A s the focus of health care reimbursement shifts from quantity of services to quality of care provided, health care professionals are looking for ways to improve patient care while remaining mindful of costs. Implementing evidence-based guidelines as standards of care in the perioperative setting can positively affect numerous patient outcomes, including reductions in surgical site infections (SSIs), length of stay, and complications related to health care-associated infections (HAIs). The Enhanced Recovery After Surgery (ERASÒ) Society has developed an innovative set of guidelines that perioperative nurses can use to improve surgical patient outcomes. 1 To take this one step further, perioperative nurses should focus on improving postoperative patient education as one component of population health management.The ERAS Society guidelines for perioperative care in elective colon procedures contain elements for optimal patient care pertinent to the preoperative, intraoperative, and postoperative periods. 1,2 The guidelines focus on care provided during all three phases of the perioperative experience, and several of these elements directly affect postoperative infection prevention.The preoperative phase includes care activities related to o performing the patient assessment and understanding and taking action on this preadmission information, o ensuring correct preoperative patient preparation, o ensuring correct timing of preoperative fasting and dealing with related carbohydrate needs immediately before surgery, o administering preanesthetic medications as ordered, o implementing thromboembolism prophylaxis, o administering antimicrobial prophylaxis in a timely fashion, and o performing appropriate skin preparation. The intraoperative phase includes care activities related to o implementing a standard anesthetic protocol, o implementing modifications of surgical access, o avoiding nasogastric intubation, o preventing unintended intraoperative hypothermia, and o ensuring accurate perioperative fluid management. The postoperative phase includes care activities related to o preventing or treating postoperative nausea and vomiting (PONV), o eliminating peritoneal cavity drains after anastomosis, o removing indwelling urinary catheters, o preventing postoperative ileus, o using postoperative multimodal analgesia, o ensuring perioperative nutritional care, o maintaining postoperative glucose control, and o ensuring early postoperative mobilization.Each ERAS element has a summary and recommendation, a literature-based evidence level (ie, very low, low, moderate, high), and a recommendation grade (ie, none, weak, strong) assigned by the ERAS Society. 1
