Fist Name M.I. Last Name
Enhanced Recovery after Surgery
Enhance recovery after surgery (ERAS) protocols are “multimodal perioperative care pathways” that are aimed at promoting early recovery after surgery. (Melynk, Casey, Black & Koupparis, 2011). This should be achieved by sustaining preoperative organ function as well as by decreasing an intense postoperative stress response. (Melynk, Casey, Black & Koupparis, 2011). Research has demonstrated several advantages in utilizing ERAS. The length of stay in the hospital, overall outcome and complication rates all improved with the use of ERAS. (Rosenberg & Kayyali, 2014). However, even in light of the substantial research showing that ERAS protocols lead to improved outcomes the implementation of ERAS has been slow. This is primarily because ERAS challenges traditional surgical doctrines. (Melynk, Casey, Black & Koupparis, 2011).
The ERAS protocol is comprised of three main elements. The first is improving preoperative care. ERAS makes improvements on traditional preoperative assessment. With ERAS preoperative assessment is viewed not only as preparation for the operation but simultaneously as preparation for discharge as well. One example is with colorectal surgery Following ERAS protocol, the patient will receive traditional preoperative assessment such as what they should be drinking before the surgery, but will also be given information about what to eat after the operation as well as information about mobilization and movement postop. (Foss 2011).
The second element of the ERAS protocol is reduction of the physical stress induced by surgery. This entails relinquishing many perioperative interventions that are now thought to be unnecessary or counterproductive. ERAS recommends administering a clear high carbohydrate drink before midnight the day before the surgery and then again two to three hours before the surgery to prevent operating on a patient in a catabolic state. Research demonstrates that this reduces preoperative hunger and thirst, and thus anxiety. Also, patients recover faster with a shorter hospital stay. Additionally, ERAS recommend no bowel preparation for colorectal surgery due to a heightened risk of anastomotic leakage. Further, ERAS recommend no postoperative nasogastric tube due to increased pyrexia, atelectasis and pneumonia with a nasogastric tube. ERAS also recommends that patients should start eating as early as four hours after surgery and found no advantage to prolonged fasting. Finally, ERAS stresses that maintaining a normal body temperature is important; thus, reducing factors during surgery that cause body cooling is important. (Foss, 2011).
The final part of the ERAS protocol is increasing comfort after surgery. Comfort does not just mean reducing pain. It also includes reduction in nausea and vomiting, and a reduction in anxiety. ERAS also focuses on mobilization and eating after four hours and normally as soon as possible thereafter. These aims mean avoiding or minimizing drugs such as opioids and gaseous anesthetics that cause nausea and vomiting, as well as administering anti-emetics. (Foss, 2011).
In implementing ERAS, the nurse’s role in patient education and communication with the patient becomes even more important. This is because with ERAS there is a limited opportunity for the patient to ask questions. The nurse needs to be cognizant of the patients’ and their relatives’ potential confusion postop. They may not be prepared for the rapid pace at which the patient’s activity and normal function is to resume postop which my lead to anxiety. Nurses need to be ready to psychologically prepare patients for discharge in the little time available to provide explanations and answer their questions. Thus, teaching effective and efficient communication skills to nurses the key to implementing a successful ERAS protocol. (Foss, 2011).
References
Foss, M. (2011). Enhanced Recovery After Surgery and Implications for Nurse Education.
Nursing Standard 25(45): 35-39. Retrieved from http://journals.rcni.com/doi/pdfplus/10.7748/ns2011.07.25.45.35.c8625
Melnyk, M., R.G. Casey, P. Black, A.J. Koupparis. (2011). Enhanced Recovery After Surgery
(ERAS) Protocols: Time to Change Practice. Canadian Urology Association Journal 5(5): 342-348. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202008/
Rosenberg, K. and A. Kayyali. (2014). Enhanced Recovery after Surgery in a Community
Hospital. American Journal of Nursing (AJN) 114(12): 69. Retrieved from
http://journals.lww.com/ajnonline/Abstract/2014/12000/Enhanced_Recovery_After_Surgery_in_a_Community.32.aspx
