Implementing Enhanced Recovery After Surgery (ERAS) Program on a Specialty Nursing Unit.

Tezber et al. The Journal of Nursing Administration. 48(6):303–309, JUNE 2018

What is already known:

There are a lot of papers about new ERAS programmes being set up. This paper gives a lot of background to how this unit went about using their own patient outcome data to help set it up.

What this paper adds:

A really interesting paper talking through how this US institution set up their specialist HPB nursing unit, after root cause analysis identified a number of key reasons as to why their pancreaticoduodenectomy patients were staying longer than expected. The speciality unit, with dedicated trained staff also included ICU level care. Six months after setting up the unit an ERAS programme was designed and then fully implemented a year later. One of the interesting parts of this programme was an activity tracker that patients wore. A baseline level was measured preoperatively and then monitored up to 60 days post-op, and if the levels fall the ERAS specialist nurses can investigate the cause. The authors showed a good level of compliance with the ERAS elements, and with that a reduced hospital length of stay, reduced readmission rates and reduced costs.

Chris Jones, Guildford.


Understanding the benefits and implications of Enhanced Recovery After Surgery

Balfour A (2019) Understanding the benefits and implications of Enhanced Recovery After Surgery. Nursing Standard. 

What is already known:
Enhanced recovery is a true multidisciplinary endeavour, but at times the focus can be too much on the medical side of things.

What this paper adds:
This excellent review gives a great overview of ERAS, focusing in particular on the nursing view and how they can be empowered rather than burdened by the pathways. It looks at the barriers to implementing ERAS, such as high patient to nursing ratios on wards and so limited time to help with mobilisation goals etc. But also shows how with increasing compliance with ERAS elements it can actually decrease nursing workload.

Chris Jones, Guildford.


The nurse’s role in the implementation of an ERAS programme

Brady KM, Keller DS, Delaney CP. Successful Implementation of an Enhanced Recovery Pathway: The Nurse’s Role. AORN J. 2015 Nov;102(5):469-81. 

What is already known:

The authors are based at the University Hospitals – Case Medical Center in Cleveland, and are experienced in ERAS for colorectal surgery. The senior author has published widely in the area.

What this paper adds:

This paper describes the nurses role in setting up a successful ERAS program in a number of different surgical specialities. In particular, it stresses the importance of nurses to patient education, assisting patients in meeting ambulatory and dietary targets, providing effective analgesia and ensuring the pathways are successfully followed (including auditing compliance).

Chris Jones, Guildford.