Standardising fast-track surgical nursing care in Denmark

Abstract

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.

Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark

“…When examining the 20 patient cause of treatment, we did not identify any need for further surgical treatment (operative complications, serious adverse events) in the first month after discharge. The findings underpin the importance of early surgical rehabilitation embedded in the surgical peri-and post-operative fast-track concept [13]. Within colorectal surgery, research in evidence-based fast-track regimes has revealed well documented effects internationally with regard to rapid recovery and reduced hospitalization [14][15][16].…”

Nursing in fast-track total hip and knee arthroplasty: A retrospective study

“…In a conventional setting more nursing hours were used for administration of medicines, eating, bathing, drains and intravenous fluids. In fast track tasks have changed to more communicative nursing care including teaching, information giving and motivation (Hjort Jakobsen et al, 2014) in order to prepare patients for caring for themselves at home (Jakobsen et al, 2006). Consequently, the new approach to nursing care led patients to be more involved in their own treatment and rehabilitation in order to manage the situation at home after discharge.…”

“…The organisation of fast-track in THA and TKA varies significantly between departments in different countries (Hjort Jakobsen et al, 2014;Kehlet, 2013). It consists of a standardised programme with improved multimodal strategies including opioid sparing pain management (Husted, 2012a;Kehlet, 2013;Specht et al, 2011), early and increased mobilisation and improved information and nutrition (Kehlet and Dahl, 2003).…”

Review of advanced nursing practice in Denmark with an exemplar

“…A more recent report from Jakobsen et al discussed the role of nurses in establishing a fast‐track colon surgery clinic. Postoperative nurses were stakeholders in the development of a program for patient information, surgical teaching, pain management, fluid management, early mobilization and rapid return to normal diet.…”

“…Nurses on this unit prepared for this role by attending seminars to improve their competency and skill level, and the overall unit was organized as part of a multidisciplinary group. Jakobsen et al reported a high positive impact on the quality of surgical nursing care because nurses had been involved in expansion of their role as the unit was conceptualized. The unit demonstrated measurable improvements in postoperative pain management and inpatient hospital days decreased, representing significant cost savings for the facility.…”