Medicine and Health Sciences Commons^™

Implementation Of A Standardized Handoff Reference Tool From The Intensive Care Unit To The Operating Room, Sophia Agbomah, Stacie Summers

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: This quality improvement (QI) intervention evaluated the effectiveness of a standardized handoff reference tool for patients transferring from the Surgical Intensive Care Unit (SICU) to the operating room (OR) in a large metropolitan level I trauma center. There was minimal data to assess the quality of this sequence of patient transfer as no systematic ICU-OR handoff content practices were currently employed at the hospital. This project aimed to help fill the practice-knowledge gap that could impact some of the most vulnerable patients during ICU-OR transfer. Methods: Pre- and post-implementation staff surveys, live observations, and chart …

Propofol Disposal In The Operating Room: Addressing The Practice Knowledge Gap, Samantha Trulove, Audreau Conley

Doctor of Nursing Practice (DNP) Student Projects

Background: There is an increasing incidence of propofol diversion and abuse amongst healthcare workers. Barnes Jewish Hospital (BJH) has implemented the Stericycle controlled substance disposal system (CsRx) in the operating rooms (ORs) to address this issue; however, propofol continued to be left unsecured.

Purpose: The QI initiative aimed to raise anesthesia clinician awareness of propofol’s abuse potential and of the Stericycle CsRx container, ultimately to reduce unsecured propofol.

Methods: An educational intervention was utilized to address the identified problem. Data on unsecured propofol was collected via an auditing process of pharmaceutical waste bin contents at the BJH North campus endoscopy …

Reducing Unsecured Medications In Anesthetizing Area, Christine Bergesch, Kate Manuel

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Anesthetic medications should be secured consistently to prevent adverse outcomes such as medication errors, drug diversion, and financial loss. Standardized practice for medication stewardship is not established by Washington University Department of Anesthesiology (WUDA). Anesthesia providers’ imprudent medication stewardship practices are a continuous challenge due to the controlled and time-sensitive drugs they provide. Purpose: The purpose of this quality improvement (QI) project was to decrease the number of medications left behind unsecured in anesthetizing areas, describe the most frequently encountered barriers and category of medications left behind unsecured, and improve knowledge and utilization of the …

Improving Anesthesia Clinicians’ Knowledge And Confidence When Selecting Prophylactic Antimicrobials For Patients On Concomitant Antimicrobial Therapy, Garry Gregson, Emily Shands

Doctor of Nursing Practice (DNP) Student Projects

Anesthesia clinicians at Barnes Jewish Hospital (BJH) in Saint Louis, Missouri experienced uncertainty and discomfort when they selected preoperative antibiotics for patients who were already receiving concomitant therapeutic antimicrobials (CTA) unrelated to surgical prophylaxis. Various evidence-based interventions were proposed to address this issue. The first intervention was the addition of pathogens of concern to the surgical antimicrobial prophylaxis (SAP) protocol at BJH. The second intervention was the creation of a reference table that supplemented the revised protocol and allowed clinicians to efficiently determine the pathogens of concern for each surgery. This also included the CTAs efficacy for preventing surgical site …

Assessing Workflow In The Postanesthesia Care Unit, Laura Mcgrath, Emma Vierod

Doctor of Nursing Practice (DNP) Student Projects

The postanesthesia care unit (PACU) environment must function smoothly as a critical recovery area for monitoring of immediate postoperative patients. Timely responsiveness to complications is imperative to ensure patient safety. Following postanesthesia observation, a patient is discharged from the PACU to home or is admitted to the hospital. If this transition is delayed by excessive discharge times or poorly managed patient adverse events, it can cause major bottlenecks and issues with throughput for the perioperative setting. This project aims to study the present workflow in the PACU, identify gaps in the workflow and provide recommendations to perioperative leadership. Current PACU …

Screening Patients For Physical Frailty In The Preoperative Phase, Sean V. Pottenger, Amanuel Gebeyehu

Doctor of Nursing Practice (DNP) Student Projects

Background: Frailty is a syndrome characterized by an increased burden of symptoms and higher susceptibility to adverse health, including higher functional decline rates, pressure ulcers, falls, delirium, extended hospital stay, and discharge to assisted living facilities. Screening patients for frailty before undergoing a surgical procedure is recommended to minimize postoperative complications. In the preoperative phase at a midwestern academic hospital, surgical patients are not screened for frailty using a validated screening tool.

Purpose: This project sought to calculate the Clinical Frailty Scale (CFS) score using a novel algorithm. After validating the novel algorithm, this research project predicted that clinicians would …

Addressing Barriers To Anesthesia Clinicians Utilization Of The Perioperative Glycemic Management Guideline In Adult Surgical Patients With Diabetes At A Level 1 Midwestern Trauma Center, Neil Frydrych, Meghan Marshall

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Diabetes Mellitus (DM) is a complex metabolic disorder characterized by hyperglycemia leading to adverse outcomes. There is an association between dysglycemia and adverse perioperative outcomes. Evidence-based research supports consistent blood glucose (BG) monitoring and narrow glycemic parameters for surgical patients in the perioperative setting. Implementing and adhering to a glycemic guideline can help improve patient outcomes and decrease hospital costs.

Purpose: This quality improvement project (QIP) aims to determine the barriers to anesthesia clinicians implementing the perioperative glycemic management guideline for BG levels greater than 180 mg/dL. Then, develop an educational component to increase anesthesia …

Implementation Of Endotracheal Tube Cuff Manometry In The Operating Room: A Quality Improvement Project, Emily Davenport, Jennifer Stephan, Paul Winson

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Endotracheal tube cuff pressure should be maintained between 20 to 30 cmH2O to prevent adverse airway outcomes. Standardized practice is not endorsed by any major anesthesia organization nor by Washington University School of Medicine’s Department of Anesthesia. The common practice of manual palpation is unreliable. Use of a manometer is effective to measure and achieve appropriate cuff pressure.

Purpose: Implement a quality improvement project to increase the proportion of anesthesia providers using syringe manometers.

Methods: The facility’s EHR was used to obtain data reports on AG Cuffill syringe manometer use and documentation at specific time …

Noise Reduction In The Obstetric Operating Room, Maddy Schroeder, Meghan Woodham

Doctor of Nursing Practice (DNP) Student Projects

Noise is a significant problem in the operating room with numerous negative impacts physically, mentally, and emotionally for both healthcare workers and patients. In particular, the obstetric operating room is the noisiest operating room in the hospital. The majority of patients in the obstetric operating room do not receive sedation medications and remain fully awake throughout the procedure; thus, they are fully aware of the noise levels surrounding them during their procedures. Elevated noise levels impair communication between providers and decrease satisfaction scores among patients and providers. Noise reduction strategies, including educating staff about the importance of noise reduction, have …

Evaluation Of Provider Adherence To An Intraoperative Glucose Monitoring Guideline At A Midwestern Academic Hospital, Lauren Schoolfield, Taylor Crittenden

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Patients with diabetes (PWD) are at higher risk of requiring surgery and developing complications in the perioperative period making euglycemia an important component of intraoperative care. There is an association between dysglycemias and adverse perioperative outcomes. Implementation science evidence indicates that education with audit feedback strategies towards barrier identification to clinical practice guideline (CPG) uptake will improve implementation success.

Purpose: The purpose of this quality improvement project was to evaluate and improve adherence to intraoperative glucose monitoring outlined by the current intraoperative glucose management guideline at a midwestern academic hospital through barrier identification with tailored …

Education Aimed To Increase Train-Of-Four Ratio Use, Frank Bougher

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: The current state of practice surrounding non-depolarizing neuromuscular blocking drug monitoring is variable among practitioners and poses a safety risk to patients who may subsequently experience residual neuromuscular blockade and complications. The literature supports that train-of-four ratio monitoring, with an emphasis on use prior to extubation, is superior to other techniques and reduces the occurrence of complications related to residual neuromuscular blockade, improving patient safety and outcomes.

Purpose: The purpose of the project was to determine if an education intervention founded on evidence-based neuromuscular monitoring leads to increased use of train-of-four ratio in practitioner …

Addressing The Gaps: Pain Management, Multimodal Analgesia, And Crna Education, Hunter Niemeyer

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Opioid consumption, addiction, and narcotic-related deaths are a prevalent public health issue in the United States. Opioids are often administered throughout the perioperative period, and their utilization can lead to unwanted side effects and negative patient outcomes. Certified Registered Nurse Anesthetists (CRNAs) are strategically placed in hospital systems; these clinicians may advocate for the responsible administration of opioids and utilize multimodal pain strategies.

Purpose: This project assessed the knowledge and attitudes of CRNAs before and after the implementation of an educational program based on the prevention of operative pain, multimodal approaches, and the perioperative use …

Anesthesia Provider’S Use And Perception Of Emergency Cognitive Aids, Katie Mette

Doctor of Nursing Practice (DNP) Student Projects

Cognitive aids have been shown to increase proper use of evidence-based practice treatment strategies in emergent scenarios. These treatment strategies can be unfamiliar to the provider as emergencies are rare, and when coupled with a heightened stress level and sense of urgency, relying on memory alone can be challenging. The purpose of this project was to implement a set of emergency-use cognitive aids developed by Stanford University known as the Stanford Emergency Manual into a set of operating rooms and measure the anesthesia providers use and perception of the cognitive aid via pre-implementation and post-implementation e-mailed surveys.

Efficacy Of A Mixed Methods Training Program For Transthoracic Echocardiography, Britni Tharp

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Currently, there is a knowledge gap in CRNA education. As anesthesia providers, CRNAs are licensed to perform cardiac diagnostic imaging such as TTE during surgery, yet it is often missing from CRNA school curriculum. Other studies have shown that simulation is an effective way of teaching this crucial skill.

Purpose: The project’s goal was to establish the efficacy of using a mixed model computerized and in-person simulation program for training CRNAs in the use of TTE during non-cardiac surgery.

Methods: A training program was created that uses a computerized training session along with a …

Standardizing Intraoperative Handoffs Amongst Certified Registered Nurse Anesthetists, Mallory Light

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: Communication errors are a leading cause of preventable medical errors and inadequate handoffs have been linked to sentinel events. Research has shown that standardizing handoff processes can reduce errors, improving patient safety, and resulting in other positive outcomes including increased staff satisfaction, without impacting handoff duration.

Purpose: The purpose of this project was to determine how the implementation of a standardized handoff tool would impact perceptions of handoff communications, retention of important patient information relayed during handoffs, staff satisfaction, and handoff duration.

Implementation Plan and Methods: Information regarding use of the tool was sent to …

Gastric Point-Of-Care Ultrasound Education For Certified Registered Nurse Anesthetists, Robert Graham

Doctor of Nursing Practice (DNP) Student Projects

Background: Pulmonary aspiration is a significant risk of general anesthesia and is related to increased perioperative morbidity and mortality. Gastric point-of-care ultrasound (POCUS) has been shown to be a reliable indicator of gastric contents and volume, and it can be used in the perioperative setting to detect gastric contents and make informed clinical decisions to prevent aspiration events.

Purpose: This project aimed to educate Certified Registered Nurse Anesthetists (CRNAs) at Washington University in the use of point-of-care ultrasound to assess gastric contents prior to surgery with the overall goal of improving knowledge, skills, and attitudes towards this practice …

Anesthesia Provider Education On The Adherence To The Fourth Consensus Guidelines For The Management Of Postoperative Nausea And Vomiting, Christine Johnson

Doctor of Nursing Practice (DNP) Student Projects

Background and Review of Literature: The occurrence of postoperative nausea and vomiting (PONV) has been linked to unplanned admissions, longer post-anesthesia care recovery units (PACU) times, and decreased patient satisfaction. The Fourth Consensus Guidelines for the Management of PONV released new guidelines in 2020 outlining evidence-based practice to manage PONV. A literature review was conducted on a total of 10 studies. The findings support the methods these guidelines employ.

Purpose: This quality improvement (QI) project aims to provide education for anesthesia providers on the fourth consensus guidelines and improve provider adherence.

Methods: A six-minute educational video, post-education quiz, provider …

Educating Perioperative Nurses On Preventing Hypothermia In Surgical Patients, Bethany Geisler

Doctor of Nursing Practice (DNP) Student Projects

Perioperative hypothermia (PH) is a preventable complication of surgical procedures that has been linked to postoperative conditions such as coagulopathies, increased cardiac morbidity, surgical site infection, increased incidence of pressure ulcers, increased length of hospital stay, and increased financial expense. Anesthetic agents given to patients during surgery directly contribute to PH and associated complications.

Background: Perioperative is a time frame involving the three stages of surgery (preoperative, intraoperative, and postoperative). Hypothermia is defined as body core temperature below 36 degrees Celsius. The incidence of PH ranges from 11% to 90% depending on the anesthesia administered, type of surgery, length of …

Improving Small-Volume Antibiotic Administration For Surgical Prophylaxis, Benjamin Thomas

Doctor of Nursing Practice (DNP) Student Projects

Background: Small-volume IV antibiotics are commonly administered for surgical prophylaxis, but no clear policy on administration method exists, leading to wide variation in anesthesia provider practice at a large academic medical center. Administration via a secondary tubing set is the recommended practice to minimize significant medication losses which could lead to poor patient outcomes. This large academic medical center performed below the national benchmark for one of these outcomes–surgical site infections.

Goals and Objectives: Objectives of this project included eliminating a potential systematic shortcoming in the administration of prophylactic antibiotics. The goal was to increase the use of …