Nurse Clinician Malkit Kaur, Major Operating Theatre, KK Women’s and Children’s Hospital, shares with us her learnings from her six weeks clinical placement in SickKids and Toronto General Hospital.
I had my six weeks clinical placement, four weeks in SickKids and two weeks in Toronto General Hospital in Toronto, Canada from 26th June to 4th August 2019. The objectives were to acquire knowledge & skills in Pre-operative assessment of patients before surgeries and to gain knowledge and skills of Nurse-led Discharge of patients from post-operative care unit in the Operating Theatre.
Following my HMDP, I will lead to implement Nurse-Led Discharge in PACU of KKH Major Operating Theatre Women’s & Children’s. Currently the discharge is done by an Anaesthetist and it is time based. By having a criteria that suits both the population, the nurses can discharge patients from PACU timely without having to wait for an anaesthetic review.
The criteria is using Modified Aldrete Scoring System that consist of Level of Consciousness, Motor Activity, Respiration, SpO2 on room air, Blood Pressure, Heart rate, Post-operative nausea vomiting, Pain Score and Temperature.
We started by collecting data for 2 weeks, mainly looking at demographics and time of discharge by anaesthetist. The data showed significant delay in discharging patients due to waiting for Anaethetist review. I presented the data and the criteria used in SickKids and Toronto General Hospital to the Anaesthesia Head of Departments for Women’s and Children’s. We then finalized the discharge criteria according to our practices and an approval letter was submitted to CMB for endorsement.
"We started the program in July 2020 to train Senior Registered Nurses in Women’s Anaesthesia and have successfully completed the training program"
A training program and exclusion criteria was drafted with the help of Women’s and Children’s Anaesthetist. The training program consist of theory topics, skill competencies and 30 discharges to be assessed by Nurse Clinician and Anaesthetist. We started the program in July 2020 to train Senior Registered Nurses in Women’s Anaesthesia and have successfully completed the training program. We then embarked to train nurses in Children’s Anaesthesia in November 2020 and our journey continues…