Implementing a Frailty-Specific Postoperative Order Set to Improve Postoperative Outcomes in Frail Adults After Elective Thoracic Surgery

J Nurs Care Qual. 2024 Oct-Dec;39(4):361-368. doi: 10.1097/NCQ.0000000000000784. Epub 2024 Jun 26.

Abstract

Background: Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status.

Local problem: There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center.

Methods: A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized.

Interventions: A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals.

Results: There were significant improvements in nurse's self-reported familiarity with frailty ( P = .003) and FPOS awareness ( P < .001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased ( P < .001).

Conclusions: Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization.

MeSH terms

  • Aged
  • Elective Surgical Procedures
  • Female
  • Frail Elderly
  • Frailty*
  • Humans
  • Male
  • Postoperative Care / methods
  • Postoperative Care / nursing
  • Postoperative Care / standards
  • Postoperative Complications / prevention & control
  • Thoracic Surgical Procedures*