Standardization of caregiver and nursing perioperative care on gynecologic oncology wards in a resource-limited setting

Abstract

Introduction: In Kampala, Uganda, there is a strong cultural practice for patients to have designated caregivers for the duration of hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care on the gynecologic oncology wards at the Uganda Cancer Institute and Mulago Specialised Women and Neonatal Hospital.

Methods: We developed, implemented, and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 - July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) post-operative surgical site infections, urinary tract infections, and pneumonia; 3) nursing documentation of medication administration, pain quality, and vital sign assessments, and 4) patient and caregiver education. Descriptive statistics, Fisher's exact test, and independent samples t-test were applied.

Results: Data were collected from 25 patients undergoing major gynecologic procedures. Pre- (N = 14) and post- (N = 11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks (3 to 8, p = 0.266) and intraoperative antibiotic administration (9 to 10, p = 0.180) in patient charts did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition.

Conclusion: Our findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.

Keywords: Nursing; Peri-operative care; Quality improvement.

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Appendix A. Sample nursing checklist used during patient intake and post-operatively.

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Appendix B. Designated table for nursing documentation of patient vital signs, inserted into patient charts.

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Appendix C. Documentation flowsheet for patients’ caregivers, stored at each patient bed and for nurses to use as reference.

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Appendix D. Consolidated post-operative nursing order set for gynecologic oncology fellows to fill out and insert in patient charts.

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Appendix E. Translated patient instructions in Luganda, printed on handouts to provide in clinic and at discharge.

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Appendix F. Standardized pre- and post-operative patient questionnaires.