned from the PACU RN reviewing discharge instructions with the family while with their child is in the PACU, to: • Having one of three Pediatric Urology Clinical Care Coordinators (CCCs) review instructions • Teaching is done in a quiet simulation room while parents wait for their child’s surgery to be completed • The CCCs have reviewed the surgery and postoperative care plan with the surgeons the week before the hypospadias surgery • A plan of care change in the OR results in the surgeon contacting the CCC and updated information is shared with the family • Teaching is enhanced by using a hands on practicum with an anatomically correct doll complete with dressings, a catheter and “double diapers” • An individualized medication schedule and worksheet are developed and reviewed with the parents • A satisfaction questionnaire is completed at their first postoperative appointment to assist in improving processes • For further continuity of care, the CCCs are the same nurses that triage phone calls should the family have questions once home • Deficits in postoperative care knowledge have been shown to increase family anxiety, decrease satisfaction and negatively affect postoperative outcomes. 1, 2, 3 A multidisciplinary team came together to form the Pediatric Urology Perioperative Process Improvement (PUPPI) team. • Our goals were to: • Improve parental knowledge • Decrease parental anxiety • Increase parental perioperative and postoperative satisfaction • Improve patient postoperative outcomes • Decrease perioperative time • Decrease postoperative phone calls to the Pediatric Urology Call Center Table 1. Comparison of patients pre-PUPPI and post-PUPPI teaching Table 2. Parent Questionnaire-5 Point Likert Scale Background • The hypospadias repair is an outpatient surgical procedure that corrects a misplaced urethral opening on the penis performed when the child is between 6 to 36 months of age. Parents are required to learn postoperative care (care for a catheter and penile dressing, management of pain and anesthesia side effects) when their child is recovering from anesthesia in the PACU while preparing for discharge. This is a: • Stressful time in a chaotic, distracting environment • Difficult place and time for parents to retain postoperative information • Difficult way to ensure consistency of educational teaching content since one of 50 PACU nurses reviews instructions4,5 • Some parents commented that they received different information from the surgeon, resident and/or nurses. After discharge, anxious parents made frequent calls to the urology call center or to the resident on call with care concerns. Conclusion / Implications • PUPPI project parents benefit from multi-modal educational techniques for postoperative education resulting in high satisfaction ratings. • In the second postoperative week, there was a reduction in the number of calls to the Pediatric Urology Call Center. • PUPPI teaching may reduce PACU times, although this is not statistically significant • Anecdotal comments on questionnaires stating that parents anxiety was relieved by PUPPI teaching • An unplanned benefit of the program is that the CCCs escort and assist parents as they transition from preop to the waiting room. The nurses are able to assess how the family is coping with this difficult transition and provide emotional support as needed. This simple contact at this vulnerable time helps continue the trust and bond that was started when the family meets the Urology staff in the clinic and helps to decrease their anxiety. References • 1. TeKain ZN, Caldwell-Andrews AA, Mayes LC, et al. Family-centered preparation for surgery improves perioperative outcomes in children. Anesthesiology. 2007;106:65–74xt • 2. Spencer C, Franck LS. Giving parents written information about children’s anesthesia: Are setting and timing important?. Paediatr Anaesth. 2005;15:547–553 • 3. Kankkunen P, Vehvilainen-Julkunen K, Pietila A, Halonen P. Is the sufficiency of discharge instructions related to children’s postoperative pain at home after surgery? Scand J Caring Sci. 2003;17:365–372 • 4. Ruiz, M., Rivers, N., Pop, R., Evaluating the Effectiveness of the Timing of Postoperative Education in the Pediatric Population, Journal of PeriAnesthesia Nursing, Volume 27, Issue 1 , Pages 10-17, February 2012 • 5. Simons J, Robertson E. Poor communication and knowledge deficits: Obstacles to effective management of children’s postoperative pain. J Adv Nurs. 2002;40:78–86 ***Thanks to John M Park, MD, Kate Kraft, MD, Julian Wan, MD, Vesna Ivancic, MD, Regina Damiani, RN, Linda Dolinski, RN, Rebecca D’Agostino, RN, Michele Gove, MSN, Thuy Phan, MSN, Alan Tait, PHD