Nurse Practitioners in Orthopaedic Surgical Settings

Spence, Brittany G.; Ricci, J.; McCuaig, Fairleth

doi:10.1097/nor.0000000000000514

Cited by 16 publications

(9 citation statements)

References 23 publications

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“…Nurse practitioners are legally qualified to prescribe antimicrobials, which account for approximately one-third of their prescriptions [45]. Nurse practitioners are more experienced in advanced practice frameworks, demonstrate leadership skills[46], and are familiar with antimicrobial stewardship and the operative environment[47–49], thus we would consider them to have a positive impact in the development and implementation of an SAP optimisation intervention. Barriers that prevent the success of such initiatives exist and largely reflect the identified issues regarding hierarchical influences of SAP prescribing.…”

Section: Discussionmentioning

confidence: 99%

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

et al. 2019

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BackgroundSurgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in the hospital setting, with demonstrated high rates of inappropriateness. Decision-making for SAP is complex and multifactorial. A greater understanding of these factors is needed to inform the design of targeted antimicrobial stewardship interventions and strategies to support the optimization of SAP and its impacts on patient care.MethodsA qualitative case study exploring the phenomenon of SAP decision-making. Focus groups were conducted with surgeons, anaesthetists, theatre nurses and pharmacists across one private and two public hospitals in Australia. Thematic analysis was guided by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivators-Behaviour (COM-B) model.ResultsFourteen focus groups and one paired interview were completed. Ten of the fourteen TDF domains were identified as relevant. Thematic analysis revealed six significant themes mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes identified were: 1) Low priority for surgical antimicrobial prophylaxis prescribing skills; 2) Prescriber autonomy takes precedence over guideline compliance; 3) Social codes of prescribing reinforce established practices; 4) Need for improved communication, documentation and collection of data for action; 5) Fears and perceptions of risk hinder appropriate SAP prescribing; and 6) Lack of clarity regarding roles and accountability.ConclusionsSAP prescribing is a complex process that involves multiple professions across the pre-, intra- and post-operative surgical settings. The utilisation of behaviour change frameworks to identify barriers and enablers to optimal SAP prescribing supports future development of theory-informed antimicrobial stewardship interventions. Interventions should aim to increase surgeon engagement, enhance the prioritisation of and accountability for SAP, and address the underlying social factors involved in SAP decision-making, such as professional hierarchy and varied perceptions or risks and fears.

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Section: Discussionmentioning

confidence: 99%

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

et al. 2019

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“…In addition to improving communication, it has been estimated that during a clinical visit, up to 80% of clinical time is spent doing tasks that do not require physician-level training. 10 Removing sutures, scribing school notes, or writing prescriptions for equipment, physical therapy, or orthotics, represent tasks that surgeons may do but violate the balance of efficiency and patient satisfaction. 17 To cope with this demanding load, care should not be provided exclusively by a physician.…”

Section: What Your Clinic Needs Is a Nursementioning

confidence: 99%

Better Patient Care Through Physician Extenders and Advanced Practice Providers

Milewski,

Coene,

Flynn

et al. 2022

Journal of Pediatric Orthopaedics

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Physician extenders and advanced practice providers (APPs) are now common in most adult and pediatric orthopaedic clinics and practices. Their utilization, with physician leadership, can improve patient care, patient satisfaction, and physician satisfaction and work/life balance in addition to having financial benefits. Physician extenders can include scribes, certified athletic trainers, and registered nurses, while APPs include nurse practitioners and physician assistants/associates. Different pediatric orthopaedic practices or divisions within a department might benefit from different physician extenders or APPs based on particular skill sets and licensed abilities. This article will review each of the physician extender and APP health care professionals regarding their training, salaries, background, specific skill sets, and scope of practice. While other physician extenders such as medical assistants, cast technicians, and orthotists/prosthetists have important roles in day-to-day clinical care, they will not be reviewed in this article. In addition, medical trainees, including medical students, residents, fellows, and APP students, have a unique position within some academic clinics but will also not be reviewed in this article. With the many different local, state, and national regulations, a careful understanding of the physician extender and APP roles will help clinicians optimize their ability to improve patient care.

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“…Hal tersebut pada akhirnya juga akan berdampak pada efisiensi biaya perawatan pasien (Bader, Sweitzer, & Kumar, 2009;Conny & Wan-Yim, 2016;Lozada, Nguyen, Abouleish, Prough, & Przkora, 2016;Tariq, Ahmed, Kulkarni, Hanif, Toolsie, Abbas, & Chilimuri, 2016). Mengingat hal tersebut, pelayanan rawat jalan untuk anestesi atau yang lebih dikenal dengan Anesthesia Preoperative Evaluation Clinic (APEC) atau ada juga yang menyebut Preoperative Assessment Clinic (POAC) telah banyak dikembangkan terutama di luar negeri (Bader et al, 2009;Conny & Wan-Yim, 2016;Fischer, 1996;Reuter, Jurack, Engelmann, Busch, & Schnoor, 2014;Sebach, Rockelli, Reddish, Jarosinski, & Dolan Jr, 2015;Tariq et al, 2016;Yakubu, 2018).…”

Section: Banyakunclassified

Asesmen Pra-Anestesi: Bukan Sekedar Kepatuhan

Agustina

Wardhani

Astari

2020

JHA

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Latar Belakang: Asesmen praanestesi adalah prosedur penting yang bertujuan untuk memastikan keamanan tindakan bedah yang akan dilakukan. Prosedur ini sebenarnya adalah tanggung jawab dokter anestesiologi. Namun, dalam prosesnya melibatkan dokter, perawat serta pasien dan keluarganya. Tujuan: Penelitian ini bertujuan untuk mengetahui gambaran pelaksanaan asesmen praanestesi serta menggali praktik pendelegasian tugas (task shifting) dalam pelaksanaan asesmen praanestesi di ruangan rawat inap. Metode: Penelitian ini dilakukan di sebuah rumah sakit (RS) tipe C (140 tempat tidur) di kota Malang Jawa Timur. Peneliti melakukan observasi selama 11 hari terhadap pelaksanaan asesmen praanestesi pada kasus operasi elektif. Untuk melengkapi data, dilakukan juga pengamatan terhadap dokumen rekam medis pasien yang sama. Untuk menilai praktik pendelegasian tugas dari dokter ke perawat, peneliti menggunakan kuesioner yang berisi 28 aspek aktivitas asesmen praanestesi. Kuesioner ini didistribusikan kepada 80 orang responden yang terdiri dari perawat dan dokter spesialis yang terlibat dalam operasi elektif. Kuesioner ini menilai persepsi responden mengenai harapan dan kenyataan tentang siapa yang seharusnya melaksanakan aktivitas tersebut. Data dianalisis secara deskriptif untuk menggambarkan pola pelaksanaan pendelegasian tugas dan asesmen praanestesi. Hasil: Asesmen praanestesi hanya dilakukan pada 19,5% dari total 43 kasus operasi elektif, namun tidak satupun yang menuliskan hasil asesmen pada dokumen yang semestinya. Dokumen rekam medis tentang asesmen praanestesi akan dilengkapi saat setelah pelaksanaan operasi (di kamar operasi). Sebagian besar responden beranggapan bahwa asesmen praanestesi dilaksanakan secara kolaborasi antara dokter dan perawat. Namun, dalam praktiknya, kebanyakan aktivitas dalam asesmen praanestesi dilakukan oleh perawat. Pendelegasian tertinggi dari dokter ke perawat terjadi pada aspek meminta tanda tangan persetujuan tindakan medis (informed consent) serta aspek menjelaskan tentang puasa kepada pasien dan keluarganya. Kesimpulan: Asesmen praanestesi belum terdokumentasi dengan lengkap dan tepat sebelum pelaksanaan operasi, serta terjadi pendelegasian tugas ke perawat terutama pada proses persetujuan tindakan medis.

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Nurse Practitioners in Orthopaedic Surgical Settings

Cited by 16 publications

References 23 publications

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

Better Patient Care Through Physician Extenders and Advanced Practice Providers

Asesmen Pra-Anestesi: Bukan Sekedar Kepatuhan

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