Stroke is a major comorbidity for CEA/CAS patients (3%-6%) periprocedural. Patients require stringent monitoring post procedure (vital signs & neurological checks) to assess for neurological decline, initiate expedited treatment as necessary for improved patient outcomes. Post assessment auditing demonstrated 37% compliance with documentation of neurological assessments.

•Background:•PACU educators tasked to improve compliance regarding institutional HH requirement•Audits not valued/ not performed on consistent basis•Staff unaware of the HH data/ issues because only two people conducted audits•Educators identified knowledge deficit•Objectives of project:•Improve awareness and compliance with policy, and submit data consistently•Identify barriers and successful process to ensure data reporting•Process of implementation:•Process of implementation•PACU educators assessed problem and received commitment from management for resources•Report out data to PACU staff by posting data graphs•Posted/emailed evidence based articles•Staff completed on-line learning module•PACU educators taught auditors daily•Charge nurses assigned auditor daily, reports submitted before deadline, exceeded requirement•Posted blank audit forms for easy access, deposit envelope for completed audits•Reminder signs posted•PACU educators monitored audits to insure completion and submitted monthly•Reward 3 months of 100% compliance with pizza party•Statement of the successful practice:•Audits consistently/ completely submitted and indicate improved staff behaviors•Increased number of monthly HH observations•Implications for advancing the practice of perianesthesia nursing:•Since hospital guidelines for HH typically reflect in-patient nursing, PACU nurses can now translate guidelines into their environment

Because the availability of new, peripherally acting mu-opioid-receptor antagonists is expected soon, it is important for all members of the surgical team to familiarize themselves with new approaches and also re-evaluate older approaches to help improve patient outcomes. "Preop nurses" have numerous responsibilities, among which are mitigating some of the adverse outcomes of surgery such as postoperative ileus (POI), making these nursing personnel indispensable to the proper implementation of multimodal management protocols for POI. Establishing basic preoperative procedures is an important primary consideration. Preoperative evaluation of general health, medical history (including surgical history), and an assessment of gastrointestinal (GI) function and habits should all be part of careful up-front assessment for each patient, especially because POI and other GI adverse effects are so often encountered in the PACU. Hand-in-hand with how we as nurses interact with our surgical colleagues is patient education regarding hospitalization and postrecovery expectations. PACU nurses will be key players in maintaining proper implementation of multimodal regimens, essentially doing this in two "phases": Phase I interventions comprise the ongoing assessment and monitoring of patients, administering medications, and evaluating patient satisfaction and overall status; Phase II considerations encompass a further set of practice guidelines that center on optimizing discharge status, including pain management and education as well as other discharge needs. Where new agents may fit into multimodal regimens that optimally incorporate preoperative and postanesthesia protocols remains to be determined. What is clear is that as nurses and the entire surgical team strive to enhance patient satisfaction, nursing personnel must assume leadership roles in how new multimodal strategies are implemented and executed. Advanced clinical data for the new peripherally acting mu-opioid-receptor antagonist alvimopan, and for the drug class as a whole, have contributed to a greater impetus on reassessing perioperative protocols and policy, helping to broach innovative clinical frontiers of how we treat pain and POI, and thus improve patient outcomes.