Opioid Free Anesthesia, Sarah Medina

Doctor of Nursing Practice Projects

Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

A Systems Approach To Increase The Icu Nursing Workforce During A Pandemic, Jennifer Mendenhall

Master's Projects and Capstones

A Systems Approach to Increase the ICU Nursing Workforce During a Pandemic

Abstract

In early March 2020 an intensive care unit (ICU) patient died of COVID-19 in an integrated healthcare system hospital in Northern California. Data from China and the CDC indicated that more healthcare members would require intensive care and could overwhelm the 21 acute care hospital macrosystem. A microsystem pilot program to upskill peri-anesthesia care unit (PACU) RNs to care for ICU patients was initiated. Concurrently the upskill pilot program was reviewed by macrosystem nursing leadership. Over a three-week period, the program was standardized, disseminated and implemented across …

Policy Analysis: Appropriate Opioid Prescribing Practices For Post-Surgical Patients, Joan S. Daversa

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from …

Decreasing The Fall Rate On A Medical Surgical Unit With An Enhanced Fall Algorithm In The Electronic Medical Record, Natali Sokolovski

Master's Projects and Capstones

This paper summarizes the quality improvement falls prevention project on a Medical-Surgical unit with an Enhanced Fall Algorithm incorporated in the Electronic Medical Record conducted by two Clinical Nurse Leader students of the University of San Francisco.

This project addresses the patient falls events in a San Francisco-Bay Area Hospital on a Medical-Surgical unit. The aim is to decrease the rate of falls on a Medical-Surgical microsystem unit by 50% with an Enhanced Fall Algorithm incorporated into the Electronic Medical Record by June 2021. The patient population consists of general medical surgical patients where many of the patients have an …

Standardized Bedside Report During The Transfer Of Care, Lauryn Fanning-Goff

MSN Capstone Projects

Optimization of our communication processes can prevent multiple adverse/sentinel events that will also prevent the organization from potentially being held liable to cover those costs. The use of a standardized form of handoff is supported by literature as a way to ensure critical information is not omitted. Completing the report at bedside allows the patient and family to be involved in care, improve patient safety, and enhance patient satisfaction scores (Baldwin & Spears, 2019). Because of this, the PICOT question is: “In staff nurses on a pediatric surgical unit (P), how would a standardized bedside report during the transfer of …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

Preceptor Training: A Quantitative Study To Determine The Effectiveness Of A Formal Preceptor Training Program For Medical-Surgical Nurse Preceptors, Jessica L. Strickland

Theses and Dissertations from 2020

Nurse preceptors are essential to the success of new graduate registered nurses entering the workforce. Nurse preceptors serve to improve the competence and confidence of new graduate registered nurses during their transition to practice. To be an effective nurse preceptor, the nurse preceptor needs to be properly trained. A trained nurse preceptor understands the roles and responsibilities of a nurse preceptor. As they utilize their formal training, they increase their skills and capabilities. A positive experience during the transition to practice process may improve nurse retention and patient outcomes. The focus of this quantitative, descriptive research study was to determine …

A Best Practice Recommendation: Decreasing Perioperative Fentanyl Used Through The Utilization Of Dexmedetomidine Prior To Surgical Incision, Shelby Harriel, Amy Houck

Doctoral Projects

Upon anesthesia induction, patients often receive fentanyl, an opioid medication that is linked to addiction, dependence, morbidity, and mortality (Stanley, 2014). The goal of this practice recommendation was to propose an alternative way of managing pain and the increased sympathetic response in the perioperative setting, specifically during the induction phase, through evaluating published research. A possible substitute for fentanyl is a drug called dexmedetomidine (Precedex™). Through a comparison of pharmacology, indications, risks, and benefits, one can conclude that if Precedex™ is given prior to induction, in the place of large doses of fentanyl, it can potentially achieve a smoother intraoperative …

Educating Student Registered Nurse Anesthetist On Malignant Hyperthermia Using An Objective Structured Clinical Examination, Ednita Street Fountain, Faith Sherman

Doctoral Projects

Malignant hyperthermia (MH) is a low-frequency, high-impact event that many student registered nurse anesthetists (SRNA) may be unprepared to manage due to limited exposure in clinical practice (Hackl et al., 1990). Lack of preparation for dealing with such low frequency, high impact events can lead to unfortunate adverse events resulting in death (Hackl et al., 1990). Thus, students should be are prepared to handle these situations if an event should occur.

An objective structured clinical examination (OSCE) is a structured method used to assess certain skills and underpinning knowledge required for practice (Harden & Gleeson, 1979). Students are allowed to …

Using Empathic Design Principles To Improve Surgical Nursing Efficiency, Roberta Sutton

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Improving efficiency to increase operating room utilization, improve turnaround time, and first case on time starts, is a goal of hospitals to increase surgical case volume. Increasing case volumes improves the hospitals bottom line by increasing reimbursement. In addition, improving the utilization will improve patient and caregiver satisfaction, show less wasted time between cases, and allowing for more timely starts. In the hospital that this study was be performed, located in Atlanta, Georgia, there is a need to improve these metrics which will improve the bottom line of the facility. This study addressed inefficiencies in processes, job duties, and preparation …

Effect Of A Self-Care And Self-Awareness Education Program On Resilience To Burnout And Depression In Clinically Experienced Nursing Students, Andrew Taylor

Undergraduate Honors Theses

The purpose was to examine the effect of a self-care educational intervention on nursing student resilience and thus the potential for compassion fatigue, depersonalization, burnout, depression, and inadequate self-care. A one-group pretest-posttest research design was applied to a convenience sample of 104 nursing students near the end of their last semester in a baccalaureate nursing program. The measurements were demographics, a psychometric resilience scale, program evaluation, and reflection question. The intervention was a standardized, intensive 30 min training program on the high degree of stress and burnout nurses face and the core self-care methods that can promote resilience to these …

Using Empathic Design Principles To Improve Surgical Nursing Efficiency, Roberta Sutton

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Improving efficiency to increase operating room utilization, improve turnaround time, and first case on time starts, is a goal of hospitals to increase surgical case volume. Increasing case volumes improves the hospitals bottom line by increasing reimbursement. In addition, improving the utilization will improve patient and caregiver satisfaction, show less wasted time between cases, and allowing for more timely starts. In the hospital that this study was be performed, located in Atlanta, Georgia, there is a need to improve these metrics which will improve the bottom line of the facility. This study addressed inefficiencies in processes, job duties, and preparation …

A Pain Control Optimization Pathway To Reduce Acute Postoperative Pain And Opioid Consumption Postoperatively: An Approach To Battling The Opioid Epidemic, Holly Franson

Student Scholarly Projects

Practice Problem: Healthcare providers worldwide are working to battle the opioid epidemic and reduce opioid-related harm to patients. Utilizing evidence-based acute pain management methods to reduce opioid consumption is critical to combat the problem.

PICOT: The PICOT question that guided this project was: In opioid-naïve adult patients undergoing general anesthesia for out-patient, minimally invasive abdominal wall hernia surgery, how does the implementation of an evidence-based, preventative Pain Control Optimization Pathway (POP) using a multimodal, opioid-sparing acute pain management technique and standardized procedure-specific opioid prescribing, compared to standard treatment, affect postoperative pain scores and opioid consumption, upon discharge from the …

A Multimodal Analgesic Virtual Reality Program To Reduce Opioid Exposure, Jessica Hovland

Student Scholarly Projects

The opioid crisis continues to be a public health concern. Traditionally, an opioid-centric approach treats postoperative pain.

The following PICOT question guided this project: Will initiating a multimodal analgesic virtual reality quality improvement program (I) compared to current practice (C) decrease opioid requirements (O) in robotic hysterectomy patients (P) during the postoperative period (T)? Several articles promote non-opioid analgesia and non-pharmacological interventions, such as multimodal analgesia and virtual reality (VR) for pain management.

This project reviewed pre- and post-implementation data after implementing new evidence-based multimodal analgesia and VR protocols. The project captured a total of 64 patients in the pre-implementation …

Developing A Clinical Practice Guideline For Surgical Diabetic Patients, Barbie Harbaugh, Diane Whitehead

Journal of Excellence in Nursing and Healthcare Practice

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and a lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients have been shown to improve quality care, decrease complications, increase the efficiency, and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which are recognized risk factors for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the northeast United States. The purpose …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

A Preoperative Hand Hygiene Campaign: " No One Left Behand.", Keri Mccoy

Master's Projects and Capstones

Abstract

Problem: Surgical site infections (SSIs) account for 20% of all hospital-acquired infections (HAIs). Performance of consistent, accurate hand hygiene practices by healthcare workers is the most effective means of preventing infection, yet the average compliance rates remain low. The preoperative (PREOP) unit carries tremendous responsibility for decreasing each patient's risk for SSI by adequately following the World Health Organization (WHO) guidelines for hand hygiene. The PREOP remains at a low average hand hygiene compliance rate of 69%, with decreased consistency, frequency, and knowledge deficit of hygiene practices. The aim of the quality improvement (QI) hand hygiene campaign is to …

Malignant Hyperthermia For The Nurse Anesthetist, Victor Clark

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia (MH) is a rare, autosomal dominant skeletal muscle disorder that can have an insidious onset in susceptible patients exposed to the triggering agents succinylcholine, halothane, desflurane, sevoflurane, and isoflurane. MH can occur in patients who have received anesthesia with these agents in the past (Nagelhout & Plaus, 2018, p 775). Patients with a family history of MH or associated skeletal muscle disorder must be treated as MH-susceptible until proven otherwise. Failure to detect an MH crisis can lead to kidney failure, profound acidosis, coagulopathies, rhabdomyolysis, cardiac dysrhythmias, cardiovascular collapse, and death (Seifert et al., 2015). It is the …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Implemented Nurse Education To Improve The Effective Use Of The Sapphire Pca Pump: Achievement Of Quality Pain Control, Fanta Keita Zable

Master's Projects and Capstones

The Sapphire ™ Infusion System Patient-Controlled-Analgesia (PCA) pump is a device that is used to administer high pain medication to manage a patient’s pain level after an invasive procedure such as surgery. In order to achieve this goal, nurses must be able to use the sapphire equipment efficiently to prevent medication overdose and underdose, as well as to preserve safety for both the patients and the nurses themselves. In addition, nurses must be able to document accurately on EPIC. The purpose of this project, led by the team of Clinical Nurse Leader (CNL) students from the University of San Francisco, …

Improving Perioperative Anxiety And Pain: Development Of A Music Therapy Protocol, Rhyz Wilson

Doctor of Nursing Practice Projects

Perioperative anxiety is strongly correlated with a higher incidence of post-surgery pain, an increase in the need for analgesics and anesthetics, and delayed recovery and discharge from the hospital (Jimenez-Jimenez et al., 2013; Kuhlmann et al., 2018). Finding multimodal approaches to ease anxiety and discomfort from unfamiliar hospital surroundings is necessary to reduce perioperative anxiety and subsequent physiological complications (Ni et al., 2011). A review of current evidence-based literature revealed that music therapy significantly decreases both perioperative anxiety and pain levels in adult patients undergoing surgery. For this quality improvement project, a music therapy protocol was developed in collaboration …

A Difficult Vascular Access Algorithm Using Intraosseous Devices In The Elective Pediatric Surgical Population, Cory R. Austin

Doctor of Nursing Practice Projects

In pediatric patients undergoing elective surgery, anesthesia is commonly induced via mask inhalation followed by peripheral IV placement before proceeding to airway management. However, IV access is often unpredictable and difficult to obtain in pediatric patients, with attempt success between 35% to 74%. During IV attempts, many dangerous clinical situations can occur amid limited options to deliver necessary medications. Failure to attain IV access may ultimately require extremes such as CVC placement or procedure cancellation. In this project, a difficult vascular access algorithm including intraosseous devices as an alternative was developed based on current evidence, existing algorithms, and implementation site …

Improving Emotional Intelligence Skills In Student Registered Nurse Anesthetists, Kathryn M. Gratza

Doctor of Nursing Practice Projects

Becoming a certified registered nurse anesthetist (CRNA) involves didactic and clinical course work that challenges the student’s cognitive, mental, and emotional well-being. Standardized cognitive factors, such as grade point average, are utilized for nurse anesthesia program admission, but those factors do not take into account the student’s emotional intelligence. The ability to manage one’s emotions has a positive correlation with academic success (Beauvais, Stewart, DeNisco, & Beauvais, 2014) and has been correlated with greater success in nurse anesthesia programs (Collins, 2013).

The goal of this doctoral project was to increase the emotional intelligence of first-year students in the nurse anesthesia …

Developing A Clinical Practice Guideline For Surgical Diabetic Patients, Barbie Denise Harbaugh, Diane Whitehead

Walden Faculty and Staff Publications

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Reflections On Texas Back Institute Internship, Shelby Jones

The Eleanor Mann School of Nursing Undergraduate Honors Theses

For my honors project, I chose to do the experimental option to gain more knowledge on topics that we do not spend much time covering in nursing school. I had the privilege to complete an internship with the Texas Back Institute, their main office is located in Plano, Texas. I worked closely the Scoliosis and Spine Tumor Center that is a branch of their team, and completed my internship from May to the first week of August 2019. I worked 20 hours a week during my internship between the clinic and the hospital. I was able to observe physicians in …

Controlled Donation After Circulatory Death: Benchmark Study, Marilyn R. Strait

MSN Capstone Projects

Abstract

In potential organ donors after circulatory death (P), does the utilization of an evidence-based critical pathway from identification of potential donor to organ donation (I) versus no utilization of an evidence-based critical pathway (C) increase the rate of organ procurement and the satisfaction of donor families with the donation process (O)? A benchmark study was conducted to answer this question, and in short, yes, it does. The utilization of a critical pathway, when individualized to a local population and hospital’s organization increases the organ procurement rate, the donor family satisfaction with the process, and increases staff satisfaction with the …

Avoiding Common Weight Gain In Kidney Transplant Recipients Via An Activity Program, Uchenna Egbosimba

The Eleanor Mann School of Nursing DNP Capstone Projects

Kidney transplant recipients have shown to have substantial post-transplant weight gain within their first year after transplantation (Henggeler, C. K., Plank, L. D., Ryan, K. J., Gilchrist, E. L., Casas, J. M., Lloyd, L. E., Collins, M. G., 2018). After the development of end stage renal disease, a reduction in physical activity can occur as well as postoperative recovery stress (van Adrichem et al., 2018). Evidence has shown that increasing physical activity post-transplantation has various beneficial effects on the metabolic profile, body composition, and quality of life of kidney transplant recipients (Chan et al., 2019). A home-based exercise walking program …

Chloraprep Dry Time, Nikki Jones, Chelsea Dennison, Becca Millard, Kristin Sapp

Nurse Presentations

Describes a project to increase the dry time compliance for solutions used in general surgery in the operating room.

A Feasibility Study Of Lavender Aromatherapy In An Awake Craniotomy Environment, Kailah Cathey, Nichole Gunyon, Nancy Chung, Nancy Conway, Diane Ames, Maharaj Singh, Amin B. Kassam, Richard A. Rovin

Journal of Patient-Centered Research and Reviews

Purpose: Integrative medicine interventions are needed for awake craniotomies, as many patients experience anxiety. Lavender aromatherapy significantly reduces anxiety or pain in a variety of surgical procedures. This feasibility study used lavender aromatherapy during awake craniotomies to determine the number of patients who would consent and complete the study, the technicality of lavender aromatherapy use, and acceptance by operating room (OR) staff.

Methods: We approached 40 consecutive patients (≥18 years old). Exclusion criteria were pulmonary issues or sensitivity to lavender. Outcome measures in consented patients were enrollment and completion rates, anxiety and pain as measured by the Visual Analog Scale …