Perioperative, Operating Room and Surgical Nursing Commons^™

Implementing A Standardized Counting Process, Paula M. Mbye

Master's Projects and Capstones

Abstract

Background: In a Northern California medical center with 11 operating rooms, two retained foreign object (RFO) events occurred following surgical procedures in 2025.

Problem: Surgical teams rely on manual counting processes to prevent retained foreign objects. Variability in counting practices among registered nurses and surgical technologists, combined with workflow interruptions and environmental distractions, can increase the risk of counting discrepancies and missed items. Standardizing the counting process may improve count accuracy and reduce the risk of RFOs.

Interventions: This quality improvement project implemented a standardized surgical counting process based on Association of periOperative Registered Nurses (AORN) guidelines within …

Standardized Infection Prevention Protocol To Reduce Surgical Site Infections In Pediatric Neurosurgery, Pisey Kareth

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Surgical site infections (SSIs) are a significant concern in the pediatric neurosurgical patient population and are associated with increased morbidity, longer hospital stays, and increased medical expenses. The absence of a standardized preoperative infection prevention process led to variability in perioperative care practices and infections at the practicum site.

Aim of the Project: The aim of the project was to reduce the incidence of SSIs among pediatric patients undergoing neurosurgical procedures who were initially evaluated in an ambulatory setting.

Review of the Evidence: Evidence supports the implementation of bundled infection prevention strategies as a more effective approach to reducing …

Ask, Advise, And Act: A Smoking Cessation Bundle For Cancer Patients, Crystal Tencate

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Smoking is the number one cause of preventable illness and death in the United States. For patients undergoing cancer treatment, continued tobacco use poses serious risks. In surgical oncology, smoking is associated with poorer treatment outcomes, increased postoperative complications, delayed wound healing, and higher mortality. For patients requiring reconstructive surgery, smoking-related complications can be devastating, sometimes resulting in significant wound complications or loss of the reconstruction. Despite these well-established risks, smoking cessation interventions are not consistently integrated into clinical practice.

To address this gap, a quality improvement project was implemented to strengthen smoking cessation efforts among advanced practice providers (APPs) …

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …

The Impact Of Parental Presence On Pediatric Recovery Outcomes Following Invasive Procedures Or Surgery, Jaymie Riza Torres, Franchesca Isabelle Andaya Lazaro

Nursing | Senior Theses

Background: Pediatric patients are severely affected by preoperative anxiety which can lead to postoperative complications and delayed recovery. This could be attributed to their developmental stage which determines their response to stress and fear. Purpose: The purpose of this paper is to evaluate postoperative recovery outcomes in pediatric patients following the implementation of parental presence at the induction of anesthesia and upon first waking up. Method: This proposed research utilizes a mixed-method approach, combining qualitative and quantitative methods through a quasi-experimental study. The target population consists of pediatric patients between the ages of three and eight years …

Smoke Evacuation In The Operating Room, Meghan Holley, Mckenzie Moon

Nurse Residency

In perioperative staff, does mandating the use of smoke evacuation in the surgical setting compared to no smoke evacuation decrease the amount of exposure to toxic byproducts found in surgical plume for each surgical case?

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Parental Presence Following Pediatric Invasive Procedures And Surgery, Jaymie Riza Torres, Franchesca Isabelle Andaya Lazaro

Nursing | Student Research Posters

Background: Pediatric patients are severely affected by preoperative anxiety which can lead to postoperative complications and delayed recovery. This could be attributed to their developmental stage which determines their response to stress and fear. Purpose: The purpose of this paper is to evaluate postoperative recovery outcomes in pediatric patients following the implementation of parental presence at the induction of anesthesia and upon first waking up. Method: This proposed research utilizes a mixed-method approach, combining qualitative and quantitative methods through a quasi-experimental study. The target population consists of pediatric patients between the ages of three and eight years …

Improving Awareness And Identifying Risks For Emergence Delirium In Military Veterans, Hannah E. Pino

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Emergence delirium (ED) is an acute state of confusion during the recovery phase from anesthesia that may be life-threatening, especially in the veteran population. Military veteran status may be explored by the Have You Ever Served questionnaire that was developed by the American Academy of Nursing to identify veterans upon admission to the hospital and thus be able to better care for them during their stay. This campaign has been in effect at the hospital site of this project for nearly 10 years. The questionnaire identifies military history risk factors such as combat history or a diagnosis of post-traumatic …

Preoperative Pain Management Education And Narcotic Use: A Quality Improvement Project, Sarah Scheller

DNP Projects

Introduction: Comprehensive preoperative education is an important aspect of pain management and helps empower patients prior to their surgery. Evidence supports the use of a combination of the teach-back method, videos, and pamphlets to educate patients prior to their surgery. A quality improvement project was initiated for patients having total shoulder arthroplasty surgery with an orthopedic surgeon in Connecticut.

Methods: An educational video and handout were created, and preoperative education sessions using the teach-back methods were performed. Postoperative phone calls were placed at 24 and 72 hours to assess the patient’s use of narcotic pain medication, alternative pain management medication …

Surgical Site Infections: Reducing Excessive Foot Traffic In The Surgical Room To Minimize The Risk Of Surgical Site Infections, Christopher D. Pobre

Master's Projects and Capstones

Problem: In 2021, a perioperative unit experienced 21 different surgical site infections (SSIs). SSIs are associated with increased medical complications and financial costs. One risk factor for SSIs is the increased or excessive operating room (OR) foot traffic, which increases airborne contaminants within the OR.

Context: A seven-room operating department performing 5,800 surgical procedures annually. The unit specializes in general, elective, and emergent procedures for the adult population predominately in the East Bay Area. A diverse mix of surgical procedures was observed throughout this project.

Assessment: A microsystem assessment was conducted to determine the causes and patterns that lead to …

Roles In Preoperative Planning, Joetta Combs

Epsilon Sigma at-Large Research Conference

This project represents the ever-changing methods surrounding Enhanced Recovery after Surgery and the protocols that compose it. The purpose of this study is to expand education of ERAS guidelines and improve patient outcomes through furthering staff education. Enhanced Recovery After Surgery has been a part of perioperative departments worldwide after being introduced in the 1990s by Northern European general surgeons and has been adapted and modified since its introduction (ERAS Society History, 2022). The preoperative and postoperative process is ever-changing and is difficult for staff to keep up with. Many staff members find it difficult to stay on top of …

Examining The Impact Of A Protein Intervention To Improve Outcomes In Frail Perioperative Candidates: A Feasibility Study, Anna M. Rose

DNP Projects

Background: Frailty is a syndrome or grouping of clinical characteristics that collectively increases one’s vulnerability to acute and external health stressors. Higher rates of frailty are present in oncology surgical patients and is a predictor of postoperative complications, as well as increased morbidity and mortality. Long- and short-term survival of surgical oncology patients is worse in frail patients than robust patients. Prehabilitation interventions during the planning phase of surgical intervention may serve to mitigate already known health concerns prior to inflicting the stressor that is surgical intervention.

Purpose: To measure the feasibility of an educational prehabilitative nutritional intervention aimed at …

Improving First Case Starts For A Neurosurgery Or, Tara L. Goodall

Master's Projects and Capstones

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide …

Standardizing Surgical Skin Antisepsis, Crystal Vackar

MSN Capstone Projects

Skin antisepsis is one of the most critical factors for preventing postoperative surgical site infections, but with the lack of high-quality research, the choice of which preoperative skin antiseptic is best remains a puzzling problem for clinicians (Chen, Chen, Guo, & Xu, 2020). Minimizing the patient’s risk of a surgical site infection by removing skin contaminants at the surgical site is the goal of surgical skin antisepsis. Therefore, the hospital or organization must choose the right product that is cutting costs, is the most effective, saving surgical time, and has the safest results for the patient. Before prepping the skin, …

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 …

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.

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 …

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

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 …

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 …

Fentanyl Administration On Emergence From Surgery And Post Anesthesia Care Unit Discharge Times And Pain Scores, Andrew Ernst Wetzel

Doctoral Projects

Problem: Pain has been historically mismanaged potentially leading to a host of negative physiological consequences. Today’s dynamic health care reform offers an opportunity to increase satisfaction with care. Utilizing the PICO question, in adults undergoing laparoscopic cholecystectomy over a 12 month period, does medication with fentanyl during emergence versus not medicating during emergence reduce the need for pain medications and discharge times? Evidence/Background: Two national studies surveyed patient perception of pain management following surgery. The first, conducted by Apfelbaum et.al (2003) showed that 80% of patients experienced acute pain after surgery with 86% rating that pain as moderate …

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 …

Patient Comfort And Multimodal Analgesia: Effects Of Preoperative Ibuprofen, Rodney Nash

Nursing Theses and Capstone Projects

Multimodal therapy for surgical patients is explified by use of a combination of a non-steroidal anti-inflammatory and an opioid to control visceral pain by decreasing both inflammation and pain transmission. Perioperative or postoperative use of multimodal therapy has been shown to provide adequate surgical pain relief while decreasing the total dose of opioids required. This project demonstrated that preoperative use of ibuprofen for women undergoing total laparoscopic hysterectomy decreased the total dose of opioids consumed in a 24-hour period, and increased the likelihood of the patient reaching her pain goal target at discharge. This finding adds to the literature support …

Surgical Delay For Hip Fracture Clients And The Use Of Clopidogrel: An Integrative Review, Phoebe Genevieve Waller

Senior Honors Theses

Abstract

Hip fractures in elderly patients have very high postoperative mortality rates and the number of hip fractures in the United States is expected to increase exponentially before 2030. Early surgery is essential to improve outcomes, but patients on clopidogrel (Plavix) have a high risk for increased bleeding if surgery is performed within the usual 72 hour window. This paper presents literature and research addressing the dangers of delaying surgery versus undergoing surgery before the effects of the clopidogrel are gone. Based on articles published after 2006, most researchers advocated earlier surgical intervention than previously recommended and emphasized an individualized …

What Is The Impact Of Tram Flap Breast Reconstruction On Self-Esteem And Perceived Body Image For Women With Breast Cancer?, Olivia Hill

Theses : Honours

Breast cancer is the most common of all cancers in women (26%) in Australia (Australian Institute Health Welfare AIHW, 1996; National Breast Cancer Centre NBCC, 1999). It is estimated that the lifetime incidence of one in eleven women in Australia will be diagnosed with breast cancer by the age of seventy-four (National Health and Medical Research Council NHMRC, 2000). Surgical resection continues to be the mainstay of treatment for early breast cancer, with approximately 50% of women diagnosed with breast cancer undergoing mastectomy (NBCC, 1999). Both the diagnosis of breast cancer and subsequent mastectomy raises a number of psychosocial issues …

An Investigation Into The Effects Of Preoperative Teaching On The Self Reported Levels Of Anxiety Of Patients Undergoing Elective Surgery, Megan Inglis

Theses : Honours

Over the last twenty years there has been a considerable amount of research conducted into the effects of preoperative teaching on postoperative recovery. While it is well known that preoperative instruction assists patients to recover from their operation, the mechanisms by which this occurs are not clear. One mechanism which may improve postoperative recovery is preoperatively. This research the reduction of anxiety examined the effects of preoperative teaching on preoperative levels of anxiety in patients undergoing elective cholecystectomy or herniorrhaphy. Twenty eight patients had their preoperative anxiety levels measured by a widely used questionnaire known as the State Trait Anxiety …