Perioperative, Operating Room and Surgical Nursing Commons^™

In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel

Doctoral Projects

Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus …

Parturient Safety: Proper Positioning Education Prior To Neuraxial Anesthesia, Christina Joy Young

Doctoral Projects

In the United States, 61% of parturient patients elect neuraxial anesthesia for labor pain (Koyyalamudi et al., 2016). The incidence of postdural puncture headache is estimated up to 81% following accidental dural puncture-especially in pregnant women receiving elective epidurals (Ragab & Facharzt, 2014). Although the combined rates of complications for spinal and epidural anesthesia are low (2.78%) (American Society Anesthesiologists, 2014), patient safety is extremely important and should be addressed by the overall healthcare system. The purpose of this project assessed a willingness to change which focused on the CRNAs incorporation of proper positioning education prior to neuraxial anesthesia into …

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 …

Adoption Of Perioperative Lidocaine Infusion For The Reduction Of Postoperative Pain, Brandon Scott Figueiredo

Doctoral Projects

Laparoscopic capability provides numerous benefits to patients requiring abdominal surgical procedures. However, the use of these techniques has presented the anesthesia provider with a unique set of challenges in terms of perioperative management and postoperative pain reduction. No standardized method has existed to reduce postoperative pain and improve recovery following these procedures. There were three primary goals of this project. The first goal was to conduct a meta-analysis of randomized controlled trials to determine the benefit of the use of intravenous lidocaine infusions to reduce postoperative pain in laparoscopic abdominal surgery. Twelve articles were included in the meta-analysis that pertained …

Fentanyl Administration On Emergence From Surgery And Post Anesthesia Care Unit Discharge Times And Pain Scores, Andrew Ernst Wetzel

Doctoral Projects

Problem: Pain has been historically mismanaged potentially leading to a host of negative physiological consequences. Today’s dynamic health care reform offers an opportunity to increase satisfaction with care. Utilizing the PICO question, in adults undergoing laparoscopic cholecystectomy over a 12 month period, does medication with fentanyl during emergence versus not medicating during emergence reduce the need for pain medications and discharge times? Evidence/Background: Two national studies surveyed patient perception of pain management following surgery. The first, conducted by Apfelbaum et.al (2003) showed that 80% of patients experienced acute pain after surgery with 86% rating that pain as moderate …

Use Of A Handoff Communication Tool Between Certified Registered Nurse Anesthetists, Anesthesiologists, And Post Anesthesia Care Unit Nurses, Rachel Louise Johnson

Doctoral Projects

Ineffective communication in the post-anesthesia care unit (PACU) is considered to have incidences of increased error, mortality, morbidity, which leads to decrease patient outcomes and quality of care. Therefore, the purpose of this study was to introduce a structured, standardized, and consistent handoff tool to Certified Registered Nurse Anesthetists (CRNA), Anesthesiologists, and Post Anesthesia Care Unit Nurses (PACU) that may result in favorable perception of usage. Without a structured handoff tool, the organization risks the occurrence of increasing errors when the message is not transmitted effectively and efficiently every time. Distractions leave the handoff susceptible to a breakdown during the …

Noise: Its Impact In The Operating Room, Brennon Wesley Sloan

Doctoral Projects

Orthopedic and neurologic cases routinely reach noise levels exceeding 120 decibels (Katz, 2014). Modern equipment and monitors used by anesthesia personnel only reach 85 decibels (Katz, 2014). These monitors can go undetected during peak noise levels creating a serious safety concern for patients that could lead to patient injury or death (Gawande, Zinner, Studdert, & Brennan, 2003). A clinical question was developed to determine if the education of noise levels in the operating room affects change in practice. For operating room managers and staff, does education of noise levels in the operating room compared to no education initiate a change …

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Opioid Use In The Cesarean Section Patient With The Preoperative Administration Of Intravenous Acetaminophen, Dana Edwards Bernardo

Doctoral Projects

Cesarean sections are one of the most common surgical procedures and there are no current guidelines for the management of postoperative pain control (Darvish, Ardestani, Shali, & Tajik, 2013). Unresolved pain in this population can lead to long lasting problems, such as chronic pain and depression (Booth, Harris, Eisenach, & Pan, 2015). The goal of multimodal therapy with IV acetaminophen for CS mothers was to ensure a rapid and safe recovery process with reduced adverse complications and shortened hospital length of stay. The independent t-test was used to compare the mean time for length of stay, first request of pain …

Using A Cost Benefit Analysis To Support The Development Of A Comprehensive Business Model For A Pre-Filled, Pre-Labeled, Pre-Diluted, Sterilely Packaged, Ready-To-Use, Syringe-Based Anesthesia Delivery System, Lance B. Kennedy

Doctoral Projects

The foundation of Certified Registered Nurse Anesthetists’ (CRNAs) entire profession is built on the ability to provide anesthetic services using a variety of medications in the safest, most efficient, cost-effective way possible. The purpose of this capstone is to address, via a comprehensive cost benefit analysis, whether pre-filled syringe drug trays are a more cost-effective way to address problems as compared to vial-filled drug trays and to implement the necessary transitions in order to improve outcomes. There are a number of identifiable problems related to anesthesia medication delivery via vial-filled medication, including increased cost of healthcare, decreased patient safety to …

Is Dexamethasone 4mg A More Effective Anti-Emetic Than Dexamethasone 8mg For The Prevention Of Early Post-Operative Nausea And Vomiting In Women Undergoing Laparoscopic Gynecological Surgery?, Steven B. Doyle

Doctoral Projects

Postoperative nausea and vomiting (PONV) is a common problem in the surgical setting. It affects as much as 20 to 80 percent of patients undergoing surgery (D'souza, Swami, & Bhagwat, 2011). PONV can lead to increased patient costs and recovery time by causing the patient to stay in the healthcare facility for a longer period of time. A retrospective cohort study was completed to examine whether or not there was a significant difference between patients who received 4mg and 8mg of dexamethasone in the incidence of PONV. All patients studied received ondansetron intraoperatively as their primary anti-emetic. English speaking patients …

The Use Of An Intraoperative Forced Air Warming Device Alone Versus Warmed Intravenous Fluid Infusion And Forced Air Warming Versus Warmed Intravenous Fluid Alone In Patients Undergoing Open Intra-Abdominal Surgery, Charlie Adderley

Doctoral Projects

Patients undergoing open abdominal surgery with general anesthesia are at increased risk for adverse outcomes associated with disturbances in thermoregulation during the intraoperative phase of the surgical experience. The purpose of this quantitative capstone project was to examine and compare the differences between the use of an intraoperative forced air-warming device and a forced air warming device plus warmed intravenous fluid (IVF) in the management of postoperative hypothermia, as measured by the postoperative temperatures of patients undergoing open abdominal surgery. A comparative retrospective chart review was performed using two groups to assess the effectiveness of preventing postoperative hypothermia in this …

Utilization Of A Focus Group To Evaluate The Perceived Stress Levels And Coping Mechanisms Of Student Registered Nurse Anesthetists, Cillora Hicks

Doctoral Projects

Each year, thousands of Student Registered Nurse Anesthetists (SRNAs) matriculate into a nurse anesthesia educational program, confronted with unforeseen challenges and stressors. Although a certain amount of stress is essential to stimulate learning, excessive stress can have dire consequences in delaying a students’ academic and clinical progression. The purpose of this Capstone Project was to explore and describe the perceptions of 12 SRNAs relevant to their stress levels and coping behaviors in the management of academic and personal stress. The clinical research questions guiding the study examined the stress levels and coping behaviors of the SRNAs as measured by the …

Phenylephrine Versus Ephedrine: Safest Vasopressor For The Neonate During Caesarean Section, James S. Hale Jr.

Doctoral Projects

One of the most common side effects of spinal anesthesia is the development of hypotension. Data collected has determined that 80% of parturients that undergo spinal anesthesia for this mode of delivery experience hypotension (Chestnut et al., 2014).

Hypotension, if sustained and severe, can lead to fetal hypoxia, neonatal depression or injury, and decreased uteroplacental perfusion. Hypotension can also cause severe health issues for the parturient including apnea, altered level of consciousness, cardiac arrest, and pulmonary aspiration. This systematic review of the literature was conducted to determine whether the administration of phenylephrine or ephedrine was safer for the neonate to …

In The Surgical Patient Requiring Neuromuscular Blockade, Is There An Increased Incidence Of Postoperative Adverse Respiratory Events With Rocuronium Or Vecuronium?, Martha Claudine Boos

Doctoral Projects

It is estimated that up to 45% of surgical patients will have postoperative residual neuromuscular blockade (NMB) upon arrival to the postanesthesia care unit (PACU), and incomplete recovery can impair upper airway function and contribute to adverse respiratory events (Nagelhout & Plaus, 2014). This retrospective cohort study examined whether there was an increased incidence of postoperative adverse respiratory events with the neuromuscular blocking agents Rocuronium or Vecuronium. Inclusion criteria included any surgical patient ages 18-65 receiving NMB agents Rocuronium or Vecuronium during the procedure. Exclusion criteria included any surgical patient ages 18-65 with ASA classification > 4, any emergent cases, any …

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 …

A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister

Doctoral Projects

The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.

PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties; …

The Effectiveness Of A Preoperative Multimodal Antiemetic Regimen On Reducing Early Postoperative Nausea And Vomiting In Total Joint Arthroplasty Patients, Jerry Mosley

Doctoral Projects

Postoperative nausea and vomiting (PONV) occurs frequently in all types of surgeries including after total joint orthopedic procedures. The resulting PONV can lead to many unwanted occurrences including immobilization, distress, and many serious adverse health complications. These unwanted occurrences may then lead to increased cost to the patient and healthcare facility. Administration of a preoperative multimodal regimen known to reduce PONV has the potential to reduce such unwanted anesthetic side effects influencing a reduction in overall healthcare cost. The purpose of this study is to determine the effectiveness of the preoperative kit which includes the administration of metoclopramide, famotidine, ondansetron, …

Intravenous Acetaminophen Reduces Opioid Use For Postoperative Pain In Obese Patients Undergoing Laparoscopic Cholecystectomy, Kimberly S. Burks

Doctoral Projects

Opioid-induced respiratory depression is categorized as a sentinel event, which is an unanticipated occurrence that may result in severe injury or death. Although the incidence of opioid-induced respiratory depression is 0.2 to 2%, this issue persists as a substantial basis of morbidity and mortality. The obese population has multiple physiologic elements that increase their risk for opioid-induced respiratory depression. This retrospective study examined if intravenous (IV) acetaminophen reduces opioid consumption in the postoperative period in obese patients who underwent a laparoscopic cholecystectomy. Adequately controlled postoperative pain provides for greater patient satisfaction, decreased hospital length of stay (LOS), and reduced costs …

Reducing The Risks Of Wrong Site Surgery Using The Joint Commission’S Targeted Solutions Tool For Safe Surgery, Stephanie Kelly Parks

Doctoral Projects

The purpose of this project was to utilize the ‘Institute for HealthCare Improvement’s Model of Improvement as a consultation framework to facilitate improvement in core processes for the prevention of wrong site surgery (WSS) using The Joint Commission Targeted Solutions Tool for Safe Surgery© Program at a surgery center in Mississippi. The TST Program was conducted across 6 months and had 6 phases: 1) Getting Started, 2) Training Data Collectors, 3) Measuring Risk Factors, 4) Analyzing Data, 5) Implementing Solutions, and 6) Sustaining the Gains. A convenience sample of 47 surgical staff participated and 8 data collectors observed behaviors. The …