Implementing Lean Daily Management System To Improve Cvor First Case On-Time Starts, Haley Borchers, Kelly Fehlhafer, Barbara Mueller, Jessica Nichols, Sarah Talken, Mary Hunter, Kenneth Sam

Posters

No abstract provided.

Pressure Injury Prevention For Urology Surgical Procedures: A Qi Initiative, Azadeh Wickham, Pat Clay, Kate Gibbs

Posters

No abstract provided.

The Impact Of The Nurse Practitioner In Pre-Admission Testing: A Comparative Review, Laurel A. Robinson

DNP Projects

Abstract

PURPOSE: The purpose of this study was to compare the efficiency of pre-admission testing (PAT) surgical clinic pre and post implementation of the APRN for patient assessment. Cancellation and delay occurrences for scheduled surgeries will be compared during two time periods on patients on the surgical schedule at Norton Women and Children’s Hospital (NWC).

METHODS: This study was a single-center, pre and post implementation retrospective comparative study of the impact of the NP led PAT unit at Norton Women and Children’s Hospital (NWC) in terms of delay and cancellation rates for day-of-surgery. The sample consisted of 411 patients for …

The Effects Of Hormone Replacement Therapy (Hrt) On Surgically Postmenopausal Women: A Review Of The Literature, Leslie M. Hertweck

Honors Undergraduate Theses

The primary purpose of this research was to examine the effects of HRT in women with acute estrogen deficiency from surgically induced menopause. The secondary purpose was to evaluate how HRT improves symptoms of acute estrogen deficiency and quality of life (QOL) in women using hormone supplementation. Peer reviewed articles published from 2000 to 2017 that were written in the English language with a focus on the use of HRT in women with acute estrogen deficiency after surgical menopause were evaluated for relevance. Evidence suggests the primary reason for decreased use of HRT is the associated risks outweighing the benefits; …

The Effects Of Emerging Technology On Healthcare And The Difficulties Of Integration, Skyler J. Pavlish-Carpenter

Honors Undergraduate Theses

Background: Disruptive technology describes technology that is significantly more advanced than previous iterations, such as: 3D printing, genetic manipulation, stem cell research, innovative surgical procedures, and computer-based charting software. These technologies often require extensive overhauls to implement into older systems and must overcome many difficult financial and societal complications before they can be widely used. In a field like healthcare that makes frequent advancements, these difficulties can mean that the technology will not be utilized to its full potential or implemented at all.

Objective: To determine the inhibiting factors that prevent disruptive technology from being implemented in conventional healthcare.

Methods: …

Interdepartmental Rounding, Peggy Anderson, Carrie Strick, R3 Med-Surg Unit, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Maine Medical Center Operational Excellence

MaineHealth Maine Medical Center

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL

Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment.

A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average.

As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

A Retrospective Analysis Of Surgeon Estimated Time And Actual Operative Time To Develop An Efficient Operating Room Scheduling System, Pearly T. Brown, Dnp, Rn, Cnor

Doctor of Nursing Practice Projects

Problem: Surgical departments account for sizable budgets in hospitals. To ensure efficiency, optimal processes need to be maintained. The current practice for posting a surgical case is using surgeon estimated times (SETs), which only includes the reporting points of component 2 (C2) “incision” to “dressing.”

Objective: To analyze if there was a significant difference in minutes between actual operative times (AOT) and SET in patients undergoing outpatient general laparoscopic and inpatient orthopedic total joint surgery.

Methods: The facility is a level one trauma teaching center, with 371 beds, and a yearly surgical volume of 17,000 cases. This retrospective …

Effects Of A Comprehensive Bariatric Program Implementation On 30-Day Readmission And 30-Day Er/Infusion Clinic Visit Rates Due To Dehydration, Azra Kukic, Dnp, Rn, Cbn, Acm

Doctor of Nursing Practice Projects

Background: Program accreditation requires adherence to MBSAQIP standards to assist patient in making needed changes to his/her diet and lifestyle. However, literature provides conflicting information regarding the value of a comprehensive bariatric program accreditation and its effects on 30-day readmission and 30-day ER/infusion clinic visit due to dehydration development.

Objectives: To examine the effects of implementing a comprehensive bariatric surgical program on 30-day readmission rates, and 30-day emergency room (ER) and infusion clinic visit rates due to dehydration for bariatric surgical patients.

Methods: Our study was a retrospective separate sample pre-post intervention chart review. The data were collected before and …

Factors Influencing Preference For Surgical Choice Among Women With Early Stage Breast Cancer, Susan G. Yackzan

Theses and Dissertations--Nursing

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among …

Evaluation Of An Enhanced Recovery After Surgery (Eras) Pathway In Two Hospitals, Jennifer A. Janes

DNP Projects

OBJECTIVE: The purpose of this study is to evaluate the Enhanced Recovery After Surgery (ERAS) pathway utilized at two Norton Healthcare facilities for colorectal and gynecological surgeries. The specific aim is to examine the impact on patient outcomes, clinical effectiveness, and costs.

METHODS: This was a multi-center, pre-post implementation retrospective study of the impact of ERAS pathways on colorectal surgery patients at Norton Audubon Hospital (NAH) and gynecological surgery patients at Norton Women’s and Children's Hospital (NWCH). The sample included 399 patients including patients from both hospitals, pre- and post-ERAS.

RESULTS: The ERAS pathway lead to a significant reduction in …

Pediatric Emergence Delirium In The Postoperative Setting, Jennifer Miranda Snell

Walden Dissertations and Doctoral Studies

Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological …

The Effects Of Tranexamic Acid On Mortality Rate In Trauma Patients Compared To Trauma Patients With No Tranexamic Acid Treatment, Bradley Earl Tolar

Doctoral Projects

Traumatic injury is the leading cause of death for many age groups. Traumatic accidents caused over 130,000 deaths in the United States in 2014. This DNP project studied the effects of Tranexamic acid on mortality rate in trauma patients. After the completion of a needs assessment at a local level II trauma center, a literature review was performed. The literature showed a decrease in mortality rate when patients were administered Tranexamic acid within 3 hours of injury with statistically significant statistics. Also, the data from the literature showed no correlation between vascular occlusive events and Tranexamic acid use in trauma …

Decreasing Surgical Site Infections In Vascular Surgery Patients, Charlene Knight Little

Walden Dissertations and Doctoral Studies

Postoperative surgical site infections are common complications in the operating room. Infections prolong hospital stays, heighten costs, and increase morbidity and mortality. The purpose of this evidence-based quality improvement project was to develop policy, program, and practice guidelines to prevent surgical site infections in vascular surgery patients. Rosswurm and Larrabee's change model was used to develop materials using the best evidence for the recommended practice changes. The Plan, Do, Check, Act model was selected to guide quality improvement. The project goal was to decrease the surgical site infection rate to below the national average. Products of the project include policy, …

Outcomes Experienced By Patients Presenting With Ventral Hernias And Morbid Obesity In A Surgical Clinic, Margaret A. Plymale

DNP Projects

Surgeons generally agree that morbid obesity is a contraindication to ventral hernia repair surgery due to risk of adverse outcomes. The purpose of this study was to describe the experience of patients with ventral hernia complicated by morbid obesity by reviewing a population of patients that were seen by a surgical service to determine the characteristics of those patients that had favorable and unfavorable outcomes. A retrospective medical record review was conducted of new patients with ventral hernias and morbid obesity (body mass index (BMI ) ≥ 40 kg/m²) seen by one surgical service over a two and …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

The Utilization Of High Flow Oxygen To Administer Inhaled Pulmonary Vasodilators In Post-Operative Left Ventricular Assist Patient Population To Facilitate Extubation, Kenneth Miller Med, Rrt-Accs, Ae-C;, Timothy S. Misselbeck, Barbara A. Ebert Crnp, Robert Allman Rrt, Linda Cornman Bs, Rrt-Nps, Rrt-Accs, Ae-C

Patient Care Services / Nursing

No abstract provided.

Gap In Patient Expectations Of Deep Brain Stimulation For The Treatment Of Parkinson's Disease, Colleen D. Knoop Dnp-C

Graduate Theses, Dissertations, and Capstones

Abstract

Purpose: This project studied a specific group of patients with Parkinson’s disease to: determine if they were asked to verbalize expectations of DBS pre-operatively; determine if patient expectations were met post-operatively; gain information that could aid in improved pre-operative patient education for deep brain stimulation (DBS), address unrealistic expectations before surgery, and meet patient expectations post-operatively.

Methodology: This study was a retrospective, single academic center, two-part design that included a questionnaire and chart review of 29 patients. Those included were patients with Parkinson’s disease who had DBS programming at the academic center, between the years 2007 and 2014.

Results: …

A Feasibility Pilot Study On The Use Of Complementary Therapies Delivered Via Mobile Technologies On Icelandic Surgical Patients' Reports Of Anxiety, Pain, And Self-Efficacy In Healing, Margaret M. Hansen Edd, Msn, Rn

Nursing and Health Professions Faculty Research and Publications

Background Complementary therapies (CT), such as relaxation technique, massage, guided imagery, and accupuncture have shown to benefit patients undergoing surgery. The aim of this study was to determine the feasibility of using audio relaxation technique (ART), music intervention (MI), nature video application with music (NVAM), and nature video application without music (NVA) delivered via mobile technologies in a clinical setting. Secondary, the effects of ART, MI, NVAM and NVA on patients’ state anxiety, pain perception, and perceived self-efficacy in healing were determined. Methods A randomized clinical trial (RCT) involving 105 same day surgery (SDS) patients, who were assigned to an …

Practices Of Tracheal Suctioning Technique Among Health Care Professionals: Literature Review, Rozina Khimani, Fauziya Ali Dr., Salma Rattani, Mohammad Sohail Awan

Department of Surgery Docs

The current study aims to assess tracheal suctioning practices among health care practitioners; nurses, critical care technicians and physiotherapist. Employing literature review as the methodology, multiple databases were searched focusing on three phases of tracheal suctioning (a) the pre suctioning phase, (b) the suctioning phase, (c) the post suctioning phase and complications related to tracheal suctioning. It was concluded that to provide quality care it is important that the evidence based practice guidelines should be followed.

The Utilization Of Independent Lung Ventilation Via High Frequency Percussive Ventilation (Hfpv) During Extracorporeal Membrane Oxygenation (Ecmo), Kenneth Miller Med, Msrt, Rrt-Accs, Nps, Ae-C, Faarc, Rita Pechulis Md, Fccp, James K. Wu, Chad Traub Rrt-Accs, Dorothea T. Watson Do

Patient Care Services / Nursing

No abstract provided.

The Utilization Of The Pressure Volume Tool To Determine The Lower Inflection Point During Extracorporeal Membrane Oxygenation (Ecmo), Kenneth Miller Med, Rrt-Nps, Rita Pechulis Md, Fccp, James K. Wu, Dorothea T. Watson Do

Patient Care Services / Nursing

No abstract provided.

La Cesárea Y El Parto Natural: Las Opiniones De Profesionales De La Salud En La Provincia De Buenos Aires / Cesarean Section And Natural Birth: The Opinions Of Health Provinces In The Province Of Buenos Aires, Jacqueline Chipkin

Independent Study Project (ISP) Collection

Introduction: The ways in which women of society give birth have the power to influence maternal-infant health and shape the economy of the healthcare system. Today, the rates of cesarean sections are increasing throughout the world. In Argentina, on average, more than 35% of pregnant women received cesarean sections in 2008, with large differences observed in the rates between the public and private health sectors. The World Health Organization (WHO) has established that healthcare systems should only employ a cesarean section if labor cannot progress safely. According to this standard, the organization estimates that cesarean sections should only be utilized …

Changing The Road To Recovery: A Lesson In Pediatric Surgery Efficiency, Hope L. Johnson Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

One Love, One Heart – Uniting Cardiac Surgery Programs Within A Network, Lori Fuehrer Rn, Hope L. Johnson Msn, Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

First Results From Application Of An Absorbable Synthetic Membrane To Superficial And Deep Second Degree Burn Wounds, Sigrid A. Blome-Eberwein Md, Hamed Amani Md, Daniel D. Lozano Md, Deborah Boorse Rn, Cnp, Patrick Pagella Rn, Cnp

Department of Surgery

No abstract provided.

Successful Long-Term Extracorporeal Cardiopulmonary Membrane Oxygenation Without Anti-Coagulation, Janissa Nair, Dorothea T. Watson Do, Rita Pechulis Md, Fccp, Nicholas M. Rini Pa-C, Timothy S. Misselbeck, Kenneth Miller Rrt, James K. Wu Md

Department of Surgery

No abstract provided.

Burn Disaster Management Planning: A Preparedness Toolkit (Poster), Brian S. Joho Msn, Rn, Daniel D. Lozano Md, Patrick Pagella Msn, Arnp, Michael Wargo Mba, Rn, Hamed Amani Md, Facs

Patient Care Services / Nursing

No abstract provided.

Comparison Of Vaginal Cuff Closure Outcomes In Patients Having Robotic-Assisted Total Laparoscopic Hysterectomy: V-Loc Vs. Vicryl (Poster), Martin A. Martino Md, R Melody Reynolds Md, A Ei Haraki Md, Rachel Morcrette Pa-C, Kyle M. Langston Pa-C, Gregory F. Kainz Md, Richard Boulay Md, M Bijoy Thomas Md

Department of Obstetrics & Gynecology

No abstract provided.