Nursing Commons^™

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

Books, Presentations, Posters, Etc.

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

Nurses Improving Nutrition Group Attendance Through Rn Invitations, Shelly Johnson, Susanna Mitchell

Articles, Abstracts, and Reports

Background: Gestational diabetes (GDM), a common pregnancy complication, increases the risk of dangerous birth outcomes, fetal anomalies, and sustained disease and comorbidity for mothers and infants throughout the lifespan. Insulin use is an independent predictor of anomalies. Our prenatal care did not include detailed nutrition assessments and modifications such as Mediterranean diet, a lifestyle associated with reduction in non-pregnant adult diabetes incidence, even reversal. Adding hands-on cooking to nutrition counseling has improved A1c outcomes. We hypothesized a comprehensive package of diet review, nutrition guidelines, and participation in an onsite cooking class initiated at the beginning of prenatal care (Green …

Planting The Seeds Of Health And Resilience, Shawna Beese, Teresa Bigand, Marian L. Wilson

Articles, Abstracts, and Reports

Purpose/Aims:

Our primary aim was to investigate whether gardens were a source of nutrition for the food bank users we sampled, and whether food bank recipients would be interested in using gardens as a nutritional resource.

Rationale/Background:

Food bank users represent an important population to explore the benefits of garden access for because they are at risk for insufficient access to fresh nutrient dense foods, may benefit from a low cost alternative sources of food, and they experience higher incidence of food insecurity. The activity of gardening also provides a myriad of secondary health benefits such as elevating mood, easing …

Solving The Sepsis Puzzle: Every Minute Counts, Jamie Roney, Amber Cline

Articles, Abstracts, and Reports

SPEMS Pre-Conference Course Sepsis Class

Electronic Fetal Monitoring Credentialing Examination: The First 4000., Mark Tomlinson, Sara A Brumbaugh, Marin O'Keeffe, Richard L Berkowitz, Mary D'Alton, Michael Nageotte

Articles, Abstracts, and Reports

No abstract provided.

Nursing Care Plan For Hypertension, Rebecca Hamlin

Articles, Abstracts, and Reports

No abstract provided.

New Patient Telephonic Visits, Deborah Satterfield, Min Stearns, Rachel Blackbburn, Elizabeth Fox, Erin Bryant, Catie Wilson, Susan Berning, Ericka Koellermeier, Mini Santiesteban, Lisa Rametes, Emily Kelsch, Sarah Phillips

Articles, Abstracts, and Reports

PMG Oregon currently schedules approximately 60,000 New Patient visits each year. New patients are often seen at their first visit, with very little, and/or, without most up-to-date medical information transferred to their new clinical care team. The delay or lack of information results in challenges to our clinic teams to provide the best care for our new patients. It also results in providers/care teams spending additional time entering clinical data either during the new patient appointment, after the appointment, and often additional appointments are needed to address patient problems that could be completed in the initial visit.

Improving Patient Satisfaction, Anita Chan, Rebecca Huskey, Jennifer Fegel, Jessie Williams, Lizzie Peterson

Articles, Abstracts, and Reports

No abstract provided.

Pmg Quality Reporting, Denise Floyd

Articles, Abstracts, and Reports

No abstract provided.

Implementing A Plan Of Care For Hypertension, Rebecca Hamlin

Articles, Abstracts, and Reports

Introduction: Providers routinely document what the next steps in treatment will be for patients who have elevated blood pressure during their office visit. In order for the plan to implemented, the patient must return to see the provider again and often wait up to 6 months before they return. This results in potentially sustained uncontrolled blood pressure.

Antepartum Screening Alignment, Shelly Johnson, Silvia Moreno-Aguilar, Joanna Sullivan, Dennis Tan

Articles, Abstracts, and Reports

No abstract provided.

Increase Postpartum Gestational Diabetes Screening, Kari Ayala, Angela Bonin, Rachael Baker, Susan Chin, Brian Drake, Joseph Kaempf, Christina Malango, Judy Marvin, Shelly Johnson

Articles, Abstracts, and Reports

Introduction:

Diabetic women did not get follow up screening after delivery. Nurses are finding a way to screen more women.

Healthy Weight Initiative, Stephanie Horlton (Presenter), Kathy Schwab, Lindsey Coppel, Ruth Fischer-Wright, Mary Potter

Articles, Abstracts, and Reports

No abstract provided.

Cqi Adoption, Kari Ayala

Articles, Abstracts, and Reports

No abstract provided.

Rn Smart Phrases In Clinical Programs, Susan Chin

Articles, Abstracts, and Reports

No abstract provided.

Ambulatory Blood Pressure Monitoring, Candice Eide, Amanda Matthews, Barb Pinson, Jayme Johnston

Articles, Abstracts, and Reports

No abstract provided.

Home Visits, Larry Acheson, Drew Bodmer, Laura Herrera, Hannah Johansen

Articles, Abstracts, and Reports

No abstract provided.

Diabetes Prevention, Shelly Johnson, Miles Hassell, Heidi Davis, Caroline Garrett, Joseph Kaempf

Articles, Abstracts, and Reports

Introduction:

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. If not treated properly, medicine is recommended = A2GDM. Both are preventable.

Use Of Befasstt Acronym To Improve Brainstem Stroke Recognition - A Case Study, Marietta Sperry, Amber Wilson

Articles, Abstracts, and Reports

Purpose: To increase recognition of lower brain stem strokes through the use of the BeFASSTT acronym to improve patient outcomes.

Oregon Region Standard Stroke Neurological Assessment Utilizing Aacn Synergy Model, Natalie Swearingen, Kailey Cox, Diane Clark

Articles, Abstracts, and Reports

No abstract provided.

Evaluation Of Intervention Aimed At Reducing Alteplase Returns Without Compromising Clinical Care In Acute Ischemic Stroke, Natalie Swearingen, Jillian Myers, Alyx Lesko, Lindsay Lucas, Elizabeth Baraban

Articles, Abstracts, and Reports

No abstract provided.

Comparisons Of Preoperative Blood Pressures In Surgical Patients, Brian Stacy, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Surgical patients expect anesthesia providers to provide high quality care. Blood pressure variability must be mitigated by establishing the patient’s blood pressure baseline and sustaining it through surgery. A consensus has not been established on which blood pressure measurement should be used as the patient’s baseline. Blood pressures before surgery in multiple care settings have been shown to vary. This may result in differences in drug and fluid administration, depending on the blood pressure considered baseline by the anesthesia provider. The purpose of this observational evidence-based practice project was to compare mean blood pressures leading up to surgery among …

Intraoperative Hypotension In Non-Cardiac Surgery Patients At Providence Sacred Heart Medical Center, Genna Ledrew, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Intraoperative Hypotension (IOH) during non-cardiac surgery is a common side effect of anesthesia that is associated with acute kidney injury (AKI), myocardial injury (MI), mortality, and other adverse outcomes1,3,4. These risks increase as the duration and severity of IOH exposure increase3,4. Blood pressure is a modifiable risk factor of mortality and organ damage that can be readily treated by the anesthesia provider2 . Limiting IOH can improve patient outcomes and produce monetary savings5 . The objective of this project is to report the incidence of IOH at a large tertiary teaching hospital, and extrapolate the risks of mortality and …

Sugammadex Versus Neostigmine: Operating Room Time And Cost, Annie Benscheidt, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background The choice of neuromuscular blockade reversal agents impacts cost and operating room time. Currently, the two medications used to reverse neuromuscular blockade are Neostigmine and Sugammadex. These medications differ in both cost and pharmacologic profiles which effect the time and predictability of reversal (Carron, Zarantonello, Tellaroli, & Ori, 2016). Evaluating cost and time differences in reversal using Sugammadex and Neostigmine helps anesthesia providers select the appropriate medication. This evidence based practice project examined the difference in case length and operating room and reversal agent costs in cases using Sugammadex and Neostigmine at Providence Sacred Heart Medical Center.

Methods • …

Transfusion Ratios Following Activation Of A Massive Transfusion Protocol: An Evidence Based Practice Project, Cody Woodbury, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Accidental injury is one of the leading causes of death in the United States and worldwide. Severe hemorrhage from injury is the leading cause of preventable death. Effective management of hemorrhaging trauma patients has been evolving since the early 1900’s. Recent studies have demonstrated the benefits of using a balanced resuscitation technique, revolving around the goal of recreating whole blood. The purpose of this project was to identify what ratios of blood products are being transfused at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH).

Methods A literature review was performed identifying seven high quality …

General Anesthetic Induction Sequence High Fidelity Simulation: Determining Efficacy Among Novice Student Registered Nurse Anesthetists, Alex Wilkie, Steven Urbick, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background High Fidelity Simulation (HFS) is used across multiple health professions. Despite the wide variety of clinical experiences that Student Registered Nurse Anesthetists (SRNA) possess prior to training, the induction sequence to a General Anesthetic (GA) is a daunting task. Although the efficacy of HFS has been widely studied within undergraduate nursing programs, there are no studies published determining the efficacy of HFS on SRNA training. The purpose of this study was to determine the efficacy of simulation training amongst entry-level SRNA’s and examine any individual participant factors that may influence clinical performance within HFS.

Methods • Human subjects were …

Hyperoxia: Current Practice Of Oxygen Delivery During General Anesthesia, Christa Kirby, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background While supplemental oxygen is routinely administered during anesthesia to prevent oxygen desaturation and optimize tissue oxygenation, oxygen delivery practices after intubation are largely unknown. Compiled evidence suggests limiting intraoperative fraction of inspired oxygen (FiO2) to below 60%. The deleterious effects of hyperoxia and the mortality benefit of conservative oxygen administration are being demonstrated in contemporary critical care literature. The lack of consensus guidelines and high level evidence on the topic of intraoperative oxygen delivery begs the question to what degree are patients being exposed to hyperoxia during general anesthesia. The purpose of this evidence-based practice project was to better …

Comparison Of Ondansetron, Dexamethasone, And Its Combination In The Prevention Of Postoperative Nausea And Vomiting, Alina Palanchuk, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative nausea and vomiting remains a common and unpleasant side effect for patients following surgery. Uncontrolled PONV can result in prolonged hospital stays, unanticipated hospital readmissions, and decreased patient satisfaction. The Apfel score identifies and counts independent risk factors for PONV; females, non-smokers, postoperative opioid use, and history of PONV or motion sickness. Rates of PONV increases as the number of risk factors increase. The primary intervention to decrease PONV is administration of prophylactic antiemetics. Research supports the use of combination antiemetic therapy for patients with a high number of risk factors. The purpose of this evidence based practice …

Ultrasound Simulation For Regional Anesthesia, Kayla Brown, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Regional anesthesia is an essential skill in the practice of Nurse Anesthesia, and future employment demands expertise. Literature supports the addition of simulation training to existing didactic and apprenticeship education to improve clinical expertise. The purpose of this project was to trial simulation training, focused on anatomical visualization with ultrasound for regional anesthesia, as a means to improve student performance and confidence.

Methods • Facility project approval and exemption determination by IRB. • Hands-On Test: Ultrasound to obtain visualization for axillary (cohort 1), interscalene (cohort 2) block on live-model. Expert CRNA observed performance to determine if image was clinically …

Intraoperative Opioid Administration Among Cancer Patients, Amanda Barrett, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Cancer prevalence continues to rise. In vitro and in vivo studies have demonstrated that opioid receptor agonists may be associated with poor outcomes for cancer patients. Laboratory studies have shown that opioids cause immunosuppression; tumor cell progression, recurrence and metastasis. The surgical environment further decreases immune function, causes an inflammatory response and promotes cancer cell mobilization. Anesthesia providers are in a unique position to influence postoperative outcomes. Opioid free anesthetic delivery is a growing trend amongst anesthesia providers and is supported by the literature. The purpose of this project is to compare intraoperative opioid administration rates for patients with …