This capstone change proposal addresses a identified gap in postoperative care for surgical inpatients who have undergone monitored anesthesia care (MAC). Unlike patients recovering from general anesthesia, MAC patients are frequently transferred to surgical floors by non-clinical personnel without PACU monitoring, elevating their risk for complications such as airway obstruction, desaturation, and cardiovascular collapse. The paper presents a PICOT-framed clinical question, reviews eight relevant studies on MAC safety and outcomes, and proposes a Rogers' Diffusion of Innovation-guided implementation plan. The plan includes staff education, development of a formal PACU admission protocol, infrastructure modifications, and a six-month audit-and-feedback evaluation strategy aimed at reducing postoperative complications and improving patient outcomes.
This paper demonstrates systematic use of a theoretical framework to scaffold a practice change. By applying Rogers' five-stage Diffusion of Innovation model, the author connects abstract change theory to concrete implementation steps — staff education, piloting, and sustained adoption — showing how theory can operationalize quality improvement in clinical settings.
The paper follows a standard capstone change proposal format: it opens with background and a clinical problem statement, moves into purpose and measurable outcomes, frames the inquiry with a PICOT question, reviews supporting literature, selects and applies a change theory, details an implementation plan with required resources, and closes with an evaluation and barrier-mitigation strategy. This logical progression mirrors evidence-based practice project models common in graduate nursing programs.
Monitored anesthesia care (MAC) has become more widely used as a means of avoiding the complications of general anesthesia (GA) (Sammour et al., 2021). MAC is a safer alternative to GA in certain surgical procedures. As Sammour et al. (2021) observe, utilizing MAC appears to be more efficient without compromising patient safety. Complications of MAC include airway obstruction, desaturation, cardiovascular collapse, and aspiration (Sohn et al., 2016). Although the complications of MAC are comparable to those of GA, inpatients who have undergone MAC are frequently kept unmonitored outside of the post anesthesia care unit (PACU) for prolonged periods, negating optimal patient care. This practice is deleterious to patient care and can cause substantial professional and institutional liability, resulting in malpractice claims (Kellner et al., 2018). A gap in care was identified among inpatients who have undergone MAC and are not admitted to the PACU but are instead transferred to surgical floors by non-clinical personnel.
The clinical challenge at the heart of this proposal centers on the increased vulnerability of surgical patients who have undergone MAC to postoperative complications. The risks associated with insufficient postoperative nursing management extend beyond the immediate recovery period, potentially leading to prolonged recuperation, heightened healthcare expenditures, and decreased patient satisfaction. Addressing this issue is imperative, as it impacts the well-being of individual patients and carries broader implications for the healthcare system. The proposed solution — effective postoperative nursing management — is poised to yield positive patient outcomes by notably reducing postoperative complications during the critical 24-to-48-hour period post-surgery. This anticipated outcome carries multifaceted benefits, including enhanced patient recovery, shortened hospital stays, and an overall elevation in the quality of healthcare delivery, aligning with the fundamental goals of patient-centered and cost-effective care.
The omission of immediate postsurgical monitoring and management significantly amplifies patients' risk for complications. By highlighting the incidence of these complications in patients who have received MAC, this quality improvement initiative prioritizes postoperative patient safety through an attempt to persuade policy change by admitting these patients to the PACU.
The following measurable outcomes were identified as relevant in this context.
Outcome 1: Staff will be knowledgeable about the complications associated with MAC, especially within the immediate postoperative period, as demonstrated by competence in recognizing such complications.
Rationale: Staff knowledge about MAC complications will facilitate early detection of clinical decline and the timely initiation of treatment and resuscitation. Staff members who are knowledgeable about MAC complications can also communicate effectively with other team members, fostering a collaborative and coordinated approach to patient care.
Outcome 2: A PACU admission protocol for postoperative inpatients who have undergone MAC will be developed.
Rationale: Development of an admission protocol for postoperative inpatients will ensure optimal, quality, and culturally appropriate healthcare delivery, improving health outcomes through utilization of the code of ethics that guides professional decisions and practices. The implementation of a defined protocol simplifies the admission procedure for MAC patients, allowing for more effective use of resources in the PACU. This involves improving personnel numbers, equipment, and monitoring capabilities to meet these patients' specific needs.
Outcome 3: Organizational barriers that may interfere with implementation of the admission protocol will be identified, and perioperative staff will be compliant with the protocol.
Rationale: Strategies to address organizational barriers will be developed, resulting in staff compliance and full implementation of the admission protocol. Recognizing and overcoming organizational impediments can help perioperative personnel adopt the admission routine more smoothly. Understanding potential issues allows for targeted interventions and educational campaigns to assist staff in integrating the new protocol into their workflow.
PICOT Question: "In surgical patients, how does effective postoperative nursing management of inpatients who have undergone monitored anesthesia care (MAC), compared to usual practice, influence the risk for developing postoperative complications within a 24-to-48-hour period?"
The PICOT question examines the impact of postoperative nursing management on the risk of developing complications within a specific timeframe for inpatients who have undergone MAC. The patient population under consideration — those who have undergone surgical procedures — makes this question relevant to a wide range of healthcare scenarios. The intervention, effective postoperative nursing management, is a potential catalyst for positive change. By comparing this intervention to the standard of usual postoperative care practices, the study aims to discern the efficacy of heightened nursing involvement in mitigating the risk of postoperative complications. The specified outcome underscores the project's clinical relevance, and the designated time frame of 24 to 48 hours sharpens the focus on the critical postoperative period, aiming for timely and targeted improvements in patient care.
Relevant search terms used in the literature search included, but were not limited to: monitored anesthesia care (MAC), MAC patient care, MAC postoperative nursing management, surgical patients MAC, and MAC postoperative complications. Synonyms for these terms were also considered. The primary bibliographic databases utilized were Google Scholar and Emerald. Identified resources were filtered for relevance to the subject matter and for currency.
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