Perioperative, Operating Room and Surgical Nursing Commons^™

The Effect Of Basal Bolus Insulin Administration Vs. Sliding Scale Insulin On Glycemic Control In Patients With Type 2 Diabetes Mellitus At A Community Hospital, Meriam Signo

Doctoral Projects

Evidence of effective insulin delivery by nurses can help prevent fluctuating plasma glucose levels of Type 2 diabetes mellitus (T2DM) in the hospital setting. Information leading to better diabetes care using either basal bolus insulin administration (BBI) or sliding scale insulin (SSI) is essential for safe blood sugar values. The purpose of this project was to measure patient glycemic control after the implementation of BBI vs. SSI during a patients’ stay in the hospital. This study was a quantitative, retrospective exploratory chart review of T2DM in medical-surgical units at a Northern California community hospital. The data were collected from routine …

Identifying Predictors Of Airway Complications In Conscious Sedation Procedures, Rosemary Bray

Doctoral Projects

Problem: Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea (OSA) screening questionnaire used as a pre-procedure evaluation tool to assess a patient’s risk for OSA. There are four verifiable, objective questions and four subjective questions. This study examines to what extent the STOP-Bang score question variables reliably predict airway complications during conscious sedation procedures.

Method: The method was a retrospective review of data from the electronic medical record (EMR) of patients who had conscious sedation for endoscopy procedures. The individual questions of the STOP-Bang …

Surgical First Assist: An Educational Program For Advanced Practice Providers, Sandra Walton Mobley

Doctoral Projects

As the number of surgical procedures increase, many Advanced Practice Providers (APPs) are being required to scrub in as a First Assist (FA). Unfortunately, many APPs lack any formal surgical training. The Association of perioperative Registered Nurses (AORN) now requires that all advanced practice providers in the perioperative environment to complete a course that complies with Registered Nurse First Assist (RNFA) standards. The purpose of this project was to evaluate knowledge acquisition of APPs participating in a surgical FA educational program. A surgical FA course was comprised of five days of didactic learning, which included lecture, small groups, skills lab, …

Comparing Two Surgical Outcomes: Minithoracotomy Or Full Sternotomy In Coronary Artery Bypass Grafting Surgery, Shirin Badrkhani

Doctoral Projects

Cardiovascular diseases and heart-related conditions can be life-threatening; however, some cardiovascular conditions can be managed with open heart surgery. Coronary artery bypass grafting (CABG) is the most common type of heart surgery performed on adults. There are two different surgical procedures to correct cardiac defects: mini-thoracotomy and full sternotomy. Mini thoracotomy approach has been shown to reduce complications, such as pneumonia, excessive blood loss, and infection in mitral valve repair surgeries. However, little research has been done to compare these two surgical approaches performed for patients undergoing coronary artery bypass grafting (CABG).

Specifically, there is inadequate data to compare these …

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

Does Preoperative Ostomy Education Decrease Anxiety In The New Ostomy Patient?, Michelle Suzann Harris

Doctoral Projects

Background: There are approximately 100,000 patients with new ileostomies and colostomies created in the United States each year. These patients have specialized needs that include acceptance of altered body image, psychological stress, learning of difficult tasks, and occasionally an ominous diagnosis leading to the need for surgery. In addition to pre-surgical stoma site marking on the abdomen, ostomy nurses have identified early education to be an important factor in long-term success and management of the patient . Early education and stoma site marking may assist with a better-situated stoma leading to fewer complications related to appliance adherence and leakage. …

Nutrition And Neurosurgery: Designing A Perioperative Pathway For Elective Spine Fusion Patients, Abigail J. Mckay

Doctoral Projects

Each additional hospital day related to a surgical complication costs an estimated $1,000 (Grusky et al., 2015). Due to the rising costs of healthcare, European professors designed Enhanced Recovery After Surgery pathways to mitigate potential adverse surgical outcomes and associated costs. A primary focus of these pathways emphasizes the importance of pre-procedure nutritional optimization. Literature increasingly supports malnutrition as an independent predictor of postoperative complications and increased length of stay (LOS) (Adogwa et al., 2014). The neurosurgical population has a wide variety of comorbidities that place them at increased risk for nutritional compromise. Thus, a perioperative nutrition pathway was implemented …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …

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 …

Elevating The Head Of Bed During Preoxygenation For Obese Patients Undergoing General Anesthesia: A Clinical Policy Proposal, Brian F. Seymour Jr.

Doctoral Projects

Preoxygenation plays a vital role in ensuring patient safety for all patient populations, especially those considered clinically obese. The negative pathophysiological effects obesity has related to body habitus and respiratory mechanics increases the risk of unexpected adverse events. Obese patients encounter a 50% decrease in functional residual capacity (FRC) when undergoing general anesthesia. Dixon et al., (2005) addressed the link between efficient oxygenation and improving oxygen storage by lessening atelectasis and intrapulmonary shunting via preoxygenation in a more upright position. Can standardizing preoxygenation techniques among anesthesia providers improve patient safety and decrease hospital system’s risk by implementing an evidence-based clinical …

Developing Cultural Competency In Anesthesia Through Student Registered Nurse Anesthetists, Emma To

Doctoral Projects

Certified Registered Nurse Anesthetists (CRNAs) are the main anesthesia providers in over 70% of rural hospitals providing anesthesia. Each year, over 2,000 student registered nurse anesthetists (SRNAs) graduate and continue as licensed CRNAs. This Doctor of Nurse Practice (DNP) project emphasizes the importance of developing culturally competent providers in anesthesia by promoting early outreach in cultural competence education of SRNAs. Cultural competence is described as possessing characteristics of congruent attitudes, awareness, and conduct that provides and enables effective skills in cross-cultural encounters. Encompassing cultural competency education early in the SRNAs profession may provide valuable lifelong cultural skills that will benefit …

An Evaluation Of Implementing Enhanced Recovery After Surgery Protocol Throughout The Perioperative Phase: A Quality Improvement Initiative To Enhance Patient Outcomes After Colorectal Surgery, Jerica Hill Dnp

Doctoral Projects

Abstract: The Enhanced Recovery After Surgery protocol (ERAS) is a multimodal collaborative approach implemented throughout the perioperative phase to enhance patient outcomes. The key mechanism for effectiveness in the ERAS protocol is the attenuation of the surgical stress response combined with treatments that support the return of functions that delay recovery in traditional methods. The purpose of this scholarly project was to evaluate the results of the ERAS Pilot program currently initiated at Baptist Memorial Hospital to improve patient outcomes undergoing major abdominal surgery. Prior to the implementation of the ERAS protocol there was no standardized method in place at …

Intraoperative Ketamine Administration: An Adjunctive Therapy That Reduces Postoperative Pain For Patients Undergoing Spinal Surgery, Brittany Pierce

Doctoral Projects

In 2017, the United States Department of Health and Human Services declared that the country was experiencing an opioid crisis (U.S. Department of Health and Human Services, 2018). As a result of this phenomenon, healthcare providers are examining how they are managing pain and researching new avenues for the treatment of pain. Anesthesia providers are in a unique position to help reduce postoperative pain and ultimately the development of chronic pain. This doctoral project was conducted in order to write an evidence-based policy that directs and educates anesthesia providers in the administration of intraoperative ketamine to reduce postoperative pain in …

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 …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

Implementing Evidence Based Practices For Preventing Cardiac Implantable Electronic Device (Cied) Infection And The Role Of Post-Operative Oral Antibiotics, Ingrid Mitchell

Doctoral Projects

Cardiac pacemakers and implantable cardioverter defibrillators (ICD) are standard therapy for patients with a bradyarrhythmia, tachyarrhythmia or heart failure (HF) with a left bundle branch block (LBBB) (Wilkoff, et al., 2008). Millions of cardiac implantable electronic devices (CIED) have been implanted worldwide and this clinical practice has improved the quality of life for millions (Epstein, DiMarco, & Ellenbogen, 2008). With the increase of implants there has been an increase in the infection rates (Klug et al., 2007). Research studies have evaluated pre-procedure, during procedure and after procedure risk and protocols. Studies have also evaluated operative factors, procedural related factors, intravenous …

Efficacy Of Continuous Passive Motion After Total Knee Arthroplasty In Veteran Patients, Jaimee Riza B. Hare

Doctoral Projects

Since the early 1980s, continuous passive motion has been used as adjunct therapy in patients’ rehabilitation following total knee arthroplasty. Although existing literature challenged the benefits of continuous passive motion claiming it had no added short-term or long-term benefits after knee arthroplasty (Boese et al., 2014; Chen et al., 2012; Herbold et al., 2014; Leach et al., 2006; Maniar et al., 2012), the existing literature is difficult to generalize and apply to the veteran population at San Francisco Veterans Affairs Medical Center. This study was undertaken to determine the efficacy of continuous passive motion in helping veteran patients at San …

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 …