Perioperative, Operating Room and Surgical Nursing Commons^™

Peri-Op Protect: A Unified Pre-Op To Pacu Medication Reconciliation System, Tyler G. Van Note, Ariana Amalia Anast, Samantha Ashley Steiner, Tara Gilbert

SPARK Symposium Presentations

Peri-Op Protect: A Unified Pre-Op to PACU Medication Reconciliation System

Peri-Op Protect is a nurse-led change initiative designed to improve medication safety and communication during surgical patient transitions from pre-operative care through the operating room and into the post-anesthesia care unit at a local hospital. Transitions of care are among the most vulnerable moments in the surgical process, as critical medication information – including home medications, last doses, allergies, intraoperative medications, and pain management plans – must be accurately communicated across multiple teams. Communication breakdowns are a leading contributor to adverse events in healthcare, and inconsistent medication handoff processes can …

Development And Implementation Of An Ob/L&D Sbar Framework To Enhance Communication Between Obstetric Nurses And Anesthesia Providers: A Quality Improvement Initiative, Jenna E. Bigam, Laina J. Uzarski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication between obstetric (OB) nurses and anesthesia providers is critical to ensure patient safety during epidural placements in labor and delivery (L&D) settings. At a large teaching hospital, communication gaps were identified when OB nurses requested anesthesia for epidural placements without consistently providing vital patient information. The lack of structured communication can result in important details being overlooked, which may lead to delays in care and potential patient harm. To address this, the SBAR (Situation, Background, Assessment, Recommendation) communication framework was implemented to standardize and improve information exchange. This Doctorate of Nurse Anesthesia Practice (DNAP) project aimed to enhance …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

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 …

Robotic Team High Reliability Organization’S Communication Evaluation Tool, Joanne F. Mercurio

Regis University Student Publications (comprehensive collection)

Multidisciplinary team communication in robotic surgery presents several safety considerations for the intraoperative surgical patient. It is an important consideration since the surgeon and the operating room team are geographically distanced with the surgeon at the console, and the other team members situated at the patient bedside. Scrubbed team members are performing such functions as positioning the robotic arms as well as exchanging instruments, while the remaining interprofessional team members are coordinating multiple patient care activities. It therefore becomes imperative that the recognition of the potential for miscommunication is of paramount importance, and strategies need to be generated that will …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Improving The Perioperative Experience Of Patients And Families In A Pediatric Setting, Anjanette Pong

Student Scholarly Projects

Practice Problem: The experience of surgery for pediatric patients and their families can be dependent on multiple factors including adequate preparation, English language proficiency and realistic expectations. Anxiety can contribute to a negative experience that may result in poor outcomes and a damaging reflection of the healthcare team and organization.

PICOT: The PICOT question that guided this project was: In preoperative pediatric patients and their families, how do therapeutic communication style and the provision of information about the perioperative experience affect their healthcare experience over eight weeks?

Evidence: A multi-modal approach to providing tailored preoperative education for the child and …

Huddle Implementation In The Perioperative Setting, Tina Thomas

DNP Projects

Background: Communication is essential for safe and effective patient care. In the perioperative setting, information sharing is critical to care coordination. Lack of communication between caregivers can lead to medical errors. Evidence shows that huddles lead to increased communication, satisfaction, and engagement between team members resulting in better patient outcomes. Huddles are short, less than 10-minute gatherings that focus on the daily schedule, identify potential obstacles, explain unique needs, and discuss preceding day issues.

Objectives: This project aimed to evaluate the effectiveness of huddles on employee satisfaction, engagement, and communication of healthcare workers while also determining if huddles were …

Closing Communication Gaps For Unplanned Surgical Patients: One Pre-Op Checklist At A Time, Seda L. Vash

Master's Projects and Capstones

Problem: Unplanned, inpatient surgical patients were experiencing poor outcomes and dissatisfaction with their overall care. This surgical patient population also lacked communication from their healthcare teams with regard to plans of care throughout their hospital stays.

Context: This was a quality improvement project for the unplanned, inpatient surgical patient population in the Central Valley of California. Approximately 13% of this hospital’s surgical patients required post-surgical care in the inpatient units. These patients, according to unfavorable HCAHPS scores, experienced unsatisfying care and insufficient communication from their healthcare teams, including physicians and nurses.

Intervention: This project implemented an Add-On Communication Tool for …

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 …

Interdepartmental Rounding, Peggy Anderson, Carrie Strick, R3 Med-Surg Unit, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Maine Medical Center Operational Excellence

MaineHealth Maine Medical Center

STRATEGIES FOR IMPROVING COMMUNICATION BETWEEN DOCTORS AND NURSES IN AN ACUTE CARE HOSPITAL

Effective interdisciplinary communication is imperative for safe patient care in an acute care hospital environment.

A surgical unit used their HCAHPs scores to assess how often patients perceived there was good communication between different doctors and nurses during their hospital stays. The data demonstrated that this occurred 22% less often than the national average.

As a result of a root cause analysis, a number of countermeasures were initiated with the goal of achieving scores greater than the national average. Post KPI inception in the second quarter of …

An Experience Of Practitioners Navigating The Role Of Patient/Caregiver, Susan M. Shaw, Rain Lamdin

Patient Experience Journal

This journey involved one of us having (repeat) intraspinal surgery in a country far from home but of a similar culture and with the same first language. The carer travelled across the world to be present during the hospital stay. We kept a journal during our admission, and following discharge realised there were significant differences between how we had documented our experience and the record presented in the clinical notes. The particular examples we present illustrate the relationships, rules and issues that we navigated. We share our experience in the form of moments from our journal, some of them alongside …

Application Of The Patient Checklist Tool In Anesthesia Handoffs, Theresa Durley

Doctor of Nursing Practice Scholarly Projects

Accurate and essential communication is required during the transfer of patient care from one health care provider to another. Communication errors during the handoff process have been identified as contributing factors in sentinel events. There is a plethora of literature supporting a standardized transfer of care process as well as several accepted handoff communication tools for the various units within a healthcare institution. However, in the anesthesia domain, there is currently only one protocol specifically created for the transfer of patient care between certified registered nurse anesthetists (CRNAs). The PATIENT protocol, created by Dr. Suzanne M. Wright, CRNA, PhD (2013) …

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 …

Improve Intra-Operative Nurse-To-Nurse Communication Using A Safety Checklist, Silvinita Tadeo Rowe

Doctoral Projects

Poor and inadequate handoff, or transfer of care of the surgical patient care from the primary to the relief operating room registered nurse circulators, can result in irreversible patient harm, or sentinel events, such as retained foreign items. In this study, Rogers' diffusion of innovation theory was the framework for implementing the handoff safety checklist. Also, Donabedian's structure process and outcome was the model to investigate the feasibility, acceptability, and improvement in the quality of patient handoff communication and improvement of nurse satisfaction over time. Nineteen-statement surveys, conducted at multiple timeframes, were completed by volunteer operating room nurse participants. In …

Improving Patient Safety In The Operating Room: Utilizing A Safety Checklist And Briefings, Lori R. Schacht

Theses and Graduate Projects

The perioperative care setting can be a hazardous environment for patients undergoing surgery. Surgical teams caring for patients undergoing complex surgical procedures may create an opportunity for surgical errors impacting patient safety. The purpose of this project is to improve consistent standardized Surgical Safety Checklist (SSC) use and briefings in the orthopedic perioperative care setting in a large Midwestern hospital, thereby supporting a culture of safety through staff engagement and a team-based communication approach. Watson’s Theory of Human Caring guided this project through the theoretical concepts of presence and faith. An initial implementation of the SSC and briefings revealed a …

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 …

Teamstepps Communication And In Situ Simulation Training To Improve Individual And Team Performance During Handoff Of The Immediate Post-Operative Cardiovascular Surgical Patient, Stacy Lynn Jepsen

All Graduate Theses, Dissertations, and Other Capstone Projects

The aim of this pilot study was to identify if establishing a reliable framework for consistent use of TeamSTEPPS communication would improve the team communication and performance during the critical handoff of the cardiac surgical patient from the OR team to the ICU team. Breakdown in handoff communication has been attributed as the cause of adverse health events, delays in treatment, inappropriate treatment, increased length of stay, and increased costs and inefficiencies from rework. Standardizing handoff communication is a Joint Commission National Patient Safety Goal, and immediate postoperative cardiac surgical patients are a high-risk population needing consistently high quality communication …