Medical Specialties Commons^™

Crnas And Sugammadex Use: A Qualitative Analysis, Natalia Izquierdo Bsn, Rn, Emily Mancewicz Bsn, Rn

Grace Peterson Nursing Research Colloquium

Background: The availability of Sugammadex has increased options for Certified Registered Nurse Anesthetists’ (CRNAs) and their choice of neuromuscular reversal agents, however administration is impacted by a variety of provider and institutional factors.

Objectives: The purpose of this study was to examine and describe the personal and institutional factors impacting the use of Sugammadex in Illinois by CRNAs.

Method: A qualitative study design using an open-ended survey yielded 209 responses. The three main themes that emerged were 1) Why CRNAs choose to use or avoid Sugammadex 2) How CRNAs dose Sugammadex and 3) Practice variations existing within the clinical setting. …

Is This Really Happening? Family-Centered Care During Covid-19: People Before Policy, Terri Savino, Karri Crispino

Patient Experience Journal

In the middle of a global pandemic, hospitals created policies for visitor restrictions to reduce the transmission of coronavirus to protect patients and staff and developed protocols allowing only one support person to call the critical care unit for patient updates. Late on a Tuesday afternoon, the Manager of Patient Experience received a phone call asking her to call Karri, the wife of one of our patients who was on a ventilator. Karri was struggling with updating her mother-in-law because she was very upset with the news she received, making it difficult to call her husband’s mom. Karri asked the …

Rate Of Unscheduled Administration Of An Epidural Bolus Among Pregnant Women Receiving Labor Epidurals, Aleksandr A. Lyakhov, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background The labor and delivery process is a painful experience that pregnant women undergo and while various medical options are available for managing labor pain, labor epidurals are the most common.1,3 Breakthrough pain, or inadequate analgesia, is a significant complication of labor epidurals that is typically managed with the administration of an unscheduled epidural bolus. The purpose of this evidence-based practice (EBP) project is to describe the rate of unscheduled epidural bolus administration in pregnant women receiving continuous labor epidurals (CLE) at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH).

Methods • Design: Retrospective, observational, EBP …

Postoperative Length Of Stay Following Enhanced Recovery After Surgery Protocol Implementation For Scheduled Cesarean Deliveries, Hannah Zimmerman, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Cesarean delivery is the most common major surgery worldwide. 1 In 2018, 1.2 million cesarean deliveries occurred in the United States, accounting for nearly 32% of all deliveries.2 Research has shown ERAS benefits include decreased length of stay, improved pain control, and improved patient satisfaction.2,3 Despite its use in numerous surgical specialties, ERAS implementation within obstetrics has been slow.2 The ERAS Society released a three-part guideline specific to cesarean deliveries in 2018 and 2019,4,5,6 yet few studies have assessed the impact of ERAS on cesarean postoperative outcomes.2 An improved perioperative course would be particularly beneficial for mothers undergoing cesarean …

Prophylactic Phenylephrine Infusion To Mitigate Intraoperative Hypotension After Spinal Anesthesia Among Orthopedic Patients, David Nelson, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background

Intraoperative Hypotension (IOH) is common after spinal anesthesia (SA) and is associated with an increased risk of end organ damage.1 2 3 The treatment regimen for IOH after SA varies in the orthopedic population. However, the current research literature suggests that a prophylactic infusion of phenylephrine significantly reduces the number of episodes and duration of hypotension.1 This EBP project aims to report the proportion of patients receiving prophylactic phenylephrine infusions and the incidence of hypotension following SA among orthopedic surgery patients at Providence Sacred Heart Medical Center (PSHMC) in Spokane, WA.

Methods

• A retrospective, observational EBP project was …

Chronic Pain, Sleep Disruption, And Work Performance In The Military, Jeffrey Ransom

Dissertations

Abstract

Background and Significance: Managing pain is a challenge for many organizations, including the U.S. military. The added complication of managing sleep disruption compounds the issue. Examining pain and sleep disruption in the context of work performance within the military is critical to understanding the impact of these conditions on our nation’s fighting forces.

Purpose: Examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Research Aims: 1) Describe sociodemographic characteristics, military service characteristics, clinical characteristics, and work performance of active duty service members, 2) Examine relationships between these …

Neostigmine Versus Sugammadex And The Relationship To Reintubation Rates In The Pacu, Delanie Urrutia, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Findings Discussion Reintubation in the post-anesthesia care unit (PACU) is a complication that may be related to residual neuromuscular blockade. Neostigmine and sugammadex have different pharmacokinetics that effect speed and completeness of reversal of paralysis. According to Tillquist et al. (2016) reintubation following general anesthesia in the PACU is associated with a 50% increased risk of mortality. Few studies have investigated the incidence rate of PACU reintubation and its possible relationship and choice of reversal medication.

Methods • Retrospective Observational Research Study. • This project was approved by the PSHMC Clinical Innovation and Research Council and deemed human subjects …

Postoperative Nausea And Vomiting With Low-Dose Propofol Infusions In Patients Undergoing Gynecological Surgeries With Volatile Anesthetics At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Adrianna Silva, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative nausea and vomiting (PONV) is a common complication following surgery. It remains the most important determinant of length of stay and leading cause of dissatisfaction in anesthesia.4 Females undergoing gynecological laparoscopic surgery have the highest rates.8 Apfel’s baseline risk factors for PONV include female gender, history of motion sickness and/or PONV, non-smoking status and administration of postoperative opioids.1 Propofol has antiemetic properties and Gan’s evidence supports the use of an intraoperative low-dose infusion to reduce baseline risk factors for PONV.6 This project aims to describe the rates of intraoperative low-dose propofol infusions in female patients undergoing gynecological surgery …

Intratracheal Lidocaine And Postoperative Sore Throat At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Jennifer Cowgill, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative sore throat (POST) is a common side effect from general anesthesia (GA) and has a prevalence of 14.4-50%.1 The experience of POST contributes to patient discomfort during recovery from surgery. The etiology of this is thought to be from tracheal mucosal erosion from the cuff of the endotracheal tube (ETT), trauma from intubation, coughing and bucking, and friction between the ETT and the tracheal mucosa during general anesthesia.2 Risk factors shown to contribute to the development of POST include, but are not limited to, elderly age, smoking history, patient positioning, ETT cuff pressure, and movement of ETT during …

Opioid Consumption After Scheduled Cesarean Delivery Following Implementation Of Enhanced Recovery After Surgery, Mindy Woodruff, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background With 47,600 opioid overdose related deaths in the U.S. in 2017, the opioid crisis is of national concern.1 Cesarean delivery is the most common surgery worldwide, with over 1.2 million in the U.S. in 2018 alone.2,3 As cesarean delivery is a highly prevalent surgery it has a large capacity to influence the opioid epidemic. Literature is showing that Enhanced Recovery after Surgery (ERAS) and multimodal analgesia are effective means of managing postoperative pain while minimizing opioid use.4,5,6,7,8 This project aims to help discover if introduction of ERAS, and more specifically it’s multimodal analgesia aspect, has helped decrease oral morphine …

Rates Of Ondansetron Administration Prior To Spinal Anesthesia: Evaluating The Practice Of Prophylactic Attenuation Of Spinal-Induced Hypotension And Bradycardia, Clare Santana, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Hypotension and bradycardia are common complications of spinal anesthesia. Intraoperative hypotension and bradycardia may lead to complications that require additional treatment and increase cost. The literature identifies intervention strategies to attenuate spinalinduced hypotension (SIH) and bradycardia.1 Prophylactic administration of ondansetron, a serotonin 5-hydroxytryptamine receptor antagonist, prior to spinal anesthesia is associated with reduced SIH and bradycardia.1,2,3,4,6 The objective of this scholarly project was to report the practice of ondansetron prophylaxis for SIH and bradycardia and the rate of rescue interventions in patients who received ondansetron prior to spinal anesthesia.

Methods Retrospective, multi-center observational evidence-based practice project conducted at Providence …

Intraoperative Hypotension And Acute Kidney Injury In Non-Cardiac Surgery At Providence Sacred Heart Medical Center, Elizabeth Davison, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Acute kidney injury (AKI) is a serious postoperative complication that increases a patient’s risk for both long and short-term morbidity and mortality.¹ Intraoperative hypotension (IOH) is an independent risk factor for AKI,^2-5 which can be readily modified by anesthesia providers. This project aims to describe the risk factors and rates of AKI following IOH at various absolute mean arterial blood pressure (MAP) thresholds for specified durations of time among adults undergoing non-cardiac surgery at Providence Sacred Heart Medical Center (PSHMC).

Methods PSHMC approved this retrospective, observational evidence-based project and deemed the project exempt by the Institutional Review …

Correlation Of Ondansetron Timing In Postoperative Nausea And Vomiting: A Retrospective Evaluation Amongst Adult Patients Receiving General Anesthesia, Jeff Tanguay, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Addressed as a national quality initiative by the Centers for Medicare and Medicaid Services (CMS), postoperative nausea and vomiting (PONV) is a vexing complication requiring further attention by anesthesia providers.3 Medication optimization is an area of focus to address this complication.4 Ondansetron, a selective 5- hydroxytryptophan subtype 3 (5-HT3 ) receptor antagonist, is effective and considered the “gold standard” in the prevention of PONV.4 GlaxoSmithKline™ suggests administering Zofran® (ondansetron) before the induction of anesthesia.5 These directions are in contrast to the synthesis of the research evidence, which supports increased effectiveness of ondansetron when administered 30 minutes before emergence from …

Intraoperative Dexmedetomidine Use On Adult Surgical Patients At Providence Sacred Heart Medical Center, Christina Rose, Scot Pettey, Norel Smith, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Opioids are considered the standard of practice for intraoperative and postoperative pain management but yield unfavorable outcomes.6 The research evidence demonstrates reductions in post-operative opioid use following intraoperative administration of dexmedetomidine.1,3,4,5,6 Due to the prospective nature of literature surrounding dexmedetomidine, the rate of implementation remains largely unknown. The aim of this retrospective, observational project was to identify the rate of adoption of intraoperative dexmedetomidine administration among adult surgical patients at Providence Sacred Heart Medical Center (PSHMC) from January 1, 2015 to December 31, 2019. Accordingly, investigation into dexmedetomidine administration at PSHMC may shed light on this strategy aimed to …

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

A 2-Hour Diabetes Self-Management Education Program For Patients With Low Socioeconomic Status Improves Short-Term Glycemic Control, Michael G. Jakoby Iv, Melissa Schleder, Vickie Luff, Cynthia Yergler, Albert Botchway, Cheryl Burns

Journal of Patient-Centered Research and Reviews

Diabetes self-management education (DSME) improves glycemic control, but patients with low socioeconomic status face institutional and personal barriers to receiving DSME. A retrospective single cohort study of a 2-hour group DSME program prioritizing accessibility and completion of a tightly focused curriculum was performed to determine if glycemic control improved and whether a longer, more comprehensive, prospective evaluation of the program is indicated. All patients who participated in the program from September 2017 to December 2018 were included in the analysis. The primary study endpoint was change in hemoglobin A1c (HbA1c) from baseline. A total of 58 out of 94 patients …

Solutions To Address Frequent Hospital Attendance, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

In this editorial, practical solutions and considerations in helping the most complex and at-risk patients in our health systems are discussed. These patients, sometimes referred to as health care “super-utilizers” in the literature, tend to be frequently seen and cared for in costly hospital and emergency department settings. Innovative care models that aim to bridge system gaps, achieve better health outcomes, and improve the well-being of both patients and providers are needed and should continue to be explored.

Mitigating Suicide Risk Post-Discharge From Inpatient Crisis Stabilization: Safety Planning Intervention, Leighia M. Mcghee

Dissertations

Abstract

Purpose: The purpose of this program evaluation is to evaluate the effectiveness of a newly implemented safety planning intervention (SPI) tool, comparing patient outcomes relating to suicide attempt rates, emergency department (ED) encounter rates, and inpatient rehospitalizations rates pre and post its integration to care in a suburban behavioral health hospital.

Methods: A descriptive cohort design utilizing a retrospective chart review was completed over six months, three months pre, and three months post implementation of the SPI program. A convenience sample of inpatient charts was reviewed to assess the rate of suicide attempts, ED encounters frequencies, and hospitalization rates …

Evaluation Of Pharmacist- Or Nurse-Driven Long-Acting Insulin Titration Protocol In Adult Primary Care Patients With Type 2 Diabetes, Ruth Manzi, Corinn Martineau, Carmine Laporta, Mary Muca, Samantha Marrier, Donald Medd, Jennifer Aronson

Journal of Maine Medical Center

INTRODUCTION

Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.

METHODS

This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was …

Current Recommendations For The Perioperative Management Of Patients On Buprenorphine: A Case Study, Coreen Tanner

Nurse Anesthesia Student Capstones

According to the US Department of Health and Human Services, more than 2 million Americans suffer from opioid use disorder (DHHS, 2020). Opioid maintenance therapy (OMT) for OUD has been shown to reduce the rates of inpatient hospitalization and overall opioid-related mortality (Quaye & Zhang, 2019). Buprenorphine is a partial mu receptor agonist and kappa receptor antagonist that is used frequently by patients on OMT. Beginning in 2010 annual prescriptions for buprenorphine products have increased dramatically (Lembke, Ottestad, & Schmiesing, 2019).

With the rising level of chronic pain and opioid use nationally, more and more patients taking buprenorphine are presenting …

Norepinephrine Use In Septic Patients Undergoing General Anesthesia, Lauren Reed

Nurse Anesthesia Student Capstones

Anesthesia providers are frequently confronted by the problem of caring for patients presenting with sepsis in the operating room. Sepsis is associated with high healthcare costs and a significant mortality rate despite advancements in the understanding of its complicated pathophysiology. The 2016 Surviving Sepsis Campaign recommends norepinephrine as the first-choice vasopressor in septic patients. Its mild beta-adrenergic effects, in addition to its alpha-adrenergic effects, make it an attractive agent for the vasoplegia and myocardial dysfunction associated with sepsis. Earlier achievement of adequate perfusion pressures, earlier lactate clearance, and higher in-hospital survival have all been associated with norepinephrine use in the …

Simulation To Reduce Medical Errors And Improve Patient Safety In Anesthesia, Matthew Leblanc

Nurse Anesthesia Student Capstones

Over the past two decades, simulation in medical education has been adopted by health education programs and established as a proven method of education for health care students and providers. Despite the addition of simulation to healthcare education, medical errors are ranked as the third leading cause of death in the United States. The purpose of this literature review is to investigate the translation of simulation education into increased patient safety and reduction of medical errors in anesthesia. Overall, the literature reviewed confirms that simulation can be used to reduce medical errors and improve patient safety. Additional correlational research between …

Dexmedetomidine Use And Various Techniques Of Administration To Reduce Emergence Delirium In Pediatric Surgical Patients Undergoing General Anesthesia With Volatile Agents, Sara K. Dusza

Nurse Anesthesia Student Capstones

This analysis of literature evaluated retrospective chart reviews and randomized controlled trials of school aged children undergoing surgical procedures necessitating general anesthesia with volatile inhalant anesthetic agents. These studies assessed and compared the efficacy of various routes and timing of administration of dexmedetomidine as a pre-medication to determine the most effective technique in reducing the incidence of postoperative emergence delirium (ED). ED presents as a transient, acute episode of delirium occurring during the transition from unconsciousness to complete wakefulness after general anesthesia with anesthetic gases. The results of this review suggested that pediatric patients treated with intranasal dexmedetomidine preoperatively experienced …

Treating Post-Dural Puncture Headaches: Sphenopalatine Block, Cosyntropin And Epidural Blood Patch, Amalia Zychowicz

Nurse Anesthesia Student Capstones

Post-dural puncture headache (PDPH) is a severe and debilitating complication that can occur following neuraxial anesthesia. Obstetric patients are at an increased risk for this complication due to their gender, young age, and widespread use of neuraxial anesthesia. A hallmark sign of PDPH is a postural headache that improves when lying down and worsens when sitting or standing. It requires prompt diagnosis and treatment due to its incapacitating effects. The gold-standard treatment for PDPH is an epidural blood patch (EBP). However, this is an invasive procedure with multiple contraindications and the potential for severe complications. Noninvasive, more conservative therapies such …

Sugammadex Versus Neostigmine In Reducing Postoperative Adverse Effects In The Pediatric Population, Robert Vieto Jr.

Nurse Anesthesia Student Capstones

Neostigmine and sugammadex are two medications used to reverse the neuromuscular blockade caused by nondepolarizing aminosteroidal neuromuscular blocking agents. Research has shown an association between the use of acetylcholinesterase inhibitors, such as neostigmine, and residual neuromuscular blockade in pediatric patients. Sugammadex has been shown to reduce residual neuromuscular blockade in adults without adverse effects, but minimal research has been performed on the effects of sugammadex in the pediatric population. Therefore, the objective of the present study is to compare sugammadex and neostigmine to determine if using sugammadex instead of neostigmine reduces postoperative adverse effects in the pediatric population. A systematic, …

Basic Airway Management For Non-Anesthesia Operating Room Personnel: Education Implementation, Dylan Ouellette

Nurse Anesthesia Student Capstones

A review of basic airway management for non-anesthesia personnel is presented. Included is a literature review of 20 articles surrounding the most current literature on preoperative airway assessment, cricoid pressure, video laryngoscopy, adjuncts for airway management, and airway management education for non-anesthesia health-care personnel. Following the review, an in-service style education presentation was developed and implemented at two sites in Maine. A pre- and post-test evaluation of the participants demonstrated an overall increase in test scores of 22%.

Anesthetic Implications Of Intraarterial Chemotherapy For Retinoblastoma: A Literature Review, Marguerite Mullin

Nurse Anesthesia Student Capstones

Retinoblastoma (RB) is a rare pediatric cancer commonly diagnosed in patients at a very young age. New therapies for this disease are emerging that involve some degree of sedation, requiring anesthesia providers to be involved in their care. Intraarterial chemotherapy (IAC) is one of these new exciting treatment options and requires general anesthesia. Multiple studies and case reports have reported a sudden decrease in pulmonary compliance during IAC for RB and attribute this response to the trigemino-cardiac reflex (TCR). Once this event occurs, patients experience associated hypoxemia, hypotension, bradycardia, and cardiovascular collapse. A systematic literature review was aimed at educating …

Exparel Versus Bupivacaine: Outcomes, Advantages, And Costs, Jessica Duraney

Nurse Anesthesia Student Research Posters

Research poster comparing two local anesthetics, bupivacaine and Exparel (liposomal bupivacaine). The use of these drugs in various regional techniques, specifically for total knee arthroplasty (TKA) and abdominal surgeries, is discussed. Research shows that adequate pain control is associated with increased patient satisfaction, faster rehabilitation, mobilization, reduced hospital stays, and ultimately decreased hospital costs. Due to the many disadvantages of opioids, such as ileus, nausea, vomiting, respiratory depression, tolerance, and physical dependence, there has been a push for opioid-sparing and multimodal analgesia perioperatively.

Malignant Hyperthermia For The Nurse Anesthetist, Victor Clark

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia (MH) is a rare, autosomal dominant skeletal muscle disorder that can have an insidious onset in susceptible patients exposed to the triggering agents succinylcholine, halothane, desflurane, sevoflurane, and isoflurane. MH can occur in patients who have received anesthesia with these agents in the past (Nagelhout & Plaus, 2018, p 775). Patients with a family history of MH or associated skeletal muscle disorder must be treated as MH-susceptible until proven otherwise. Failure to detect an MH crisis can lead to kidney failure, profound acidosis, coagulopathies, rhabdomyolysis, cardiac dysrhythmias, cardiovascular collapse, and death (Seifert et al., 2015). It is the …

Exparel Versus Bupivacaine: Outcomes, Advantages, And Costs, Jessica Duraney

Nurse Anesthesia Student Capstones

Research shows that adequate pain control is associated with increased patient satisfaction, faster rehabilitation, mobilization, reduced hospital stays, and ultimately decreased hospital costs. Due to the many disadvantages of opioids, such as ileus, nausea, vomiting, respiratory depression, tolerance, and physical dependence, there has been a push for opioid-sparing and multimodal analgesia perioperatively. The purpose of this paper is to compare two local anesthetics, bupivacaine and Exparel (liposomal bupivacaine). The use of these drugs in various regional techniques, specifically for total knee arthroplasty (TKA) and abdominal surgeries, will be discussed.