Development and Implementation of an Enhanced Recovery After Surgery
                                           Guideline for Women Undergoing a Mastectomy
                                       Michael Braun, Victoria Mahler, & Brian Mueller DNP Candidates
                    Introduction                                                                      Project Implementation
• Enhanced Recovery After Surgery (ERAS) is a patient                                   • ERAS mastectomy guideline development
   centered, evidence based, multidisciplinary pathway                                  • Perioperative staff educated prior to implementation
   created to optimize a patient's physiological function,                              • A guideline and checklist were placed in each OR and
   reduce surgical stress response, and facilitate                                        patient chart
   recovery.                                                                                                    Outcomes
                       Purpose                                                          • In patients who did not follow the ERAS guideline, 28/39
• Create an ERAS Mastectomy guideline based                                               patients (72%) required rescue opioids and the average
  on current research                                                                     MME/patient was 37 with a median MME/patient of 29.4
• Project Focus: decrease the incidence of post                                         • In patients who followed the ERAS guideline, 19/22 patients
  operative nausea and vomiting (PONV) and total                                          (86%) required rescue opioids and the average MME/patient
  morphine milligram equivalents (MME) in the post                                        was 23.5 with a median MME/patient of 22.5
  operative care unit (PACU)                                                            • In patients who did not follow the ERAS guideline, 10/39
• Clinical Question: In women 18 years or older                                           patients (26%) required rescue PONV medication.
  undergoing a mastectomy procedure, does the                                           • In patients who followed the ERAS guideline, 2/22 patients
  implementation of an ERAS guideline lower the                                           (9%) required rescue PONV medication.
  incidence of PONV and reduce MME requirements in
  PACU?                                                                                     Practice Implications & Conclusion
              Literature Synthesis                                                      • Implementation of ERAS guideline was shown to reduce the
                                                                                          incidence of PONV and MME
• Postoperative pain symptoms can have a significant
                                                                                        • Additional work is needed to address the barriers to adoption
  impairment on physical and mental health.
                                                                                          of guideline
• Breast cancer surgery patients have reported
                                                                                        • Implementation of ERAS guidelines can be distributed to
  incidences of PONV up to 80%.
                                                                                          other service lines within Trinity Health System.
• In other surgical populations such as colorectal, ERAS
  implementation reduced morbidity, hospitalization, and                                                  Acknowledgments
  reinterventions.                                                                      • Dr. Gayle Lourens DNP, CRNA
• In bariatric patients, ERAS implementation reduced                                    • Kathy Everts MSN, CRNA
  PONV, postoperative pain, and led to earlier discharge                                • Katherine Hoffhines MSN, RN, CNL