Standardization Of Caregiver And Nursing Perioperative Care On Gynecologic Oncology Wards In A Resource-Limited Setting

Introduction In Kampala, Uganda, there is a cultural practice for patients to have a caregiver present for the duration of a hospitalization. At the same time, nursing support is limited. This quality improvement project aimed to standardize caregiver and nursing perioperative care at the Uganda Cancer Institute and Mulago Women’s Hospital gynecologic oncology wards. Methods We developed and evaluated a multidisciplinary intervention involving standardization of nursing care, patient education, and family member integration from October 2019 – July 2020. Data were abstracted from medical records and patient interviews pertaining to the following outcomes: 1) pain control; 2) infections during hospitalization; 3) nursing documentation of medication administration, pain quality, and patient checks, and 4) patient and caregiver education. Descriptive statistics, Fisher’s exact test, and independent sample t-test were applied. Results Data were collected from 25 patients undergoing major gynecologic procedures (table 1). Pre- (N=14) and post- (N=11) intervention comparison demonstrated significant increases in preoperative patient education (0% to 80%, p = 0.001) and utilization of a comprehensive postoperative order form (0% to 45.5%, p = 0.009). Increased frequency in nursing documentation of patient checks and intraoperative antibiotic administration in patient charts were noted but did not reach significance. There was no change in infection rate, pain score utilization, caregiver documentation, or preoperative medication acquisition. Conclusion Our findings suggest that patient- and family-centered perioperative care can be improved through standardization of nursing care, improved education, and integration of caregivers in a nursing-limited setting.