Perioperative, Operating Room and Surgical Nursing Commons^™

Improvements Upon Reprocessing Of Orthopedic Single-Use Instruments, Alyssa P. Nguyen

Master's Projects and Capstones

Internal Medline data for Hospital A, a level I academic trauma center, identified a quality gap due to improper segregation and underutilization of orthopedic single-use device reprocessing bins. The baseline reprocessing rate of 4% for orthopedic products results in missed sustainability opportunities, financial strain, and increased regulated waste. A proposed quality improvement intervention implemented updated communication strategies, visual management tools, and education modules to reinforce current reprocessing workflows and close knowledge gaps. Outcome measures include the percentage of SUDs collected for reprocessing, survey results on reprocessing awareness, and potential financial savings in Appendix I. Early data showed a 10% year-to-year …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

Implementation Of Evidenced Based Practice Guidelines For Reducing Emergence Delirium In Elderly Patients Undergoing A Total Hip Replacement, Luke D. Kleinfelder

Doctor of Nursing Practice Scholarly Projects

A total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the …

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …

Assessing The Impact Of Interprofessional Simulation Training On Perioperative Staff's Confidence In Managing Maternal Hemorrhage, Mallory Duncan, Lidia Vazquez

Scholars Week

Globally, maternal mortality rates remain a critical public health challenge, often related to inadequate healthcare infrastructure in low-income countries. Yet according to the American Journal of Obstetrics and Gynecology (ACOG), maternal mortality rates in the United States are also on the rise, with nearly 32.9 deaths per 100,000 live births. These deaths are largely contributed to maternal hemorrhage (PPH), defined by ACOG as cumulative blood loss of at least 1,000 mL accompanied by symptoms of hypovolemia within 24 hours of the birth process. These findings underscore an urgent need to strengthen the training for perioperative staff in the management of …

Expanding Waste Segregation Initiatives To Reduce Regulated Medical Waste: A Multi-Departmental Quality Improvement Project, Emily M. Su, Anuja L. Sarode, Mohammed Sami, David R. Nehring, Erica L. Laipply, Mustafa Culcuoglu

HCA Healthcare Journal of Medicine

Background

Regulated medical waste (RMW) drives up health care costs, largely due to misclassification of general waste, especially in operating rooms (ORs), intensive care units (ICUs), and obstetrics and gynecology (OBGYN) departments. This study aimed to reduce RMW volume and costs at Akron City Hospital (ACH) through department-specific interventions aligning with Occupational Safety and Health Administration (OSHA) and Ohio Environmental Protection Agency guidelines.

Methods

Periodic analyses compared hospital-wide aggregate RMW volume, pick-up frequency, and disposal costs before and after interventions. The ORs initiated interventions in October 2022, expanding to ICUs and OBGYN by February 2024. Strategies included staff education, flyers …

The Fascia Iliaca Regional Nerve Block Using Ultrasound And Landmark Technique: An Objective Structured Clinical Examination For Nurse Anesthetists, Braxton T. Beech, Parker F. Rigby

Doctoral Projects

The fascia iliaca block (FIB) is an effective regional anesthesia technique used in various clinical settings, including operating rooms, emergency departments, and pain management clinics. Despite its advantages in reducing postoperative complications and minimizing opioid use, FIB remains underutilized among Certified Registered Nurse Anesthetists (CRNAs), primarily due to limited exposure and training. This doctoral project examines the implementation of an Objective Structured Clinical Examination (OSCE) as an educational intervention to enhance CRNA proficiency in performing FIB using both ultrasound-guided and landmark techniques.

A pre- and post-test study design was conducted with 18 CRNA participants attending a continuing education workshop. Demographic …

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 …

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 …

The Influence Of Perioperative Education On Postoperative Digestive Restoration, Christian Cedeno

Doctor of Nursing Practice Scholarly Project

The human body often needs encouragement to return to its natural state of functioning following intraoperative and postoperative drug therapy. Anesthesia can sedate the gastrointestinal tract and frequently requires medical and physical interventions to allow the body to return to full functionality. There are several methods thought to be beneficial in overcoming of this condition, and some have proven their significance more so than other methods. This project seeks to measure the power-of-knowledge methodology via a chart review of individuals specifically educated on what they can expect in the postoperative phase of care compared to those that receive routine education. …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

A Multidisciplinary Approach To Identify Postoperative Delirium In Geriatric Patients Using A Brain Health Screening Tool, Ashlyn Mccartney

Graduate Theses, Dissertations, and Problem Reports (ETD)

Postoperative delirium (POD) is a common occurrence, effecting nearly 61% of the surgical population recovering from anesthesia. POD increases risk of morbidity and mortality leading to prolonged hospital length of stay by 0.8 to 7.3 days and increased costs by $1,551 to $23,698 (Masharaf et al., 2022; Sethi, 2021). An academic medical center in northern West Virginia (WV) lacks a structured practice/protocol to identify high risk patients and assess POD. An evidence-based solution was developed based on the PICO question: Does a multidisciplinary approach to perianesthetic care utilizing a brain health screening tool, compared to lack of a screening tool, …

Power Safety Plan Checklist As An Intervention In The Operating Room, Scott John Fankhauser

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Power Safety Plan Checklist as an Intervention in the Operating Room

Scott J. Fankhauser

Background: Intraoperative power failures (IOPF) force anesthesia providers to quickly make decisions to prevent patient harm when equipment does not operate as designed. Familiarity with alternative methods is critical during this decision process to deliver high-quality care during IOPF events. Purpose: The purpose of this project was to assess the impact of a checklist on anesthesia providers’ perceptions regarding continuation of care during an IOPF. Interventions: Pre- and post-intervention surveys were conducted during a simulation and education setting for annual competencies. Methods: The study …

Implementation Of A Pilot Quality Improvement Project To Guide The Administration Of Intraoperative Dexamethasone For Postoperative Nausea And Vomiting Prophylaxis In Patients With Diabetes Undergoing Orthopedic Procedures, Brittany W. Hall

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: At a local tertiary care hospital, there was no recommendation to guide anesthesia providers in the administration of intraoperative dexamethasone to patients with diabetes. While dexamethasone is a highly effective antiemetic, it may promote hyperglycemia in patients with diabetes.

Purpose: The purpose of this project was to guide and educate about current recommendations for the administration of dexamethasone for PONV prophylaxis in patients with diabetes.

Intervention: 1) Examined pre-intervention practices of dexamethasone administration. 2) Educated about current and best practices to anesthesia staff. 3) Developed badge buddy cards outlining the guideline. 4) Examined post-intervention practices. 5) Evaluated the effect …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Implementing Audiovisual Education To Improve Quality And Patient Experience For Outpatient Colorectal Cancer Screening Patients, Stephanie Armstrong

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Colorectal cancer continues to be the second most deadly cancer in the United States, with thousands of new cases being diagnosed each year. Comprehension of bowel preparation education is an important factor in ensuring patients follow purgative and diet instructions. Inadequate bowel preparations lead to longer procedure lengths, decreased cancer screening capabilities, and decrease patient satisfaction. Audiovisual education has been shown to positively impact patient comprehension and instruction adherence, when compared to the standard written education. The goal of this quality improvement project was to implement audiovisual education and identify whether it improved bowel preparation adequacy and patient satisfaction. The …

Improving Access To Cardiac Catheterization, Sunitha Dharman

Student Scholarly Projects

The American Heart Association lists cardiovascular disease as the underlying cause of death for 874,613 people who lost their lives in 2019 (Tsao et al., 2022). On average, someone in the United States has a myocardial infarction every 40 seconds, and someone dies of a stroke every 3 minutes and 30 seconds. Studies support coronary artery disease as a significant contributor to cardiac arrest in a non-hospital setting (Yannopoulos et al., 2019). The authors provide evidence supporting the importance of early cardiac catheterization. There is a 10-15% survival rate with a higher level of functioning compared to delayed or no …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Utilizing Gastric Point-Of-Care Ultrasound Assessment For Patients With Questionable Npo Status, Carolina Botero

Doctor of Nursing Practice Projects

Perioperative aspiration is a rare but serious complication with high morbidity and mortality for patients. This event often occurs from anesthetic depression of protective airway reflexes. NPO guidelines are implemented before anesthesia to eliminate the presence of any gastric contents. However, patients with certain comorbidities may still persist with a full stomach before an anesthetic. Patients may complicate matters further by not following NPO instructions, the patient’s NPO status may be unknown, or the timing of surgery may prevent adequate NPO times. In these situations, the anesthesia provider is faced with the difficult decision to alter, delay or potentially cancel …

Lateral Decubitus And Prone Positioning: An Objective Structured Clinical Evaluation, David Hesley-Hernandez, James Bailey

Doctoral Projects

Improper positioning of patients in the lateral decubitus or prone positions can lead to significant complications, including but not limited to: airway and invasive line loss, physiologic derangements, soft tissue injury, and peripheral nerve injuries (PNI) (Barash et al., 2017; Butterworth et al., 2018). Chui et al.’s (2018) analysis found that PNIs accounted for 12% of anesthesia malpractice since 1990, making PNIs costly. PNIs effects are not limited to cost and result in increased lengths of stay, increased pain levels, and decreased quality of life (Wojtkiewicz et al., 2015). The massive effect poor positioning can have requires that the anesthesia …

The Effects Of Hospital Policy And Procedure On Cauti Occurrence, Kevin Kaga, Michaela Morrison, Daniel John

Symposium of Student Scholars

Abstract

Background: Clients that require indwelling catheterization often get bacterial infection causing catheter-associated urinary tract infections. These infections lead to longer hospital admissions and poorer outcomes for clients.

Objectives: To assess the effectiveness of the use of suggested hygiene methods from hospital policy/guidelines in preventing catheter-associated urinary tract infections.

Methods: Using the Kennesaw State Library search system, 10 articles were found to support that the use of consistent evidence based practices can prevent urinary tract infection occurrence.

Results: Our articles identified appropriate and inappropriate indications for catheterization and effective hygiene techniques used by nurses in the prevention of CAUTIs. These …

Utilization Of The Nurse Practitioner Skillset In Partnership With The Medical Device Industry, Daniel C. Rowland

Doctor of Nursing Practice (DNP) Projects

BACKGROUND: Millions of nurse practitioners (NP), physician assistants (PA), and registered nurses (RN) are optimistic that their current employers will help them reach their full potential. One area that can add value to the hospital and empower employees to work to the full scope of their practice, and utilize the skillsets like that of an NP, is to train these providers to support medical device equipment in the operating room instead of relying on medical device representatives (MDRs) of medical device companies.

METHODS: Training NPs, PAs, or RNs how to support neurological medical device equipment will better utilize the skillset …

Developing A Clinical Practice Guideline For Surgical Diabetic Patients, Barbie Denise Harbaugh, Diane Whitehead

Walden Faculty and Staff Publications

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

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 …

Educational Prevention Program Of Surgical Site Infections (Ssi), Carena Leung

Master's Projects and Capstones

Surgical site infections (SSI) cause negative health care effects to patients and hospitals. SSI is one of the most common types of healthcare-associated infections (HAI) accounting for 31% among hospitalized patients (Centers for Disease Control and Prevention [CDC], 2012). It is associated with prolonged length of stays (LOS), higher morbidity and mortality, and increased healthcare costs. The purpose of this quality improvement project is to decrease SSI rates by enhancing patient education and engagement in preoperative care and hygiene before surgery. In a metropolitan pediatric hospital, a microsystem analysis of the preoperative unit was conducted before generating the SSI Prevention …

Failure-To-Rescue Simulations As A Risk Management Strategy For Registered Nurses, Trena K. Seago

Graduate Theses, Dissertations, and Capstones

In the hospital setting, prevention of failure-to-rescue (FTR) events is an important aspect of patient safety. The use of patient simulation as a strategy to educate nurses on the prevention of these events offers two modes of learning: 1) experiential learning through simulation and 2) reflection through debriefing. The act of practicing to recognize a deteriorating patient through experiential learning and reflection may help increase nurses’ self-efficacy in recognizing a similar situation in their future practice. This quasi-experimental, one-group, pretest-posttest pilot study investigated the use of patient simulation among registered nurses (RNs) in the hospital setting as an anticipatory educational …

Individualizing Care For Pediatric Patients With Autism Spectrum Disorder In Perioperative Services, Erin Scheller

Master's Theses

This research explores solutions for individualizing and improving care for pediatric patients with Autism Spectrum Disorder in the Perioperative Setting of an Outpatient Surgery Center. Specifically, it seeks to determine if providing parent and staff resources on Autism Spectrum Disorder is significantly helpful in increasing confidence in the staff by the parents and the staff themselves. Participants included thirty-five surveyed families who had pediatric patients visiting perioperative services and staff who work on the unit. Methods used include information dissemination with the use of printable and online evidence-based resources, an in-person education event for staff, and a pilot study of …