In early 2007, patients at our small community hospital's outpatient surgery center experienced postoperative nausea and postoperative nausea and vomiting (PONV) at a rate of 27% to 35%. Many record reviews and a written survey of nurses in the postanesthesia care unit and same day surgery center revealed that little or no risk assessment and no consistent prophylaxis or treatment were in use by nurses, physicians, or anesthesia care providers. After a review of the literature and discussions with anesthesia care providers, we developed and put into practice a risk assessment tool and perioperative care path. A formal evaluation to assess the effectiveness of the plan was performed one year after implementation. We found that the rates of PONV had decreased to 16%. AORN J 90 (September 2009) 391-413. (c) AORN, Inc, 2009.
This is an exploration of some of the evidence that supports the notion that negative illness perceptions are a barrier to accessing cardiac rehabilitation services for people with heart disease. The evidence that exists and potential strategies to improve the issue will be explored. It is hoped that ideas for future service development can be recommended. Cardiac rehabilitation is a cost-effective service that offers people with heart disease a structured programme of care. Given the evidence that shows the effectiveness of cardiac rehabilitation, health professionals need to be aware of the barriers that exist so that services can be improved for patients, ensuring that they are tailor made, menu-based and patient driven.
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