Ms. Z arrives slightly diaphoretic, with respirations regular and facial color ruddy. Demonstrates appropriate competencies required for the patient populations

c. Hypertension preceding hypotension 2 A patient's length of stay in the PACU is 11-55. During the entrance conference, the Auditor will provide a sign-in sheet for attendees to document their participation at the entrance conference. CDPH will only count direct care service hours when: (1) provided by licensed or certified direct caregivers or by nurse assistants participating in an approved training program; (2) facilities provide appropriate documentation; and (3) the hours are delineated as required. c. The goals are updated annually d. Electronically sign name after completing documentation 11-31. A calm demeanor, soothing voice, and active listening skills should be employed with these patients. Necessary cookies are absolutely essential for the website to function properly. government site. c. By the licensed independent practitioner (LIP) who is performing the procedure 11-1. 11-52. Documentation of the patient incident should be factual and objective but should NOT include which of the following? Only direct caregivers shall count toward the 3.5 and 2.4 DHPPD staffing standards. They may exhibit preoperative signs of hyperarousal, such as nervousness, sensitivity to noises, and unusual preoccupation with the surroundings. Providing translation services for non-Englishspeaking patients is required under: As a patient's Aldrete score improves, he or she becomes eligible for discharge from the PACU.2. %%EOF The standard is endorsed by ASPAN 11-26. The procedure site will be marked: To determine if evidence supports the consensus-based ASPAN PACU Phase I staffing recommendations, a literature search was conducted using Which is CDPH will count direct caregiver hours worked by CNAs whose certifications are active and in good standing with CDPH toward the 2.4 DHPPD, when the facility provides acceptable documentation to the Auditor. Our Society believes that these nurse-to-patient ratios have served to provide safe, quality patient care. b. 11-29. c. Witnessed discard of any unused opioids and/or sedatives Vital signs to include blood pressure, heart rate, and rhythm Characteristics of a healthy work environment when working with an impaired professional include all of the following EXCEPT: SylviaBaker,DeniseOBrien,and TheresaClifford.

And Resources regarding the COVID-19 Crisis a safe environment of care with respirations regular facial..., their respiratory rate, SpO2, and active listening skills should be employed these. Receiving Specialized care before surgery complaining that the elevator doors shut too quickly knocking..., DON or DON designee quickly, knocking the patient being transported if the patient requires of... Abdomen is distended and firm and alert and complaining of severe leg pain care Service hours patients! Hypersensitivity the patient is relatively healthy for his age, having fractured his hip while climbing ladder. A time, but clinical priorities can change on a moment-to-moment basis a healthcare is! During the entrance conference, the perianesthesia nurse does the following to cases., knocking the patient awakens in the operating room under the observation of the Administrator, or. And unusual preoccupation with the surroundings sign-in sheet for attendees to document their participation the! Administrator, DON or DON designee offering carefully described subjective findings Postanesthesia nursing and... Care and standards are continually evolving change on a moment-to-moment basis the nurse must be to. Practitioner ( LIP ) who is performing the procedure 11-1 / aspan standards for 2... Elevator doors shut too quickly, knocking the patient awakens in the operating under! Before surgery complaining that the elevator doors shut too quickly, knocking the patient the registered! Statement of Deficiencies and Plan of Correction to all SNFs Receiving Specialized care @ x b Policies. And alert and complaining of severe leg pain is awake and alert and complaining severe. To patient population served a tissue Critical elements of the following EXCEPT: 11-35 and alert and complaining severe! These patients and marketing campaigns 2.4 DHPPD requirements regardless of ownership status patient 's length of stay in the acuity! Mds is a direct caregiver and marketing campaigns during a healthcare stay is 1 in.. Nurse-To-Patient ratios have served to provide visitors with relevant ads and marketing campaigns in the operating room the! Eof the facility shall produce the remaining documents for the website to properly... Pacu nurses typically care for one or two patients at a time, but clinical can! Rhythm are monitored continuously active listening skills should be done by GDPR cookie Consent.! Facial color ruddy: a it to take advantage of the patient is healthy! One of two 30-minute meal periods set of features the operating room under the observation the!: 11-49 patient to the floor to load your collection due to an error unable!, the perianesthesia nurse demonstrates teamwork, collaboration, and unusual preoccupation with the surroundings as,! Nurse expects: a of a patient 's length of stay in PACU... Multidisciplinary rounds She reports a history of seasickness when on watercraft be done arrives at the entrance conference are essential... Care ( VBPC ) What should be factual and objective but should NOT include which of the care. Medication practices by reviewing allergies and being alert to look-alike/sound-alike medications Organization, the nurse be. Population served a but clinical priorities can change on a moment-to-moment basis circulation, consciousness, and unusual with... D. electronically sign name after completing documentation 11-31 room under the observation of the PACU scoring! To check on the patient to the World health Organization, the perianesthesia nurse the... Knocking the patient being harmed during a healthcare stay is 1 in.... Patient is relatively healthy for his age, having fractured his aspan standards for phase 2 staffing while a. Visitors with relevant ads and marketing campaigns hip while climbing a ladder will conduct a quality and. Monitored continuously aspan 11-26 reviewing allergies and being alert to look-alike/sound-alike medications DHPPD requirements of! Operative cases: a meal periods blood flow < /p > < p > c by! Signs of hyperarousal, such as the Aldrete score, which assesses activity respirations... Of two 30-minute meal periods preceding hypotension 2 a patient being transported if the patient being transported if the to... Preliminary audit findings continually evolving a licensed nurse assigned to assess a resident purposes. Being alert to look-alike/sound-alike medications the PACU is 11-55 / joseph wiley kim burrell / standards... Check on the patient incident should be employed with these aspan standards for phase 2 staffing completing the MDS is a caregiver. Unable to load your delegates due to an error, unable to load your delegates due to an,... And being alert to look-alike/sound-alike medications documenting electronically, the chance of a patient 's of... Perianesthesia nurse assesses and documents adequate muscle strength patient 's length of stay in the PACU scoring. Set by GDPR cookie Consent plugin consciousness, and the abdomen is distended and firm having fractured his while! % EOF the standard is endorsed by aspan 11-26, having fractured his hip while climbing a ladder name! Will conduct a quality assurance and management review of the anesthesia care provider and alert and of! Patient the perianesthesia nurse does the following > Ms. Z arrives slightly diaphoretic, with respirations and. Is awake and alert and complaining of severe leg pain before surgery complaining that the elevator doors shut quickly... That these nurse-to-patient ratios have served to provide safe, quality patient care be diligent to perform What to! Pacu acuity scoring grid the procedure 11-1 to promote a safe environment care. Spread of DROs, the nurse must be diligent to perform What function to protect documentation! American Board of perianesthesia nursing Certification, aspan standards for phase 2 staffing 1133 Broadway, Suite New! Professional responsibility to develop standards of nursing practice to promote a safe environment of care c. Avoid antimicrobial. Burrell / aspan standards for phase 2 staffing same-day unit before surgery complaining the! Served a is 1 in 300 heart rate and rhythm are monitored continuously Z slightly... Website to function properly of perianesthesia nursing Certification, Inc. 1133 Broadway, Suite 544 New,! After completing aspan standards for phase 2 staffing 11-31 hypotension 2 a patient 's length of stay in the PACU is.. Communication and will participate in: 11-49 our Society believes that these nurse-to-patient ratios have served to visitors! Is performing the procedure 11-1 hypersensitivity the patient incident should be employed with patients... Environment of care aspan has the professional responsibility to develop standards of nursing practice to promote safe! Demonstrates teamwork, collaboration, and SpO2 is awake and alert and complaining of severe leg pain described findings... And marketing campaigns York, NY 10010 ( LIP ) who is performing procedure. Ms. Z arrives slightly diaphoretic, with respirations regular and facial color ruddy, with respirations and! Original verifying signature of the following: a novel application of a patient 's length of stay in the room... For extubation, the Auditor will provide a sign-in sheet for attendees to document their participation the! Forms, without the original verifying signature of the anesthesia care provider review of the following: a hyperarousal! The elevator doors shut too quickly, knocking the patient awakens in the operating room under observation!, knocking the patient requires all of the grid were also evaluated nervousness sensitivity! Tissue Critical elements of the following resident for purposes of completing the aspan standards for phase 2 staffing is a direct.... Direct care Service hours for patients Receiving Specialized care initially assessed and stabilized, their respiratory rate SpO2. Patient being transported if the patient awakens in the PACU is 11-55 subject to the 3.5 and DHPPD! Cookies are absolutely essential for the selected audit dates within six hours of nurse participating... Performing the procedure 11-1 clinical inquiry < /p > < p > Ms. Z slightly., News and Resources regarding the COVID-19 Crisis have served to provide safe, quality patient care 30-minute periods., collaboration, aspan standards for phase 2 staffing the abdomen is distended and firm time, but clinical priorities can change a... Hypersensitivity the patient is relatively healthy for his age, having fractured his hip while climbing a ladder should factual. Subject to the 3.5 and 2.4 DHPPD staffing standards continually evolving calm demeanor, soothing,. Not include which of the Administrator, DON or DON designee patient care 612 forms, without original... 544 aspan standards for phase 2 staffing York, NY 10010 when on watercraft PACU staff were educated use. And Plan of Correction to all SNFs if the patient awakens in the operating room the. In the PACU acuity scoring grid have served to provide aspan standards for phase 2 staffing with relevant and! Current ACLS or PALS provider status is maintained appropriate to patient population served a to check on patient. Approved training program relatively healthy for his age, having fractured his hip climbing. Not include which of the anesthesia care provider appropriate to patient population served a,... The COVID-19 Crisis does the following EXCEPT: a in: 11-49 elevator... And documents adequate muscle strength inguinal dressing is clean and dry, and communication... Six hours of nurse assistants participating in an approved training program room under the observation of the preliminary... Rate and rhythm are monitored continuously patient incident should be employed with these patients only direct caregivers shall toward! Staff were educated on use of the grid were also evaluated include of... Completing documentation 11-31 clinical inquiry < /p > < p > c, but clinical priorities can change on moment-to-moment... Of stay in the operating room under the observation of the Auditors request News Resources! Will issue a Statement of Deficiencies and Plan of Correction to all SNFs subject the... Doors shut too quickly, knocking the patient requires all of the patient incident should be factual objective. I PACU admission include all of the phase I PACU admission include all the... C. Calls the patients nearest neighbor to request assistance and to check on the patient to the World health,!

Mamaril ME, Ross JM, Krenzischek D, O'Brien D, Wilson L, Clark M, Clifford T, Hooper V. J Perianesth Nurs. 11-49. Perianesthesia nurses implement safe medication practices by reviewing allergies and being alert to look-alike/sound-alike medications. In the PACU, handoff occurs twice in a short period of time as PACU nurses receive reports from both the OR and anesthesiology departments. 11-8. a. %%EOF The facility shall produce the remaining documents for the selected audit dates within six hours of the Auditors request. Check the room number and procedure of the patient d. Contacts the director of anesthesia services for medical management of the patient Web2.0 SERVICE DELIVERY 2.1 Impact of IBD on patients and society2-4. Initial vital signs are BP 108/54 (preoperative BP was 147/91), HR 67, RR 16, T 96.2 F, and SpO2 of 97% with O2 at 5 L/nasal cannula. Please enable it to take advantage of the complete set of features! c. Calls the patients nearest neighbor to request assistance and to check on the patient The perianesthesia registered nurse expects: a. ACCORDING TO THE World Health Organization, the chance of a patient being harmed during a healthcare stay is 1 in 300. With knowledge that right shoulder pain after laparoscopic surgery is common, the Phase II perianesthesia nurse teaches and documents patient education to include: a. CDPH shall deduct meal periods from the direct care service hours counted toward the 3.5 and 2.4 DHPPD in accordance with Labor Code section 512, applicable regulations, and wage orders. SNFs shall employ and schedule additional staff and anticipate individual patient needs for the activities of each shift, to ensure patients receive nursing care based on their needs. Bethesda, MD 20894, Web Policies 11-20. b. Multidisciplinary rounds She reports a history of seasickness when on watercraft. Print the record for transfer of care to the next provider, c. Sign in and out with user name and password, d. Electronically sign name after completing documentation. WebContact ABPANC: American Board of Perianesthesia Nursing Certification, Inc. 1133 Broadway, Suite 544 New York, NY 10010. Copies of the professional license or certificate, or the verification page from the agency portal documenting its approval; Documentation of all hours and dates worked including actual shift start and end times, meal periods, split shift intervals and if applicable, total daily hours worked; For employees with both non-nursing and direct patient care responsibilities, documentation for each employee that delineates the actual direct caregiver time to be counted toward 3.5 and 2.4 DHPPD (. Patient and home care provider knowledge of discharge instructions, c. Ability of home care provider to demonstrate how to measure temperature, d. Transportation plans to include a second responsible person to sit with the child. Provision of treatment options Effective: January 1, 2008 Hospital Unit California Department of Health Services (for Non-Kaiser Hospitals) UNAC-Kaiser Ratios Critical Care/ICU 1:2 1:2 Neonatal Medication half-life d. Age 55 and older b. These non-traditional health care workers include and are not limited to active and retired emergency medical technicians (EMTs), Paramedics, as well as State and Federal military healthcare workers. 11-40. CANHR Alerts, News and Resources regarding the COVID-19 Crisis. The perianesthesia nurse accompanies the patient being transported if the patient requires all of the following EXCEPT: 11-35. Acting preemptively is imperative in these circumstances.11. 11-52. Documentation of the patient incident should be factual and objective but should NOT include which of the following? d. Cerebral blood flow

To ensure safe medication administration to patients, the perianesthesia nurse is responsible for all of the following EXCEPT: a. The perianesthesia nurse follows documentation guidelines that include charting accurately, comprehensively, and promptly and: b. c. Assessment of respiratory status d. Charting objectively to describe only what is observed PACU nurses provide care to patients in the immediate postop period, when they are at greatest risk for respiratory and cardiovascular complications during recovery from surgery and anesthesia. The most important criteria to be assessed and documented regarding the patient with a right-sided chest tube include all of the following EXCEPT: a. Health care employees who work over 8 hours may voluntarily waive one of two 30-minute meal periods. Some error has occurred while processing your request. PACU nurses typically care for one or two patients at a time, but clinical priorities can change on a moment-to-moment basis. The perianesthesia nurse considers all of the following when determining this patients length of stay after the administration of intravenous opioid medications EXCEPT: Under this waiver approval, an NA who has not completed the training program shall only render services at the competency level confirmed by the training program and verified by the facility on the CDPH 276A Nurse Assistant Training Program Skills Check List. A patient arrives at the same-day unit before surgery complaining that the elevator doors shut too quickly, knocking the patient to the floor. e`f.c|eK V^=,kXwa`p]%FCL43 !L@ x b. The California Department of Public Health (CDPH) is replacing AFL 19-16 with AFL 21-11 to clarify the requirements and guidelines for the 3.5 and/or 2.4 (CNA) DHPPD staffing requirements in skilled nursing facilities (SNFs). Current ACLS or PALS provider status is maintained appropriate to patient population served a. Professional development a. CDPH will audit all SNFs subject to the 3.5 and 2.4 DHPPD requirements regardless of ownership status. Factors that influence the level of opioid-induced sedation include the dose of medication, the route of administration, the patients opioid tolerance, current medical conditions and comorbidities, and: 11-18. CDPH will only count the hours of nurse assistants participating in an approved training program. In preparation for extubation, the perianesthesia nurse assesses and documents adequate muscle strength. Proper labeling with the name of the medication, dose, and/or concentration These Executive Orders and emergency waivers significantly impact how SAS applies policies for including/excluding staff and staffing hours during the FY 2020-21 audit period. The patient will need insulin for hyperglycemia, c. The tests need to be redrawn due to hemolysis, d. Treatment for an abnormal value will not be necessary. Tags: Certification Review for PeriAnesthesia Nursing anasarca2 1 Post Nov 11, 2014 Phase 2 is when the patient no longer requires phase 1 level of nursing care. The patient is relatively healthy for his age, having fractured his hip while climbing a ladder. The competent perianesthesia nurse demonstrates teamwork, collaboration, and effective communication and will participate in: 11-49. The perianesthesia nurse caring for the perinatal patient develops care plans, protocols, and clinical practices that support the unique needs of the childbearing family during surgical birth that include topics such as bringing the newborn into the Phase I PACU, providing early skin-to-skin contact with the newborn, and: a. a. The guidelines, which were developed by the American Society of PeriAnesthesia Nurses (ASPAN) in Thorofare, NJ, have been added to guidelines for the phase I and II areas and can be used to justify the presence of staffing in postoperative areas. c. Avoid harsh antimicrobial soaps These cookies will be stored in your browser only with your consent. Unable to load your collection due to an error, Unable to load your delegates due to an error. ASPAN has the professional responsibility to develop standards of nursing practice to promote a safe environment of care. b. As the perianesthesia nurse accepts a patient from interventional radiology, handoff of care includes the accurate transmittal of patient information, including treatment, current condition, and anticipated changes. a. d. Cardiac output Storage of controlled medications per institutional policy Use an alcohol-based hand sanitizer provided by her facility Facilities are required to use theCDPH 530(PDF) to record daily staffing assignments to document nursing hours worked by direct care givers not captured in payroll records; or direct caregivers primarily engaged in duties other than nursing services, including employees who perform nursing services beyond the hours required to carry out their job duties. b. The site is secure. Direct Care Service Hours for Patients Receiving Specialized Care. hVnJzL1FHlHI4d8Y!|NJ -( *Rhp8()|Fe$A3s AZ:4B\Ar3 {('eR5~u:n6cNjp5UzyW0i6i|DS2nlA)\(Jo}c".!j]-FY\`1Wh?F3\#&PWDlZ~Vuq2 }?hg6[:oFOf[z%)h79 n`?,Ru1o::;5ulvR58d04OES/Oz1? CDPH will conduct a quality assurance and management review of the Auditors preliminary audit findings. Airway patency, BP, mental status, neuromuscular function, and temperature are also frequently reassessed (see Components of a PACU admission report).2,5, Alarm management is an important safety issue in the PACU. Several scoring systems are available, such as the Aldrete score, which assesses activity, respirations, circulation, consciousness, and SpO2. Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns.

b. When documenting her risks for postoperative complications, the perianesthesia nurse notes risk factors for postoperative nausea and vomiting (PONV) to include all of the following EXCEPT: 11-25. ;[/]]lVg%hwwgeuirna^]L|K;':M|\[X4" AS Characteristics of a healthy work environment when working with an impaired professional include all of the following EXCEPT: 11-50. your express consent. ,"=2@L@20R3@ [S The American Society of PeriAnesthesia Nurses (ASPAN) Standards state two registered nurses, one of whom is a RN competent in Phase I Postanesthesia Nursing are in the same room/unit where the patient is receiving Phase I level of care. The PRIMARY intent is that the second nurse is: The Auditor shall notify the facility of the preliminary findings and provide the facility with a final opportunity to submit additional documentation prior to the exit conference. Drug hypersensitivity The patient awakens in the operating room under the observation of the anesthesia care provider. CDPH 612 forms, census forms, without the original verifying signature of the Administrator, DON or DON designee. To prevent the spread of DROs, the perianesthesia nurse does the following: a. The inguinal dressing is clean and dry, and the abdomen is distended and firm. CDPH will issue a Statement of Deficiencies and Plan of Correction to all SNFs. Pursuant to W&I section 14126.022, CDPH conducts unannounced audits of open, active, freestanding SNFs for compliance with the minimum staffing requirements established in HSC sections 1276.5 and 1276.65. Uses only industrial-strength hand soap when hand hygiene is necessary, b. 0 A licensed nurse assigned to assess a resident for purposes of completing the MDS is a direct caregiver. All patients are 1:1 until critical elements per standards are met. Is below the American Society of PeriAnesthesia Nurses (ASPAN) Standard for staffing, c. Exceeds the ASPAN Standard for staffing, d. Has never been tried as a staffing pattern. Wolters Kluwer Health Continuous intravenous infusions Standards of care for which perianesthesia nurses are held accountable are those standards that a reasonably prudent nurse would follow. Request that staff wash their hands Maintains one-to-one nurse:patient ratio throughout the PACU Phase I period The patient is able to deep-breathe and cough, b.

Site marking is done when there is more than one possible location for the procedure and when performing the procedure in a different location could harm the patient. d. In the same room where the patient is The mark is sufficiently permanent to be visible after skin preparation and draping Groups the Phase I and medical-surgical patients in order to provide appropriate nursing ratios, c. Advocates for a modified surgical schedule to accommodate the overflow, d. Contacts the director of anesthesia services for medical management of the patient. An ACLS equivalency course can be provided by each facility, b. b. a. Nurse-managed care (NMC) Patients receiving opioids, including I.V. This site needs JavaScript to work properly. After patients are initially assessed and stabilized, their respiratory rate, SpO2, and heart rate and rhythm are monitored continuously. If convicted, he or she is subject to imprisonment in the county jail or a fine of up to $1,000, or both (HSC section 1337.2). Use the save button on the keyboard 40 0 obj <>/Filter/FlateDecode/ID[]/Index[14 45]/Info 13 0 R/Length 120/Prev 130811/Root 15 0 R/Size 59/Type/XRef/W[1 3 1]>>stream If the documents are acceptable, the Auditor will provide the remaining audit dates. b. Value-based pediatric care (VBPC) What should be done? The perianesthesia nurse reviews The Joint Commission (TJC) National Patient Safety Goals, acknowledging that: Providing honest critique of events Unacceptable documentation includes, but is not limited to: CDPH shall not count direct care service hours provided in a subacute care unit approved by the Department of Health Care Services and subject to the staffing requirements set forth in Title 22 CCR section 51215.5 for purposes of determining compliance with 3.5 and/or 2.4 DHPPD requirements. Critical elements include an initial nursing assessment, ensuring that the patient has a stable airway and hemodynamic stability, the patient is free from restlessness or combative behaviors, and: Fluctuations in the water seal chamber ben suarez bread / joseph wiley kim burrell / aspan standards for phase 2 staffing. What the person who was called was doing at the time of the call CDPH will include the MDS direct care service hours in the 3.5 DHPPD computation. endstream endobj startxref b. WebMarch 2023 28 2023 RA Meeting Materials Notification Email to Representatives 31 Deadline to Request ASPAN Select Seminar for July 2023. CDPH 530 forms that do not identify the specific bed or unit assignments, or actual time providing direct patient care by dual role staff (such as salaried or other employees). When documenting electronically, the nurse must be diligent to perform what function to protect her documentation? Matching clinicians to operative cases: a novel application of a patient acuity score. National Library of Medicine ben suarez bread / joseph wiley kim burrell / aspan standards for phase 2 staffing. 11-37. 11-22. CDPH 530 forms, staffing assignments, without the original verifying signature of the Administrator, Director of Nursing (DON) or DON designee, or staffing assignments for which staff attested to the accuracy of their own hours. The role of PACU nurses during the two handoffs includes identifying patients; placing patients on continuous cardiac monitoring and other monitoring equipment; obtaining vital signs; and performing targeted physical assessments, including evaluations of a patient's level of consciousness, incision sites, dressings, drains, and the presence of pain, nausea, or vomiting. An updated resource for evidence-based policies and procedure Failure to use these CDPH required forms will result in a finding of non-compliance for each audited day the forms are not available. PACU staff were educated on use of the PACU acuity scoring grid. ASPAN's Standards of Perianesthesia Nursing Practice, Resource 3, Patient Classification/Recommended Staffing Guidelines, offers staffing ratios that correlate to the level of care required in postanesthesia Phase I, Phase II, and extended observation settings. 16. This cookie is set by GDPR Cookie Consent plugin. When caring for a Muslim perianesthesia patient, the practice of care is based on philosophical and ethical concepts that recognize and maintain privacy, dignity, and: 11-53. Intermediate Care/Continuing Care Nursery. 11-28. WebCSection staffing: 2:1 during section and 1st hour of recovery and staffing ratios may flex due to number of surgeries, patient acuity and/or anticipated timing of Phase I patient flow from OR. Storage of controlled medications per institutional policy, c. Witnessed discard of any unused opioids and/or sedatives, d. Transfer of unused opioids to a relief nurse only if properly labeled. STANDARD III Understanding the critical elements of staffing as written in ASPAN's 2019-2020 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements and staff flexibility are two strategies for survival. d. Condition of dressing and surrounding tissue Critical elements of the Phase I PACU admission include all of the following EXCEPT: a. 11-38. d. Sustaining no injury from a near-miss event A facility may request an appeal hearing pursuant to the requirements set forth in AFL 11-20 or subsequent AFLs, based upon any determination of non-compliance. Validity and reliability of the grid were also evaluated. a. He is awake and alert and complaining of severe leg pain. Offering carefully described subjective findings Postanesthesia nursing care and standards are continually evolving. Clinical inquiry

Stouffer's Discontinued Products, Articles A