Nursing Commons^™

Quality Improvement Initiative Through Staff Development: Using Education To Increase Preoperative Handoff Communication, Victoria L. Mcgovern

Master's Theses and Capstones

Abstract

Background: Handoff communication is essential for patient safety, especially in the perioperative setting as a critical care environment. Preoperative communication between operating room nurses and preoperative room nurses was suboptimal in a local microsystem as evidenced by pre-intervention data collection where 82% of cases did not participate in handoff, 11% with partial adherence of policy and only 7% in full adherence. The global aim of this project was to improve the handoff communication between the preoperative nurse and operating room nurse in the surgical day center (SDC) within the chosen microsystem to promote patient safety and positive patient outcomes. …

Cesarean Skin-To-Skin Contact: Who Gets The Experience In The Operating Room?, Jessica S. Junk-Wilson

Graduate Theses/Dissertations

For the past decade, skin-to-skin contact immediately after birth has been the general recommendation for all births, as there is evidence that it provides many benefits for mothers and infants. Yet, research has shown that immediate skin-to-skin contact is not the standard practice after most Cesarean births. This study assessed access, incidence, and circumstances surrounding Cesarean skin-to-skin contact (CSSC) in the operating room and examined influencing maternal characteristics of age, education, race, and number of births via a survey of 2327 people. Women who experienced a Cesarean section birth in the past 10 years were recruited through Facebook groups for …

Implementation Of Standardized Handoff Reporting To Improve Communication Among Certified Registered Nurse Anesthetists And Postanesthesia Care Unit Nurses In The Postanesthesia Care Unit, Lauryn G. Macfawn

Graduate Theses, Dissertations, and Problem Reports (ETD)

Standardization of handoff reporting has been proven to increase the quality of information being transferred and improve patient safety. Poor quality handoff between providers increases morbidity and mortality, hospital length of stay, healthcare costs, as well as decreases patient satisfaction The aim of this Doctor of Nursing Practice quality improvement (QI) project was to implement the situation, background, assessment, recommendation (SBAR) handoff reporting tool in the postanesthesia care unit (PACU) at a hospital in Western Maryland. There was no standardized handoff process in place between certified registered nurse anesthetists (CRNAs) and PACU registered nurses (RNs) at the facility. The participants …

A Preoperative Intervention To Improve Glycemic Control In Surgical Patients With Diabetes, Kelsey L. Boyd

Graduate Theses, Dissertations, and Problem Reports (ETD)

Perioperative hyperglycemia is reported in 20-40% of patients undergoing general surgery and is an independent risk factor for negative surgical outcomes. Patients with diabetes presenting to a local community hospital are at risk for negative surgical outcomes due to the lack of strategies to prevent perioperative hyperglycemia. This project aimed to implement and evaluate the usefulness of succinct diabetes education for preoperative total joint surgical patients with diabetes. The intervention was a nurse-led, face-to-face diabetes education session provided to total joint surgical patients with diabetes during a preoperative evaluation appointment, compared to usual care (no preoperative diabetes education). This project …

A Quality Improvement Initiative For Intraoperative Low Dose Ketamine Utilization In Thoracotomy, Jason Wampler

Graduate Theses, Dissertations, and Problem Reports (ETD)

The challenge of postoperative pain control following a thoracotomy is well noted among anesthesia providers. The intraoperative utilization of low-dose ketamine in several patient populations, including those undergoing a thoracotomy, has been deemed a viable intervention in the multi-modal analgesia plan at not only reducing postoperative pain scores for patients, but also reducing opioid consumption. This quality improvement project sought to increase provider awareness of this intervention among anesthesia providers in a community hospital with a goal to influence a practice change. This was completed using a pre-post design centered around an educational in-service, with an additional 60-day follow-up survey …

Surgical Site Infections And Hand Hygiene Discharge Teaching, Jesus A. Rodriguez Hernandez

Master's Projects and Capstones

Problem: During the span of a nine-month period, the PACU of a perioperative unit in an acute care hospital in the East Bay Area saw an incidence of 13 surgical site infections (SSIs). SSIs have been associated with negative patient health outcomes, diminished quality of life, and increasing healthcare costs.

Context: The PACU consisted of 20 beds and a competent staff of registered nurses, medical assistants, patient care technicians (PCTs), and management staff. It served mostly adults from diverse backgrounds receiving elective and emergent surgeries.

Intervention: A Standardized 3-Step Hand Hygiene Discharge Teaching model with nurse self-audits for every surgical …

The Relationship Between Surgical Site Infections And Hand Hygiene Discharge Teaching, Eishlee Renel A. Jasa

Master's Projects and Capstones

Problem: In the span of a nine-month period, the incidence of surgical site infections (SSIs) in a singular perioperative unit reached 13. SSIs have been linked with negative consequences for both the patient and healthcare system, decreasing quality of life and increasing costs.

Context: The 20-bed post-anesthesia care unit (PACU) primarily serves adult patients in the East Bay Area, where a variety of surgeries including elective and emergent procedures are performed. This facility specializes in general surgeries, where laparoscopic excisions and hernia repairs were the most commonly observed.

Intervention: The Standardized 3-Step Hand Hygiene Discharge Teaching is aimed to improve …

Improving Patient Hand-Off Communication By Utilizing The Situation-Background-Assessment-Recommendation (Sbar) Tool Between The Perioperative Services Departments, Maureen Mijares

Master's Projects and Capstones

Problem: The Situation-Background-Assessment-Recommendation (SBAR) patient handoff communication is required when the patient is transferred from one department/unit to the next phase of care. There is no standard SBAR utilized within the perioperative services departments.

Context: There are three types of patient handoff communication utilized in the perioperative services departments; Electronic Health Record (EHR), paper form, and verbal via phone.

Intervention: A standardized SBAR patient handoff communication tool to provide a framework to improve patient handoff communication between nurses within the perioperative services departments.

Measures: The outcome measure for this process improvement project is defined as the number of patient handoff …

Improving First Case Starts For A Neurosurgery Or, Tara L. Goodall

Master's Projects and Capstones

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide …

Enhanced Recovery After Surgery: Effectiveness Of Real Time Data Tracking Tools, Alatia S. Jentons

Master's Projects and Capstones

Enhanced Recovery after Surgery (ERAS) has been proven by evidence to lower both recovery time and postoperative complication rates while also being cost-effective. It is a new recovery process that consists of several bundles in order to meet adherence. The hospital site where this project was conducted was at a Northern California Medical Center which provides care for in-patient postoperative, urgent and non-urgent cases. On our assigned units, we identified the potential for improvement after observing a lack of standardization of real-time charting for ERAS. This resulted in retro data, which is not an effective way to collect data when …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Identifying And Evaluating Pain Management In Hospitalized Older Adults With Hip Fractures: An Integrative Review, Monique Guinocor

Master of Science in Nursing Final Projects

Hip fractures are known to have the highest health morbidity and mortality, especially in the aging population. Having a hip fracture comes with insurmountable pain. Older adults experiences pain differently from other populations due to physiological changes, but this population experiences an undertreatment and mistreatment for pain, resulting in negative outcomes. Current methods for pain control include pharmacologic and nonpharmacologic interventions. Exploring different interventions for pain management is necessary so providers can implement methods that are effective in pain relief without inducing complications. The aim of this integrative review is to identify current pain management interventions and determine their effectiveness …

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 …

Evidence-Based Update In Practice Development Of A Nursing Checklist For Documentation Of Pediatric Pre-Operative Fall Safety Measures, Susan Shemper

Doctoral Projects

ABSTRACT

Fall safety is an important component of patient care in the healthcare setting. Communication and implementation of fall safety measures are a critical part of the plan of care for each patient. Pre-operative pediatric patients have an increased risk of falls due to sedation, under-developed motor skills, and fall safety education. It is important for the pre-operative nursing staff to evaluate and implement a plan of care, including fall safety measures, according to each patient’s needs. The Joint Commission, (additionally known as TJC), is a United States based nonprofit, tax-exempt 501(c)(3) organization that accredits more than 22,000 U.S. healthcare …

A Performance Improvement Project To Improve Hand-Off Communication Documentation Within The Surgical Services Department, Bobbie J. Wich, Millie Escalona, Judy E. Bowling, Ana L. Santos

Nursing & Health Sciences Research Journal

Over 80% of adverse events in healthcare are due to miscommunication. To improve patient safety, The Joint Commission recommended the use of standardized hand-off communication tools in 2012. One acute care hospital in Southeast Florida implemented standardized handoff reports in 2014 with few revisions since that time. The COVID-19 pandemic brought to light additional critical information was needed to keep patients and staff safe, such as laboratory results indicating the need for isolation precautions. The nurses within the surgical services noticed this critical information was not sufficiently included in the handoff report. The lack of this information led to unnecessary …

Standardizing Surgical Skin Antisepsis, Crystal Vackar

MSN Capstone Projects

Skin antisepsis is one of the most critical factors for preventing postoperative surgical site infections, but with the lack of high-quality research, the choice of which preoperative skin antiseptic is best remains a puzzling problem for clinicians (Chen, Chen, Guo, & Xu, 2020). Minimizing the patient’s risk of a surgical site infection by removing skin contaminants at the surgical site is the goal of surgical skin antisepsis. Therefore, the hospital or organization must choose the right product that is cutting costs, is the most effective, saving surgical time, and has the safest results for the patient. Before prepping the skin, …

Bedside Shift Reporting: A Benchmark Project, Clydea C. Hale

MSN Capstone Projects

Patient care is forever changing to improve satisfaction, safety, and overall treatment. Over the past few years, patients and their families are more invested in their overall care in the hospital and expect to be informed every step of the way. A common complaint from patients or their families is that one nurse or staff did not know the individuals care or treatment plan, there were no shift goals to work toward discharge, and the nurse did not update the patient/family with changes in care. All of these complaints along with the patient satisfaction scores and communication between the treatment …

Deterring Delirium In The Intensive Care Unit, Kimberly Allen

MSN Capstone Projects

There is growing concern about the increase in cases of delirium associated with a critical care hospitalization encounter. Discovery of different types of research that can eliminate or at least minimize occurrences of delirium including early recognition, eye masks and earplug usage, and environmental changes have show promise in reducing the risk of ICU delirium.

Standardizing The Superior Preoperative Skin Antiseptic, Marissa Eckeberger

MSN Capstone Projects

Preoperative skin antisepsis is a critical component in the prevention of surgical site infections. Evidence has shown Chlorhexidine to be more effective than Povidone Iodine as well as any other agent, therefor it should be a standard of care for surgical patients. Patients expect to receive exceptional care and have good quality outcomes. Surgery is a means to resolve patient problems, not to develop new ones. Not having a standardized process in place means that patients are subject to receiving substandard care based on which surgeon they have and the surgeon’s preferences. Surgical nurses may be a part of two …

Increased Use Of Opioids Perioperatively Leads To Unmanaged Postoperative Pain, Halida Sehic

Nursing | Senior Theses

Background: Total knee and total hip joint arthroplasty are two frequently preformed surgeries, with 5.2 million total knee arthroplasties performed the United States between the year 2000 and 2010 (Williams et al., 2015). Opioids are widely used to manage pain for patients undergoing total joint arthroplasty. However, use of opioids is associated with undesirable adverse effects, such as nausea and respiratory depression, (Johnson et al., 2011). In postoperative patients following total joint replacement, 75 % of the patients complain of inadequately controlled moderate to severe pain (De Luca et al., 2018). Increased use and overprescribing increase tolerance to opioids …

Best Practice Recommendation On Anesthesia Involvement In Preoperative Interdisciplinary Rounding On Surgical Inpatients, Elizabeth Davis

Doctoral Projects

Healthcare professionals are always seeking methods to improve patient care and patient outcomes and increase efficiency while reducing errors. By improving communication through the implementation of interdisciplinary communication, improved care quality, fewer variations in care, and enhanced collaboration among the healthcare team may be an outcome (Hoke & Falk, 2012). While anesthesia is involved in patient care throughout the perioperative period, their expertise may impact the patient’s outcome and quality of surgical care. With the involvement of anesthesia in interdisciplinary rounding, the patient may be optimized, and the plan of care may be more appropriate and individualized.

The potential for …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Closing Communication Gaps For Unplanned Surgical Patients: One Pre-Op Checklist At A Time, Seda L. Vash

Master's Projects and Capstones

Problem: Unplanned, inpatient surgical patients were experiencing poor outcomes and dissatisfaction with their overall care. This surgical patient population also lacked communication from their healthcare teams with regard to plans of care throughout their hospital stays.

Context: This was a quality improvement project for the unplanned, inpatient surgical patient population in the Central Valley of California. Approximately 13% of this hospital’s surgical patients required post-surgical care in the inpatient units. These patients, according to unfavorable HCAHPS scores, experienced unsatisfying care and insufficient communication from their healthcare teams, including physicians and nurses.

Intervention: This project implemented an Add-On Communication Tool for …

Patient Satisfaction Towards Nursing Care In General Wards Of Tertiary Care Hospital Of Eastern India, Nanda Kumar Paniyadi, Asha P. Shetty

Manipal Journal of Nursing and Health Sciences

Patient satisfaction is one of the elements of determining the care provided as a desirable outcome of clinical care in the hospital. A patient’s expression of the care received is considered an important indicator regarding the quality of hospital care in all of its aspects. Indian nurses need to be aware of the importance of patient satisfaction and their role in providing need-based care. Objective: To identify patient satisfaction towards nursing care. Methods: A descriptive study design with a stratified sampling technique was used. The data was collected from 350 patients aged between 18-65 years at general wards of tertiary …

Pre-Admission Patient Education For A Prostatectomy Enhanced Recovery After Surgery Pathway, Vanessa C. Cotton

Doctor of Nursing Practice

Background. In the United States, prostate cancer is the most common cancer diagnosed in men and a common treatment choice is a radical prostatectomy. The Enhanced Recovery After Surgery® Society developed evidence-based guidelines to optimize treatment and improve outcomes in prostatectomy patients, yet not all hospitals are utilizing these guidelines or employing all of the elements, including pre-admission education. Purpose and Objectives. The purpose of this quality improvement project was to develop, implement, and evaluate a pre-admission patient education component for a prostate surgery pathway based on the Enhanced Recovery After Surgery guidelines. Objectives included assessing the nurse’s intention to …

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Postoperative Nausea And Vomiting Implications In Neostigmine Versus Sugammadex, Corey Lee Johnson, Colton Bradley James, Sarah Grace Traughber, Charles Anthony Walker, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Purpose/Background: Postoperative nausea and vomiting (PONV) is a frequent complaint in the postoperative period, which can delay discharge, result in readmission, and increase cost for patients and facilities. Inducing paralysis is common in anesthesia, as is utilizing the drugs neostigmine and sugammadex as reversal agents for non-depolarizing neuromuscular blockers. Many studies are available that compare these two drugs to determine if neostigmine increases the risk of PONV over sugammadex. Sugammadex has a more favorable pharmacologic profile and may improve patient outcomes by reducing PONV.

Methods: This review included screening a total of 39 studies and peer-reviewed articles that looked at …