LEADing Pediatric Surgical Nursing Care

Purpose:
Historically,the summertime volume of pediatric surgical patients on the surgical unit exceeds census, resulting in overflow to non-surgical units. To facilitate care throughout all nursing units at The Children's Hospital of Philadelphia,LEAD(Liaison for Extra Admissions and Discharges)was created.

Significance:
The high number of diverted patients could lead to a gap in specialized care. Therefore, the LEAD initiative proposed that an experienced surgical unit RN be designated as a liaison to optimize care for the surgical patient admitted to a non-surgical unit.

Strategy and Implementation:
During the high surgical volume period, the LEAD RN traveled to units where overflow patients were assigned and collaborated with bedside RNs. The LEAD RN reviewed physician orders, discussed patient/family education, pain management, and the discharge plan and process. The LEAD RN was available by beeper to address changes in patient needs, and bedside RN questions and concerns. In addition to the LEAD role, surgical nurses provided educational inservices to the non-surgical units about post-operative care, highlighting frequent diagnoses. Due to the initiative's success in 2008 and 2009, plans have been developed for the 2010 high volume season. Data were collected for a nine week period of time for each year.

Evaluation:
Over a 2 year period of time, there were a total of 229 patients overflowed to 7 different units. LEAD had a total of 361 interactions with nursing, and/or patients/families. Through surveys, non-surgical nurses reported that participating in the initiative was beneficial for patients and staff.

Implications for Practice:
This initiative enhanced surgical nursing care regardless of patient location. During future high volume periods, LEAD will be available for education and bedside care. Surgical nursing education for non-surgical nurses continues through presentations on common diagnoses and procedures.