Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Lacey Buckler

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

PURPOSE: The purpose of this study is to evaluate pre-procedural anxiety with the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in the adult population of the Interventional Radiology department at University of Kentucky Medical Center. The objective is to provide meaningful data to providers in this clinical area that could potentially facilitate better departmental workflow and also promote quality patient outcomes.

METHODS: A retrospective chart review, using a pre/post design, was used to evaluate the departmental implementation of APAIS. Case logs for the department were observed from January 2018 to June 2018 and then again, following APAIS implementation, from July 2018 to December 2018. Data evaluated from the case logs included: number of cases, number of cancellations, and number of general anesthesia cases as a means to evaluate if APAIS was effective in reducing cancellations and use of anesthesia for minimally invasive procedures. In addition, data was extracted from APAIS and the electronic medical records of the 259 inpatients and outpatients that met inclusion/exclusion criteria to determine the extent of pre-procedural anxiety in Interventional Radiology (IR) and to measure if APAIS scores were a predictor of intra-procedural anxiety. Staff participation with completing the APAIS form was also evaluated.

RESULTS: In this sample of 259 patients, APAIS identified 86 (34.5%) as not having any anxiety, 105 (42.2%) as having some anxiety, and 57 (22.9%) as having high anxiety prior to procedures. There was a positive correlation between needs information scores and anxiety scores, as well as, a negative correlation between age and anxiety scores. For intra-procedure measures, there was no significance between anxiety levels and amounts of medications received with the exception of those having percutaneous drains placed. However, there was a significant negative correlation between anxiety and level of sedation achieved. Post APAIS implementation saw a decrease in all measures; although, only number of cancellations had a p-value < 0.05. There was only a 44% staff completion rate of APAIS forms.

CONCLUSION: The implementation of APAIS was effective in identifying those with pre-procedural anxiety, predicting some physiological measures during procedures, and with lowering case cancellations. While not all outcomes were statistically significant, there is clinical significance worth further discussion. The implementation of a validated anxiety tool is beneficial in promoting quality departmental and patient outcomes.

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