Doctor of Nursing Practice
Date of Defense
Jean Bachman, DSN
Advanced practice nurses (APNs) play an important role in preoperative screening. The purpose of this project was to determine the effectiveness of pre-operative screening criterion established February 2012 for patients greater than 40 years old who underwent total knee or hip replacement surgery. Of the 1850 electronic health records reviewed, 1065 (57.6%) total knee and total hip replacement surgeries took place before and 785 (42.4%) took place after screening criteria were implemented. Before implementation of screening criteria 53 (4.98%) patients experienced critical changes (code blue or critical assessment team call); after the implementation of screening 30 (3.82%) patients experienced critical changes (code blue or critical assessment team call), a decrease of 1.16% after screening. Critical changes (code blue or critical assessment team call) were higher for patients undergoing total knee replacement (pre 3.47% and post 2.80%) than for patients undergoing total hip replacement (pre 1.50% and post 1.02%) before and after the implementation of screening. Preoperative risk factors that resulted in a critical change (code blue or critical assessment team call) included patients with renal disease 4 (4.8%), cerebral vascular accident/transient ischemic attack 13 (15.7%), cardiac disease 36 (43.4%), hypertension, 2 (2.4%), 2 preoperative risk factors 1 (1.2%), and 3 preoperative risk factors 1 (1.2%). Post-operative complications that caused a critical change (code blue or critical assessment team call) included: pneumonia, 11 (13.3%); surgical site infection, 2 (2.4%); urinary tract infection, 1 (1.2%); anemia, 2 (2.4%); and pulmonary emboli, 10 (12%); and 1 (1.2%) with 2 two post-operative complications. Findings from this project demonstrate that preventive prescreening by APNs can reduce the incidence of critical changes (code blue or critical assessment team call) and guide care for those patients who do experience a critical change.
Rude, Jill Ann, "Retrospective Electronic Health Record Review of Preoperative Screening of Candidates for Total Joint Replacement" (2015). Dissertations. 197.