Anesthesiology Commons^™

Point-Of-Care Gastric Ultrasound For Preoperative Assessment Of Gastric Contents: An Objective Structured Clinical Examination, Joshua Mann, Michael Sykes

Doctoral Projects

Pulmonary aspiration remains a leading cause of anesthesia-related mortality. The current nil per os (NPO) guidelines are proving unreliable in the presence of delayed gastric emptying due to comorbidities and the increasing use of glucagon-like peptide-1 (GLP-1) agonists. Gastric point-of-care ultrasound (POCUS) use provides a non-invasive, evidence-based, and cost-effective approach to assess gastric content and volume directly. However, limited formal training exists for advanced practice registered nurses (APRNs), and this lack of training contributes to the lack of its utilization. This doctoral project evaluated the effectiveness of an educational intervention that incorporated a didactic lecture as well as a hands-on …

Breastfeeding Safety Following Maternal Anesthesia: A Guideline Development, Megan Honea, Mary Johnson

Doctoral Projects

Recommendations regarding breastfeeding following maternal anesthesia are inconsistent and often not up to date with current best practice guidelines. Previous recommendations have led to mothers unnecessarily “pumping and dumping” breast milk has benefits for both mother and baby. These benefits include (a) increasing the infant’s access to colostrum, (b) encouraging mother-baby bonding, (c) improving the mother’s breastfeeding experience, (d) and providing significant health benefits to the infant. The purpose of this scholarly project was to develop a set of evidence-based recommendations that focus on mothers who desire to breastfeed following general anesthesia. These recommendations will highlight maternal- fetal transfer of …

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …

Advancing Anesthesia Provider Proficiency In Airway Assessment Using Point-Of-Care Ultrasound: An Osce-Based Educational Initiative, Austin Fike, Trevor Jordan, Sam Sherrill Iii

Doctoral Projects

Airway management is one of the fundamental pillars of anesthesia. Traditionally, tools such as the Mallampati classification and the thyromental distance are used for airway assessment in the perioperative area. However, often, these methods fail to reliably predict difficult intubations. The use of point-of-care ultrasound (POCUS) has emerged as a valuable adjunct in airway assessment. However, a knowledge deficit exists among anesthesia providers regarding its application in airway assessments for perioperative adult patients. This doctoral project addressed the knowledge deficit in POCUS airway assessment among Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) through the development and …

Enhancing Crna's Knowledge Of Radiation Safety Through Online Education, Angela Iledan, Madeline Pousson

Doctoral Projects

Although ionizing radiation is frequently used in anesthesia-related procedures, many CRNAs receive minimal training in radiation safety principles and protective measures. This knowledge gap increases the risk of cumulative radiation exposure for providers and patients. To address the issue, this doctoral project developed and implemented an online educational intervention designed to enhance CRNAs’ understanding of radiation safety, ultimately promoting safer practices in radiation-prone environments.

The doctoral project follows a QI and EBP approach that incorporated diverse adult learning styles to enhance engagement and knowledge retention of CRNAs. The online educational module was designed and delivered to CRNAs that currently practice …

Objective Structured Clinical Examination (Osce) For Interscalene Brachial Plexus Block Utilizing Ultrasound Guidance And Landmark Technique, Madison Mize, Mckayla Moore, Peyton Shell

Doctoral Projects

The purpose of this doctoral project was to create learning and evaluation tools for interscalene brachial plexus blocks (ISBPB) to be used by certified registered nurse anesthetists (CRNAs) and students in the Nurse Anesthesia Program (NAP) at The University of Southern Mississippi (USM). ISBPB is a regional anesthesia technique used to provide anesthesia for procedures of the shoulder and upper arm. CRNAs and students can use these tools to refresh their current knowledge and enhance their regional anesthesia skills.

The objective structured clinical examination (OSCE) and cognitive aid for ISBPB utilizing landmark and ultrasound-guided techniques were evaluated by the USM …

Point Of Care Ultrasound For Gastric Residual: An Objective Structured Clinical Examination, Brandon Quinn, Kaitlyn Gray

Doctoral Projects

Point of care ultrasound (POCUS) has become an invaluable tool in modern medical practice offering real-time diagnostic and procedural guidance for anesthesia providers. POCUS is a non-invasive assessment tool that gives anesthesia insight into a quantitative assessment of gastric residuals. Furthermore, POCUS assessments are useful in preventing anesthetic complications that can cause major morbidity and mortality such as aspiration pneumonia. Despite the growing relevance, formalized training on POCUS for assessing gastric residuals remains limited in many nurse anesthesia programs. The University of Southern Mississippi currently lacks a standardized curriculum for teaching student registered nurse anesthetists how to utilize gastric ultrasound …

Comparison Of Two Learning Methodologies: Virtual Reality And Osce Simulation, Connor Blackwell, Tabor Mcgee

Doctoral Projects

Anesthesia education has evolved immensely over the past twenty years, and with the new virtual reality (VR) simulations created by SIMVANA, the exponential growth can continue. The anesthesia program at The University of Southern Mississippi (USM) currently utilizes an educational platform known as the Objective Structured Clinical Examination (OSCE) for their students’ clinical curriculum. With the development of technology and education models, the purpose of the doctoral project is to determine if VR simulation can produce more effective learning than the OSCE modules. To determine the effectiveness, pharmacologic lessons for intraoperative hypotension were administered through both platforms and then tested …

Ultrasound-Guided Erector Spinae Plane Block: An Objective Structured Clinical Examination For First-Year Anesthesia Providers, Andrew Edwards, Jonathan Mardis

Doctoral Projects

The use of ultrasound-guided regional anesthesia (UGRA) in anesthetic practice is an invaluable tool for anesthesia providers to implement into their daily practice. One of these regional techniques is the erector spinae plane block (ESPB) which has anesthetic implications in numerous surgical procedures including cervical spine, thoracolumbar spine, thoracic wall, and chest wall procedures. Because of the novelty of this regional anesthetic technique, it is important to educate first-year anesthesia providers about the implications, skillset, and complications of the ESPB.

To bridge the gap between didactic knowledge and clinical practice in first-year anesthesia providers, an objective structured clinical examination (OSCE) …

Perioperative Chest X-Ray Interpretation For Anesthesia Providers, Kaitlyn Brown, Jessica Parsons

Doctoral Projects

Currently, a knowledge gap exists among anesthesia providers regarding perioperative chest x-ray (CXR) appropriateness and interpretation (Collins, 2022). The Council on Accreditation (COA) requires that students graduating from a nurse anesthesia program (NAP) interpret a minimum of five CXRs before program completion (Council on Accreditation [COA], 2020). This DNP project aimed to address the knowledge gap by offering an easily accessible online forum that guides anesthesia providers on CXR indications in surgical patients, and in identifying pathologies and invasive line and tube placement using CXR.

The authors created four learning modules regarding perioperative CXRs using Microsoft PowerPoint presentations with animation …

Objective Structured Clinical Examination For Intraoperative Hypotension And Hypertension Management, Andrew Mcginity, James David Ingram

Doctoral Projects

Managing intraoperative hypotension and hypertension is a non-technical skill anesthesia providers need to maintain patient safety. Upon transitioning from didactic training to clinical training, SRNAs may find it difficult to manage a patient’s blood pressure intraoperatively. The ultimate consequence of the delayed or improper treatment of intraoperative blood pressure perturbations is end-organ damage at the patient’s expense. Unintentionally causing a patient harm will lead to an SRNA losing confidence in their abilities. This OSCE is intended to increase SRNA confidence and competence regarding intraoperative hypotension and hypertension management before entering the clinical arena.

The hypotension and hypertension management tools and …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Implementation Of A Pre-Anesthesia Take-Home Evaluation (Pathe) As A Means Of Process Improvement: A Best Practice Recommendation, Russell Gray, Hunter Brown, Trey Galloway

Doctoral Projects

The pre-anesthesia evaluation (PAE) is a vital component to anesthesia providers when choosing an appropriate anesthetic plan for patients requiring surgery. The PAE, pre-anesthesia risk-factor assessment, and provision of pre-anesthesia instructions are standards of care implemented in order to assess the patient’s likely outcome of surgery and anesthesia as well as stratify any known risk factors to optimize surgical/anesthetic outcomes. Any disruption in this process could potentially lead to decreased patient/provider satisfaction, reduced patient compliance with pre-anesthetic instructions, reduced patient safety, and unnecessary financial burden.

After the completion of a literature review, the need for a best practice recommendation was …

Objective Structured Clinical Evaluation For Supraclavicular And Femoral Nerve Blocks Utilizing Ultrasound Guidance For Student Nurse Anesthetists, Mitchell Fowler, Christopher Bond

Doctoral Projects

The purpose of this DNP project was to create a tool to teach and evaluate student registered nurse anesthetists (SRNAs) at TheUniversity of Southern Mississippi (USM) on supraclavicular and femoral nerve blocks to promote safety in the clinical setting. An objective structured clinical evaluation (OSCE) for ultrasound-guided supraclavicular and femoral nerve blocks was created as the basis for this project. Best-practice techniques as identified by the AANA’s 14^thstandard of nurse anesthesia practice were researched and used in the development of the OSCE to promote a culture of safety for SRNAs and patients (AANA, 2019).

A culture of safety …

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

Uniform Clinical Evaluation For Video Laryngoscopy In Nurse Anesthesia Training: A Policy Proposal, Kristen Yelverton

Doctoral Projects

At The University of Southern Mississippi’s (USM) Nurse Anesthesia Program (NAP), no standardized clinical evaluation for video laryngoscopy (VL) use exists. To address the gap in standardized evaluation of VL, an evidence-based, objective structured clinical examination (OSCE) will be developed and proposed to the USM NAP. The intervention to this need is the evaluation of the OSCE and supporting documents by the panel of experts. The aim of the OSCE would be to teach SRNAs in a step-by-step process how to properly handle a video laryngoscope and the necessary techniques to ensure both patient and student safety (Wunder et al., …

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Developing A Local Anesthetic Systemic Toxicity Protocol In A Mississippi Hospital, James Dearman, Terry J. Tieman

Doctoral Projects

Local anesthetic systemic toxicity (LAST) is a rare complication of administering local anesthetic medications. However, this complication is potentially deadly, especially without prompt and correct treatment. Due to the rarity of LAST and the fact that its treatment differs from the conventional treatment of cardiac arrest, the authors sought a best practice recommendation to guide its treatment. While the most effective treatment for LAST has been well established, a thorough review of literature and survey of clinical preceptors demonstrated that most providers have not encountered LAST in clinical practice. Additionally, lipid emulsion therapy is a somewhat controversial treatment among some …

A Market Analysis Of Pay Rates For New Graduate Certified Registered Nurse Anesthetists, Zachary Halliwell

Doctoral Projects

The profession of Certified Registered Nurse Anesthetists (CRNA) is a thriving occupation. In their national Occupational Outlook Handbook, the Bureau of Labor Statistics (U.S. Department of Labor, 2018), reported the national market for CRNAs is predicted to continue its steady growth through 2026. The Bureau of Labor Statistics (BLS) provides numerous statistics, as previously mentioned, on their website. However, the stats available include CRNAs of varying experience levels. The Mississippi Department of Employment Security (MDES) has a few statistics, online, regarding the market for CRNAs. The data provided by MDES, while appreciated, is lacking in numerical significance, given the minuscule …

Evidence-Based Best Practice Policy Recommendation For Postoperative Sore Throat, Corey Gambrell

Doctoral Projects

Airway management is a fundamental aspect of patient care when general anesthesia is being administered. Unfortunately, tracheal intubation can lead to the development of postoperative sore throat (POST) in the recovery room. POST is a minor yet preventable consequence of manipulation and injury of the airway mucosa. POST is routinely considered a minor postoperative complication; however, the occurrence of POST can have a negative influence on patient satisfaction as well as their perception of the perioperative experience. The etiology of POST is multifactorial, but evidence indicates that prevention is possible when evidenced-based practices are employed by anesthesia providers. A targeted …

Student Registered Nurse Anesthetists’ Perception Of Simulation As A Positive Reinforcement To Classroom Lecture In Handling A Difficult Airway, Kayla Forbis

Doctoral Projects

The management of a difficult airway by anesthesia providers is a core component of providing safe care. Simulation provides an opportunity for the student to manage uncommon clinical scenarios without harm to an actual patient. This project aimed to determine if the use of simulation may be useful in training Student Registered Nurse Anesthetist in the management skills of a difficult airway. The proposed intervention of this project was the addition of simulation experience to didactic lecture covering difficult airway management techniques. As supported in the Adult Learning Principles of Medical Learners, by allowing the SRNA to actively participate in …

Following Epidural Pca Use, Do Obstetric Patients Feel Satisfied With Their Pain Control, James Mcrae

Doctoral Projects

ABSTRACT

Pain is a source of anxiety for many patients, and uncontrolled pain can have deleterious effects on patient outcomes (Patak et al., 2014). Pain associated with labor is a particular concern of obstetric patients. Epidural analgesia is currently the frontline treatment for pain associated with labor, with epidural patient-controlled analgesia (PCA) often being utilized (Braveman, Scavone, Blessing, & Wong, 2013). Little evidence exists that details what factors of epidural PCA that patients considered important (Patak et al., 2014). In this project, a randomized questionnaire was administered to obstetric patients to assess satisfaction levels with their epidural PCA. The questionnaire …

Best Practice Policy Recommendation For Neuraxial Anesthesia Skin Antiseptic Solutions, Kyle Adams

Doctoral Projects

A clinical affiliate hospital in Mississippi lacked a best practice clinical policy regarding the most appropriate skin preparation solution to use prior to neuraxial anesthesia. The evidence showed that alcoholic chlorhexidine is the optimal solution due to advanced characteristics which help reduce infection. Reducing infections can potentially reduce further complications for the patient, hospitalization length, and cost. Also, chlorhexidine was found safe to use for neuraxial anesthesia if cross-contamination is avoided and adequate drying time is allowed. Lastly, alcoholic povidone-iodine is an appropriate alternate if 0.5% chlorhexidine is unavailable.

A best practice clinical policy was formulated and presented to a …

Laryngeal Mask Airway: A Postoperative Sore Throat Clinical Practice Guideline, Logan Williams

Doctoral Projects

One of the most common and preventable complications experienced by patients undergoing general anesthesia is a postoperative sore throat (POST). Up to 70% of patients who receive a laryngeal mask airway (LMA) during anesthesia suffer from POST. Despite its regular occurrence and designation as a minor complication, POST has proven to be a distressing complication for patients afflicted. Consequently, a perceived minor complication can, in fact, play a major role in a patient’s perception of their care, the skill of their anesthesia provider, and their overall satisfaction with their experience.

Evidence shows that inflation of LMA cuffs beyond the recommended …

Referral Policy For Moderate To High-Risk Obstructive Sleep Apnea Patients Identified By The Stop-Bang Questionnaire: A Quality Improvement Project, Martha Kate Goforth, Price Roberts

Doctoral Projects

BACKGROUND: An increase in the prevalence of Obstructive Sleep Apnea is as high as 70% in the surgical population. OSA is associated with a higher incidence of complications in the perioperative setting showing the increased need for proper identification of moderate to high-riskpatients for referral to local sleep clinics. Identifying and treating OSA is an important step to improve managementof chronic diseases, decrease complications both inside and outside the perioperative setting, and reduce healthcare spending.

METHODS: The purpose of this project was to create an OSA referral program for patients undergoing general anesthesia at a hospital in Mississippi. The recommended …

Implementation Of A Sustainable Peer Mentor Program In Student Registered Nurse Anesthetists (Srnas)”, Kristin Cox

Doctoral Projects

Evidence has shown that Student Registered Nurse Anesthetist’s (SRNAs) stress is perceived as above average and is correlated with substandard patient care during clinical courses (Chipas et al., 2012). Some studies have indicated SRNAs experience low self-efficacy during clinical, which could lead to difficulty in thinking clearly or responding to clinical situations (Imus, Burns, & Weglarz, 2017). Peer mentoring has shown to result in stress reduction and improvement in self-efficacy in students (Barker et al., 2012; Giordana & Wedin, 2010). Despite the current evidence, a nurse anesthesia program in the southeastern United States did not have an organized peer mentor …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Evaluation Of Delivery Methods Of Chemical Dependency And Wellness Education, Marissa Coggin

Doctoral Projects

Anesthesia practice is learned in a stressful environment, and these stressors may lead to the students’ development of maladaptive coping mechanisms. Despite significant improvements in our understanding of addiction and our approaches to combat this problem, the risk of substance misuse remains high in nurse anesthesia students. Education and intervention are imperative when taking preventative measures. The purpose of this Doctor of Nursing Practice (DNP) project was to determine whether delivery method of chemical dependency/wellness educational program effects the level of understanding of anesthesia providers and substance misuse and the development of healthy coping mechanisms.

In determining whether the delivery …

Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance

Doctoral Projects

Roughly 100 million surgical procedures are performed in the United States (U.S.) each year and more than 80% of these patients experience acute postoperative pain. Pain costs the U.S. an estimated $560 to $635 billion annually and is a significant contributor to national rates of mortality, morbidity, and disability. Despite these findings, patients continue to receive suboptimal postoperative pain relief.

The adjunct administration of subanesthetic ketamine is opioid-sparing and can improve the effectiveness of a multimodal pain management approach. This project used an exploratory descriptive design to examine how an evidence-based presentation impacted the clinical practice of certified registered nurse …