A Patient-Centered Approach To Improving Patient And Family Education On Perioperative Processes To Reduce Anxiety: A Quality Improvement Initiative, Ashley Lauren Doherty

Master's Theses and Capstones

Background: Perioperative anxiety is common among surgical patients and their family members. Anxiety may be increased by uncertainty and limited understanding of the surgical experience. Improving perioperative education may enhance understanding, reduce anxiety, and support a more patient and family centered surgical experience.

Local Problem: A Post-Anesthesia Care Unit (PACU) identified knowledge gaps in patient and family education about the perioperative process. The existing waiting room bulletin board was outdated and provided limited information. PACU nurses observed anxiety-related behaviors and confusion among patients and family members about the perioperative process. Patient satisfaction surveys routinely collected by the hospital also demonstrated …

Improving Operating Room First-Case On-Time Starts And Reducing Turnover Times: A Quality Improvement Project, Ashley Cote

Master's Theses and Capstones

Abstract

Background: Delays in first case on-time starts (FCOTS) contribute to decreased operating room (OR) efficiency, increased healthcare costs, workflow disruptions, and reduced staff and patient satisfaction. Evidence suggests that standardized workflows, improved communication, and Lean Six Sigma methodologies can improve perioperative efficiency and reduce delays.

Local Problem: Baseline data from a local OR microsystem demonstrated an FCOTS rate of 77%, below the organizational benchmark of 80%. Root cause analysis identified inconsistent preoperative workflows, communication gaps, and variable staff adherence to standardized processes as primary contributors to delayed first-case starts.

Methods: A quality improvement project utilizing the Define, Measure, Analyze, …

A Quality Improvement Initiative: Implementing An Effective Massive Transfusion Protocol Cognitive Aid Tool Within An Operating Room & Post-Anesthesia Care Unit Setting, Jenna L. Farrell

Master's Theses and Capstones

Abstract

Background: Massive Transfusion Protocol (MTP) activations are low-frequency, high-acuity events in the post-anesthesia care unit (PACU) setting.  These events necessitate the rapid formation of codes teams, interdisciplinary communication amongst unfamiliar providers, critical decision-making, high-volume rapid blood transfusions, and critical laboratory marker monitoring.

Local Problem: Due to the infrequent nature of hemorrhagic events in the PACU, nurses may have limited experience participating in these protocols at their institutions, resulting in potential for documentation errors from retrospective back charting, decreased confidence regarding blood product sequencing and laboratory draw timing, and increased cognitive workload overall.  This quality improvement (QI) project implemented …

A Quality Improvement Initiative To Enhance The Effectiveness Of Pre-Anesthesia Documentation And Nurse Satisfaction In The Pacu, Stephanie Colon

Master's Theses and Capstones

Background: Documentation is an essential component of healthcare delivery, especially in perianesthesia nursing. Electronic health records (EHR) have helped create high-quality documentation according to the standards of the American Nurses Association. However, EHRs have been found to be burdensome on nurses when they interfere with their workflow.

Local Problem: The documentation process for pre-operative anesthesia assessments within a nine bed PACU in Southern New Hampshire was found to be inefficient, increased chances of error or mistakes, and delayed patient data being accessible to the team.

Methods: Using the Plan-Do-Study-Act (PDSA) model, a quality improvement project was performed to update and …

Optimizing Surgical Count Accuracy And Efficiency Through Enhanced Operating Room Communication To Promote Patient Safety: A Quality Improvement Project, Jessica L. Limbocker

Master's Theses and Capstones

Abstract

Background: Retained surgical items (RSIs) are classified as “never events” because they are preventable and pose significant risks to patient safety. This quality improvement (QI) project aimed to reduce the risk of RSIs, particularly during Cesarean sections by identifying gaps in surgical count practices and implementing targeted interventions.

Local Problem: At the project site, baseline assessments revealed gaps in surgical count practices. These included inconsistent documentation, absence of formal education on count procedures, and communication barriers among the intraoperative team—all contributing to increased risk of RSIs.

Methods: This QI project implemented a multi-faceted intervention to enhance …

Improving The Effectiveness Of Post-Anesthesia Care Unit Transitions: A Quality Improvement Initiative Using A Standardized Nurse Handoff Report Sheet, Myra Mcauley

Master's Theses and Capstones

Background: Effective communication during patient handoff in the post-anesthesia care unit (PACU) is essential to ensuring patient safety and continuity of care. Unstructured or inconsistent handoff processes can lead to information omissions and care delays.

Methods: This quality improvement project implemented a structured nurse-to-nurse handoff report tool in the PACU. A pre- and post-intervention survey design was used to assess nurses’ perceptions of handoff clarity, completeness, and satisfaction. Educational sessions supported implementation.

Results: Pre-intervention survey data revealed dissatisfaction with the current handoff process, citing frequent information gaps. Following implementation of the structured tool, post-survey results showed improved communication clarity, increased …

Improving Patient Safety And Continuity Of Care By Educating Nurses About Standardized Handoffs In The Post-Anesthesia Care Unit: A Quality Improvement Project, Remi Dos Santos

Master's Theses and Capstones

Background: Effective communication during patient handoffs is crucial for ensuring patient safety and continuity of care. The I-PASS handoff tool has been identified as an effective method to standardize communication and reduce errors during these critical transitions.

Local Problem: In the Post-Anesthesia Care Unit (PACU) of a hospital in New England, the lack of standardized procedures for nurse handoffs posed a risk to patient safety and care quality.

Methods: A quality improvement project was conducted using the Plan-Do-Study-Act (PDSA) cycle to implement and evaluate an educational intervention aimed at improving PACU nurses' proficiency with the I-PASS handoff tool. Pre- and …

A Quality Improvement Initiative To Redefine The Process Of Instrument Decontamination From The Surgical Field In The Operating Room To The Sterile Processing Department., Nicole Dannett Denton

Master's Theses and Capstones

Background: The Operating Room (OR) faces a significant challenge with the increasing presence of bioburdens on instruments. Research-based on evidence has demonstrated the critical role of precleaning at the point of care with sterile water in reducing bioburden incidence. While current practices recommend the use of an enzymatic solution post-procedure to spray instruments, it is clear that a more comprehensive approach is needed to effectively manage bioburdens and reduce the risk of Surgical Site Infections (SSI).

Methods: Utilizing the Plan-Do-Study-Act (PDSA) model to create a Quality Improvement (QI) solution, the project leader recommended using sterile water at the point of …

Improving Quality Of Documentation In Perianesthesia Care Units To Increase Nurse Satisfaction And Patient Safety: A Quality Improvement Project, Anja Novcic

Master's Theses and Capstones

Abstract

Background: Quality documentation in healthcare settings is essential to ensure nurse satisfaction and patient safety. Documentation templates for patient charting should be in a format that follows best practice nursing care and captures all necessary assessments and interventions ordered by providers for patient care. A quality improvement was conducted in a PACU to evaluate the nurse satisfaction with the use of a new and revised documentation template for pain block procedures.

Local Problem: Within the perianesthesia care unit (PACU) of a Same Day Surgery center, a problem was identified regarding the nurse dissatisfaction with the template in place for …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

Using Education To Promote Waste Segregation And Waste Reduction In The Operating Room: A Quality Improvement Initiative, Sarah E. Landgraf

Master's Theses and Capstones

Background: The operating room (OR) is known to be one of the largest producers of medical waste and of the surgical specialties, orthopedic surgery tends to the largest portion of this. Waste from the OR can be mitigated by recycling non-contaminated materials. This reduces the number of raw materials needed to create new products, decreases landfill use, and lowers hospital costs.

Local Problem: It was observed that a gap in knowledge existed related to recyclables in the OR of a large medical center in New England. Also, it was observed that there was potential for waste and recycling to be …

Improving Initial Pain Assessments Upon Arrival To The Post Anesthesia Care Unit By Implementing The Critical Care Pain Observation Tool, Molly Jacques Ms, Rn

Master's Theses and Capstones

Abstract

Background

Pain assessments in the post-anesthesia care unit (PACU) are crucial to recovery, the discharge process, patient outcomes, length of stay, and readmission rates. It is one of the main responsibilities of PACU nurses to adequately assess and treat pain when patients are in phase one and two of recovery after surgery. A thorough and accurate pain assessment tool is needed for these critically ill patients because not all of them are able to verbally express discomfort.

Local Problem

The problem that was identified during this quality improvement project was inconsistent initial pain assessments in the PACU. Patients arrive …

Reducing Clabsi Rates Through Education On Maintaining Cvc Dressing Integrity: A Quality Improvement Initiative, Hanna I. Lentine

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units.

LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma …

Improving Patient Safety In The Post-Anesthesia Care Unit By Identifying Nurses’ Perceived Barriers To The Implementation Of Barcode Medication Administration, Colleen Gauvin

Master's Theses and Capstones

Background: In the landmark report To Err is Human: Building a Safer Health System published by the Institute of Medicine in 1999, it was estimated that 98,000 Americans die annually due to medical mistakes (Institute of Medicine et al., 2000). Since then, major advancements have been made to improve patient safety in the United States relating to safe medication administration. Barcode medication administration (BCMA) is a technology that was designed to help decrease medication errors by automating the five rights of medication administration (Thompson et al., 2018). BCMA was first utilized at a Veteran Affairs (VA) Medical Center in …

Improving The Patient Repositioning Process: A Quality Improvement Project, Sydney Elizabeth Mcgough

Master's Theses and Capstones

Background: Research has shown that visual turn reminders can improve patient repositioning to prevent pressure injuries. The aim of this quality improvement project was to improve adherence to repositioning by increasing the perceived usefulness of the visual turn reminder.

Methods: A pre-intervention survey was distributed to 70 staff members with 22 responses. Staff were given the opportunity to recommend changes to the visual reminders and were informed that feedback would lead to the identification of common themes. Based on feedback, high visibility turn reminders were developed and implemented on the unit. A post-intervention survey was distributed to the same 70 …

Increasing Perioperative Nurse Knowledge Of Preoperative Urine Pregnancy Testing: A Quality Improvement Project, Brooke K. Hall

Master's Theses and Capstones

Background: Nurses in the perioperative environment are responsible for assessing patients prior to undergoing surgery. Preoperative urine pregnancy testing is utilized to determine the pregnancy status of patients. Various risks of anesthesia and surgery exist for pregnant patients and the fetus. The perioperative nurse must be knowledgeable about these risks and ensure preoperative urine pregnancy tests are obtained when appropriate.

Local Problem: Within this microsystem, a gap in knowledge of perioperative nurses related to the nature and significance and institutional policy for preoperative urine pregnancy testing was identified.

Aim: The aim of this project was to increase knowledge of preoperative …

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. …

Use Of A Simplified Protocol For The Prevention Of Postoperative Nausea And Vomiting In Adult Ambulatory Surgical Patients, Roger Horne

DNP Scholarly Projects

Postoperative nausea and vomiting (PONV) remains a common complication affecting surgical patients after receiving anesthesia. Prevention of PONV is important in an ambulatory surgical setting where patient access to rescue treatment is limited after discharge. A quality improvement (QI) project introduced a simplified PONV prevention strategy to decrease the incidence of PONV at a Veterans Health Administration ambulatory surgery center. A retrospective chart audit of all facility surgical patients receiving anesthesia care (n = 94), excluding ophthalmology patients, was conducted prior to COVID-19 restrictions to establish baseline PONV incidence. An evidence-based, simplified PONV prevention protocol was developed and implemented. …

Implementation Of Safe Patient Toileting To Decrease Patient Falls On Medical-Surgical Unit, Kimberly A. Goldsborough

DNP Scholarly Projects

BACKGROUND: Patient falls are a serious safety concern in the hospital setting throughout the country. Falls are one of the most challenging patient safety events to prevent, as there are many contributing factors with toileting activities producing the highest incidence. Fall prevention bundles are used to minimize and reduce these such events although multifaceted. The project was conducted with an academic medical center on an acute inpatient medical-surgical unit primarily housing burn wound patients. Nursing leaders and front-line nursing staff participated.

METHODS: Literature review to determine the gap in knowledge of interventions to prevent acute inpatient falls was completed. Concepts …

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 …

Inefficiency In The Post Anesthesia Care Unit: A Quality Improvement Initiative, Ashley St. Martin

Master's Theses and Capstones

Background: The post anesthesia care unit (PACU) is a busy environment in which nurses communicate with patients, family members, and a large team of perioperative professionals. PACU nurses were experiencing an unmanageable number of work interruptions due to a higher patient census which increased the daily surgical caseload.

Aim: The purpose of this project was to improve efficiency and nurses’ job satisfaction by making work interruptions manageable in the PACU.

Methods: Based on Kotter’s Change Theory, a quality improvement initiative was implemented using a change in the communication process. Qualitative and quantitative data was gathered in the PACU and on …

Sleeping In Safety: A Study Of Nurse Anesthetists In Ghana, Lauren Kasparian

Inquiry Journal 2011

No abstract provided.