Journal of Pediatric Surgical Nursing

Adolescents undergoing surgery have expressed a willingness to obtain information about their surgery and to be involved in the decisions about their health care process. Around 80% of adolescents experience anxiety before undergoing surgery. On the basis of the adolescents' shared experiences, areas of possible nursing intervention have been identified to prevent anxiety and the multitude of adverse effects associated with it. The purpose of this study is to present a nursing intervention program to prevent perioperative anxiety in adolescents (3P2A) designed based on the first phase of the complex intervention's framework.

The design of this program followed the updated guidance for developing complex interventions issued by the Medical Research Council and the National Institute for Health Research. Five Portuguese nurses, experts in perioperative nursing, and pediatric specialists evaluated and validated the final version of this program.

The nursing intervention program to prevent perioperative anxiety in adolescents (3P2A) consists of three phases that correspond to the preoperative, intraoperative, and postoperative periods. The first phase includes conducting a preoperative nursing consultation to identify stressors, providing written and verbal information about the surgery, and applying nonpharmacological interventions to reduce anxiety. In the intraoperative period, nonpharmacological interventions are implemented in the anesthetic induction room immediately before the adolescent falls asleep. Finally, the postoperative period comprises a nursing visit to identify postoperative complications and promote the adolescents' well-being.

The program is structured with specific interventions to be implemented in each of the perioperative periods. Because of its flexibility, it may be fully or partially implemented considering the identified needs, priorities, and resources when caring for an adolescent with anxiety during the perioperative period.

Preoperative pregnancy status is a vital measure necessary for patient safety. At our institution, missing or delayed pregnancy test results, measured by human chorionic gonadotropin (HCG) levels, were identified as a contributing factor to surgical delays.

A quality improvement project was initiated in 2020 at a free-standing children’s hospital after missing or delayed HCG results were identified as a cause of surgical delays. A team was created to specifically evaluate this problem and devise an intervention. As a result, an automatically generated HCG test order was established to address surgical delays associated with missing or delayed HCG test results. The automatic order is triggered when the patient’s initial admission order is activated. For female patients 9 through 11 years of age, an order is automatically generated only if the admitting physician answers “No” to the question “Is the patient premenses?” when prompted. The system automatically generates an order for all female patients greater than 12 years of age regardless of menstruation.

Pre-intervention data revealed approximately 6% of surgical cases were delayed because of pregnancy test results; post-intervention data revealed approximately 2.6% of surgical cases were delayed because of pregnancy test results.

Initiation of an automatically generated HCG test order helped achieve the overall goal of reducing surgical delays linked to missing or delayed HCG results. Continued education and collective efforts are underway to help ensure the automatic order’s continued success.