Evaluating Nurses’ Utilization of Alderete’s Score Chart in Monitoring of Patients in the Post Anesthesia Care Unit at Kenyatta National Hospital

Abstract

Background: There have been several advances in anesthesia and surgical techniques that have led to improvement of patients’ care after surgery. However post anesthesia patients are at risk of developing complications and need to be monitored closely. Alderete’s scoring tool was introduced in May 2018 at Kenyatta National Hospital to determine the suitability of patients for discharge to the post-surgical care units after anesthesia. Introduction of the monitoring tool was necessitated by the fact that patients were deteriorating post anesthesia due to complications. There was also no standard tool for monitoring the post anesthesia patients that had been adopted to detect any deviation from the normal. Alderete’s scoring system includes assessing a patient’s responsiveness, activity or movement of limbs, respiration, blood pressure and oxygen saturation level as determined by pulse oximetry. Since the introduction of the monitoring tool, no study has been done to assess its utilization in monitoring patients. Objective: To evaluate nurses’ utilization of Alderete’s score chart in monitoring of patients in post anesthesia care unit of Kenyatta National Hospital (KNH). Methods and materials: A descriptive cross sectional study was conducted among nurses working in post anesthesia care unit main theatres at KNH. The study used mixed research methodology combining both quantitative and qualitative methods. Self-administered questionnaires were used to collect data from nurses and the theatre in charge. Quantitative data was collected using closed-ended and rating questions while qualitative data was collected using interview based questionnaires. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics were presented in frequencies and percentages. Categorical data was subjected to inferential statistics using Pearson’s Chi square to determine relationship between variables. Qualitative data was coded using assigned numbers to the responses then arranged in groups into emerging patterns and analyzed using thematic analysis. Propositions and conclusions were made and results presented in form of tables, pie charts and narrative texts. Results: A total of 73 nurses participated in the study of which 56% were females while 45% were males.54.9% of the nurses were aged between 25-39 years, 33.8% were aged between 40-49 years while 11.3% were aged between 50-59 years. The mean age of the participants was 38 years. There was no significant relationship between the use of Alderete’s score chart and level of training at confidence interval of p=0.210. However 85.7% of BScN trained were able to use the chart followed by 82.4% of KRPON trained nurses. This implied that those with higher training understood the importance of using the Alderete’s chart more than the lower level of training. There was significant statistical evidence at p=0.028 that the use of Alderete’s score chart depends on training of staffs on its use as evidence in the odds ratio showed that those nurses using the monitoring tool were 1.488 times more likely to be trained on the use of the tool than those who were not trained on its use. Conclusion: The findings of the study concluded that Alderete’s score chart was being used by nurses to monitor patients even though most of the nurses had not been trained and therefore did not understand the components of the chart. Recommendations: There is need to train nurses to understand the components of the tool better. The hospital needs to improve on the nurses to patients’ ratios and also ensure that there are enough equipment and supplies necessary for monitoring patients.