Assessment & Intervention

The category of Assessment & Intervention includes information on standards of practice related to the various care situations in the medical-surgical setting. This information may be gained by conducting comprehensive, holistic assessment using evidence-based techniques and tools and/or identifying potential risks to patient safety, autonomy, and quality of care based on these assessments.

Photo: "The Many Faces of AMSN Members," taken at a recent annual convention.

Are there other facilities that use a symptom driven alcohol withdrawal program in acute care?

Answer: Out of the members, there were no systematic programs that have been initiated in the inpatient units. However, many follow different variations of alcohol assessment tools within their clinical unit...

Have there been any revisions to the standard of care with regard to: TENS application and use, TENS removal, prone positioning and ARDS?

Answer: A majority of the members of committee state that a TENS device is not used within their facility and that it is possible that it is used in a more restrictive environment, in a specialty practice, or most likely, performed at home

What is the best Evidence Based Practice for safe assessment and care of epidurals?

Answer: The standards of care (2014) and practice guidelines (2013) published by the American Society of Anesthesiologists provide guidance about postoperative care for patients who have received general or regional anesthesia, as well as moderate or deep sedation...

Question: A female patient has CIDP and receives Gamminex C every four weeks... blood tests... symptoms... general treatment...?

Answer: Upon investigation of your clinical question, members of the committee have provided their expertise in regards to Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart of that acute disease...

Question: What are the recommended components of a routine neurological assessment for patients on a general med-surg unit? Are pupil checks part of this assessment?

Answer: ...many organizations queried do not use have a specific policy in regards to a neurological assessment. Most facilities tend to vary in their practice, as most of it based upon the provider’s orders, and dependent on each individual patient...

Question: What are the latest recommendations for performing a bed bath?

Answer: ... Most healthcare institutions provide available disposable bath wipes for bed bound patients...

Question: How often should Neurovascular checks be done on a post leg bypass patient?

Answer: Many organizations queried do not use have a specific policy in regards to a femoral-popliteal bypass neurovascular assessment. Most facilities tend to vary in their practice, as most of it based upon the surgeon's preference...

Question: Is it standard practice on a med surg unit to assess patients head to toe every 8 hours when you work a 12 hour shift?

Answer: We queried our member hospitals as well as reviewed what information is in the literature around standard assessments. The following information is based on staffing at 12 hr. shifts on the general Med-Surg unit...

Question: I'm looking for evidence-based information related to the admission criteria for med/surg units.

Answer: With the differences in patient populations, proximity to surgery and other invasive procedure services, telemetry, staffing, staffing mix and overall geographical differences in medical or surgical units, we find no literature that provides a detailed answer to your question. However, we did locate references...

Question: ...best practice r/t venous thrombolytic event prevention... (four questions posed)

Answer: I will address your questions below as you have them numbered: 1. We are questioning if the use of PCDs at other facilities is nurse driven or is a physician's order required? Pneumatic compression devices (PCDs) are placed on surgical...

Question: What are the guidelines for “routine vital signs”? What is your reference for this practice?

Answer: The frequency for obtaining vital signs on Med-Surg units vary somewhat. Nursing reference textbooks generally do not suggest a frequency for this, but stress the need to obtain vital signs and to "follow organization policy"

Question: I am curious if the nurses on the CPC work at hospitals where whipple surgery is performed...

Answer: For the CPC members that work at hospitals where whipples are performed, all pts. go to ICU from PACU...

Question: I am looking for best practice articles on abdominal or pelvic drain irrigation.

Answer: If seeking literature to support or prohibit the practice of abdominal or pelvic drain irrigation in the Med-Surg arena, we suggest you perform a literature search, and evaluate the evidence for or against. As a result of that process, follow up with establishing appropriate practice protocols within your organization.

Question: What is the correct terminology for fine crackles? Is it crackles or rales? I have seen both terms used and it is confusing for students.

Answer: Crackles, formerly referred to as "rales", it the term used to describe the adventitious sound of cracking/clicking/rattling usually heard on inspiration, that result from the re-opening of deflated airways...

Question: ...regarding infection control and IV solutions... we have IV tubings changed q96hrs and plain IV solutions q96hr but questioning if it should be q24hr?

Answer: Guidelines around the frequency of changing IV fluids will vary. Manufacturer of the fluids may indicate a specific number of hours for changing bags, others may not... the following are the standards of practice identified by the CPC for the changing of IV fluids...

Question: Is there a standard of care for med/surg patients regarding assessments... I was trying to find out if the every "4" hour reassessment is too stringent for the med/surg setting.

Answer: The following information is based on staffing at 12 hr. shifts on the general Med-Surg unit: 1). Perform a complete biophysical and psychosocial assessment upon admission ("upon admission" ranges from within 2-4 hours)...

Question: What is the EBP standard for assessment of the post-operative patient after discharge from PACU, how often should these assessment occur?

POPTARTS Answer: We receive this question several times a year and, unfortunately, there is no evidence indicating a specific frequency for obtaining post-op vital signs on the Med-Surg unit...

Question: As a professional organization, does AMSN have clinical practice guidelines on delirium?

Answer: We have completed a review of the AMSN publications, and we currently do not have practice guidelines for delirium. Our members have provided some information...

Question: I am looking for recent recommendations for trach care, can you help me?

Answer: The use of a patient's own supplies is permissible in most settings. The few references to this that we found state that your facility should have a policy covering this practice...