Using Safety Checklists Outside Of The Operating Room, Annabelle Gerhardt

Doctor of Nursing Practice Scholarly Projects

Abstract

The use of a Time Out checklist for patient safety in non-operating room procedural areas is equally important for positive patient outcomes as in the operating room (OR). In this busy southwestern United States hospital, the procedural teams in the non-operating room areas were reported to not be fully engaged during the performance of the Time Out pre-procedural pause prior to gastroenterological (GI) procedures. This study was conducted to improve compliance with the scripted Time Out checklist and promote full engagement of the GI procedural team during the Time Out thus reducing risks of wrong site surgery. Literature has …

Human Factors Applied To Perioperative Process Improvement, Joseph R. Keebler, Elizabeth H. Lazzara, Elizabeth Blickensderfer, Thomas D. Looke

Publications

• Human factors/ergonomics (HF/E) is its own scientific discipline that can be applied to understanding performance in perioperative medicine.
• Humans are not perfect decision makers and are affected by a variety of factors that can greatly harm their ability to perform, including attention, bias, stress, and fatigue.
• HF/E has a unique perspective on human error, and HF/E can illustrate how moving away from blame can enhance safety.
• HF/E offers strategies for undertaking a systematic approach to assessment of work processes in perioperative medicine that can be used to increase safety and wellbeing of patients and providers.

What’S In A Name: Performance Improvement, Evidence-Based Practice, And Research?, Andrea Prentiss, Eve Butler

Nursing & Health Sciences Research Journal

No abstract provided.

Irrisept: Redefining Irrigation, Nicole Koening

Nursing Posters

IrriSept is the only FDA-Cleared device that delivers a pressurized solution containing Chlorhexidine Gluconate (CHG) for cleansing and debridement. As a final rinse, prior to closure in surgical procedures, IrriSept has the potential to help reduce SSIs and associated treatment costs. IrriSept was developed with the goal of becoming the "Standard of Care" and improving patient outcomes.

IrriSept has a wide range of activity against gram positive and gram negative bacteria, fungi, and viruses. It has demonstrated antimicrobial efficacy and persistence in laboratory testing.

Effects Of Energy-Based Therapies On Postoperative Recovery: An Integrative Review Of The Literature, Emily M. Wooten

Honors Undergraduate Theses

Associated with health care reform, there has been a growing interest among healthcare professionals regarding use of energy-based therapies as a complementary therapeutic intervention. The purpose of this integrative literature review was to examine the impact of energy-based therapies (i.e. healing touch, reiki, therapeutic touch) on patients’ postoperative recovery. The methodology included identifying appropriate peer-reviewed, English-language research articles on the topic area that were published between 2006 to 2018. Following a search in select data bases, articles focusing on the topic were critiqued, analyzed and synthesized by the researcher. Consistent and inconsistent findings along with gaps in the literature are …

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.

A Program To Prepare Frontline Nurse Leaders For Peer Review, Suzanne K. Murdock

DNP Scholarly Projects

Introduction: The purpose of nursing peer review is to assess the quality of nursing care against established standards, identify strengths and weaknesses in practice, and identify knowledge gaps. Studies of nurse peer review predominantly focuse on staff nurse attitudes and knowledge after an educational intervention and barriers to implementation. Frontline nurse leaders (FLNL) can influence adoption of new practices such as peer review.

Purpose: The purpose of this project was to engage frontline nurse leaders in a role specific peer review program, preparing them to support their staff in the implementation of peer review in the future and providing an …

Vapocoolant Spray’S Effect On Peripheral Inserted Venous Catheter Pain In Adult Patients, Zachary Krol, Fiona Flaherty, Ryan Williams

Williams Honors College, Honors Research Projects

Intravenous (IV) cannulation is required to administer medications and fluids to patients. In addition, it is also a recognized source of pain and anxiety in over one-half of all patients requiring IV insertion (Page & Taylor, 2010). Pain management is within nurses’ scope of practice, therefore it’s important to identify effective pain management strategies. The purpose of this study is to determine the effect that a topical vapocoolant spray has on pain in pre-operative adults during IV cannulation. The gate control theory of pain will guide this randomized, experimental study of a convenience sample of adults in an outpatient endoscopic …

Evaluation Of Risk Factors And Postoperative Outcomes In Surgical Laryngectomies With Intraoperative Hypothermia, Kristen V. Carter

DNP Projects

PURPOSE: The purpose of this study is to determine whether intraoperative hypothermia exposure would be identified as an independent risk factor for surgical laryngectomy patients’ rate of postoperative complications within their surgical admission. The findings would help to justify the institution of “pre-warming” laryngectomy patients to prevent detrimental effects postoperatively.

METHODS: Retrospective chart review of 245 patients who had laryngectomies at the University of Kentucky from 2010-2017. Rate of complication and variables predictability of postoperative complications was evaluated.

RESULTS: In the sample, 157 patients developed complications. Complications included 35 transpharyngeal fistulas, 29 free flap failures, 43 hematomas, 50 wound infections/ …

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 …

Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam Iv

Theses and Dissertations

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home

patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.

Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity …

Implementation Of An Opioid Risk Assessment Tool, Stacey Cuomo

Seton Hall University DNP Final Projects

The increased prevalence of opioid use in society has led to an increase in surgical patients with a history of such use. Patients who use or are addicted to opioids have different tolerances and responses to anesthesia than non-opioid users, and will require different care than non-users both pre- and post-operatively. The means to identify this population prior to a surgical procedure is needed as a way to organize, plan and manage patient care during the perioperative period. An Opioid Risk Assessment Tool (ORAT) was used as a way to streamline the process of identifying these patients. This paper addresses …

Improving Nursing Adherence To Pediatric Pain Management Bundle Using The Pdsa Cycle, Stephen W. Lovern

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Given the current standards, pediatric post-operative pain management can be a distressing outcome to the patient and family. Adequate management of post-op pain in this population is a challenge despite the availability of evidence-based interventions combined to form care bundles. Tonsillectomies are common procedures in the pediatric population and often include moderate to severe pain with ineffective pain relief. Inadequate pain management leads to unplanned admissions, longer post anesthesia care unit (PACU) stays, slower oral intake, and longer recovery periods. In this project, two interventions were tested using the plan-do-study-act (PDSA) model for rapid cycle improvements. The first intervention was …

Development Of A Nurse Practitioner First Assistant Orientation Program, Romoanetia Lofton

Doctor of Nursing Practice (DNP) Projects

The demand for surgical services continues to increase, creating a strain in our healthcare system and causing increasing backlog hours for the operating room. Allowing nurse practitioners (NP) to function in an expanded role in the perioperative environment requires additional training beyond the generic NP program. With this additional training, the NP can function as a first assistant, providing delegated medical functions in the perioperative environment. An in-house NP registered nurse first assistant orientation program was developed based on the adult learning theory as a conceptual framework combined with the AORN perioperative standards as a foundation. The cost of using …

Fall Prevention, Linda Fang

Master's Projects and Capstones

Fall Prevention Abstract

Background: According to the CDC, the medical cost for falls was approximately $30 billion in 2012. When a patient falls, and gets serious injury, these costs could sum up to $14,056 per patient. As a result, hospital stays per patient are observed to increase by approximately 6.3 days longer than those patients who haven’t encountered falls.

This study focused on identifying high fall risk patients, and developing a plan of care to reduce the occurrence of falls in a hospital setting. Nurses using safe fall interventions techniques have been proven to inspire fall preventions.

An assessment of …

Surgical Site Infection Reduction Through Nasal Decolonization Prior To Surgery, Melissa S. Schmidt

Master's Projects and Capstones

Surgical site infections (SSIs) are the most common and expensive healthcare-acquired infection. The objective of this nurse-driven process improvement project was to implement a cost-effective and practical decolonization protocol to improve outcomes for high-risk veteran populations undergoing surgery at a large veteran’s hospital in the Pacific Northwest. Prior to the implementation, a decolonization protocol was used for cardiac and orthopedic preoperative patients. The process involved screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization via nasal swab preoperatively and treating positive patients with mupirocin ointment to nares BID and chlorhexidine showers for five days prior to surgery. Adherence to the protocol was …

Reducing Turnover Time To Improve Efficiency In The Operating Room, Myrna Jafari

Master's Projects and Capstones

Abstract

The purpose of this project is to improve efficiency by reducing turnover time in the operating room (OR) that can consequently enhance patients’ and physicians’ satisfaction, promote teamwork, and decrease the cost of operating room delays. The increasing trend of turnover time (TOT) requires attention for microsystem improvement in the OR of Santa Rosa Memorial Hospital. The intervention to improve efficiency is to educate the OR team members on roles and responsibilities to establish a standard workflow which can promote accountability and teamwork during the turnover process. Havelock’s theory of change is used as a framework for the action …

Administering Dexamethasone Prior To Peripheral Nerve Blocks, Jacob Millwood

Doctoral Projects

Post-operative pain creates burdens for the patient and their family members while also drastically increasing the price of cost to the healthcare system. The Institute of Medicine Committee on Advancing Pain Research, Care, and Education states that the annual economic cost of chronic pain in adults is $560-630 billion (IOM, 2011). Regional anesthesia has been shown to provide potent analgesia that often times leads to a reduction in systemic analgesic requirements, opioid related side effects, general anesthesia requirements, and possibly the incidence of chronic post-operative pain. There are several adjunct medications that can be combined with peripheral nerve blocks to …

Increasing Student Registered Nurse Anesthetists Clinical Self-Efficacy Using Peer Mentoring, Megan Christine Bass

Doctoral Projects

The purpose of this project is to determine if clinical self-efficacy is increased in SRNAs at The University of Southern Mississippi after participation in the peer mentoring program. The project was a one-group pre and posttest design in a sample of SRNAs who received peer mentoring. To evaluate the students’ perceived clinical self-efficacy before and after the peer mentoring educational intervention, the Rowbotham and Schmitz Student Self-Efficacy scale (SSE) (2013) was adapted and administered to second-year SRNAs (N=17). Clinical performance, skill and knowledge development, social interaction with clinical faculty, and coping with clinical stress are the four areas evaluated by …

Non-Invasive Positive Pressure Ventilation In The Obese Patient Population An Intervention To Enhance Oxygenation: A Quality Improvement Project, Justin Smith

Doctoral Projects

Obesity is a comorbidity that can be challenging to the anesthetist. Patients who are obese are at risk for rapidly desaturating after becoming apneic during the induction of a general anesthetic. This rapid desaturation is mainly attributed to their decreased oxygen reserve that is a result of their obesity. Mississippi is known to have a disproportionately higher percentage of citizens who are obese, compared to other states (Johnson, 2016). Desaturation in the obese is important to avoid because it leads to atelectasis and prolongs recovery. When an anesthetist is providing a general anesthetic to the obese patient population, it is …

The Effects Of In-Service Education On Workplace Incivility For Crnas, Tran King

Doctoral Projects

Workplace incivility (WPI) affects many healthcare providers, including Certified Registered Nurse Anesthetists. This project was an exploration of the prevalence, nature, and sources of WPI affecting CRNAs. The project’s intervention was an in-service education on WPI for CRNAs. The purposes of the project were to measure the effectiveness of the in-service education in increasing awareness of CRNAs about WPI; and to offer a practice change proposal in terms of a policy against WPI in the anesthesia department.

A Needs Assessment Survey and Demographic Data Information form were distributed from Survey Monkey to participants’ email by way of blind copy. Data …

Multicenter Handoff Collaborative, Philip E. Greilich, Joseph R. Keebler

Publications

Communication and team-based care are at the heart of patient safety. As anesthesia professionals, we witness this at its very best and worst when transferring patients to and from the operating room (see article by Dr. Lorinc on types of transfers in this issue). In response, we have an opportunity to take a leading role in redesigning the most ubiquitous teaming event in hospitals in a manner that promotes team-based behaviors. The impact of unreliable handoffs on communication failures and medical errors is well known. To combat this issue, mandates by The Joint Commission (TJC) in 2006 and the American …

Monitoring Patient Safety In The Recovery Room, Gail Davis

Dissertations

Respiratory depression is a serious complication after surgery. Early detection is a major patient safety concern for recovery room personnel as patients recover from anesthesia and experience pain. The opioids used for pain management may contribute to over-sedation effects and respiratory depression. Vital signs and pulse oximetry are standard postoperative monitoring procedures. End-tidal capnography and arterial blood gases may augment the standard-of-care procedures but may not be effective at detecting early respiratory depression. The purpose of this study was to generate baseline data trending patient safety variables and outcomes for postoperative patients using standard monitoring with standard-of-care plus transcutaneous capnography …

Knowledge And Attitudes Of Orthopedic Nurses Regarding Pain Management, Matthew Neumann

Doctoral Dissertations and Scholarly Projects

Nurses are at the forefront in the care of patient pain management; however, many nurses do not possess the knowledge, skills, and attitudes required for best pain management outcomes. Adequate pain management education is often infrequent in academic settings and in post-graduate health care environments. That shortcoming suggests a need to improve pain management education as advocated by The Joint Commission and U.S. Department of Health and Human Services. The purpose of this study is to measure 20 nurses’ knowledge and attitudes regarding pain and pain management while working in an orthopedic setting. It was an evidence-based practice project utilizing …

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 …

Implementation Of An Evidenced-Based Practice Curriculum To Improve Nursing Practice For Epidural Administration And Monitoring, Chatty O'Keeffe

Master's Projects and Capstones

Abstract

Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor …

2017-2018 Graduate Studies In Nursing Handbook, Otterbein Office Of Graduate Programs

Graduate School

A graduate handbook for the Graduate Studies in Nursing programs at Otterbein University.

Malignant Hyperthermia, Garrett Erickson

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia is known as a pharmacogenetic disorder which manifests itself in the skeletal muscle (Heytens, Forget, Scholtès, & Veyckemans, 2015). When a susceptible patient, who carries the autosomal dominant trait, is exposed to volatile anesthetics and/or the neuromuscular blocker succinylcholine, a detrimental response can occur. This response is a hypermetabolic state with hypercapnia, hemodynamic instability, rigidity, hyperthermia, and signs of rhabdomyolysis (Heytens et al., 2015). MH is a rare condition with incidences between 1/5,000 and 1/50,000 (Nagelhout and Plaus, 2014, p. 829), and often occurs during the induction of anesthesia but can also occur intraoperatively or one hour post …

Timing Is Everything: Discharge Teaching To Parents In Pediatric Outpatient Surgery, Kate Boulder Dnp Candidate, Ccrn, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: Over 50 years of literature support the nursing “golden rule” that discharge teaching begins upon admission. Parents’ poor understanding of pediatric post-operative instructions following outpatient day surgery can put their child at risk for some preventable complications after arriving home.

Purpose: To improve parents’ understanding of discharge education using earlier initiation of post-operative teaching to best meet the needs of adult learners caring for a child under age 18 after surgery.

Process Used: Parents were educated using four cardinal strategies: early initiation of instructions, reinforcement of key points throughout the length of stay, optimal timing in a distraction-free environment, …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …