Staff Education On The Use Of The Lace Index In Clinical Settings, Carrole Dorcent

Walden Dissertations and Doctoral Studies

As of 2008, the Centers for Medicare and Medicaid Services has instituted monetary penalties for institutions with excess readmissions. As a result of these initiatives, hospitals are investing resources and efforts to educate their staff to use tools aimed at reducing readmission rates. The LACE index tool is one metric used to identify patients at high risk for readmission. The practice-focused question addressed in this project was whether the use of a teaching module is effective at improving clinical staff knowledge on the LACE index. The purpose of the project was to develop a teaching module to educate advanced practice …

The Effects Of Scheduling Acetaminophen And Methocarbamol Administration On Postoperative Opioid Use And Related Side Effects Among Cardiac Surgery Patients, Whitney Jamison

DNP Projects

The Effects of Scheduled Acetaminophen and Methocarbamol Administration on Postoperative Opioid Use and Related Side Effects Among Cardiac Surgery Patients

ABSTRACT

Purpose

Opioid therapy is commonly prescribed to combat surgical pain in hospitals across the United States and is associated with many negative side effects including dependence and nausea. The purpose of this study was to retrospectively examine the effects of scheduling acetaminophen and methocarbamol administration postoperatively throughout the cardiac surgery patients’ hospital stay. Through retrospective chart reviews, the aims of postoperative opioid use, postoperative opioid use according to hospital length of stay, antiemetic use, and opioid prescription at discharge …

Adult Postoperative Open-Heart Patients: Anemia And 30-Day Hospital Readmission, Lindsey Ryan

Dissertations

Background. In 2013 alone, more than 4% (3.9 million) of patients discharged from a hospital were readmitted. Anemia following a surgical procedure is associated with early hospital readmission.

Purpose/Aims. The following were specific aims of this dissertation:

• Aim 1. To develop an operational definition of the term condition-based maintenance as applied to health care and discuss the applicability and effectiveness of condition-based maintenance within health care.
• Aim 2. To identify the number of adult patients undergoing elective open-heart surgery with preoperative anemia.
• Aim 3. To examine the relationship between preoperative anemia, sociodemographics, and 30-day hospital readmission rates among postoperative open-heart …

Early Extubation After Cardiac Surgery: An Evidenced-Based, Nurse-Driven Protocol, Emily Brooks

DNP Final Reports

Prolonged mechanical ventilation in cardiac surgery patients has been associated with increased hospital stay, increased intensive care unit (ICU) length of stay, higher health care costs, and higher morbidity from atelectasis, intrapulmonary shunting and pneumonia. Early extubation of post-operative cardiac surgery patients has been associated with shorter ICU and overall hospital stays, reduced mortality, decreased resource use, and is safe and effective in elderly patients with no increased risk of reintubation. As such, the question arises in intubated post-operative cardiac surgery patients, how does a nurse-driven extubation protocol compared to no standardized protocol affect extubation rates within six hours post-operative? …

Factors Associated With Postoperative Pain Among Patients After Cardiac Surgery In The Tertiary Care Teaching Hospital Of Karachi, Pakistan, Sineer Micah, Rubina Barolia, Yasmin Parpio, Santosh Kumar, Hasanat Sharif

School of Nursing & Midwifery

Background: Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients' beliefs, cultural values, physiological features, hospital policies, and healthcare providers' knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan.
Methods: Quantitative correlational study design was employed to attain the study purpose. Data …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …

Establishing A New Cardiac Surgery Service In An Australian University Hospital: Pitfalls And Lessons Learned, Claudia Ciobanu, Sharon Latimer, Brigid M. Gillespie

Journal of Perioperative Nursing

Cardiovascular disease is the leading cause of death among Australians. Creating and delivering a world-class cardiac surgery service in a cost-effective way is the principle goal of health care organisations and managers. Establishing a new health care service is a unique opportunity and requires detailed planning and implementation. Managing change is pivotal to establishing a new patient-focused health care service, and should be coupled with effective communication and teamwork among all stakeholders. There are foreseen and unforeseen challenges associated with any project so sharing the lessons learned is an important way for others in a similar situation to avoid potential …

Vasoplegic Syndrome, Monica Arce

Nursing Student Class Projects (Formerly MSN)

Vasoplegic syndrome is a loss of vasomotor tone and a medical emergency. It is frequently seen in cardiac surgery cases, long OR cases, with use of cardiopulmonary bypass, and in certain septic patients. It has a high morbidity and mortality, and must be recognized early for a positive outcome. Vasoplegia is vaguely defined as a severe hypotension that is nonresponsive to usual treatment, such as fluids, inotropes, or vasopressors. It has a complicated pathophysiology and requires precise and closely monitored treatment. Advanced practice nurses need to be prepared to care for these complex and emergent patients.

Frailty Screening In Cardiac Surgery Patients: Improving Risk Stratification, April P. Hargett

Nursing Theses and Capstone Projects

Frailty has been noted throughout the literature to have a negative effect on patient outcomes especially in patients undergoing major surgical interventions such as cardiothoracic surgery. Preoperative assessments have historically included assessment of all body systems, however fails to evaluate patients for baseline physical functioning or frailty. The American College of Cardiology has recommended frailty screening on all cardiac surgery patients; however, facilities have failed to educate staff providing care to this population on the impact of frailty and use of commonly used frailty screening tools. This project hypothesized that Cardiothoracic Surgery Nurses and providers would have improved knowledge and …

Improving The Patient Handoff From Or To Picu In Children Who Have Undergone Cardiac Surgery Using A Standardized Handoff Tool, Amanda Taylor

Doctoral Projects

Inpatient hospitalizations for children are often costly. Children often transition from one setting to the next while hospitalized, therefore their provision of care is also transferred from one care team to the next. This transition presents a vital time for the child, that may be associated with adverse events and medical error. Adverse events can lead to poor outcomes for the child. Despite efforts to improve patient handoffs, communication failures are still abundant in healthcare. Research indicates that the use of a standardized handoff tool from one setting to the next is an effective method for improving the patient’s transition. …

Preoperative Activity Level And Outcomes In Older Adult Cardiac Surgery Patients: A Pilot Study, Don Howard Sorensen

Theses and Dissertations

ABSTRACTPreoperative Activity Level and Outcomes in Older ¨Adult Cardiac Surgery Patients: A Pilot StudyDon Howard Sorensen Jr.College of Nursing, BYUMaster of SciencePurpose: To assess the relationship between preoperative physical activity levels and health related quality of life on intra- and post-hospital outcomes following scheduled cardiothoracic surgery in older adults.Rationale/Background: Adults age 50 and older tend to accumulate more sedentary time and are less physically active. Sedentary behavior is linked with early morbidity and death and may predispose patients to postoperative complications. Preoperative activity levels and its relationship to surgical outcomes is an underexplored area. Insight on this topic could influence …

Implementation Of The State Avoidable Rehospitalizations (Staar) Initiative In A Np-Led Transitional-Care Program To Reduce Readmission Rates And To Provide Safe Transitional Care In Post-Cardiac Surgery Patients:A Quality Improvement Project, Araceli Carrera

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Readmissions after cardiac surgery are often preventable, costly, and potentially life-threatening events. Hospital readmissions may be influenced by low health literacy and ineffective transitional care. The Centers for Medicare and Medicaid Services have included reducing hospital-bundled payment for frequent occurrence of readmissions and episodic care after coronary artery bypass grafting in 2017. Purpose: This Quality Improvement project explored the impact of applying the STAAR initiative to reduce unplanned readmissions, and to provide safe transitional care in post-cardiac surgery patients. Design/Methods: This was a QI project design with educational and observational methods. The DNP student used the transitional-care toolkit …

Incidence Rate Of Delirium After Cardiac Surgery And Feasibility Of A Delirium Prediction Rule, Kelly Bohl

DNP Projects

Delirium is an acute, temporary cognitive disorder that is characterized by a change in mental status, altered level of judgement, and changes in perception and behavior. Elderly patients who undergo open cardiac surgery are particularly at risk for developing delirium postoperatively. Although it is a temporary disorder, there are many consequences associated with delirium after cardiac surgery, including a longer length of stay in the hospital, long term functional decline, a greater use of health care resources and an increase in mortality risk. The purpose of this project was to identify the one-year incidence of postoperative delirium after cardiac surgery …

The Impact Of Pre-Operative Mupirocin Prophylaxis On Surgical Site Infections In Same-Day Admission Open Heart Patients, Joanna Gerry

Electronic Theses and Dissertations

The CDC estimates that one in 20 patients admitted to the hospital is a carrier of methicillin-resistant Staphylococcus aureus (MRSA). Staphylococci are commonly found on the skin and mucous membranes within the anterior nares, which provides the principle reservoir for this organism. These organisms can go on to cause surgical site infections in hospitalized patients. Mupirocin is an effective topical medication used to eliminate nasal carriage of Staphylococcus aureus (S. aureus). Based on Level A evidence, the 2007 Society of Thoracic Surgeons has made a Class I recommendation for the use of mupirocin for all patients undergoing cardiac surgery in …

Blending The Roles Of Home Care Nursing And Cardiovascular Specialties: A Model For Nursing Practice In The Community, Margaret A. Guthaus, Diane White

Peer Reviewed Articles

Changes in reimbursement and advances in technology have resulted in a decreased hospital stay for patients undergoing cardiac surgery. These patients are being discharged into the community setting earlier, resulting in an increased demand for transitional specialty home care. This article relates the experience of a Midwest home care agency charged with the development of specialty home care for these complex patients. It offers a new practice model for professional nursing staff delivering this level of care. This model challenges traditional beliefs that cardiac specialty home care can best be provided by nurses with critical care or acute care cardiology …