Molly Bonenberger, DNP'20, Andi Stamper, DNP'12, Chris Simmons, associate professor and DNP scholarly project chair, Julie Thompson, consulting associate, and AnnMarie Thompson, of Duke School of Medicine, recently published “Use of a standardized perioperative note to enhance continuity of care and increase safe and effective perioperative management of the patient with a cardiac implantable electronic device” in the "Journal of Perianesthesia Nursing." 

Abstract

Purpose: Over three million people have a cardiac implantable electronic device (CIED) in the United States. Without an organization-wide, standardized approach to the perioperative management of patients with CIEDs, communication errors and subsequent approach for perioperative management of patients with CIEDs at a large academic medical center.

Design: A pre-post implementation design with two independent groups in which a revised preprocedure note was developed and implemented into the electronic health record. 

Methods: Patients with preexisting permanent CIEDS (n=405) undergoing surgical and nonsurgical procedures with anesthesia were included. A preprocedure note was revised and implemented in the electronic health record for patients with CIEDs to include information about the device type, perioperative plan, and contact information for technical support. 

Findings: When the preprocedure notes was used, completion of the perioperative plan and contact information increased with statistical significance (P<.001) and the number of undocumented interventions that occurred with CIEDs in the intraoperative period (magnet use, preoperative reprogramming and postoperative reprogramming) was significantly reduced (P<.05). 

Conclusions: While documentation of the preprocedure note and intraoperative interventions increased, ongoing perioperative management improvements for patients with CIEDs are needed.