Perioperative, Operating Room and Surgical Nursing Commons^™

Improvements Upon Reprocessing Of Orthopedic Single-Use Instruments, Alyssa P. Nguyen

Master's Projects and Capstones

Internal Medline data for Hospital A, a level I academic trauma center, identified a quality gap due to improper segregation and underutilization of orthopedic single-use device reprocessing bins. The baseline reprocessing rate of 4% for orthopedic products results in missed sustainability opportunities, financial strain, and increased regulated waste. A proposed quality improvement intervention implemented updated communication strategies, visual management tools, and education modules to reinforce current reprocessing workflows and close knowledge gaps. Outcome measures include the percentage of SUDs collected for reprocessing, survey results on reprocessing awareness, and potential financial savings in Appendix I. Early data showed a 10% year-to-year …

The Efficacy Of Transversus Abdominis Plane Block As An Adjunct To Spinal Anesthesia For Cesarean Delivery: An Evidence Synthesis And Implementation Toolkit, Alyssa Hebert, Alex Potts, Gabriela Robertson

Graduate Theses, Dissertations, and Capstones

Postoperative pain hinders cesarean delivery recovery and overall patient experience. Although spinal anesthesia with intrathecal opioids remains the standard of practice, associated side effects and concerns regarding opioid exposure highlight the need for effective opioid-sparing strategies. Anesthesia providers play a critical role in advancing postoperative pain management through evidence-based protocol development, provider education, and interdisciplinary collaboration to optimize maternal outcomes. The transversus abdominis plane (TAP) block provides somatic analgesia to the anterior abdominal wall by targeting the thoracolumbar nerves (T6–L1) and has increasingly been incorporated into multimodal postoperative pain management strategies for abdominal surgery. Nevertheless, a gap remains in obstetric …

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 …

Reduction Of Length Of Stay For Total Joint Replacement Patients, Melody C. Golden

Master's Projects and Capstones

Abstract

Problem: Prolonged LOS in the PACU for patients undergoing total joint replacement surgery contributes to inefficiencies in patient flow, delayed throughput, and increased resource utilization. At Hospital A, recent LOS averages exceed internal and regional benchmarks, indicating a need for process improvement.

Context: The PACU is a high-volume, fast-paced environment requiring coordination among nursing, physical therapy, anesthesia, and discharge planning teams. Variability in workflow, communication gaps, and inconsistent timing of key processes contribute to delays in discharge readiness.

Interventions: From May through July 31^st, 2026, a quality improvement project was implemented using the Baldrige Excellence …

High-Flow Nasal Cannula Oxygen Therapy Versus Standard Oxygen Therapy On Perioperative Outcomes In Patients Undergoing Transcatheter Aortic Valve Replacement, Kirsten B. Whiteside, Jacqueline M. Case

Graduate Theses, Dissertations, and Capstones

Abstract 

Background and Purpose: Transcatheter aortic valve replacement (TAVR) is increasingly performed under monitored anesthesia care (MAC) to facilitate faster recovery and reduce complications associated with general anesthesia. Standard oxygen therapy (SOT) may be insufficient in maintaining adequate oxygenation in this high-risk population. High-flow nasal cannula (HFNC) therapy has emerged as a potential alternative. This literature review evaluates the effects of HFNC compared with SOT on perioperative outcomes in patients undergoing TAVR under MAC. 

Methods: A comprehensive review of the literature was conducted to identify studies evaluating HFNC versus SOT during TAVR procedures performed under MAC. Six studies met inclusion …

Integrating Music Therapy Into Post-Surgical Care: A Quality Improvement Strategy For Reducing Post-Operative Anxiety, Yosdania Hernandez Benitez

Doctor of Nursing Practice Final Project Abstract

Integrating Music Therapy into Post-Surgical Care: A Quality Improvement Strategy for Reducing Post-Operative Anxiety

Purpose

This quality improvement (QI) project aimed to reduce postoperative anxiety among adult patients after general surgery in the post-anesthesia care unit (PACU) by 30% using nurse-led music therapy in an ambulatory surgical center.

Results

Mean VAS-A scores decreased from 6.9 (SD = 0.5) pre-intervention to 4.0 (SD = 0.5) post-intervention, representing a 2.9-point (41.9%) reduction in anxiety and exceeding the project's target of 30%. Nurse adherence to the intervention protocol was 100%, and the mean patient satisfaction score was 4.6/5.0. All 100 patients completed both …

Implementation Of A Perioperative Normothermia Bundle To Improve Temperature Maintenance In Adult Colorectal And Hysterectomy Surgical Patients: A Quality Improvement Project, Jessica L. Salisbury

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement project evaluated the effectiveness of an evidence based perioperative normothermia bundle in improving maintenance of normothermia among adult colorectal and hysterectomy surgical patients at a community hospital. The project aimed to reduce perioperative hypothermia through standardized warming interventions while improving compliance with evidence based practice.

Background

Preventable perioperative hypothermia increases postoperative complications, prompting implementation of an evidence based warming bundle to maintain intraoperative temperatures 36 Celsius or greater.

Methodology

Using the Iowa Model, an interdisciplinary team implemented an evidence based perioperative normothermia bundle incorporating multimodal warming, temperature monitoring, and staff education. Compliance and temperature outcomes were …

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

Doctor of Nursing Practice (DNP) Scholarly Project

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 …

Skin Is In: Promoting Breastfeeding Through Immediate Cesarean Skin-To-Skin, Autumn Spencer

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and the American College of Obstetricians and Gynecologists identify immediate, uninterrupted skin-to-skin contact as a standard of care that improves neonatal stability, breastfeeding outcomes, and maternal satisfaction. Despite these recommendations, timely initiation following cesarean birth remains inconsistent. At the project site, skin-to-skin initiation averaged 72 minutes after birth, exceeding the 10-minute benchmark, and exclusive breastfeeding rates were below the national standard of 70%. Contributing barriers included workflow variability, unclear role expectations, and inconsistent communication.

Aim of the Project: The aim of the project was to improve infant and maternal …

Improving Iv Access Outcomes In Obstetric Care Through A-Diva Scale Utilization And Point-Of-Care Ultrasound, Parth S. Patel, Matthew T. Komorowski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric (OB) patients frequently present physiological changes, including edema, obesity, and peripheral vasoconstriction, that increase the risk of difficult intravenous access (DIVA). Multiple IV attempts can delay time-sensitive therapies in obstetric emergencies and increase patient discomfort and provider workload. Research studies have supported the use of the Modified Adult Difficult Intravenous Access (A-DIVA) scale to assess patients for DIVA, and the use of point-of-care ultrasound (POCUS) guided peripheral intravenous access (PIVA). In 2025, a preceding Doctor of Nurse Anesthesia Practice (DNAP) project implemented A-DIVA in the Labor & Delivery (L&D) unit of an OB department and found that 35% of …

Impact Of Gum Chewing On Postoperative Ileus Following Open Heart Surgery At Swedish Cherry Hill, Jacinta Smith

All Podium Presentations

No abstract provided.

Exploring Clinical Ladder Program Participation Among Operating Room Nurses, Camille Sistoso-Lorenzana

Doctoral Projects

Continuous professional development among nurses is vital, yet not all nurses embark on this career journey. The Clinical Ladder Program (CLP) is a retention strategy among various health institutions to retain talent and improve nurses' satisfaction, but this plan is unappealing or indifferent to some nurses. While the CLP is a motivation tool for nurses to focus on clinical expertise in bedside care (Riley et al., 2009), and resources are available to increase a nurse's chances of successfully advancing the ladder, participation in and perspectives on the CLP remain unknown, especially among operating room nurses. This project is guided by …

From Chew To Throughput: Supporting Faster Recovery, Lindsay Kephart, Morgan Thiry

InnovateHER Meeting 2026

Patients admitted with bowel-related diagnosis groups (DRGs) are experiencing extended lengths of stay.  The delay in return of bowel function is a barrier to care progression for patients admitted with a bowel DRG. Evidence supports early implementation and consistent use of chewing gum to improve early GI motility, reducing overall length of stay.

This pilot aims to standardize gum chewing after surgery for our bowel patient population to promote early bowel function and help reduce hospital length of stay.

Headset To Reset: Virtual Reality Therapy In Postoperative Heart And Lung Transplant Patients, Michaela Sanchez

Doctoral Projects

Postoperative heart, lung, and heart-lung transplant recipients are at increased risk for anxiety and depression, both of which have been associated with increased risk of complications and higher mortality rates. The purpose of this quality improvement project was to implement a mindfulness-based virtual reality (VR) therapy intervention for postoperative transplant recipients at a Northern California academic medical center and to evaluate its feasibility, tolerability, and acceptability during the index hospitalization. Over a 15-week period, five participants completed a total of eight VR sessions. Participants selected from immersive mindfulness-based environments, including guided meditation and other relaxation experiences. Anxiety and depression were …

Two-Year Retrospective Evaluation Of Frailty To Optimize Postoperative Spinal Fusion Outcomes In Adults Aged 65 And Older, Sheri Loo

Doctoral Projects

Many older adults over the age of 65 have both spinal stenosis requiring spinal fusion surgery and frailty. As life expectancy has increased, many older individuals will undergo elective spinal fusion surgery to decrease their chronic pain in pursuit of improved quality of life. There is currently an underutilization of frailty screening for risk stratification of postoperative complications. A retrospective chart review over a two-year period from July 2023 to June 2025of adults aged 65 and older who underwent posterior spinal fusion surgery, involving 126 participants, was completed. We assessed the correlation between frailty and postoperative outcomes, discharge disposition, and …

A Quality Improvement Initiative Evaluating Factors Influencing Patient Experience With Virtual Reality During Awake​ Interventional Radiology Procedures, Quynh Dao-Payne

Doctoral Projects

Procedural anxiety and pain are common among pediatric patients undergoing awake interventional radiology (IR) procedures and may negatively affect patient comfort, cooperation, and overall patient experience. Virtual reality (VR) has emerged as a promising nonpharmacologic intervention to reduce anxiety and improve patient-centered outcomes. The purpose of this quality improvement project was to evaluate patient-reported experiences and perceived outcomes associated with VR use during awake pediatric IR procedures at Children’s Hospital Los Angeles.​ A qualitative descriptive quality improvement design was utilized. Twenty pediatric​ patients ages 10–21 years undergoing awake IR procedures with VR as part of standard clinical​ care completed structured …

Improving Postoperative Handoff For Placenta Accreta: Implementing A Structured Handoff Communication Tool, Isabelle L. Gerrard

Doctor of Nursing Practice Final Project Abstract

Purpose Implement a standardized postoperative handoff tool to improve interdisciplinary communication during transfer of placenta accreta spectrum (PAS) patients from the operating room to an obstetric intensive care unit at an academic women's hospital.

Background Placenta accreta spectrum (PAS) is a high-risk obstetric condition requiring coordinated multidisciplinary care. At the project site, operating room (OR)-to-obstetric intensive care unit (OB ICU) handoffs lacked a standardized process. This resulted in inconsistent communication and omission of critical information. Nurses reported reduced confidence. Standardized handoff tools can improve communication and promote safer transitions of care.

Methodology This 10-week quality improvement project used Plan-Do-Study-Act methodology …

Measuring Effectiveness Of A Mobility Aide On A Medical-Surgical Unit, Jamie L. Granatowicz, Laura N. Rogers, Leeza A. Struwe

Doctor of Nursing Practice Projects: College of Nursing

Purpose: To evaluate the effectiveness of a mobility aide on a medical-surgical inpatient unit to improve patients’ surgical outcomes, decrease hospital length of stay, and decrease the number of falls.

Design: A retrospective review was conducted to determine the effects of a mobility aide implemented on a medical-surgical unit. The intent was to ensure the utilization of the Enhanced Recovery After Surgery (ERAS) protocol for early mobilization before and after implementation. Two-month periods were analyzed before and after implementation.

Findings: The results demonstrated clinical significance for patients when implementing a mobility aide. The mean length of stay was 1.044 days …

2025 Nursing Annual Report, Children's Health System Of Texas

2025

No abstract provided.

Reducing Intraoperative Hypothermia In Adults 18-60 Undergoing Primary Elective Unilateral Total Knee Replacement With General Anesthesia, Carrigan Collinsworth

Doctor of Nursing Practice Final Project Abstract

Reducing Intraoperative Hypothermia in Adults 18-60 Undergoing Primary Elective Unilateral Total Knee Replacement with General Anesthesia

Background

Intraoperative hypothermia (core temperature < 36°C) is associated with increased surgical site infections, blood loss, prolonged recovery, and longer hospital stays. Because forced-air warming devices are restricted during total joint arthroplasty at the project site due to infection concerns, patients relied on passive warming, resulting in a baseline hypothermia rate of 63.3%

Purpose

The purpose of this quality improvement project was to reduce the incidence of intraoperative hypothermia among adults aged 18-60 undergoing primary elective unilateral total knee arthroplasty with general anesthesia by implementing a conductive warming device in the operating room of a large level 1 trauma hospital

Methodology

This evidence-based quality improvement project implemented a conductive warming blanket following staff education. Data was collected through the electronic health record. Primary outcomes included hypothermia incidence and average intraoperative temperature. Secondary …

Evidence-Based Practice Guidelines For Lung Protective Ventilation In Adult Patients Undergoing Abdominal Laparoscopic Surgery, Marco A. Spada

Doctor of Nursing Practice Scholarly Projects

The rise in abdominal laparoscopic surgeries has underscored the need for improved ventilation strategies to reduce postoperative pulmonary complications, such as atelectasis, ventilator-induced lung injury, and pneumonia. These complications can increase hospital stays, healthcare costs, and mortality. This final scholarly project investigates the impact of lung protective ventilation in adult patients undergoing abdominal laparoscopic procedures and proposes guidelines for implementation. Lung protective ventilation strategies, including low tidal volume ventilation, individualized positive end-expiratory pressure, and recruitment maneuvers. Current research shows potential in mitigating postoperative pulmonary complications by improving intraoperative oxygenation and lung compliance. Using the Johns Hopkins Evidence-Based Practice model, this …

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 …

The Relationship Between Mc1r Gene Variants For Red Hair And Clinical Responses To Anesthesia, Analgesia, And Pain: A Systematic Review Of The Literature, Mary Clark Allen

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: Genetic variations of the melanocortin-1 receptor (MC1R) are commonly associated with red hair and pale skin. Research has linked MC1R variants with alterations in anesthetic response, pain perception, opioid sensitivity, and pain-related fear. Existing literature presents inconclusive findings, highlighting the need for further investigation.

Purpose: This review aims to synthesize current evidence concerning the role of MC1R variants in altering physiologic responses.

Methods: A systematic literature review was conducted by accessing CINAHL, MEDLINE, and PubMed through the University of Arkansas Libraries OneSearch platform. After applying inclusion and exclusion criteria, a total of 20 peer-reviewed articles were extracted for review. …

The Effects Of Sugammadex Vs. Neostigmine On Intraoperative Heart Rate In Pediatric Patients Under Two Years: A Scoping Review, Saumel Abston, Jackson Cobb, Elle Dean, Tanner Dillard, Pauline Dinh, Dwayne Accardo Dnp, Crna, Faana, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

Neuromuscular blockade (NMB) reversal is a critical component of anesthesia care, particularly in infants under two years of age who have immature autonomic regulation and heightened vagal tone, predisposing them to bradycardia. Neostigmine, the traditional reversal agent, is associated with parasympathomimetic effects such as bradycardia, requiring anticholinergic co- administration. Sugammadex, a selective relaxant binding agent, offers rapid and predictable reversal of aminosteroidal neuromuscular blocking agents with less cholinergic side effects. Although the safety profile of sugammadex is well established in older pediatric populations, limited evidence exists regarding its cardiovascular effects in infants under two years of age.

Methods

A …

The Effect Of Fall Prevention Programs With Hourly Rounding On Fall Rates Among Adults Patients In Neurological Unit, Oyinlola A. Ogundeji

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this QI project was to evaluate the effect of a structured hourly rounding program on patient fall rates in an adult neurological inpatient unit.

Background

Patient falls remain a major safety concern in acute care, particularly among hospitalized neurological patients with impairments in mobility, cognition, and balance. In an adult neurological unit within a Magnet-designated hospital, fall rates exceeded national benchmarks, underscoring the need for a targeted quality-improvement

Methodology

A pre–post QI design, guided by the Plan-Do-Study-Act framework, was implemented over 12 weeks in a 28-bed neurological unit. This intervention featured structured hourly rounding using the …

Improving Anesthetic Management Of Pheochromocytoma: ​ ​An Educational Initiative Led By Student Registered Nurse Anesthetists​, Kerryn Nicholls

Scholars Week

Anesthetic management of pheochromocytoma presents challenges to experienced nurse anesthetists and recent graduates alike due to the rarity and complex pathophysiology. The purpose of this DNP project was to provide information and education informed by an extensive literature review regarding the anesthetic management of pheochromocytoma for the benefit of future nurse anesthesia practice. The project was accomplished through an educational presentation and novel clinical care flow chart focused on perioperative anesthetic care of pheochromocytoma excision to an audience of practicing certified registered anesthetists (CRNA’s) in two rural Kentucky hospitals. The findings of this project demonstrated that student nurse anesthesia students …

Improving Anesthesia Provider Confidence In The Identification, Management, And Treatment Of Postoperative Delirium, Brittany M. Whistle, Charles Dustin Phelps

Scholars Week

Purpose: Postoperative Delirium (POD) is a potentially devastating complication of anesthesia that is poorly understood by clinical staff leading to poor outcomes for surgical patients. This study is meant to determine if a focused knowledge presentation accompanied by visual aids could increase anesthesia providers confidence in identifying, diagnosing, and treating Postoperative Delirium.

Methodology: Utilizing a statistical model to analyze respondents results on a standardized test administered before and after an informational presentation with visual aids on the topic of Postoperative Delirium.

Results: Results indicated a statistically significant difference between pretest and posttest scores, with a p-value of .002, t(11) = …

Assessing The Impact Of Interprofessional Simulation Training On Perioperative Staff's Confidence In Managing Maternal Hemorrhage, Mallory Duncan, Lidia Vazquez

Scholars Week

Globally, maternal mortality rates remain a critical public health challenge, often related to inadequate healthcare infrastructure in low-income countries. Yet according to the American Journal of Obstetrics and Gynecology (ACOG), maternal mortality rates in the United States are also on the rise, with nearly 32.9 deaths per 100,000 live births. These deaths are largely contributed to maternal hemorrhage (PPH), defined by ACOG as cumulative blood loss of at least 1,000 mL accompanied by symptoms of hypovolemia within 24 hours of the birth process. These findings underscore an urgent need to strengthen the training for perioperative staff in the management of …

Occupational Sevoflurane Exposure And Awareness Of Health Effects Among Anesthesia Providers, Hayden Fell

Scholars Week

Key words:

Sevoflurane exposure Occupational safety CRNAs Anesthetic gas exposure Workplace hazard

The anesthetic gas sevoflurane is of unique interest amongst anesthesia providers as a potential workplace hazard. This project aimed to evaluate CRNA knowledge, clinical practices, symptoms, and perceptions related to occupational sevoflurane exposure amongst Certified Registered Nurse Anesthetists (CRNAs) at a regional hospital in Kentucky.

This quality improvement project used a pre- and post-intervention survey design. Ten CRNAs participated in the project. A pre-survey was given, followed by an educational session informing participants of guidelines regarding Sevoflurane exposure and literature findings of Sevoflurane as a potential workplace …

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 …