Perioperative, Operating Room and Surgical Nursing Commons^™

Implementing A Surgical Infection Prevention Practice In An Integrated Healthcare System, Tammy Peacock

Doctor of Nursing Practice (DNP) Projects

Problem: One of the most preventable health care associated infections (HAI) is surgical site infection (SSI). Approximately sixty percent of SSI’s could be prevented. The devastation of an SSI to the patient can be catastrophic. The cost to the health care system for treating SSI’s can be substantial (Ban et al., 2017).

Context: The rate of surgical site infections has been on the increase over the past three years. The concern for the amount of harm affecting our patients was worrisome. The cost of reputation and the bottom line to the organization was recognized by senior leadership. The support from …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

Improving Operating Room Turnover Cleaning Communication, Alexander Lao Jr.

Master's Projects and Capstones

Operating room (OR) turnover cleaning is an important part of perioperative workflow for surgical teams, particularly to prevent cross-contamination of infectious pathogens from the surgical environment to staff and patients. Incomplete OR turnover cleaning ultimately leaves vulnerable surgical patients at risk for surgical-site infections (SSIs) and other types of hospital acquired infections (HAIs), which leads to delays in overall operations of the OR. A microsystem assessment at a large metropolitan hospital revealed an issue with incomplete OR turnover cleaning evident by the presence of dirty canisters, filters, and unclean anesthesia machines/work-areas after sterile surgical supplies had already been opened in …

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 …

Scarring And The Psychosocial Impact On Surgical Patients: A Review Of Questionnaires, Shandra Melick

Grace Peterson Nursing Research Colloquium

Scarring and the Psychosocial Impact on Surgical Patients:

Integrative Literature Review

Abstract

Background: Skin scars have the potential to impact patients in a variety of ways which can include impaired psychological, physical, social, and emotional well-being. Beginning in the 1990s, guidelines were created for patient-reported outcomes (PRO) to measure these patient specific concepts of scarring. but guidelines require refinement.

Objectives: The primary objective was to examine validated instruments to measure the psychosocial impact of surgical patients in relation to their acquired scar.

Methods: An integrative literature review was conducted to analyze results and findings of different validated …

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 …

The Perioperative Patient Experience Of Hand And Wrist Surgical Patients: An Exploratory Study Using Patient Journey Mapping, Else F. De Ridder, Tessa Dekkers, Jarry T. Porsius, Gerald Kraan, Marijke Melles

Patient Experience Journal

Patient-centred care is becoming more important in healthcare. The success of patient-centred care can be assessed by exploring the patient experience through a patient journey map. As the number of outpatient surgeries is increasing, it is important to reveal the specific characteristics of this type of surgery. The perioperative patient experience is considered very important for outpatient surgery, because all perioperative activities are condensed in one day. To investigate this experience, we performed a case study of hand and wrist surgery. Six teams of two industrial design engineering students interviewed 40 patients in total in two private and two public …

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 …

Attitudes And Beliefs Among Anesthesia Provides Regarding Smartphone Use For Intraoperative Anesthetic Management, Jasprit Dulat, Marjorie Reeves

Grace Peterson Nursing Research Colloquium

Background: Smartphone technology has evolved at the same accelerated pace as healthcare technological innovation. The literature shows that healthcare providers already utilize Smartphone technology to bridge gaps in knowledge and provide quality care to patients. Critics of these advancements are leery about Smartphone use in the operating room (OR) because it may be a source of distraction for anesthesia providers; however, supporters argue that their use is also recognized as a potential aid in learning. Objectives: This study was conducted to assess workplace attitudes and beliefs regarding the use of Smartphones in the operating room in order to establish policies …

Improving Surgical Patient Outcomes Through A Cross-Training Program For The Hybrid Operating Room, Ana Chozet-Griggs

Master's Projects and Capstones

Abstract

Innovations in the treatment of abdominal aortic aneurysms have resulted in the reduction of open surgical procedures and the increased use of minimally invasive procedures known as endovascular aortic artery repairs (EVAR) and thoracic endovascular artery repairs (EVAR). These hybrid procedures integrate the technical skills and resources used in surgical procedures with the technology used for radiological interventions. (Odle, 2011). These procedures are performed in a Hybrid Operating Room (HOR) within the Catheterization Laboratory (Cath Lab) microsystem. A HOR is a surgical operating room that is equipped with interventional radiology imaging and equipment (Taylor, 2017). These high-risk procedures demand …

The Association Of Prescription Opioid Exposure And Patient Factors With Prolonged Postoperative Opioid Use In Opioid Naive Patients, Jennifer Lanzillotta

Electronic Theses and Dissertations

Background

Research suggests prolonged postoperative opioid use occurs in 4-13% of opioid naïve patients and is related to factors other than surgical pain. However, it is unclear which patient factors and prescribing practices are associated with prolonged use after surgery among opioid naïve patients.

Objectives

To identify factors associated with prolonged postoperative opioid use (refills 90-180 days after surgery) in opioid naïve patients in two domains: specific patient characteristics (demographics, smoking status, comorbidities, etc.) and exposure through postoperative opioid prescriptions (in oral morphine milligram equivalents [OME]).

Methods

An electronic medical record dataset analysis of inpatient and outpatient opioid naïve adult …

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 …

Educational Prevention Program Of Surgical Site Infections At A Metropolitan Pediatric Hospital, Myra Hasan

Master's Theses

Surgical site infections (SSI) are a common cause of healthcare-associated infections (HAI). They remain a significant problem, as they are associated with increased morbidity and mortality and cause an increase in demand for several healthcare resources. In order to address this problem, hospitals have implemented several protocols and polices that are aimed to reduce these infections. However, the rates of SSIs continue to rise. Healthcare team members have found that while it is their responsibility to enforce preventative measures to the patient in the preoperative and surgical room, patient compliance to preventive measures at home also plays a role.

At …

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 …

A Protocol For The Use Of A Pre-Printed Medication List For Pre-Operative Patients In The Strong Surgery Center: A Formative Pilot Study, Casey Faessler

Nursing Masters

No abstract provided.

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 …

Impact Of Student Nurses' Clinical On The Workload Of Rn's On A Medical-Surgical Unit Of A Critical Access Hospital, Reta Hamilton

Doctor of Nursing Practice Scholarly Projects

This pilot study explored Registered Nurses (RNs) perceptions of the impact of student nurses’ clinical on the workload of medical-surgical RNs in a Critical Access Hospital (CAH). The real-life experience of students in the clinical learning environment has been seen as a valuable part of nursing student education. With the increase in the number and size of nursing programs leading to a shortage of clinical sites, maintaining a positive relationship with clinical sites is extremely important to nursing programs. Previous research has found that nurses often have ambivalent feelings regarding nursing students on their units. Purpose: Explore RNs” perceptions of …

Anesthesia "Hand Off" Process For Patients At High Risk For Obstructive Sleep Apnea, Terry Yeager

Student Scholar Showcase

No abstract provided.

Implementation Of The Banner Mobility Assessment Tool For Bariatric Patients, Nicole Benkert

Scholars Week

Abstract

The prevalence of morbidly obese patient within the United States is on a rapid incline. Evidence correlates an increase in patient falls, comorbidities, and hospital admission among this specific patient group. As a result, there is an increase in workload and injuries to staff as they tend to these patients. Healthcare facilities need to continuously update current patient handling programs and create specific policies for safely handling obese patients. Research suggests that Safe Patient Handling and Mobility Programs, as well as the Banner Mobility Assessment Tool (BMAT), have substantially decreased nurse injuries through a wide range of nursing specialties. …

News From The Graduate School - Nursing, Otterbein Office Of Graduate Programs

Graduate School

Newsletter that provides updates from the Graduate School and the Nursing Graduate Program.

Missed Nursing Care Reported By Medical-Surgical Rns In A Community Hospital, Anne Schmidt, Dnp, Msn, Rn, Aprn-Bc, Cenp

Doctor of Nursing Practice Projects

Background: Missed nursing care is defined as any lapse in essential patient care. It is a previously studied, persistent phenomenon. If unrecognized, it can compromise patients’ recoveries, trigger adverse events, and increase healthcare costs.

Objectives: To examine the prevalence of missed nursing care reported by medical-surgical registered nurses (RNs) and contributing factors for its occurrence.

Methods: The project used a cross-sectional, correlational design. A convenience sample of 96 RNs, recruited from three medical-surgical units, completed the MISSCARE Survey between September and October 2017. An analysis of survey responses quantified the frequency, nature, and common contributing factors for care omissions. The …

Differences In The Rothman Index Score In Evolving Emergent Events In Medical-Surgical Patients, Deborah Cardenas, Dnp, Msn, Rn, Paralegal

Doctor of Nursing Practice Projects

Background: The Rothman Index (RI), an early warning system using software integrated with the electronic medical record provides scores monitoring patient conditions. Minimal findings exist regarding RI scores in medical-surgical patients.

Objectives: Explore differences in the RI scores in medical-surgical patients who suffered rapid response, cardiopulmonary resuscitation or death events.

Methods: A retrospective comparative design of 75 subjects with a rapid response or cardiopulmonary resuscitation event on medical-surgical units over 12-months at an academic medical center using RI scores at admission, 48- and 24-hours before and at time of event. Deaths were identified immediately following the emergent events.

Results: The …

The Impact Of Digital Education Delivery On Postoperative Pain Outcomes, Amber Stitz, Dnp, Ms, Aprn, Acns-Bc, Ocns-C

Doctor of Nursing Practice Projects

Background. Advances in technology and communication tools offer new, innovative methodologies for delivering information to patients. Research is needed to understand the clinical effectiveness of different education delivery methods on outcomes and comprehension.

Purpose. Compare the effects of digital education with conventional, written and verbal instructions on patients’ pain outcomes, knowledge attainment, and treatment participation.

Methods. A quasi-experimental design evaluated outcomes in 133 patients undergoing major hip (n=73) and knee (n=60) arthroplasty who received point-of-care pain education delivered via a dynamic mobile-computing (iPad) platform (n=65) or by conventional education (n=68). The significance level was set at 0.05. Person’s r and …

Using Safety Checklists Outside Of The Operating Room, Annabelle Gerhardt

Doctor of Nursing Practice Scholarly Projects

Abstract

The use of a Time Out checklist for patient safety in non-operating room procedural areas is equally important for positive patient outcomes as in the operating room (OR). In this busy southwestern United States hospital, the procedural teams in the non-operating room areas were reported to not be fully engaged during the performance of the Time Out pre-procedural pause prior to gastroenterological (GI) procedures. This study was conducted to improve compliance with the scripted Time Out checklist and promote full engagement of the GI procedural team during the Time Out thus reducing risks of wrong site surgery. Literature has …

Human Factors Applied To Perioperative Process Improvement, Joseph R. Keebler, Elizabeth H. Lazzara, Elizabeth Blickensderfer, Thomas D. Looke

Publications

• Human factors/ergonomics (HF/E) is its own scientific discipline that can be applied to understanding performance in perioperative medicine.
• Humans are not perfect decision makers and are affected by a variety of factors that can greatly harm their ability to perform, including attention, bias, stress, and fatigue.
• HF/E has a unique perspective on human error, and HF/E can illustrate how moving away from blame can enhance safety.
• HF/E offers strategies for undertaking a systematic approach to assessment of work processes in perioperative medicine that can be used to increase safety and wellbeing of patients and providers.

What’S In A Name: Performance Improvement, Evidence-Based Practice, And Research?, Andrea Prentiss, Eve Butler

Nursing & Health Sciences Research Journal

No abstract provided.

Irrisept: Redefining Irrigation, Nicole Koening

Nursing Posters

IrriSept is the only FDA-Cleared device that delivers a pressurized solution containing Chlorhexidine Gluconate (CHG) for cleansing and debridement. As a final rinse, prior to closure in surgical procedures, IrriSept has the potential to help reduce SSIs and associated treatment costs. IrriSept was developed with the goal of becoming the "Standard of Care" and improving patient outcomes.

IrriSept has a wide range of activity against gram positive and gram negative bacteria, fungi, and viruses. It has demonstrated antimicrobial efficacy and persistence in laboratory testing.

Effects Of Energy-Based Therapies On Postoperative Recovery: An Integrative Review Of The Literature, Emily M. Wooten

Honors Undergraduate Theses

Associated with health care reform, there has been a growing interest among healthcare professionals regarding use of energy-based therapies as a complementary therapeutic intervention. The purpose of this integrative literature review was to examine the impact of energy-based therapies (i.e. healing touch, reiki, therapeutic touch) on patients’ postoperative recovery. The methodology included identifying appropriate peer-reviewed, English-language research articles on the topic area that were published between 2006 to 2018. Following a search in select data bases, articles focusing on the topic were critiqued, analyzed and synthesized by the researcher. Consistent and inconsistent findings along with gaps in the literature are …