Development Of Evidence-Based Practice Guidelines For Utilizing Erector Spinae Plane Blockade For Patients Undergoing Cardiac Surgery, Gabrielle Metoyer

Doctor of Nursing Practice Scholarly Projects

In the United States, the aging population and high rates of cardiovascular disease leads to increased cardiothoracic surgeries. Analgesia for cardiac surgeries often involves high-dose opioids. However, with an ever-increasing opioid epidemic and adverse effects on the postoperative healing process, recent literature seeks to decrease opioid consumption by utilizing alternative methods of analgesia. The American Association of Nurse Anesthetists recommends the use of regional anesthesia techniques to reduce the incidence of undertreated postoperative pain that can occur from opioid-sparing methods of analgesia. This project aims to create an evidence-based analgesia guideline for adult patients undergoing cardiac surgery. Interventions will include …

Neuropsychological Outcomes After Cardiac Surgery: A Pilot Feasibility Study, Sydni G. Paleczny

Electronic Thesis and Dissertation Repository

Approximately half of patients who have cardiac surgery will experience deficits in attention, memory, and thinking speed after their operation. Given that heart surgery is one of the most common medical procedures in Canada, it is necessary to better understand the natural history of cognitive impairment after such surgery. Yet, there is no globally accepted method for measuring cognitive function in patients who undergo heart surgery. To address this, we assessed whether it was feasible to use a web-based approach to measure cognition in heart surgery patients before and after their operation. Findings showed that remote administration of cognitive testing …

Postoperative Atrial Fibrillation Prevention: A Quality Improvement Project, Emily O. Schneiderman

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Postoperative atrial fibrillation remains one of the most common complications after cardiac surgery despite surgical and medical advances in the field. While generally transient, postoperative atrial fibrillation increases long-term morbidity and mortality, hospital length of stay, and financial obligation. The postoperative heart's unique chemical and physical properties make tactics for preventing and treating postoperative atrial fibrillation differ from classic atrial fibrillation management. This quality improvement project utilizes a care bundle for non-pharmacologic measures and early beta-blockade administration to reduce the incidence of postoperative atrial fibrillation. Implementation of this care bundle establishes a standard of care, increases clinician knowledge and accountability, …

Complications In Cardiac Surgery, Christine Williamitis

Theses and Dissertations--Nursing

Quality of care and outcomes from cardiac surgery have always been of primary importance to providers and the entire health care team when caring for cardiac surgical patients. Providers in cardiac surgery have had a long history of tracking procedural morbidity and mortality rates in programs nationally and internationally. Morbidity and mortality rates vary widely among hospitals. In most studies in which procedural outcomes from cardiac surgery are evaluated, the focus has been on operative morbidity and mortality and the probability of death after a cardiac surgical procedure. Less attention has been paid to predictors of perioperative complications, and sample …

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 …

Pulling Heart Strings: Quality Improvement Algorithm For Temporary Epicardial Pacing Wire Removal Post Cardiac Surgery, Jessica Norman

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The placement of temporary epicardial pacing wires (TEPW) is considered standard practice post cardiac surgery and is dependent on the patient’s cardiac function intra-operatively and their electrophysiologic profile after weaning from cardiopulmonary bypass (Reade, 2007; Elmistekawy et al, 2016). Complications associated with TEPW removal include myocardial damage, infection, perforation, tamponade, disruption of anastomoses, ventricular arrythmias, and death (Bojar, 2009; Carroll et al, 1998;Timothy & Rodeman, 2004). Currently there is no standard practice on the removal of TEPW and there is wide variation in removal practices involving patients who are routinely on medications such as dual antiplatelet therapies and systemic anticoagulation. …

Complications And Management In Pediatric Heart Surgery, Hannah Berndt

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this literature review is to evaluate current research surrounding management of pediatric patients after cardiac surgery. Acute kidney injury (AKI) and neurodevelopmental deficits are the main discussion topics. This review analyzes the causes, risk factors, and effects of AKI. The diagnostic and management methods surrounding AKI are compared, and diagnostic approaches such as serum Cystatin C and fibroblast growth factor 23 are analyzed as potential future replacements to serum creatinine. The modality of renal replacement therapy is evaluated, and early initiation of peritoneal dialysis is preferred. This review discusses the most common causes, effects, and management of …

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 …

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 …

Evaluation Of Perioperative Peripheral Nerve Injury In Cardiac Surgery Using A Novel Automated Ssep Monitoring Device, Satoru Fujii

Electronic Thesis and Dissertation Repository

INTRODUCTION: The high incidence of peripheral nerve injury (PNI) in conventional cardiac surgery (CCS) is believed to result from mechanical injury during sternotomy and/or retraction of the sternum. Minimally invasive cardiac surgery (MICS) is a newly developed type of cardiac surgery which does not require sternotomy or retraction of the sternum. Since surgery related PNI can lead to serious problems for both the patients and care providers, the incidence and details of PNI in cardiac surgery needs to be investigated. OBJECTIVE: To compare the degree of nerve injury in MICS and CCS using somatosensory evoked potential (SSEP) signals. …

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 …

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 …

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. …

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 …

Augmented Image-Guidance For Transcatheter Aortic Valve Implantation, Pencilla Lang

Electronic Thesis and Dissertation Repository

The introduction of transcatheter aortic valve implantation (TAVI), an innovative stent-based technique for delivery of a bioprosthetic valve, has resulted in a paradigm shift in treatment options for elderly patients with aortic stenosis. While there have been major advancements in valve design and access routes, TAVI still relies largely on single-plane fluoroscopy for intraoperative navigation and guidance, which provides only gross imaging of anatomical structures. Inadequate imaging leading to suboptimal valve positioning contributes to many of the early complications experienced by TAVI patients, including valve embolism, coronary ostia obstruction, paravalvular leak, heart block, and secondary nephrotoxicity from contrast use.

A …

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 …