BACKGROUND

A. Definition

1. The patient is discharged from the PACU following an established protocol, such as the Aldrete Score, a postanesthesia recovery score.
2. Nursing priorities when the patient arrives from the PACU to the surgical unit include high-quality handoff; focus on airway, breathing, and circulation; assessment of vital signs based on specific protocol; monitoring of complications; and discharge readiness (ACS, 2019).

B. Etiology/epidemiology

1. In 2018, 9.6 million inpatient stays involved an OR procedure; of this, 36.5% were among patients older than 65 years, with a vast majority having OR as the principal procedure, costing approximately $210 billion (McDermott & Liang, 2021).
2. Hospital stays that involve surgical procedures have been shown to be costlier, required longer lengths of stay, and resulted in higher morbidity and mortality (McDermott & Liang, 2021).
3. The need for comprehensive baseline status assessment and the use of an interdisciplinary team with surgical and geriatric expertise to follow the patient from presurgery to discharge are essential for achieving positive outcomes (ACS, 2019).
4. Postoperative delirium can occur in up to 50% of high-risk older adult surgical patients, leading to prolonged and more costly hospitalizations, functional decline, and death (AGS, 2014).
5. Older adult surgical patients are at higher risk for delirium resulting from medication side effects; immobility; infection; inadequate pain management; and cardiac, renal, and respiratory complications (AGS, 2014).
6. Hospitalized older adults are consistently less likely to receive adequate pain control compared with younger adult patients (ACS, 2019).
7. A lack of pain control for the older surgical patient can lead to delirium, depression, fluid imbalances, atelectasis, and fatigue (AGS, 2014).
8. A large majority of hospitalized older adults are malnourished or at risk of malnutrition, placing them at risk of impaired skin integrity, wound or other infections, sepsis, and death (ACS, 2019; Dent et al., 2023).
9. Patients with an ASA physical status of 3 undergoing noncardiothoracic surgery requiring 2 hours or more of general anesthesia with mechanical ventilation developed at least one PPC (e.g., need for prolonged oxygen therapy by nasal cannula and atelectasis). Patients with one PPC or more, even mild, had significantly increased early postoperative mortality, ICU admission, and increased ICU/hospital length of stay (Fernandez-Bustamante et al., 2017).
10. Each day the indwelling urinary catheter remains confers a 3% to 7% increased risk of acquiring CAUTI (Lo et al., 2014).
11. CLABSI has been shown to double mortality risk, add up to 10 additional hospital days, and increase healthcare costs (Kaye et al., 2014).
12. Postsurgical deconditioning can slow recovery, delay restoring independence with ADL, and increase risk for VTE, delirium, incontinence, constipation, pressure injuries, and falls (ACS, 2019).
13. The postsurgical period is a vulnerable time for increased risk of falls (Chow et al., 2012).
14. A systematic review estimating the global prevalence and incidence of pressure injuries reported a pooled prevalence of 12.8% (95% CI 11.8%–13.9%), incidence rate of 5.4 per 10,000 patient-days (95% CI 3.4–7.8), and hospital-acquired pressure injury rate of 8.4% (95% CI 7.6%–9.3%) among hospitalized adult patients (Li et al., 2020).
15. The postsurgical older adult is at increased risk for VTE (Major Extremity Trauma Research Consortium [METRC] et al., 2023).
16. Restraint use increases the risk of falls, pressure injuries, and delirium, leading to increased morbidity, mortality, and length of stay (Inouye et al., 2007).

PARAMETERS OF ASSESSMENT

A. The PSIs are the key drivers of assessment and screening of surgical older adult patients. PSIs that are relevant to surgical patients include (AHRQ, 2017):

1. Death among surgical inpatients
2. CVC-related bloodstream infection
3. Postoperative hemorrhage or hematoma, physiological and metabolic derangements, respiratory failure, pulmonary embolism or DVT, sepsis, and wound dehiscence
4. Transfusion reaction

B. A seamless synthesis of various practice guidelines, such as those recommended in the ACOVE-3 quality indicators (Arora et al., 2007), Beers Criteria for potentially inappropriate medication use in older adults (AGS, 2019), and Clinical Practice Guideline for Postoperative Delirium in Older Adults (AGS, 2014), will be essential in achieving positive outcomes. All older adult postsurgical patients must be assessed and screened for:

1. Falls (Arora et al., 2007)
2. Frailty (Arora et al., 2007)
3. Inappropriate medication use (AGS, 2019)
4. Postoperative atelectasis (Arora et al., 2007)
5. Postoperative delirium (AGS, 2014)
6. Postoperative ileus (Arora et al., 2007)
7. PONV (Gan et al., 2020)
8. Postoperative pain (ACS, 2019)
9. Pressure injuries (Arora et al., 2007)
10. SSI (TJC, 2022)
11. VTE (Arora et al., 2007; Maynard, 2016)
12. Restraint use (McGory et al., 2009)

C. Other epidemiologically significant assessment parameters, depending on the specific patient scenario, would include screening patients for CAUTI, CLABSI, and VAP. The nurse is expected to be familiar with the current best practices related to the prevention and management of these HAIs.

NURSING CARE STRATEGIES

A. Unit admission

1. Provide for high-quality handoff to include the following information:
   • Preoperative assessment of cognitive and functional status
   • List of comorbidities and preoperative home medications
   • Preoperative assessment for falls and pressure injuries
   • Course of surgery, including any surgical complications and interventions, such as blood loss, blood transfusions, and intraoperative fluid use
   • Description of surgical sites, including dressings and instructions for care
   • Identification of invasive lines, including arterial and/or venous catheters, urinary catheters, GI tubes, chest tubes, and any other drainage devices (e.g., Jackson–Pratt, t-tube)
   • Patient’s respiratory, cardiovascular, and cognitive status before transfer
   • Patient’s current pain level and description of pharmacological and nonpharmacological interventions (used since surgery) before transfer
2. Perform geriatric vulnerability screens (ACS, 2019).
   • Age ≥85 years
   • Impaired cognition
   • Delirium risk
   • Impaired functional status
   • Impaired mobility
   • Malnutrition
   • Difficulty swallowing
   • Need for palliative care assessment
3. Discuss plan of care with the patient and caregivers, addressing pain management, mobility, nutrition, hydration, and functional status.
4. Advocate for older adult patients who are unable to fully engage in their own care and for their designated caregiver.

B. Duration of stay—comprehensive management to prevent postoperative complications and sentinel events

1. Postoperative delirium/cognitive and sensory function
   • Use a validated tool to assess for delirium at least once per shift.
   • Provide continuity of care (familiar residents, nurses, and care technicians).
   • Provide continuous environmental and personal orientation.
   • Adequately manage pain (see Chapter 18, “Pain Management in the Older Adult”).
   • Avoid delirium-inducing medications such as benzodiazepines and anticholinergics (AGS, 2019).
   • Avoid use of routine sedation.
   • Provide adequate fluid and nutrition intake.
   • Avoid use of restraints.
   • Avoid urinary catheterization or ensure prompt removal if in place.
   • Promote adequate sleep, including involving family and caregivers in managing daytime sleepiness.
   • Promote appropriate use of glasses, hearing aids, and other assistive devices.
   • Provide adequate communication as necessary, including the use of pen/paper, nonverbal communication, or translators.
   • Minimize noise and patient care activities, as much as possible, during nighttime hours.
2. Pain management
   • Perform comprehensive pain assessment during hourly rounding or, at a minimum, with each set of vital signs.
     • Rating of intensity (numeric, verbal, or visual scales)
     • Pain description to include location, characteristics, and impact of pain on function
     • Observation of signs of pain
     • Using appropriate scales (e.g., PAINAD) for patients with dementia
   • For pain scores greater than 5, initiate comprehensive pain management plan.
     • Pharmacological strategies
       1. Preferable use of nonopioid pain medications
       2. Address medication side effects, as necessary (e.g., constipation from opioids)
       3. Avoid NSAIDs, if possible
     • Nonpharmacological strategies (e.g., massage, acupuncture, cognitive behavioral therapy, distraction)
   • Reassess pain postintervention.
     • At 15 minutes, for IV medication interventions
     • At 1 hour for by-mouth medication interventions
     • Within 4 hours, at a minimum, for other interventions
3. Nutrition and GI complications
   • Assess for postoperative dysphagia.
     • Assessment by speech therapist if patient is at high risk for aspiration
     • Modification of diet as necessary (e.g., alteration in food consistency)
   • Assess for and aggressively manage PONV.
   • Implement a comprehensive nutrition plan.
     • Assessment by a registered dietitian specializing in geriatric care
     • Include adequate nutritional intake with supplementation as necessary
   • Implement a collaborative feeding plan, involving care technicians, family, and caregivers.
     • Maintain upright position while feeding and for at least 1 hour after.
     • Provide comprehensive oral care.
     • See Chapter 13, “Assessment and Management of Mealtime Behaviors, Function, and Nutrition in Older Adults Living With Dementia,” for further discussion.
   • Assess for and manage constipation.
     • Avoid use of anticholinergics and opioid medications, with quick transition to acetaminophen for mild to moderate pain.
     • Administer bowel stimulants (e.g., senna, bisacodyl) and osmotic agents (e.g., polyethylene glycol) as needed.
     • Provide adequate hydration.
     • Promote early ambulation and mobilization.
   • Assess for and manage diarrhea.
     • Maintain adequate hydration and nutritional intake.
     • Collect stool samples, as ordered, to assess for Clostridium difficile infection.
     • Provide prompt treatment if positive for C. difficile, including implementation of contact precautions and maintenance of adequate hand hygiene regimens.
   • Manage postoperative ileus for GI surgery patients.
     • Promote early feeding and mobilization.
     • If NG decompression is used, monitor for aspiration and postoperative pulmonary complications.
4. Hydration and renal complications
   • Initiate oral hydration as soon as feasibly possible.
     • Promptly manage PONV.
     • Provide adequate hydration through IV fluids or tube feedings if oral hydration is not possible.
     • Provide comprehensive oral care.
   • Monitor fluid status at least once per shift for the first 5 days postoperatively.
     • Weigh patient daily.
     • Accurately assess and document intake and output.
     • Assess for changes in blood pressure, mental status, and new-onset atrial fibrillation that could indicate dehydration.
     • Monitor for signs and symptoms of fluid overload.
   • Perform routine screening of serum electrolytes, blood urea nitrogen, and creatinine.
5. Respiratory complications
   • Implement an aggressive pulmonary toilet regimen.
     • Promote use of incentive spirometer 10 times per hour.
     • Perform turn, cough, and deep breathing exercises every 2 hours.
     • Provide chest percussion or chest physiotherapy as needed.
     • Promote early mobilization and ambulation.
     • Maintain head of bed in an elevated position.
     • Adequately manage pain (see earlier section on “Pain Management”).
     • Avoid excessive use of narcotics and sedatives.
   • Implement VAP and/or VAE prevention measures (Klompas et al., 2022).
     • Avoid intubation and prevent reintubation
     • Avoid benzodiazepines in favor of other agents.
     • Use a protocol to minimize sedation.
     • Maintain and improve physical conditioning.
     • Elevate the head of the bed to 30 to 45 degrees.
     • Provide oral care with toothbrushing but without chlorhexidine.
     • Provide early enteral versus parenteral nutrition.
     • Consider postpyloric rather than gastric feeding for patients with gastric intolerance or at high risk for aspiration.
     • Change the ventilator circuit only if visibly soiled or malfunctioning.
     • Use endotracheal tubes with subglottic secretion drainage ports for patients expected to require more than 48 to 72 hours of mechanical ventilation.
6. Infection prevention (CDC, 2015)
   • Implement unit-wide HAI prevention programs.
     • provide continuing education on the appropriate use of guidelines for HAI prevention.
     • Enforce universal precaution and contact precaution protocols.
     • follow hand hygiene protocols, including hand rubbing with alcohol-based products or scrubbing with soap and water if hands are visibly soiled.
       1. Before touching the patient
       2. Before clean and aseptic procedures
       3. After contact with body fluids
       4. After touching a patient
       5. After touching a patient’s surroundings
   • Assess for signs/symptoms of infection.
     • Local signs/symptoms, including redness, tenderness, swelling, and warmth
     • Systemic signs/symptoms, including:
       1. Fever greater than 38.0°C after postoperative day 2
       2. Altered mental status, agitation, respiratory distress, tachycardia, and hypotension
       3. Elevated white blood cell count
   • Implement SSI prevention measures (Seidelman et al., 2023).
     • Do not remove hair at the surgical site unless necessary.
     • Decolonize with intranasal antistaphylococcal agent and antistaphylococcal skin antiseptic prior to high-risk procedures (e.g., cardiothoracic, orthopedic).
     • Use a chlorhexidine gluconate-alcohol antiseptic agent for skin preparation.
     • Maintain normothermia intraoperatively.
     • Control perioperative glucose values between 110 and 150 mg/dL.
     • Use incisional negative pressure wound dressing. SSI CDC Guidelines (Berríos-Torres et al., 2017)
     • Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day.
     • Administer antimicrobial prophylaxis only when indicated and timed to be given within 60 to 120 minutes of incision.
     • Topical antimicrobial agents should not be applied to the surgical incision.
     • Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation.
     • Transfusion of blood products should not be withheld from surgical patients as a means to prevent SSI.
   • Implement CAUTI prevention measures (Chow et al., 2012).
     • Before insertion of urinary catheter
       1. Determine if catheter insertion is appropriate.
       2. Consider frequent, scheduled toileting with assistance in incontinence patients.
       3. Educate staff regarding proper insertion and maintenance of urinary catheters.
     • During insertion of urinary catheter
       1. Ensure that only trained personnel insert urinary catheters.
       2. Use the smallest appropriate catheter (14 Fr, 5 mL or 10 mL balloon usually appropriate).
       3. Practice hand hygiene immediately prior to insertion of catheter.
       4. Use standard barrier precautions prior to any manipulation of the catheter/drainage system.
     • After insertion of urinary catheter
       1. Properly secure to prevent movement/urethral traction.
       2. Maintain sterile, closed drainage systems.
       3. Position drainage bag below bladder and off floor.
       4. Perform routine daily meatal care (use of antiseptics is not necessary).
       5. Practice hand hygiene and wear clean gloves prior to any manipulation of the catheter/drainage system.
       6. Obtain urine sample aseptically from sampling port.
       7. Avoid routine catheter irrigation. If obstruction is anticipated, closed continuous irrigation may be used.
       8. To relieve obstruction due to mucus or clots, an intermittent method may be used.
     • See Chapter 25, “Catheter-Associated Urinary Tract Infection,” for further information on the prevention of CAUTI.
   • Implement CLABSI prevention measures (O’Grady et al., 2011).
     • Implement a CLABSI bundle.
       1. Maintain adequate hand hygiene regimens.
       2. Provide maximal barrier precautions when inserting lines.
       3. Use chlorhexidine skin antiseptic before insertion.
       4. Optimize site selection, avoiding the use of the femoral vein.
       5. Review necessity of line daily and provide for prompt removal if no longer indicated.
     • Institute appropriate dressing-change regimens.
       1. Use sterile gauze and a transparent, semipermeable dressing to cover the site.
       2. Replace dressing if it becomes damp, loosened, or visibly soiled.
       3. Replace gauze dressings every 2 days and transparent dressings every 7 days for short-term sites.
       4. Use chlorhexidine-impregnated sponge dressing for temporary catheters if other measures are not working.
       5. Use a 2% chlorhexidine wash for daily skin cleansing.
     • Replace administration sets at appropriate intervals.
       1. At least every 7 days (but not less than 96 hours) for continuous or secondary infusion tubing
       2. Within 24 hours for tubing involving blood, blood products, or fat emulsions
       3. Every 6 to 12 hours for propofol infusion tubing
     • Disinfect (scrub) using an appropriate antiseptic when accessing catheter hubs, needleless injectors, and injection ports, using only sterile devices/equipment.
     • Educate the patient and monitor to prevent submersion of CVC sites in water during showering or bathing.
     • Continue to assess for local and systemic signs/symptoms of infection.
7. Mobility, function, and frailty (ACS, 2019)
   • Work with interprofessional team to develop a plan for reenablement after surgery.
   • Incorporate the patient, family, and caregivers in the development of the plan of care for reenablement.
   • Address barriers to plan, including lack of understanding of roles among healthcare team members, patient dependence and daytime sleepiness, scheduling conflicts, and patient care equipment (e.g., IV tubing, catheters, SCDs).
   • Ensure physical therapy provides early assessment of the patient postsurgery and develops a mobility and strengthening plan, including the need for assistive devices.
   • Provide ambulation by postoperative day 2.
     • If ambulation is not possible, then documentation should be provided as to why ambulation did not occur.
     • Provide ROM exercises for patients unable to ambulate.
     • If ROM exercises cannot be performed, then documentation should be provided as to why they did not occur.
   • Assist patient with ADL and IADL, while allowing for as much independence as possible.
8. Fall prevention (ACS, 2019)
   • Perform routine screening of fall risk, at least once per shift, using validated assessment tools.
   • Use a multipronged approach to address falls, including:
     • Fall risk screening on admission
     • Injury and injury risk factors screening on admission
     • In-depth admission screening for any positive findings
     • Communication and education about the patient’s fall risk
     • Standardized interventions (e.g., armband identification, bed alarms, exercise and toileting regimens, pain relief) for any positive findings
     • Customized interventions for those at highest risk
   • If a fall occurs, perform a comprehensive fall evaluation within 24 hours to include the presence or absence of any signs/symptoms of injury and a review of medications that may have contributed to the fall.
9. Skin integrity
   • Address pressure injury prevention from admission to discharge, including:
     • A comprehensive skin assessment and adequate documentation of findings on admission to the unit
     • Completing a pressure injury risk assessment at least daily using a validated assessment tool (e.g., Braden Scale)
     • Daily comprehensive assessment of skin integrity
     • Moisture management
       1. Skin cleaning routinely and at times of soiling with mild cleansing agents
       2. Use of skin moisturizers for dry skin
       3. Use of absorbent underpads for excessive incontinence, perspiration, or wound drainage
     • Maintenance of adequate nutrition and hydration
     • Minimizing pressure on skin and bony prominences
       1. Turn and reposition the patient every 2 hours.
       2. Use mattresses and cushions to redistribute pressure.
       3. Address pressure from medical devices.
     • Using care when removing dressings, pads, tape, or leads in order to prevent skin tears
   • See Chapter 30, “Pressure Injuries and Skin Tears,” for further information on the prevention of pressure injuries in older adults.
10. VTE prevention (Chow et al., 2012)
    • Institute VTE prophylaxis, including:
      • Assessment of VTE risk factors using validated measures (e.g., Caprini Risk Score)
      • Patient education about VTE risk
      • Early ambulation
      • Mechanical prophylaxis
        1. Use of SCDs
        2. Caution when using compression stockings as tight fit may impair circulation and lead to complications
        3. ROM exercises for patients unable to ambulate
      • Pharmacological prophylaxis
        1. Use LMWH or LDUH, as indicated; monitor platelet count.
        2. Monitor for signs/symptoms of bleeding.
11. Restraint use (Cotter & Evans, 2018)
    • Restraint use should be avoided if at all possible.
    • If restraints must be used, address the target behavioral or safety issue with the patient and caregivers and document in the chart.
    • Use and document methods other than restraints that can be used as part of the plan of care.
    • Seek early removal of devices or lines that will allow for the discontinuation of restraint use.
    • Implement a care plan for the management of the patient in restraints.
      • Release from restraints and reposition every 2 hours.
      • Perform face-to-face assessment at least every 4 hours (with provider assessment before renewal of restraint order).
      • Provide 15-minute observations, more frequently if warranted by the patient’s condition.
      • Perform nurse-related interventions every 2 hours to address nutrition, hydration, toileting, personal hygiene, and ROM.

C. Discharge

1. Assess the need for social support or home healthcare expected after discharge.
2. Collaborate with transitional care team as needed.
3. Perform comprehensive discharge assessment of cognition and function (mobility, ADL, IADL) and compare with preoperative levels.
4. Assess nutritional status before discharge.
5. Perform comprehensive medication reconciliation.
   • Address both prior-use and new medications.
   • Facilitate education for new medications, including purpose of the drug, how to take it, expected side effects, and adverse side effects.
6. Provide detailed explanation to patient, family, and caregivers about the plan of care, including:
   • Home health visits
   • Physical or occupational therapy appointments
   • Follow-up appointments
   • Education on the use of new equipment or devices, and activity
   • Education using teach-back strategies on performance of activities such as dressing changes, wound care, and medication administration

EVALUATION/EXPECTED OUTCOMES

A. Patient outcomes

1. Maintain patient safety across the postoperative continuum.
2. Assess patient decision-making capacity and honor patient and family care decision choices.
3. Receive a comprehensive unit admission screening and ongoing assessment, including, but not limited to, the following domains: cognitive and behavioral, cardiopulmonary, functional status, nutrition, medication, and frailty.
4. Receive adequate pain control through implementation of a patient-centered pain management plan.
5. Restore mobility and functioning to preoperative levels before discharge.
6. Receive timely and accurate information related to plan of care, including transitional care and long-term follow-up.
7. Patient will not develop postoperative complications such as delirium, HAI, VTE, cardiopulmonary adverse events, GI or renal complications, and pressure injuries.
8. Patient will be free from adverse events such as medication errors and falls.
9. Comprehensive discharge planning, including discharge assessment of cognitive, functional, and nutritional status; medication reconciliation; discharge location; and home health or other follow-up care.

B. Provider outcomes

1. Receive education and ongoing training on best practices in the care of the geriatric surgical patient.
2. Assess patient’s and family’s decision-making capacity and involve the patient and family in the development of the plan of care.
3. Provide patients and caregivers with timely and accurate information of patient’s condition and plan of care, including transitions.
4. Participate in high-quality interprofessional collaboration throughout the perioperative period, including rounding, handoff, pain management, early mobility, nutrition and hydration, medication reconciliation, and transitional care.
5. Use an evidence-based teamwork system to improve communication and teamwork skills (e.g., TeamSTEPPS) for patient safety.
6. Employ consistent and accurate documentation throughout the perioperative period.
7. Apply teach-back method in all patient and family education encounters that are culturally competent and patient-centered.
8. Staff nurses achieve a minimum of a bachelor’s degree and obtain practice-specific certification (e.g., gerontological nursing).
9. Organize and participate in unit-based practice and quality improvement councils.
10. Receive education and undergo competency verification that addresses the specialized knowledge and skills related to the care of older adults.

C. Systems outcomes

1. Uphold patient safety and quality in the care of older adults through policy and social statements (e.g., safety language in hospital’s mission).
2. Review and align existing institutional policies and procedures with the latest national standards.
3. Facilitate and sustain interprofessional geriatric care teams.
4. Establish a system of reporting patient safety issues (e.g., falls, medication errors, HAI, restraint use) across the postoperative continuum to identify opportunities for improvement.
5. Adopt specific patient safety initiatives for older adults that include use of informatics, algorithms, checklists, and personnel oversight.
6. Develop ongoing quality improvement initiatives consistent with practice guidelines.
7. Facilitate clinical rotations for nursing students across perioperative units to promote experiential learning for prelicensure students.
8. Enforce SSI, CAUTI, CLABSI, and VAP prevention policies, and conduct surveillance based on CDC and TJC guidelines.
9. Organize and support interprofessional unit-based practice and quality improvement councils (ACS, 2019).
10. Demonstrate a commitment to culture of safety based on openness and mutual trust (ACS, 2019).

RELEVANT PRACTICE GUIDELINES

A. ACS NSQIP and the AGS’s Best Practices Guidelines for Optimal Preoperative Assessment of the Geriatric Surgical Patient (2012): https://www.facs.org/media/inyehw0d/acsnsqipagsgeriatric2012guidelines.pdf

B. AGS Clinical Practice Guideline for Postoperative Delirium in Older Adults (2014): http://onlinelibrary.wiley.com/doi/10.1111/jgs.13281/epdf

C. AGS Assessing Care of Vulnerable Elders-3 Quality Indicators (2007): https://doi.org/10.1111/j.1532-5415.2007.01329.x

D. AORN Position Statement on Care of the Older Adult in Perioperative Settings (2015): https://www.aorn.org/guidelines/clinical-resources/position-statements

E. CDC—Guideline for Prevention of Surgical Site Infection (2017): https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725

F. Evidence-Based Guidelines for Selected Hospital-Acquired Conditions: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/Downloads/2016-HAC-Report.pdf

G. The Joint Commission: https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2022/simple_2022-hap-npsg-goals-101921.pdf

H. Munday et al. (2014)

I. SCIP Core Measure Set. (2014): https://manual.jointcommission.org/releases/archive/TJC2010B/SurgicalCareImprovementProject.html

J. Enhanced Recovery After Surgery (ERAS) Guidelines: https://erassociety.org/guidelines/

ABBREVIATIONS

ACS            American College of Surgeons

ACOVE       Assessing Care of Vulnerable Elders-3

ADL            activities of daily living

AGS            American Geriatrics Society

AHRQ         Agency for Healthcare Research and Quality

ASA            American Society of Anesthesiologists

CAUTI         catheter-associated urinary tract infections

CDC            Centers for Disease Control and Prevention

CLABSI       central line-associated bloodstream infections

CVC            central venous catheter

DVT            deep vein thrombosis

ERAS          enhanced recovery after surgery

GI               gastrointestinal

HAI             hospital-acquired infection

IADL           instrumental activities of daily living

IV                intravenous

LDUH         low-dose unfractionated heparin

LMWH        low-molecular-weight heparin

NG              nasogastric

NSAIDs       nonsteroidal anti-inflammatory drugs

NSQIP         National Surgical Quality Improvement Program

OR              operating room

PACU          postanesthesia care unit

PAINAD      patient assessment in advanced dementia

PPC             postoperative pulmonary complications

PONV          postoperative nausea and vomiting

PSI              patient safety indicators

QOL            quality of life

ROM           range of motion

SCD            sequential compression device

SCIP            surgical care improvement project

SSI              surgical site infection

TJC             The Joint Commission

VAP            ventilator-associated pneumonia

VAE            ventilator-associated event

VTE            venous thromboembolism

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Updated: January 2025

Boltz PhD, RN, GNP-BC, FGSA, FAAN, M., Capezuti, PhD, RN, FAAN, E.A., & Fulmer PhD, RN, FAAN, T. T. (2025). Evidence-Based Geriatric Nursing Protocols for Best Practice (7th ed.). Springer Publishing. Retrieved December 17, 2024, from https://www.springerpub.com/evidence-based-geriatric-nursing-protocols-for-best-practice-9780826152763.html#tableofcontents

Chapter 37, Lim, F. & Slater, L.Z. (2025) General Surgical Care of the Older Adult