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��EVALUATING NURSES’ UTILIZATION OF ALDERETE’S SCORE CHART IN MONITORING PATIENTS IN POST ANESTHESIA CARE UNIT AT KENYATTA NATIONAL HOSPITAL.�

BY:ROSELYNE ATIENO ODUNDO

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF AWARD OF MASTER OF SCIENCE IN NURSING-UON

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Background information

Alderete’s score chart is used to determine suitability of patient for discharge from Post Anesthesia Care Unit.
Introduced by Jorge Antonio Alderete in 1970 (Dowling, 2015).
Measures activity, respiration, blood pressure, oxygen saturation and responsiveness.
Introduced in KNH theatre in May 2018 to standardize and improve patient monitoring.

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Problem statement

Patient monitoring is vital after anesthesia due to the risk of complications (Burke and Kyker, 2013).
Also to ensure quality healthcare for the patients.
Chart introduced to prevent conflicts between theatre nurses and ward nurses over condition of the patients.
There were some inconsistencies in completion of the Alderete’s score chart.

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Justification�

Since introduction there has been no study to assess it’s utilization.

Inconsistencies in utilization of the tool.

The site of study is convenient and it also serves as a center of policy formulation.

Can guide improvement of care in other institutions.

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Broad objective

To evaluate nurses’ utilization of Alderete’s score chart in monitoring of patients in the PACU at KNH.

Specific objectives

To determine the nurses’ level of utilization of Alderete’s score chart in monitoring patients.
To determine factors that hinder utilization of Alderete’s score chart.
To determine institutional factors that affect compliance to Alderete’s score chart.

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Literature review

Patients should be monitored closely to avoid post operative complications (Moro, Eduardo, 2009).
Staffs require knowledge and skills to effectively utilize Alderete’s score chart (Menlah et al., 2018).
There is no standard rule that post anesthesia monitoring tool has to be the same in all the institutions (Karakitsos et al., 2014).
An institution should have policies that should be revised and improved according to the needs (Michard, 2017).

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Theoretical framework

Two theoretical frameworks applied

1.Practice Partnership Model by Marjorie Splaine Wiggins.

Theory highlights collaboration between different healthcare providers for the benefit of the patient. Surgeon, physician, anesthesiologist, physiotherapist collaborate to ensure patient gets quality car

2. Ida Jean Orlando’s nursing process theory

Describes effective interaction between the nurse and the patient.
Aimed at realizing effective interventions.
Patient needs to be monitored efficiently using Alderete’s score chart to prevent complications.

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Conceptual framework

INDEPENDENT VARIABLES DEPENDENT VARIABLE OUTCOME VARIABLES

Staff factors

Knowledge
Skills
Attitude

Patient factors

Demographic characteristics
Condition
Pain

Institutional factors

Policy
Procurement
Staffs deployment

Nurses’ utilization of Alderete’s score chart

Improved care of post anesthesia patients

Patients admitted to the surgical wards without complications

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Methodology (1)

Research design: A descriptive cross sectional study that involved mixed research methods.
Study site: KNH main theatres PACU.
Study population: Nurses in PACU.
Data collection: Quantitative data collected using self administered questionnaire.
Qualitative data through interview based questionnaires for nurses and theatres in-charge.

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Methodology (2)

Inclusion criteria:

Nurses who had worked in main theatres for 6 months by the time of the study.
Nurses who consented to take part in the study.

Exclusion criteria

Nurses who were either on leave or off duty.
Sample size determination: Calculated using Fishers and adjusted using Yamane’s that yielded a sample size of 73 nurses.

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Methodology (3)

Sampling method: Stratified and simple random sampling method.
Data analysis: Statistical package for social sciences version 20.

-Categorical data subjected to inferential statistics using Pearson Chi square to determine relationship between variables.

-Qualitative data coded, arranged in groups and analyzed thematically.

Descriptive presentation: frequencies, percentages and figures.

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Ethical consideration

Approval by ERC KNH-UON
Authority from KNH research committee
Authority from the head of department anesthesia and theatres
Informed consent from nurses

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Years of experience

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Professional qualification

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Knowledge on Alderete’s score chart

	Participant understanding of Alderete’s score chart	Yes	No
1	Training on the use of Alderete’s score chart	15%(n=11)	85%(n=61)
2	Use of the chart to monitor post anesthesia patients.	73%(n=53)	27%(n=20)
3	Does the patient’s condition affect use of Alderete’s chart?	39%(n=27)	61%(n=42)
4	Does the time taken to fill the chart affect performance of other nursing procedures?	18%(n=13)	82%(n=60)
5	Is there any improvement that can be made on the chart?	24%(n=16)	76%(n=52)

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Perception towards hospital support

	Strongly agree%(n)	Agree%(n)	Neutral%(n)	Disagree%(n)	Strongly disagree%(n)
All theatre nurses should be trained on the use of Alderete’s score chart	79%(56)	18%(13)	0	1%(1)	1%(1)
It should be mandatory for nurses to monitor patients using the chart	34%(21)	44%(27)	15%(9)	5%(3)	2%(2)
I am confident using the chart	27%(16)	32%(19)	27%(16)	12%(7)	2%(2)
I understand the components of Alderete’s score chart	27%(16)	12%(7)	4%(3)	51%(36)	8%(6)
Shortage of nurses hinder the use of Alderete’s score chart	51%(36)	30%(21)	6%(4)	6%(4)	8%(6)

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Discussion (1)

Staff related factors

Nurses utilized the tool though not all had been trained on its use.
Statistical significance on training on the use of the tool and utilization.
Similar findings of a study by Cancedda et al 2015 in East and Central Africa stated that training is important to improve on care.
Nurses utilized the tool because it made their work easier.

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Discussion (2)

Patient related factors

Patient’s condition did not affect nurses utilization of Alderete’s score chart.

This was in contrast with a study done in Japan at Iwate medical center which concluded that patient’s condition affects monitoring (Kobayashi et al.,2017).

This could be due to the tool being favorable for all the conditions.

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Discussion (3)

Institutional related factors

Nurse in charge acknowledged that there was a policy governing use of Alderete’s score chart, though not all nurses followed the policy.
Policy not followed due to shortage of staff and supplies.
Similar to findings from ICU management and practice where it was concluded that an institution should have policies (Michard, 2017).
Shortage of nurses and supplies also affected utilization of Alderete’s score chart.

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Conclusion

Most nurses were utilizing the scoring chart.
Most nurses had not been trained on the use of Alderete’s score chart and so they did not understand the components of the chart.
Shortage of nurses hindered utilization of Alderete’s score chart.
Patient’s condition did not affect utilization of Alderete’s score chart.
Lack of equipment hindered the nurses from using the scoring tool.

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Recommendations

Training of nurses on Alderete’s score chart to include importance and components.

Hospital management to deploy more nurses to PACU.

Hospital management to improve supply of equipment necessary for care of patients.

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References

Burke, B. and Kyker, M. (2013) ‘Speeds Criteria vs . Modified Aldrete and Fast-Track Criteria for Evaluating Recovery in Outpatients’, Open Journal of Anaesiology, 2013(September), pp. 309–314. doi: 10.4236/ojanes.2013.37068.
Dowling, L. P. (2015) ‘Aldrete Discharge Scoring: Appropriate for Post Anesthesia Phase I Discharge?’
Partnership Model : An innovative approach for nursing at The Prince Charles Hospital ( TPCH ) Final Report’, (October 2015). doi: 10.13140/RG.2.1.2179.6327.
Moro, Eduardo, T. (2009) ‘Main concerns of patients regarding the most common complications in the post-anesthetic care unit’, Revista brasileira de anestesiologia, 59(6), p. 716.