Perioperative, Operating Room and Surgical Nursing Commons^™

Improving Patients' Pain Management Through Proper Documentation, Virzen Merina

Master's Projects and Capstones

The aim of this project was to improve pain documentation on the Surgical Unit as a means to enhance caregiver communication on finding the best methods to manage patients’ pain. Effectively managing patients’ pain leads to better patient outcomes, increased patient and nurse satisfaction, and decreased length of hospitalization. The setting is a not-for-profit hospital in Southern California. The microsystem selected is the 32-bed capacity Surgical Unit that mainly admits pre- and post-surgical patients, but also accommodates non-surgical, telemetry, and trauma cases.

To improve pain assessment documentation, collaboration was sought with the multidisciplinary team (IT department, clinical nurse specialists, and …

The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, Collyn West

Master's Projects and Capstones

On a 28 bed post-surgical unit, reviewing patient records revealed only 26% had thorough patient controlled analgesia (PCA) documentation. A pre-quiz no staff knew all of the required components for documentation or which policies to reference and, on average, the staff were only able to correctly answer 30% of the questions. Therefore, a project utilizing the clinical nurse leader improvement theme of clinical outcomes management was initiated to standardize the documentation of PCA medication administration to improve post-operative pain management, improve patient satisfaction, and improve patient safety.

The current process was determined using a fishbone diagram, a SWOT analysis was …

Breast Cancer Specimen Collection, Handling & Adherence To Asco/Cap Guidelines, Vicki F. Rocconi

Master's Projects and Capstones

Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines

Background

Specimens removed from their blood supply begin to degrade immediately. Specimens are placed in formalin to halt the process of degradation. Under or over-exposure of specimens to formalin can result in false positive or false negative test results for estrogen receptors, progesterone receptors & Her-2/neu receptors.

Goals & Objectives

Improve the process of breast cancer specimen collection & handling and insure that the process is consistent with ASCO/CAP Guidelines (College of American Pathologists, 2013). The objectives included: Documentation of the time the specimen was removed from the blood supply. …

Preventing Hapus In High-Risk Cardiac Cath Patients Using Foam Dressing Protocol, Charles Jasper

Master's Projects and Capstones

The purpose of this project is to implement an evidence-based change in practice resulting safer procedures as evidenced by zero hospital acquired pressure ulcers (HAPUs). It is relevant to nursing as it provides an ethical perspective regarding patient safety and contributes to our present understanding of HAPU prevention. In spite of having already decreased the total number of HAPUs by 50% in 2015, the cardiac catheterization lab (CCL) was implicated in 30% of those reported. My objective is to improve patient safety by reducing the number of HAPUs acquired in the CCL to 0% by three months using a prophylactic …

Preoperative Education: A Patient-Centered Care Approach, Gia L. Wendt

Master's Projects and Capstones

Abstract

This project addresses the need for delivering high quality preoperative education to the Arabic speaking patient population served by Sharp Healthcare’s orthopedic service line. A goal set during the institution’s 2015 The Joint Commission Disease-Specific Care survey is to discharge major joint patients to home in two days or less. Data abstracted from Sharp Healthcare’s orthopedic registry revealed that only 30% of Arabic speaking patients are meeting this goal. The current process for educating Arabic speaking patients preoperatively during a one to one educational session with a third party interpreter takes three hours, costs $402.00 per patient, and education …

Barriers Encountered By Nurses And Nursing Assistants That Prevent Purposeful Rounding, Mar Joseph B. Odias

Master's Projects and Capstones

Purpose: The aim of the study was to identify barriers encountered by registered nurses (RNs) and nursing assistants (NAs) that prevent purposeful (hourly) rounding.

Background: The literature has shown that purposeful rounding improves patient outcomes and safety. However, few studies show the barriers encountered by nursing staff that hinder the purposeful rounding process.

Methods: A pre-post test design was implemented on a 25-bed oncology, urology medical surgical unit with a staff of 38 RNs, 9 NAs, and 4 Unit Secretaries (US). A pre-implementation needs assessment survey was completed by 55% (21/38) of RNs, 33% (3/9) of NAs, and 100% (4/4) …

Implementation Of A Warming Protocol To Prevent Inadvertent Perioperative Hypothermia In The Ambulatory Surgical Setting, Joan Abigail Slagle

Master's Projects and Capstones

The implementation of a standardized warming protocol aims to improve patient outcomes by preventing inadvertent perioperative hypothermia (IPH) and its complications in the ambulatory surgical setting. All patients, regardless of age or gender, are at risk for experiencing a 1-2° C drop in body core temperature within thirty minutes of anesthesia induction. The global aim of this project is to prevent IPH and its complications in the ambulatory surgical setting by implementing a warming protocol at a freestanding ambulatory surgery center. While an audit of the microsystem revealed a normothermia rate of 28%, a standardized warming protocol is expected to …

Preventing Surgical Site Infections By Utilizing Chg Wipes For Preoperative Skin Preparation, Jini K. Paek

Master's Projects and Capstones

Abstract

The Clinical Nurse Leader project took place at a 106-bed community hospital in Washington. The microsystem has five operating rooms where they provide outpatient, and inpatient surgical procedures. The goal of this project is to reduce and sustain a near zero number of surgical site infections by implementing the use of a no rinse 2% CHG cloth in the surgical patient. The specific aim of the project is to reduce the rate of SSIs by 80% by December 31^st, 2015. Due to a lack of a standardized care, specifically designed for the prevention of SSIs, the microsystem …

Performing A Correct Surgical Time Out, Natalia E. Mariscal

Master's Projects and Capstones

The ending data reflected what we expected in that we would see a significant incline but

not quite the 100% compliance rate we are looking for. Our highest compliance rate has reached

90% and we have contributed the margin error to new staff that requires the proper teaching and

education. In conclusion I feel that the majority of staff was aware that they were not in

compliance with the time out but would proceed anyways due to the rush of the case or surgeon

or simply that they had become laxed in practice. Once the data was brought to staff …

Emergency Response Improvement Project, Ewan Stephen Macdonald

Master's Projects and Capstones

The objective of this CNL internship project is to improve team response to emergencies through staff education and protocol development with 100% participation within six months. This need was determined after an intense analysis following a near code on a pediatric patient. After an investigation, two problems were chosen as a focus for improvement: limited educational opportunities, and poor coordination and delegation during codes. Lewins’s theory of change was used as the theoretical framework, which involves the concept of unfreezing, movement, and refreezing. The method utilized was to offer education and training sessions twice per month in the form of …

Using Video Simulation To Enhance Rn-Pca Communication, Boris Chang

Master's Projects and Capstones

The purpose of this project was to develop a video simulation exercise to enhance communication between Registered Nurses (RNs) and Patient Care Assistants (PCAs). From a general microsystem assessment initially performed on an urban hospital medical-surgical unit, 75% of respondents noted that the most pertinent issue to address was improving communication between RNs and PCAs. Literature review of evidence-based practices found several studies that support the use of human clinical simulation to promote teamwork and interdisciplinary communication. RNs (n = 24) and PCAs (n = 9) were then individually interviewed with surveys and responses scored based on the …

Relocation Of Orc To Or2, Svetlana N. Schopp

Master's Projects and Capstones

The goal of this Clinical Nurse Leader (CNL) internship project was to maintain safety and quality of care of obstetric (OB) patients undergoing Cesarean Sections (C/S) after operating room for cesarean sections (ORC) is relocated from obstetric unit to the main operating room (OR). The microsystem will accomplish this through effective teamwork, clear interdisciplinary communication, collaboration, and standardization of processes involved. The institution is a not for profit rural health care facility and is a designated Critical Access Hospital; it is located in Northern California. A general obligation bond was passed in 2007 to fund seismic upgrades. Old OB unit …

Employee Engagement In The Pacu, Michelle Spadaro

Master's Projects and Capstones

A clear vision is a powerful tool that can help advance employee engagement within nursing units. There is a great need for a compelling vision for the operation of a safe, efficient, equitable, effective, and patient centered healthcare delivery system. It is crucial to identify what actions are needed to achieve this vision and what realistic strategies are necessary for success. The purpose of this vision statement is to achieve excellence in nursing by establishing a common identity and direction that responds to an ever-changing healthcare environment. The project was conducted on a 25 bed peri-operative and post anesthesia care …