Perioperative, Operating Room and Surgical Nursing Commons^™

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Improving Perioperative Communication: Can Labelled Theatre Caps Play A Role?, Maree Yates, Paula Foran

Journal of Perioperative Nursing

Studies have shown that approximately one third of operating room communications fail. This has a negative impact on patient safety, with half of all adverse events being attributed to communication failures. However, human factors have the capacity to protect patients. Aviation’s human factors strategies provide guidance for staff and are beneficial in the operating room. Currently, no intervention is universally applied to improve operating room communication and team performance. Closed loop communication, though poorly utilised, has been demonstrated to counteract communication errors, therefore protecting patient safety. In 2018, calls were made to take advantage of theatre caps to display staff …

Uncertainty In Post-Anaesthesia Nursing Clinical Reasoning: An Integrative Review In The Light Of The Model Of Uncertainty In Complex Health Care Settings, Lara Daniela Matos Cunha, Márcia Pestana-Santos, Lurdes Lomba, Margarida Reis Santos

Journal of Perioperative Nursing

Problem identification: Post-anaesthesia nursing plays an important role in the early detection and treatment of clinical deterioration after surgery and/or anaesthesia. Concomitantly, the effectiveness of post-operative care is highly dependent on the accurate analysis, synthesis of patient data and quality of diagnostic decisions through clinical reasoning. Given the dynamic processes required to come to a diagnosis, uncertainty is common in clinical reasoning and expected during practice. Nevertheless, uncertainty may permeate the foundations of clinical reasoning, which can jeopardise diagnostic accuracy and consequently the quality and safety of health care.

Literature search: The objectives of this review are to identify available …

Implementation Of Lean Principles During Operating Room Turnovers, Makenzie Marshall

Doctor of Nursing Practice Projects

Background

Many operating rooms across the country face the daunting task of making their turnovers between surgical patients quicker and more efficient. Turnover time is defined as the time it takes to clean an operating room and set up the next sterile field between surgical patients. The time begins when the patient leaves the operating room suite and stops when the next patient enters the same suite. Running an operating room is a complex and costly endeavor, and even small shortfalls can have a snowball effect, leading to delays, wasteful spending, and substandard patient outcomes; therefore, it is imperative to …

Undertaking The Surgical Count: An Observational Study, Victoria Ruth Warwick, Brigid M. Gillespie, Anne Mcmurray, Karen G. Clark-Burg

Journal of Perioperative Nursing

Objective

To systematically measure and describe perioperative nurses’ surgical count practices using the Surgical Count Observational Tool, to measure conformity with standardised processes and identify barriers and enablers influencing nurses’ practices.

Sample and setting

A large public tertiary hospital in Western Australia.

Methods

The Surgical Count Observational Tool (SCOT) was developed using the Content Validity Index over two Delphi panel rounds and then pilot tested. Individual observations were analysed according to 14 criteria based on the 2016 Australian College of Perioperative Nurses (ACORN) standard ‘Management of accountable items used during surgery and procedures’¹. Count processes were observed over …

Identifying Barriers To Patient Advocacy In The Promotion Of A Safety Culture: An Integrative Review, Teena Shoemark, Paula Foran

Journal of Perioperative Nursing

Problem identification

Promoting patient safety, through patient advocacy, is an important part of the perioperative nurse role. However, identified barriers to effective patient advocacy have also reflected deficits in the characteristics of safety culture. This integrative review aims to highlight these barriers and discuss strategies for promoting patient safety within the perioperative context by presenting links between patient advocacy and safety culture.

Literature search

An electronic search of the databases, EBSCOhost, Academic search ultimate, Cumulative Index Nursing and Allied Health Literature (CINAHL), Healthsource, MEDLINE and PubMed, was undertaken and yielded ten articles for inclusion. Primary research included in this review …

Covid Changes To Post Anaesthesia Care Unit Nursing Practices, Heather J. Stapleton

Journal of Perioperative Nursing

The pandemic year of 2020 brought unparalleled and swift changes to health care processes within Australia. All registered nurses in the Post Anaesthesia Care Unit (PACU) of a regional tertiary referral hospital had to make changes to routine personal protective equipment (PPE) practice to accommodate a safer environment for both staff and patients. Changes to PPE practices included the addition of heat moisture exchange (HME) filters to laryngeal mask airways (LMAs), and the use of Level 3 surgical masks during aerosolising procedures such as extubation and nebulisation. Changes were also made to the structured handover from anaesthetic nurse to the …

Optimizing Operating Room Throughput, Amanda Brendel

Student Scholarly Projects

Practice Problem: Throughput is an instrumental aspect for hospitals to maximize patient capacity; therefore, methods to improve patient flow should be consistently implemented. Surgical areas are a major contributor to inpatient admissions and the subsequent revenue; however, without the appropriate oversight, patient throughput can be negatively impacted.

PICOT: The PICOT question that guided this project was: In operating room patients who require inpatient admission (P), how does the implementation of a standardized bed flow process (I), compared to the current methods for care transitions (C), reduce perioperative delays and improve hospital financial metrics (O), over a three-month period (T)?

Evidence: …

The Impact Of Distractions And Interruptions In The Operating Room On Patient Safety And The Operating Room Team: An Integrative Review, Sonia Mackenzie, Paula Foran

Journal of Perioperative Nursing

Problem identification: In the operating room (OR), distractions and interruptions are frequent, impacting patient safety, coordination and efficiency and causing errors and patient harm. The OR team is impacted while attempting to perform critical work. This review explores the impact of distractions and interruptions in the OR on patient safety and the OR team.

Literature search: Inclusion and exclusion criteria were determined. Six databases were searched with the search criteria for inclusion being in English, peer-reviewed and published between 2014 and 2019. In total 296 papers were identified.

Data evaluation synthesis: Duplicates were removed, and 195 papers were screened …

Perioperative Nurses’ Engagement With The Surgical Safety Checklist: A Focused Ethnography, Julie A. Rogers, Paul Mcleish, Jan Alderman

Journal of Perioperative Nursing

Purpose

To gain greater insight into how nurses engage with the multidisciplinary team during the surgical safety checklist process.

Participants and setting

Participants were a purposeful sample of eight operating room nurses. The study was conducted in the operating room department of a major tertiary teaching hospital in South Australia.

Methods

Phase 1 employed participant observations while phase 2 employed semi-structured interviews.

Findings

Participants supported the use of the surgical safety checklist and valued its role to enhance patient safety. Multidisciplinary team culture played a significant role in how the checklist was conducted and heavily influenced the level of nurse …

The Patient, Case, Individual And Environmental Factors That Impact On The Surgical Count Process: An Integrative Review, Victoria Ruth Warwick, Brigid M. Gillespie, Anne Mcmurray, Karen G. Clark-Burg

Journal of Perioperative Nursing

Problem identification

The surgical count is an integral component of the perioperative nurse’s role designed to reduce the risk of unintentional retained items (URIs) during surgery. Current literature provides statistical data that URIs continue to occur which has exposed a lack of adherence to the surgical count process as a possible contributing factor. This review was undertaken to identify what is currently known about perioperative nurses’ practices in relation to the surgical count and the perceived barriers and enablers when trying to follow best practice as outlined in ACORN’s Standards for Perioperative Nursing in Australia.

Literature search

The objective …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Perceived Impact Of Ambient Operating Room Noise By Certified Registered Nurse Anesthetists, Marianne S. Cosgrove

Theses and Dissertations

It is widely acknowledged that elevated levels of noise are commonplace in the healthcare environment, particularly in high acuity areas such as the operating room (OR). Excessive ambient noise may pose a threat to patient safety by adversely impacting provider performance and interfering with communication among perioperative care team members. With respect to the certified registered nurse anesthetist (CRNA), increased ambient OR noise may engender distractibility, diminish situation awareness and cause untoward health effects, thereby increasing the possibility for the occurrence of error and patient injury.

This research project analytically examines the perceived impact of ambient noise in the operating …

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 …

Reshaping Perioperative Nursing Practice To Get The Job Done: A Constructivist Grounded Theory Study, Sharon Bingham, Kenneth Walsh, Karen Ford

Journal of Perioperative Nursing

No abstract provided.

Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam Iv

Theses and Dissertations

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home

patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.

Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity …

Multicenter Handoff Collaborative, Philip E. Greilich, Joseph R. Keebler

Publications

Communication and team-based care are at the heart of patient safety. As anesthesia professionals, we witness this at its very best and worst when transferring patients to and from the operating room (see article by Dr. Lorinc on types of transfers in this issue). In response, we have an opportunity to take a leading role in redesigning the most ubiquitous teaming event in hospitals in a manner that promotes team-based behaviors. The impact of unreliable handoffs on communication failures and medical errors is well known. To combat this issue, mandates by The Joint Commission (TJC) in 2006 and the American …

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 …

The Collaborative Development Of A Pre-Operative Checklist: An E-Delphi Study, Katherine Murphy, Kim Walker, Jed Duff, Robyn Williams

Journal of Perioperative Nursing

The aim of this study was to identify which items should be included in a pre-operative checklist based on recommendations by nurse experts in order to promote patient safety and effective communication in the perioperative environment.

Method: Thirty-five nurses participated in this e-Delphi study, which was conducted online via SurveyMonkey.. Each survey presented participants with a list of potential items for inclusion in a pre-operative checklist. Participants were asked to identify items they felt should be included in the checklist with the option to include comments. Comments were de-identified and shared with other participants to allow confidential interaction. The surveys …

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) …

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 …

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 …