Decreasing Preoperative Anxiety: Implementing Assessment and Management Guidelines

Abstract

Problem and Purpose: Preoperative anxiety (PA) in adult surgical patients was about 60 – 80% and adversely influenced surgical outcomes. PA assessment and management guidelines exist but are not being used by nurses at this hospital to routinely monitor and manage PA in patients before their surgery despite evidence-based recommendations. This Quality Improvement project aimed to implement evidence-based PA assessment and management guidelines. Methods: The Amsterdam Preoperative Anxiety and Information Scale (APAIS), a well validated and reliable tool, was used by trained nurses to assess PA in all adult surgical patients scheduled for elective surgical procedures before implementing evidence-based interventions and making appropriate referrals. This was done within a week prior to the surgery date during routine Pre-Anesthesia Testing follow-up call with patients by nurses. Interventions provided for patients with positive anxiety screening included providing educational materials or answers to frequently asked questions about surgery or anesthesia, procedure-specific information and links, surgery suite virtual tour video, and listening to music on the day of surgery. Referrals were made to the surgery or anesthesia team. Results: Compliance with the use of the APAIS tool to assess PA was 73% (276/380), and 100% (161/161) of patients with positive anxiety screening received at least one of the interventions provided before or on the day of surgery. The overall prevalence of PA was 58%. 96.9% of patients with positive anxiety found interventions received prior to the day of surgery very useful. All patients (100%) that required referrals were appropriately referred. Conclusion: Though the goal of 100% compliance was not met, implementation of PA assessment and management guidelines is feasible, and routine implementation helps ensure timely interventions to prevent adverse surgical outcomes. An adequate number and availability of staff nurses is key to implementing these guidelines.