Best Practice Updates for Nursing Care in Weight Loss Surger

Abstract

IntroductIonEvidence-based best practice guidelines for nursing in weight loss surgery (WLS) have been previously described (1). Earlier guidelines focused on staff education; preoperative, perioperative, and postoperative care; postanesthesia care; discharge and follow-up (2). This report covers key updates relating to WLS nursing.WLS patients are a high-risk population for morbidity and mortality, with a hazard ratio that increases with BMI. Surgical and anesthetic advances, combined with changes in the demographics and obesity levels of patients, have increased the need for effective and vigilant nursing care. The latest studies show an increase in the number of procedures performed, with more WLS in adolescents; decreases in length of stay; advances in the use of clinical pathways; and development of ergonomic technology. This report updates best practice guidelines with a focus on long-term outcomes and patient safety. Methods And ProceduresWe searched PubMed, MEDLINE, and the Cochrane Library for articles published on WLS and perioperative nursing, preoperative, perioperative, postoperative, anesthesia, and discharge follow-up published between April 2004 and May 2007. The system used to grade the quality of the evidence has already been described (2). We identified >54 papers; the 46 most relevant were reviewed in detail. These included a randomized controlled trial, prospective and retrospective cohort studies, meta-analyses, case reports, prior systematic reviews, and expert opinion. The focus of the recommendations and the process used to develop them are reported elsewhere (2). results Planning and communicationThe WLS nurse is responsible for assessment, documentation, and communication with all members of the heath care team. The nurse assesses all data, formulates a care plan, and determines nursing diagnoses and interventions for each patient. Planning is initiated at the first patient contact with the WLS program. Communication with the patient during each phase of care allows for adjustments in the plan. The nurse promotes multidisciplinary team collaboration by developing and implementing education programs related to the care of the WLS patient. This collaboration promotes awareness of evidencebased practices and sensitivity to the needs of extremely obese patients (3).Effective communication between all members of the health care team is essential for quality care. Certain practices may lead to decreased adverse advents, prompt diagnosis and treatment, and better outcomes. These include: allowing sufficient time to listen to, and collect information from patients; use of time out; site verification in the operating room; concise and timely reporting of symptoms; and the repeating back of information (hear back method) between team members. The objective of this study is to update evidence-based best practice guidelines for nursing in weight loss surgery (WLS). We performed a systematic search of English-language literature on WLS and perioperative nursing, postoperative, anesthesia, and disch...

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