SAFETY
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that might extend their lives.
Whenever possible, surgeons should try to perform less stressful
surgery that accomplishes the same clinical goal. They should focus
on spending a little extra time in the OR and truly focus on their tech-
nique to ensure patients won't have bleeding problems during recov-
ery.
In PACU
Nurses should have access to the entire pre-op evaluation, so they
know the patients' baseline levels of consciousness, function and
frailty. Patients who fail the cognition test are at increased risk of post-
op delirium — hallucinations, changing levels of consciousness and
potential agitation — and are more likely to remain in the PACU for
extended periods.
Elderly patients who retain urine or are severely constipated are also
at increased risk of delirium. Post-op pain increases delirium risk, too,
but the elderly might not be able to express the discomfort they're feel-
ing. In fact, post-op pain sometimes manifests as agitation.
Nurses should take extra care with patients who are cognitively
impaired heading into surgery in order to prevent delirium. Let the
family be at the bedside early in the recovery phase and try to keep
the patient oriented with large, easily seen clocks.
Patients who are kept overnight should be assigned to quiet rooms
so their normal sleep patterns remain intact. My facility, Sinai Hospital
in Baltimore, Md., recently renovated 19 rooms specifically for geri-
atric patients. The renovation included larger clocks, warm wall colors,
muted lighting, floors with less glare and signage with larger print.
Outpatient settings can include the same elderly-friendly design fea-
tures in their recovery spaces.
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