Authors

• Dubravka Crnković — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0003-3846-820X
• Renata Habeković — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-1695-0874

Keywords

patient safety, standardization of procedures, cognitive disorders

DOI

Full Text

Postoperative mental disorders are a common complication of cardiovascular surgery (1), with consequences that limit performance of patient’s everyday activities. Nursing role is important in postoperative recovery that refers to falls prevention and improving security environment. Safety improvement for cardiac patients who underwent surgical myocardial revascularization, and who developed cognitive disorders afterwards. Investigation of preoperative risks, intraoperative optimization of oxygenation of the brain, multimodal postoperative approach to the patient are effective methods. In prevention of fall and fall- injury the most important is to minimize risk factors and their number, obligation of training of all health workers in usage of preventive measures, registration of fall-related injuries and deaths in hospital. During patient restriction it is important to asses and plan the procedures that are least aggressive and stressful for the patient, without endangering his physical safety, as the health workers and others also. After the nursing diagnosis is set, the interventions are performed: first verbal calming, then medication restriction, and in the end physical restraint. During patient restriction it is essential to observe the patient and evaluate the possibility for cease the restraint, with mandatory documentation of all the procedures. Cardiac patients who underwent surgical myocardial revascularization, and who developed cognitive disorders afterwards, have an increased mortality and morbidity, longer period of healing, longer stay in hospital, greater need for tertiary care and lower quality of life than patients without cognitive impairment. The risk factors are numerous, improving preventive actions will recognize and optimize risk factors. With adequate prevention of falls and adequate calming, the rights and safety of the patients will be preserved. Cognitive disorders after surgical myocardial revascularization are still relatively common. These disorders lead to difficulties in conducting normal daily activities and significant reduction in quality of life. (2) With improvement of preventive actions, the risk factors will be recognized and optimized, which requires teamwork of the medical staff who cares for the patient. Patient safety will be achieved by using a standardized procedure and operating instructions for the prevention of fall and restraints of patient who is destructive or self-destructive. All health workers are trained to apply preventive measures for the safety of patients and patient restriction, and are required to keep patient safety, implement measures to prevent falls, and to protect their rights in case of application of restriction.

Literature

1. Čolak Ž. Poremećaj kognitivnih funkcija i uloga cerebralne oksimetrije kod kirurške revaskularizacije srca. [doktorska disertacija]. Zagreb: Medicinski fakultet Sveučilišta u Zagrebu; 2011.
2. Tonković D, Marinić DK, Baronica R, Oberhofer D, Pavlović DB, Perić M. Postoperative mental disorders in cardiovascular surgery. Acta Med Croatica. 2012;66(1):67–72. https://pubmed.ncbi.nlm.nih.gov/23088090/