Background

There is limited evidence in the literature for nursing management of bariatric surgery in severely obese patients with left ventricular assist device (LVAD) implantations.

Methods

The Plan-Do-Study-Act (PDSA) method was used to guide nursing care, along with multidisciplinary team collaboration for patient care and nursing management.

Results

The Cardiologist and Bariatric Surgeon collaborated on the medical care for these patients, but missed including the nursing care for the patients. Due to the LVAD status of the patients, the patients had to be recovered in the Cardiovascular Unit and not on the Medical Surgical floor, which was extremely challenging due to lack of knowledge for Bariatric post-op care by the Cardiovascular Unit Registered Nurses (CVU RNs). Literature available for nursing management at that time was not sufficient to support care for this combined patient population. The LVAD Coordinator & Bariatric Clinical Supervisor collaborated to formulate an appropriate plan of care, based on the Bariatric Surgeon's orders, while balancing the bariatric surgery postoperative orders with the Cardiologist's recommendations, to manage the patient's immediate needs. Multidisciplinary meetings were held to present, discuss, and approve the Clinical Nursing Pearls tool that was utilized after several PDSA cycles between patients. The tool provided streamlined guidance and support (e.g. pain management, postoperative activity, fluid management, cardiovascular stability, which team/service to call for issues, etc.) for the CVU RNs, as additional patients underwent bariatric surgery post LVAD implantation.