Perioperative, Operating Room and Surgical Nursing Commons^™

Implementation Of Evidenced Based Practice Guidelines For Reducing Emergence Delirium In Elderly Patients Undergoing A Total Hip Replacement, Luke D. Kleinfelder

Doctor of Nursing Practice Scholarly Projects

A total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the …

Improving Compliance With Preoperative Antibiotic Protocols For Cardiac Implanted Electronic Devices: A Quality Improvement Project, James Kaup

DNP Projects

Abstract

Background

Cardiac implantable electronic device infections remain a serious complication of permanent pacemaker implantation despite evidence-based infection prevention guidelines.

Local Problem

An academic electrophysiology laboratory identified inconsistent guideline-concordant antibiotic selection despite consistently high compliance with recommended antibiotic timing.

Methods

A nurse-led, quasi-experimental pre-post quality improvement project evaluated implementation of a standardized preoperative antibiotic prophylaxis protocol. Data from 36 permanent pacemaker implantations (16 pre-intervention, 20 postintervention) were analyzed.

Interventions

The intervention included a standardized antibiotic protocol, multidisciplinary staff education, and performance feedback.

Results

Guideline-concordant antibiotic selection improved from 37.5% to 95.0% (χ² = 11.27, P = .001). Antibiotic timing remained …

Enriching The Perioperative Enhanced Recovery After Surgery (Eras) Program For Patients Undergoing Whipple Procedure For Pancreatic Cancer, Natalie E. Fisher

Doctor of Nursing Practice Final Manuscripts

Pancreatic cancer remains one of the most complex and lethal diseases worldwide with surgical resection as a major treatment choice. Although surgery may be one of the only options for advanced pancreatic cancer, it is not without a lengthy hospital stay, a long list of possible postoperative complications, and an increased risk for readmission after discharge. Enhanced recovery after surgery (ERAS) programs have been implemented for years in other surgical services for cancer care. These programs have now been extended and researched to include patients undergoing surgery for pancreatic cancer. These programs are designed to assist patients and their families …

Improving Patient Outcomes With Post-Op Education For Nurses Caring For Patients Undergoing Total Joint Replacement, Amanda Collier

Doctor of Nursing Practice Projects

Background: Surgical site infections (SSI) are the third most reported nosocomial infection causing an increased length of stay, increased healthcare cost, and a substantial increase in morbidity. A SSI is an infection developing within 30 days of surgery without using an implant and within one year of surgery utilizing any form of implant. Typically SSI occurs at the time of incision. However, poor postoperative wound care can lead to an SSI.

Purpose: This project aims to educate nursing staff on care of the total joint replacement (TJR) patient to reduce readmission rates for postoperative SSI.

Design Methods: This …

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 …

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 …

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

Nursing & Health Sciences Research Journal

No abstract provided.

Implementation Of An Evidenced-Based Practice Curriculum To Improve Nursing Practice For Epidural Administration And Monitoring, Chatty O'Keeffe

Master's Projects and Capstones

Abstract

Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor …

Telephone Follow-Up To Reduce The Readmission Rate In Gynecologic Oncology Surgery Patients, Karla Kenyon Fernandez

Nursing Theses and Capstone Projects

Unplanned hospital readmissions are commonly viewed as a marker of poor quality care and result in increased costs for both healthcare institutions and patients. Factors associated with readmission for gynecological oncology patients can be related to the radical surgical interventions required for the management of their disease, as well as complex comorbidity profiles, surgical complexity, cancer stage, and perioperative complications. The purpose of this study was to explore and examine the impact of nursing-led telephone follow up on the reduction of the readmission rate in gynecologic oncology abdominal surgery patients following initial discharge post-operatively. A cross-sectional research study was used …

Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, Melinda C. Nwanganga

Evidence-Based Practice Project Reports

Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia due to the risk of self-inflicted injury of patients, the disturbance of surgical incisions, the development of postoperative maladaptive behaviors, and the increased use of sedatives and analgesics resulting in prolonged recovery time and delayed discharge from the post-anesthesia care unit (PACU). Due to the multiple ramifications of ED, appropriate care is needed to promote a safe recovery from anesthesia and an optimum perioperative experience for these patients. As PACU …

Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, Erin Long

Evidence-Based Practice Project Reports

The lack of standardized handoff from the operating room (OR) nurse to the post anesthesia care unit (PACU) nurse may result in the miscommunication or omission of patient information, which increases the risk of patient safety events. The goal of this EBP project was to standardize OR to PACU nurse handoff in order to reduce risks to patient safety. A literature review revealed guidelines for handoff which included implementing a standardized protocol and using a mnemonic phrase. The Iowa Model of Evidence-Based Practice and Lewin’s Model of Change guided the EBP project. Handoff quality was evaluated by OR and PACU …

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) …

The Effects Of Implementing Best Practices On 30-Day Readmission Rates In Adults Following Cabg Surgery, Linda Elaine Kline

Evidence-Based Practice Project Reports

Coronary artery bypass graft (CABG) surgery is one of the most frequent and expensive cardiac surgical procedures in the U.S. today. Complications from CABG surgery are one of the top causes of 30-day hospital readmissions. Readmissions after CABG surgery are often preventable and add to health care costs. Recent government legislation mandates penalties for hospitals with excess readmission rates. The purpose of this evidence-based practice project was to determine if implementation of best practice recommendations effected 30-day readmission rates following CABG surgery. A critical appraisal of the literature was conducted to identify best practice recommendations. The Iowa model and Lewin’s …

The Effect Of Telephone Follow-Up On Pain Experienced By Patients After Knee Replacement Surgery, Laurie J. Jones

Evidence-Based Practice Project Reports

Hospital length of stays are decreasing throughout the U.S. in an effort to contain healthcare costs, but these measures can be detrimental to patients. Those who get knee replacement surgery are finding their length of stay reduced from an average of 3 to 4 days to 24 to 48 hours, which can affect pain control and interfere with rehabilitation and recovery. This affects many people, as more than 632,000 knee replacements occur each year (American Academy of Orthopedic Surgeons, 2008). The purpose of this evidence-based project was to evaluate the effect of telephone follow-up on pain experienced by knee replacement …