PEER RESPONSE; BORN 

"For adult patients on a medical-surgical unit, does implementation of the Enhanced Recovery After Surgery (ERAS) protocol, as compared to current practice, impact surgical site infection (SSI) rates in 8-10 weeks?"

The evidence-based intervention I chose for this DNP project was the implementation of the Enhanced Recovery After Surgery (ERAS) protocol to help decrease the incidence of surgical site infections in colorectal surgical patients. I chose this intervention based upon discussion with stakeholders within the organization I work. I found that we currently do not implement ERAS protocol on surgical patients. 

In the United States, surgical site infections affect as many as 300,000 patients annually (Loyola University Health System, 2017) contributing to the costliest hospital-acquired infections with an estimated cost of $3.3 to $10 billion dollars annually and account for nearly 1 million additional inpatient days (Loyola University Health System, 2017; Centers for Disease Control and Prevention, 2021). The risk of surgical site infection after colorectal surgery is one of the highest when compared to any other surgical specialty. Colorectal surgery places a considerable burden on health care systems related to high complications risks, notably surgical site infections, and contributes to poor outcomes and increased readmission rates (Leaper et al., 2020; Turner & Migaly, 2019). 

The purpose of this proposed DNP project is to reduce the surgical stress response, optimize physical function, and facilitate recovery for adult patients undergoing colorectal surgery. This will be done through the implementation of the Enhanced Recovery After Surgery (ERAS) protocol. This protocol is a multi-modal pathway intended to reduce stress, maintain homeostasis, for quick postoperative recovery for the patient undergoing surgery (Gados & Nador, 2019). The main aspects of the ERAS protocol are to optimize perioperative management using procedures established on scientific evidence. The ERAS protocol has been nationally recognized as contributing to positive patient outcomes, reducing postoperative complications, and early discharge without increasing costs (AANA, 2017; Pagano et al., 2021; Arrick et al., 2019; Johnson & Fogel, 2017; Kim et al., 2016).

Initially, the plan was to implement my proposed practice change within the organization in which I work, however, due to the current pandemic policies for allowing practicum hours to be completed within the hospital had to be postponed and I opted for the case study. I am hoping that once my project is complete, to present this to the major stakeholders in an attempt to influence a policy change with the implementation of the Enhanced Recovery After Surgery (ERAS) protocol to assist in better patient outcomes, decreased length of stays, decreased monies spent related to complications, increase patient satisfaction, and decrease mortality and morbidity. 

References: 

American Association of Nurse Anesthesiology. (2017). Enhanced recovery after surgery:

Considerations for pathway development and implementation. AANA American Association of Nurse Anesthesiology. https://aana.com/practice/clinical-practice-resources/enhanced-recovery-after-surgery

Arrick, L., Mayson, K., Hong, T., & Warnock, G. (2019). Enhanced recovery after surgery in

colorectal surgery: Impact of protocol adherence on patient outcomes. Journal of Clinical Anesthesia, 55, 7-12. doi:10.1016/jcliniane.20.18.12.034

Centers for Disease Control and Prevention. (2021, January 1). Surveillance for surgical site

            infection (SSI) events. https://www.cdc.gov.nhsn/pdfs/pscmanual/9pscssicurrent.pdf (Links to an external site.)

Gajdos, C., & Nader, N. D. (2019). Enhanced recovery after surgery in colorectal surgery:        Impact of protocol adherence on patient outcomes. Journal of Clinical Anesthesia, 56, 50–51. https://doi.org/10.1016/j.jclinane.2019.01.038 (Links to an external site.)

Johnson, N., & Fogel, S. (2017). An expanded preoperative component within an enhanced recovery protocol improves outcomes in colorectal surgery. The American Surgeon. 83(8), 928-934.

Kim, B., Park, S., Park, K., & Ryoo, S. (2017). Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme. Journal of clinical nursing, 26(21-22), 3336-3344. https://doi.org/10.111/jocn.13862 (Links to an external site.)

Loyola University Health System. (2017, January 19). Surgical site infections are the most costly of hospital infections: Guidelines for preventing surgical site infections are updated. Science Daily. Retrieved November 18, 2021 from www.sciencedaily.com/releases/2017/01/170119161551.htm (Links to an external site.)

Leaper, D., Holy, C., Spencer, M., Chitnis, A., Hogan, A., Wright, G., Po-Han Chen, B., & Edmiston Jr., C. (2020). Assessment of the risk and economic burden of surgical site infections following colorectal surgery using a US longitudinal database: Is there a role for innovative antimicrobial wound closure technology to reduce the risk of infection? Dis Colon Rectum, 63, 1628-1638. https://doi.10.1097/DCR.0000000000001799Links to an external site.

Pagano, E., Pellegrino, L., Rinaldi, F., Palazzo, V., Donati, D., Meineri, M., Palmisano, S., Rolfo, M., Bachini, I., Bertetto, O., Borghi, F., & Ciccone, G. (2021). Implementation of the ERAS (Enhanced Recovery After Surgery) protocol for colorectal cancer surgery in the Piemonte Region with an Audit and Feedback approach: study protocol for a stepped wedge cluster randomized trial: a study of the EASY-NET project. BMJ Open, 11(6), e047491. https://doi.org/10.1136/bmjopen-2020-047491