Clinical Issue of Interest
The complication of Hip and Knee arthroplasty especially in older patient from 65 years and up with elective surgery. The Enhance Recovery After Surgery (ERAS) approach aims to address issues including surgical stress and organ malfunction that slow postoperative healing. A multi-source and integrated clinical care pathway uses ERAS protocols, which is a set of evidence-based interventions, as part of its overall care plan. They stand for a comprehensive strategy aimed at minimizing surgical complications, cutting down on hospital stays, raising patient satisfaction, and quickening recovery (Kaye et al,. 2019). Postoperative complications and length of hospital stay are strongly influenced by pre-existing illnesses such organ failure, hypertension, chronic obstructive pulmonary disease, diabetes, and coronary artery disease ( Alan et al,. 2019).
Most importantly, my clinical issue of interest is: If not ambulating the first day of hip or knee arthroplasty (total replacement) and blood glucose check can lead to complication in elderly people?
PICO Question
P: Older adult 65 years and up with post-operative hip and knee surgery
I : Early ambulation and post-operative blood glucose control
C: Post operation early ambulation on the day of surgery to no ambulation
O: Reduction of complication, hospital stay and early recovery with ERAS protocol
(T): Accomplish year-end performance measures.
PICO Question developed
In Older adult aged 65 and above, if not ambulating on the first day of surgery with the nurse or physical therapy and not checking blood glucose, can it lead to postoperative complications?
Database Search
Two database were selected for my search: CINAHL and PubMed ; PubMed literature search terms used “ Enhanced recovery after hip and knee replacements” and received 104 search results while in CINAHL search term “ ERAS Orthopedic” and received 27 search result. Using the exact word in my search provided many articles to select from.
Strategies to increase the Rigor and Effectiveness of Database search
By enabling the electronic health documentation sidebar summary and daily-tracking skills that are intended to validate appropriate documentation on ERAS elements, the ERAS task at this organization specifically aims to boost actual data tracking. In both articles, it emphasizes the essential components of an improved recovery program and explained the clinical use of ERAS.
References
Jentons, Alatia S., “Enhanced Recovery after Surgery: Effectiveness of Real Time Data Tracking Tools” (2021). Master’s Projects and Capstones. 1266.
https://repository.usfca.edu/capstone/1266
Kaye, A. D., Urman, R. D., Cornett, E. M., Hart, B. M., Chami, A., Gayle, J. A., & Fox, C. J. (2019). Enhanced recovery pathways in orthopedic surgery. Journal of anaesthesiology, clinical pharmacology, 35(Suppl 1), S35–S39. https://doi.org/10.4103/joacp.JOACP_35_18
Gwynne-Jones DP, Martin G, Crane C. Enhanced Recovery After Surgery for Hip and Knee Replacements. Orthop Nurs. 2017 May/Jun;36(3):203-210. doi: 10.1097/NOR.0000000000000351. PMID: 28538534.
Walden University Library. (n.d.-a). Databases A-Z: NursingLinks to an external site.Links to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
In 2021, more than 107,000 Americans died from drug overdoses (FDA, n.d.). Today’s drug overdose crisis is multifaceted and has evolved beyond prescription pain medications. Illicit opioids, largely driven by fentanyl and heroin, have become key contributors. Naloxone is a safe medication that is widely used by emergency medical personnel and other first responders to prevent opioid overdose deaths (NIDA, n.d.). Naloxone can quickly restore normal breathing and save the life of a person who is overdosing. Improving Naloxone access and carrying to persons who inject drugs (PWID) may reduce overdose mortality associated with the influx of fentanyl and heroin in the market (Buresh et al., 2020).
Using the PICO(T) acronym (Stillwell et al., 2010), the following clinical question was developed: Among PWID and are participants in a syringe exchange program, how effective is the distribution of free Naloxone in reducing fatal overdoses during a time span of 12 months?
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