Shands Cancer Hospital Endoscopy Suite, on the second floor of the Shands Cancer Hospital, includes 12 pre/post procedural bays and 4 procedure suites. The Endoscopy Suite is dedicated to general and advanced therapeutic procedures for the inpatient and outpatient adult population. Hours of Operation are 7:00 a.m. to 5:30 p.m. Monday through Friday, Designated/Pre-determined Saturdays for general endoscopy cases, with emergency on-call services 24/7.
Description of Patient Populations
The patient population consists of adult outpatients and inpatients receiving general endoscopy, and advanced therapeutic endoscopy procedures, liver biopsies, and paracentesis. Outpatients arrive from home accompanied by a responsible person, 18 years old or older, who is capable of receiving discharge instructions, signing patient out, and driving them home or accompanying the patient home when there is an additional adult driver who is not the patient. Patients also arrive from other facilities, the emergency department, clinics, and inpatient nursing units. Intensive Care Unit (ICU) patients who require endoscopy, have procedures done at bedside by designated endoscopy staff and the medical team. Only ICU patients that require fluoro/specialized equipment i.e. ERCP’s are done in the endoscopy suite. Those arriving from an IMC or ICU (i.e. ERCP’s) are accompanied by an RN from that unit and also upon return to that unit. The most common procedures include colonoscopy, upper endoscopy, flexible sigmoidoscopy, small bowel enteroscopy, video capsule endoscopy, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic mucosal resection (EMR); endoscopic ultrasound (EUS); spyglass; spirus enteroscopy; endoscopic surgical dissection (ESD); and per oral endoscopic myotomy (POEM).
Nursing Care
The GI (gastrointestinal) staff strives to provide compassionate patient centered care that recognizes and respects the patient’s values, culture, and preferences consistent with Patient Rights and Responsibilities and Code of Ethics policies. The nursing staff strives to achieve excellence in quality patient care using the nursing process. The focus is on the pre, intra, and post procedure assessment and care of GI procedural patients. The GI unit specific job descriptions and competency requirements identify the skills required for each specific role. Standard of Practice guidelines utilized by the department are consistent with:
- Gastroenterology Nursing, A Core Curriculum
- American Society for Gastrointestinal Endoscopy
- Society of Gastroenterology Nurses and Associates, Inc.
- Association for the Advancement of Medical Instrumentation Standards
- Multisociety Guideline on Reprocessing Flexible Gastrointestinal Endoscopes
Health Care Team
The Endoscopy Medical Director is board certified in his/her respective specialty and a faculty member of the University of Florida Division of Gastroenterology, Hepatology, and Nutrition. Procedural Care is provided by gastroenterology, hepatology, surgery, and anesthesia attendings, fellows, residents, CRNA/AA’s, RN’s, Clerk/PCA’s, Surgical Technologists, and Anesthesia/Endoscopy Technicians. Support staff includes a receptionist and Administrative Assistant. Multi-disciplinary care is provided by nursing, medicine/surgery, pharmacy, respiratory, and other health care services as indicated by the patient’s health status and identified needs.
The nursing management structure consists of a Nurse Director of GI/ Endoscopy and a Clinical Coordinator. In the absence of the Clinical Coordinator, the Charge Nurse will facilitate clinical care delivery and the Director will serve as a resource for problem resolution. There is an assigned Charge Nurse over the Pre/Intra /Post-Procedural areas every day. The Endoscopy Suite is under the umbrella of the Operations Division with nursing oversight from the CNO.
Staff is oriented to the unit during a planned orientation program based on job requirements and past experience. Competency assessment on identified skills and knowledge needs is performed initially, annually, and on an as needed basis. Staff educational requirements are defined by the unit/role specific job descriptions and organizational and Nursing expectations and requirements. All direct patient care staff are provided training experiences to obtain and maintain competencies in their role as defined by the job description for the specific role.
Basic RN requirements include licensure by the Florida State Board of Nursing and BLS/ACLS certification. Professional certification (CGRN) from the Society of Gastroenterology Nurses Association is available and encouraged.
Basic requirements for Clerk/PCA’s are CNA licensure by the Florida State Board of Nursing and BLS.
Basic requirements for Anesthesia/Endoscopy Technicians/Surgical Technologist is BLS. Professional certification (CFER) from the Certification Board for Sterile Processing and Distribution, Inc. (CBSPD) or CER from the International Association of Healthcare Central Service Materiel Management (IACSMM) is available and encouraged. SGNA Associates and Advanced Associates Programs are available and encouraged. Certification in Surgical Technology (CST) is available from the Association of Surgical Technologists (AST) as applicable.
Staffing Plan
The team nursing model is used as the method of care delivery on this unit. Staffing of caregivers is based upon actual number of planned cases and number of procedure rooms daily. Scheduled working hours may be flexible, based on the distribution of the case load.
Staffing Pattern:
- The intra-procedural team includes a minimum of 1 RN and 1 Anesthesia/Endoscopy Technician/Surgical Technologist
- The pre/post procedural team includes RN’s a minimum of 1 per two bays plus Charge Nurse, and 2 Clerk/PCA’s.
- Scope Reprocessing Room: 1 Anesthesia/Endoscopy Technician or Surgical Technologist
- Portable (Off unit case): 1 Anesthesia/Endoscopy Technician or Surgical Technologist
- Waiting area: Receptionist
- Emergency/afterhours cases: 1 RN and 1 Anesthesia/Endoscopy Technician or Surgical Technologist
Patient assignments are made by the Charge Nurse and are based upon safety concerns, experience level/competencies of the staff member, degree of supervision required, relevant safety and infection control issues, complexity of care, monitoring capabilities, and skills required.
The Clinical Coordinator or designee, in accordance with the Hospital Plan for Nursing Care and nursing policy, determine the need for overall adjustment in staff, either increasing or decreasing according to census.
In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate at 75% occupancy would be 11 Registered Nurses, 4 Tech’s, 2 Clerk/PCA’s and 1 receptionist.
Requests for Planned Time Off (PTO) will be reviewed on a case by case basis and will take into account the staffing needs of the unit. Requests are granted only if minimum staffing numbers are maintained with coverage that does not incur overtime.
Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous.
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