Medicine and Health Sciences Commons^™

Protocol Development For Preventing Inadvertent Perioperative Hypothermia In Outpatient Surgical Patients, James Lower

Doctor of Nursing Practice Scholarly Projects

Hypothermia changes normal physiology resulting in altered clotting, metabolism, immune function, and healing processes which increases patient’s risk for adverse outcomes. During the perioperative period anesthesia is recognized as a main cause of inadvertent perioperative hypothermia (IPH). As a result several organizations have developed clinical practice guidelines (CPG) to prevent IPH. There is an inconsistent utilization of warming devices and a lack of policy and procedure directing the effective maintenance of normothermia for surgical patients at a medium sized academic level one trauma hospital in the Midwest. Having no established standard practice protocol within this institution places the patients at …

Bridging The Gap Between Evidence Based Opioid Sparing Techniques And Anesthesia Provider Practice, Kelly Hempfling

Doctor of Nursing Practice Scholarly Projects

In light of the current opioid epidemic in the United States, multiple sectors of health care specialties and nursing leaders have been called to aide in reversing this deadly opioid abuse trend. As a team, Certified Registered Nurse Anesthetists (CRNA), surgeons, and anesthesiologists have made great strides in developing evidence-based protocols titled Enhanced Recovery After Surgery (ERAS). ERAS protocols vary according to the surgical specialty; however, one universal component includes opioid sparing techniques such as peripheral nerve blocks. Despite ERAS protocol’s benefits throughout the perioperative period, according to the literature, many anesthesia groups across the nation are non-compliant with their …

Evidence-Based Practice Guideline Development: Selection Of Local Anesthetics And The Additive Dexamethasone In Brachial Plexus Blocks, Alexandra Mcguire

Doctor of Nursing Practice Scholarly Projects

Brachial plexus blocks (BPB) are a type of regional anesthesia that inhibits the sensory and motor function of the upper extremity. The efficacy of a BPB depends on the type and dose of local anesthetics (LA), as well as the use of any additive agent. The selection of LA depends on the type, concentration, and volume of LA. Certain additives, such as dexamethasone, when added to BPB, were shown to increase motor and sensory block duration.

A chart audit conducted by the pharmacy and anesthesia departments revealed a significant variability of clinical practice in the use of LA and additives …

Evidence Based Practice Strategies: Using Price Lists And Peer Coaching To Improve Medication Cost Containment And Documentation Practices In Anesthesia Providers At An Urban Level One Trauma Center, Abigalle Ryan Sparrow

Doctor of Nursing Practice Scholarly Projects

According to the American Association of Nurse Anesthetists (AANA) guidelines for Documenting Anesthesia Care Practice and Policy Considerations, anesthesia provider documentation represents a detailed account of the patient’s anesthesia care during various phases of anesthesia during their hospital stay (Documenting Anesthesia Care: Practice and Policy Considerations, 2016). The primary purpose of anesthesia documentation is to capture accurate and comprehensive information communicating a patient’s anesthetic experience, which includes the documentation of all administered medications. The patient’s electronic or written medical record is a legal document, which is also referenced for reimbursement, quality improvement, and review by external organizations for …

Eras For Cardiac Surgery: Development Of A Clinical Practice Guideline For Antifibrinolytic Administration In Cardiac Surgery, Christopher T. Foltz, Katonya C. Lawson

Doctor of Nursing Practice Scholarly Projects

Enhanced Recovery After Surgery (ERAS) guidelines are multimodal perioperative care

pathways based on evidence-based practice to promote faster recovery after surgical procedures.

For cardiac surgery ERAS, one intervention that is strongly recommended based on high levels

of evidence is the use of antifibrinolytic medications, such as Tranexamic acid (TXA) and

epsilon aminocaproic acid (EACA) which are synthetic antifibrinolytics and analogs of lysine,

both known for exerting procoagulant effects by competitively inhibiting activation of

plasminogen to plasmin. Antifibrinolytic medications have been shown to decrease blood loss as

well as the need for blood transfusions and reoperation.

There is strong evidence from …

Safety Measures In The Epilepsy Monitoring Unit: An Organizational Assessment, Tina Yates

Doctor of Nursing Practice Scholarly Projects

Long-term video-electroencephalography (EEG) monitoring in the epilepsy monitoring unit (EMU) is an elective procedure and generally safe. Clinical experts determined the EMU protocols at a level-4 comprehensive epilepsy center were not followed correctly. The project is a retrospective chart audit incorporating Ray’s Bureaucratic Caring theoretical framework with Donabedian’s conceptual model. The project objective is to evaluate if safety measures protocols are implemented appropriately in the EMU and determine whether a need exists for quality improvements.

The project reviewed patients admitted to the EMU from September 2021 through November 2021 who developed a generalized tonic clonic (GTCs) seizure with electrographic epileptiform …

Clinical Recommendations For Non-Anesthesia Healthcare Providers Performing Emergency Airway Management Outside The Operating Room, Danielle Ridgway

Doctor of Nursing Practice Scholarly Projects

Emergency endotracheal intubations occurring outside of the Operating Room (OR) are often performed by non-anesthesia providers. At a large, urban, level one trauma center, the current airway management policy for these non-anesthesia providers does not follow best practices based on the literature. Specifically, some non-anesthesia providers are not credentialed and/or privileged to administer neuromuscular blocking agents (NMBAs) during emergency endotracheal intubations. The purpose of this project was to develop evidence-based clinical recommendations for emergency airway management outside of the OR. The following objectives are framed using the Johns Hopkins Evidence-Based Practice (EBP) Model and were established to achieve the projects …

Nosocomial Antibiotic-Associated Clostridium Difficile Infections: An Organizational Assessment, Allison Bruce, Paxton Schwaderer

Doctor of Nursing Practice Scholarly Projects

Clostridium difficile (C. difficile) are toxigenic, spore-forming bacteria that live in the gastrointestinal (GI) tract of healthy individuals without harm to the host due to the protection offered by the natural intestinal flora. Antibiotics can disrupt the intestinal flora and create an environment within the GI tract that promotes the infectious growth of C. difficile. C. difficile infections (CDIs) are the most common cause of antibiotic-associated diarrhea, are highly contagious, and can result in an increased risk of morbidities and mortality to individuals affected. Recent studies and literature reviews identified the use of probiotic therapy in patients receiving …

Sedation Assessment And Management In The Intensive Care Unit, Kimberly Dyer, Courtney Garvey

Doctor of Nursing Practice Scholarly Projects

Nursing management of sedation medications in critical care patients is a complex responsibility, and studies have shown that proper use of sedation protocols can lead to improved patient outcomes. A knowledge gap among critical care nurses in the performance of Richmond Agitation Sedation Scale (RASS) assessments was identified within a critical care unit during the 2019 annual skills day. Inaccurate RASS assessments may lead to inaccurate sedation management according to the current unit protocol and evidence from the literature, and therefore may impact patient outcomes. This project aims to improve a clinical practice within an intensive care unit. The objective …

Change For The Ohio Nurse Practitioner Treating Worker's Compensation Patients: A Needs Analysis, Jessica Huff

Doctor of Nursing Practice Scholarly Projects

Autonomous nurse practitioners are an effective and useful member of the healthcare team, particularly when given a less restrictive scope of practice at the state level. The autonomous nurse practitioner can help improve patient outcomes/needs as a decision-making health care team member.

Ohio nurse practitioners treating worker’s compensation patients are limited in treating the injured worker not because of the nurse practitioner scope of practice, but because of the bureaucratic paperwork worker’s compensation requires of its patients/providers. The purpose of the project was to conduct a needs analysis regarding a legislative change proposal for the practice authority of nurse practitioners …

Evidenced-Based Practice Guideline Development: Selection Of Local Anesthetics And The Additive Dexamethasone In Brachial Plexus Blocks, Sabina Lamichhane Wagle

Doctor of Nursing Practice Scholarly Projects

Brachial plexus blocks (BPB) are a type of regional anesthesia that inhibits the sensory and motor function of the upper extremity. The efficacy of a BPB depends on the type and dose of local anesthetics (LA), as well as the use of any additive agent. The selection of LA depends on the type, concentration, and volume of LA. Certain additives, such as dexamethasone, when added to BPB, were shown to increase motor and sensory block duration.

A chart audit conducted by the pharmacy and anesthesia departments revealed a significant variability of clinical practice in the use of LA and additives …

Proposal Of A Clinical Practice Guideline For A Non-Pharmacologic Music Listening Complementary Pain Therapy, Alec Smith, Sean Lawler, Joel Griffith

Doctor of Nursing Practice Scholarly Projects

Background: As many as 65% of post-surgical patients experience moderate to severe pain. Post-surgical pain is associated with a variety of negative physical and psychological consequences for patients. Currently, medical treatments for postoperative pain rely heavily on pharmaceuticals which can cause adverse side effects. Opioid analgesics, most notably, cause hypoventilation, apnea, and in some cases, dependence and addiction. In 2017, in response to state and national opioid prescription reduction programs, The Joint Commission (TJC) began requiring healthcare institutions to provide patients with non-pharmacologic pain treatment modalities. These pain treatment modalities, also known as complementary therapies, include music listening interventions, which …

The Development Of An Assessment Plan For Wellness And Risk For Substance Use In Nurse Anesthesia Students, Tessa Friend, Lauren Zaleski

Doctor of Nursing Practice Scholarly Projects

Student Registered Nurse Anesthetists (SRNAs) are at an increased risk for low levels of perceived wellness and substance use disorder (SUD) due to a multitude of factors. Disturbances in perceived wellness and SUD pose mental and physical risks to the student as an individual, and may have an impact on their academic and clinical performance. Designing an assessment plan for the evaluation of wellness and risk for substance use in the SRNA population may aid anesthesia program directors in identifying early warning signs, implementing wellness curricula tailored to their student’s unique needs, and evaluating the effectiveness of these wellness curricula …

Analysis Of Clinical Outcomes And Cost-Effectiveness Of Neuromuscular Blocking Drug Reversal In Patients With Obstructive Sleep Apnea, Samantha Kinglsey, Aaron "Mitch" Corn

Doctor of Nursing Practice Scholarly Projects

Non-depolarizing neuromuscular blockers are used during many surgical procedures to induce muscle relaxation for tracheal intubation and improve surgical conditions for surgeons. The use of these medications requires an agent to be given to fully reverse the effects of the neuromuscular blocking drug. Historically, neostigmine has widely been used as the primary reversal agent. However, sugammadex, a recently FDA approved drug, is also available for the reversal of common neuromuscular blocking drugs, rocuronium and vecuronium. In the literature, sugammadex is widely regarded as a clinically superior reversal agent. But its use is commonly limited to emergent situations due to the …