51 - Nursing Jambalaya: Mixing Safety, Surgery, and Research Protocols

Description: Description of the team
The administration of chemotherapy via Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) intraoperatively presents unique clinical challenges requiring meticulous coordination, rigorous safety protocols, and innovative process development.

This clinical improvement project highlights the pivotal role of the perioperative team. The registered nurses (RNs) within a multidisciplinary team- including surgeons, surgical technologists (STs), anesthesiologists, and pharmacists- are involved in designing and implementing a safe, standardized workflow to deliver PIPAC chemotherapy effectively.
Our team, comprised of 4 perioperative RNs, 4 STs, 4 surgeons, 1 anesthesiologist, and 1 pharmacist, collaborated to develop a comprehensive intraoperative process integrating patient safety measures, staff safeguards, and operational efficiency. Key elements included preoperative planning with enhanced communication strategies, real-time intraoperative coordination, and postoperative debriefing to ensure continuity of care and procedural safety.

Preparation and planning
To prepare the team, special considerations addressed by the team involved training all staff on the novel procedure, specialized equipment use, and strict adherence to occupational safety standards. This includes adhering to a specialized protocol to reduce aerosolized chemotherapy exposure risks with three layers of safety: establishing an airtight abdomen with laparoscopic balloon trocar ports, presence of an advanced ventilation system, and removal of all OR personnel for remote patient monitoring outside the operating room.
The team had to plan to meet requirements for remote monitoring of the patient during the surgery and aerosolized chemotherapy. The team also navigated the utilization of equipment for off-label for research purposes, necessitating a rigorous protocol development and staff education to maintain compliance and patient safety with strict adherence to the protocol. Additionally, the team worked to establish a robust supply chain and inventory management system to source and manage international disposables critical to the procedure. Implementing PIPAC protocols is a special circumstance and requires extensive preparation and dedication from the team.

Assessment
This initiative demonstrates how perioperative RNs serve as essential facilitators in bridging clinical innovation with safety and quality care standards. By fostering multidisciplinary collaboration, comprehensive education, and stringent process controls, the team successfully integrated PIPAC chemotherapy delivery into intraoperative practice, enhancing patient outcomes while mitigating risks.

Implementation
The team prioritized training, which focused on the overall procedural changes, including educational sessions and practice run-throughs. The process was dynamic, and adapting quickly was essential to ensure that safety measures and workflows were effectively established for each team member.

Outcome and Implications
The team successfully integrated PIPAC chemotherapy delivery into intraoperative practice, enhancing patient outcomes while mitigating risks. There have been zero chemotherapy spills or staff exposures.
Our findings support the expanding role of perioperative nursing in clinical research environments and underscore the importance of innovation-driven teamwork in improving complex surgical procedures.