September FY21

[kristenhorsman]

The September journal club article is presented by Jen Pease. She has chosen the AANA Journal Course: Assessing Frailty and Its Implications on Anesthesia Care and Postoperative Outcomes in Surgical Patients. We frequently encounter many frail patients in our facility and can really benefit from the ideas presented in this article. You will find the article attached to the email I sent out.

Please answer the following two questions after reading the course:

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes?
2. How will the information in this article impact your practice?

[kelseyleonard]

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes?
Identifying factors such as cardiovascular and pulmonary comorbidities, functional status and cognitive ability play an important role in tailoring an appropriate anesthetic to a frail patient. These patients can be difficult to manage because they often have greater responses to smaller doses of medications. This results in greater swings in hemodynamics and slower emergence/return to baseline.


2. How will the information in this article impact your practice?
This article pointed out that the ASA classification is subjective and does not always reliably correlate with postop outcomes. All factors including physical, cognitive and emotional should be taken into consideration. In terms of anesthesia, "less is more" is often the best approach for frail patients such as sedation vs GA, avoiding benzos and narcotics when appropriate and using short acting medications.

[clawry]

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes?


Frailty screening could have potential beneficial effects on intraoperative and post operative outcomes. Frailty scores may improve outcomes because we can identify the highest risk patients and mobilize care resources early in the postoperative period. This is one of our most vulnerable patient populations and we will continue to see more elderly patients in the OR. We need to be gentle with our anesthetics and try to avoid certain medications that may cause post operative complications such as delirium. Benzodiazapines is one of the drugs that I avoid in this frail population.


2. How will the information in this article impact your practice?

I have always been very mindful of my anesthetic plan for this frail elderly population. This article just reminds us to be extra vigilant with this population and to think beyond the OR. We need to think of how our anesthetic can impact these patients in the postoperative phase. We should do everything that we can to make sure that appropriate resources are notified to ensure the best care for these patients after they leave our care.

[LarSharVeA Bailey]

The article reads surgical site infections are hospital stay is prolonged by 7-10 days and is costing a hefty $10 billion annually. Improving outcomes for patients requires a team approach, thus, those with a high frailty score could benefit from regional anesthesia when feasible. With surgical site infections, atelectasis, and increased mobility in mind, just to name a few, nurse anesthetists can weigh in on whether it is best for the patients to have a foley, encourage incentive spirometer immediately in the post operative period, et cetera.

I will do more of the things that I listed above. When blocks are possible, I will request them to obviate the need for high narcotic use.

[Christine Velarde]

Some implications of frailty screening for anesthesia is providing regional or short acting agents to the frail, elderly patient. Unfortunately these are the patients that need procedures due to the acuity of the injury or emergency procedures due to bleeding/obstruction. It is important to inform the family and the patient that GA might cause some confusion and the patient might be slower to wake up. The frail patient may need an ICU bed post-op /post- procedure so the team can make appropriate accommodations for the patient.
How will the article impact my practice?
I think careful preop evaluation and involvement of the surgical team, medical team, and anesthesia can formulate a plan to place a frail emergent patient appropriately. We may need more invasive monitoring or the aid of BIS monitoring to lessen our anesthetic.

[Anne McNulty CRNA]

Sept 9, 2020 8:11:58 GMT -5 clawry said:

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes?


Frailty screening could have potential beneficial effects on intraoperative and post operative outcomes. Frailty scores may improve outcomes because we can identify the highest risk patients and mobilize care resources early in the postoperative period. This is one of our most vulnerable patient populations and we will continue to see more elderly patients in the OR. We need to be gentle with our anesthetics and try to avoid certain medications that may cause post operative complications such as delirium. Benzodiazapines is one of the drugs that I avoid in this frail population.


2. How will the information in this article impact your practice?

I have always been very mindful of my anesthetic plan for this frail elderly population. This article just reminds us to be extra vigilant with this population and to think beyond the OR. We need to think of how our anesthetic can impact these patients in the postoperative phase. We should do everything that we can to make sure that appropriate resources are notified to ensure the best care for these patients after they leave our care.

Knowing the patient and all their co-morbidities , keeping the anesthetic plan as simple as possible, using regional if possible , knowing the pt's medications and drug interactions  will result in  the best outcome.  The team approach , from pacu to the floor or home will help the patients quality of life  to be maintained. Reduced surgical time improves the outcome for this population.  (2) The elderly are a very special population. Careful watch is required

[Lu Lin]

1. Improving outcomes for patients requires a team approach, thus, those with a high frailty score could benefit from regional anesthesia when feasible. With surgical site infections, atelectasis, and increased mobility, nurse anesthetists can weigh in on whether it is best for the patients to have a foley, encourage incentive spirometer immediately in the post operative period,

2. I will try to engage regional team if surgeons will agree with it for this type of patient. Encouraging all the necessary methods to improve outcomes.

[ben waldbaum]

1.) I tend to think on the "frail" that less is better, and that less complicated anesthetics with as few medications as possible is best.

2.) It's good to have additional tools to identify patients who we need to be more calculated in how we manage

[kels]

1.The goal is to decrease postoperative complications as best as we can in our frail population . The fail patient presents with a decline in many aspects of health and has a difficult time " bouncing back " like our younger/ healthy/ ASA 1 population . In the frail person I tend to give less in narcotics, gas , fluids to name a few. One can always give more and I take it slow with the frail pt.
2. This article reinforces how much care and attention to detail is required when caring for the frail pt and how what is done in the or has a greater and longer lasting impact on the pt outside of the time that was spent in the or

[Jennifer Hannon]

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes?


Frailty screening would have beneficial effects on perioperative outcomes because we can identify the highest risk patients and plan accordingly. As one of our most vulnerable patient populations, we are going to see more elderly patients in the OR. I try to avoid certain medications known to cause post operative delirium, and other postop complications common to the eldery population.

2. How will the information in this article impact your practice?

This article reminds me to be vigilant outside of the OR.

[Jessica Hadley]

1. I think this article was a good reminder that anesthetic choices we make can really make a difference in the postoperative course for patients. I agree with those who have already mentioned that in the frail population less is more. I try to be discerning in the choice of anesthetic technique and amount of medications I am giving. Particularly in the elderly frail population I try to avoid excessive narcotics, benzos, and fluids. Typically if I can utilize the BIS as another indicator of anesthetic depth I will.

2. This is a good reminder that as the population is steadily aging we need to be prepared to care for the increasing frailty and complexity of our patients.

[Katya]

1.Frailty screening is necessity tool to keep patients safe during procedure and after. It helps to identify high risk patients and make anesthesia plans (may be min sedation or regional or use different anesthetic medications like precede and ketamine).
2. This article is a good reminder to be vigilant and pay attention to details when it comes to patients safety.

[Gordon Han]

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes?

The frailty screening is able to identify high-risk patients among the elderly population. By identifying these high-risk comorbidities, prior to the surgery, it allows us to optimize these patients. The anesthesia providers can mobilize hospital resources and expertise, and provide individualized care early and safely. Ultimately, with the frailty screening, we could reduce poor outcomes and complications, both in short and long terms.

2. How will the information in this article impact your practice?

I believe, with corroboration from this article, that we still do not know a lot about providing anesthesia to elderly patients, especially ones with frailty. With the information provided by this article, I want to stay updated with my practice. I hope to utilize opioid-sparing techniques and avoid polypharmacy. When it comes to medication selection for these elderly patients, Beers Criteria Medication List is another source that I often use for reference.

[Soo-Ok Kim]

1. What are some of the potential anesthetic implications of a frailty screening and its impact on intraoperative case management and postoperative outcomes? Frailty screen can give another tool to customize the anesthetic management rather than cookie cutter approach to anesthesia care. Less is more, minimal chemical use to achieve the best outcome would be the best.

2. Patience and more vigilance is to be given in addition to the care I would normally render.

[aileenm4]

1. since I am mainly in pediatrics, I wonder if we have an exclusive fraility pathway or team that helps identify and manage these patients. I was always in awe at the Jehovahs witness team and how helpful they are with managing the bloodless surgery cases. maybe a similar team could help outcomes

2. I believe good communication between all the team members, surgeons, nurses, family and patients to create the best and most effective care with best outcomes