Perioperative, Operating Room and Surgical Nursing Commons^™

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed a …

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Postoperative Nausea And Vomiting Implications In Neostigmine Versus Sugammadex, Corey Lee Johnson, Colton Bradley James, Sarah Grace Traughber, Charles Anthony Walker, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Purpose/Background: Postoperative nausea and vomiting (PONV) is a frequent complaint in the postoperative period, which can delay discharge, result in readmission, and increase cost for patients and facilities. Inducing paralysis is common in anesthesia, as is utilizing the drugs neostigmine and sugammadex as reversal agents for non-depolarizing neuromuscular blockers. Many studies are available that compare these two drugs to determine if neostigmine increases the risk of PONV over sugammadex. Sugammadex has a more favorable pharmacologic profile and may improve patient outcomes by reducing PONV.

Methods: This review included screening a total of 39 studies and peer-reviewed articles that looked at …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

Efficacy Of Handoff Education For Icu Nurses When Transferring Patients To The Operating Room, Sandra Ruth Horace

Doctor of Nursing Practice Projects

Background: The transition of care from the Surgical Intensive Care Unit (SICU) to the Anesthesia team in the Operating Room (OR) is a vulnerable time for patients. There is currently no formal process for the patient transitioning from the Surgical ICU to the OR. The disarray of this transition can lead to serious omissions in communication and be harmful to the patient.

Purpose: Currently, there is no formalized or universal process for handoff communication between the SICU team and the Anesthesia team. This project aimed to provide handoff education for SICU nurses when sending a patient from the OR. This …

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 …

Promoting Mobility In Post-Surgical Patients: A Quality Improvement Project, Abel Sawa, Teresa Bigand

2021 Providence Nurse Research Conference

Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital.

Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation …

Effectiveness Of Apfel Simplified Risk Score In Predicting Postoperative Nausea And Vomiting In Day Surgery Unit, Leni Alejo, Cherry De Guia, Cynthia Rodriguez, Cassandra Luck-Bird

2021 Providence Nurse Research Conference

Background: Postoperative nausea and vomiting (PONV) continues to be a perioperative complication despite improvement in quality and safety of anesthesia care causing an increased overall healthcare cost and sometimes serious physical complications. The American Society of PeriAnesthesia Nurses (ASPAN) supports that risk assessment for PONV helps with its prevention which is in line with the Society of Ambulatory Anesthesia's (SAMBA) current guidelines for PONV management. Literature supports that PONV can be predicted and prevented in patients by assessing risk factors such as gender, smoking status, history of PONV and use of postoperative opioids, among others. At present there is no …

2020 Nursing Annual Report, Children's Health System Of Texas

2020

No abstract provided.

Optimizing Pediatric Preoperative Experiences In The Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one …

Optimizing Pediatric Experiences In Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one hour staff inservice …

Influence Of Resilience, Emotional Intelligence, And Teamwork On Registered Nurse Circulator Intent To Leave, Mary Alice Anderson

Nursing Theses and Dissertations

Registered Nurse (RN) circulator attrition is detrimental to the future of the nursing profession. The high average age of perioperative nursing leaders and high intent to leave of younger nurses in the perioperative setting leads to a high vacancy percentage and high expense to retrain and recruit nurses. The purpose of this dissertation was to explore the influence of resilience, emotional intelligence (EI), and teamwork on intent to leave RN circulator positions in full-time nurses who are members of the Association of periOperative Registered Nurses (AORN). Understanding factors that influence RN circulators’ intent to leave is key to developing interventions …

Guided Imagery And Sentinel Lymph Node Biopsy Pain, Brandy Alicia Kirk

Evidence-Based Practice Project Reports

The standard of care in the treatment for women diagnosed with breast cancer includes identification and biopsy of the sentinel lymph nodes (SLN) of the breast (Chaterjee et al., 2017; Kneece, 2017). The process of identifying the SLNs involves radioisotope injections into or near the areola. Because this area is highly sensitive, women report this procedure to be considerably painful. The purpose of this evidence-based practice (EBP) project was to determine if the provision of a 5-minute session of guided imagery (GI), as a complementary alternative medicine, prior to SLN injections was effective in mitigating reports of procedural pain. A …

Post-Operative Nursing Care Of The Renal Transplant Patient, Emily Smith

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Kidneys are the most commonly transplanted organ in the United States. All patients who receive a renal transplant must be on lifelong immunosuppressants to prevent rejection of the donor organ. The majority of patients do not take their immunosuppressant medications as instructed, making noncompliance a huge issue for medical professionals. The purpose of this literature review is to explore what evidence-based techniques nurses should employ to increase the long-term compliance of immunosuppressants in renal transplant patients. A literature review was performed of fifteen studies to identify interventions that nurses can employ to increase immunosuppressant compliance. CINAL and Medline were …

Dnp Final Report: Enhancing Nurses' Knowledge On Opioids To Promote Safe Opioid Use In Post-Operative Patients: An Evidence-Based Practice Project, Amardeep Gill

DNP Final Reports

Pain control remains suboptimal in the United States, while the use and misuse of opioids are growing. Opioid use disorder and opioid misuse are associated with an increased risk of postoperative mortality and morbidity. The Centers for Disease Control and Prevention reported more than 232,000 deaths from a prescription opioid overdose from 1999 to 2018. The economic burden related to prescription opioid misuse in the United States is $78.5 billion a year. According to the literature, lack of knowledge makes patients vulnerable to misuse and nonmedical use of opioids. This lack of patients’ knowledge and over-prescription of opioids are among …

Post Operative Handoff Tool Benchmark Project, Savannah E. Vinson

MSN Capstone Projects

According to a sentinel event statement issued by The Joint Commission in 2017, inadequate hand-off communication is responsible for many adverse-events, including sentinel events in healthcare. A study released in 2016 estimated that communication failures in U.S. hospitals and medical practices were responsible at least in part for 30 percent of all malpractice claims, resulting in 1,744 deaths and $1.7 billion in malpractice costs over five years(The Joint Commission [TJC], 2017). Successful handoff communication has the potential to substantially improve patient safety when leadership displays their commitment to successful handoff, when handoff is standardized and done face-to-face between healthcare providers, …

Implementation Of A Perioperative Pathway For Individuals With Or At High Risk For Obstructive Sleep Apnea, Kimberly Claude

Doctor of Nursing Practice Scholarly Projects

Background At the Veterans Affairs Boston, pre-operative screening for obstructive sleep apnea using the STOP-Bang questionnaire and referral to pulmonary service for those who fail screening is not reliably completed. For patients identified as having OSA or at high risk for OSA, advice on how to reduce postoperative risk may not be adequately communicated through the perioperative process. The project aim is to construct and implement a perioperative pathway to ensure surgical patients with OSA or suspected OSA receive evidence-based care throughout the perioperative period.

Methods The intervention for this quality improvement project was an evidence-based perioperative pathway which includes …

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: …

Educating Registered Nurses (Rns) To Improve Knowledge, Comfortability & Ability Of Communication In Advance Care Planning (Acp), Sirena Blount-Sears, Pamela Bishop

College of Health Sciences Posters

Purpose: The purpose of this project was to assess the knowledge, comfortability, and ability to communicate with confidence, along with the usage of communication tools, among Med/Surg RNs r/t to ACP before & after participation in an ACP educational webinar.

Aims: To evaluate whether the knowledge, comfortability, ability to communicate, including usage of communication tools, and confidence among medical-surgical registered nurses related to ACP improves following participation in an ACP educational webinar.

Research Questions/Hypotheses: RQ1: Will there be a significant difference before & after an ACP educational webinar r/t: knowledge, comfortability, ability to communicate with confidence, & the …

2021 Nursing Annual Report, System Of Texas Children's Health

2021

No abstract provided.

Dnp Final Report: Practice Change Compliance, Laura Duran

DNP Final Reports

Healthcare professionals in acute care hospital settings at the frontline of patient care affect many aspects of the patient's hospital stay, including infection prevention. The wearing of artificial nails by healthcare professionals in direct patient care is against best practice, although it is often seen. Therefore, the following PICOT question arises: In direct patient care providers who fail to adhere to policy (e.g., artificial nail use per hand hygiene policy) (P), how does a multimodal approach (I) compared to a single approach (education) (C) affect compliance with policy (0) within six months (T)? A systematic review was conducted using CINAHL, …

A New Approach To Sternal Precautions: Keep Your Move In The Tube, Kelijo Fernholz, Jayna Theis, Erik Anderson

Nursing Posters

Purpose:

• To guide patients and staff in a new approach to sternal precautions following median sternotomy

Current Practice:

• 10-pound lifting restriction for 4 weeks
• 20-pound lifting restriction until 3 months post operation
• Limited arm exercises
• Sit to stand push restrictions

Why Change:

• Literature review demonstrates great variation in sternal precautions
• Currently too restrictive; may hinder recovery and long-term mobility. Too many restrictions can create fear of movement, resulting in short term rehab discharge needs
• To create more independence for the patient, less reliant on family members for ADLs and basic needs. Patients to return to regular home and work activities …

Routine Post Surgical Vital Signs: Time For A Change, Kristina Kjellberg, Elizabeth Plante, Sadie Seezs

Nursing Posters

Purpose Statement:

The purpose of this evidence-based practice project is to evaluate the current routine post operative vital signs and determine if reduced frequency of vital signs is as effective in identifying deterioration after a post anesthesia care unit (PACU) discharge.

Synthesis of Evidence:

• Patient survival in the post operative time period is maximized with the recognition and management of abnormal vital signs
• Post op periods can carry great respiratory and circulatory complications, which are identified by abnormal vital signs especially heart rate and blood pressure
• Multiple sources have identified that current frequency of post operative vital signs is based …

Teamstepps In A Pediatric Operating Room, Lisa Kerrick

Regis University Student Publications (comprehensive collection)

Despite numerous patient safety and quality programs available and in use in the healthcare environment, adverse events in operating rooms continue to occur. The operating room is a complex and chaotic environment where teamwork is necessary for safe patient care. Team training is a strategy that improves teamwork. TeamSTEPPS is an evidence-based team training program designed to integrate teamwork into clinical practice. This project aims to determine if TeamSTEPPS communication tools and strategies improve the perception of teamwork and efficiency in a pediatric operating room. The outcome objectives for this project are to increase the perception of teamwork and improve …

Use Of A Simplified Protocol For The Prevention Of Postoperative Nausea And Vomiting In Adult Ambulatory Surgical Patients, Roger Horne

DNP Scholarly Projects

Postoperative nausea and vomiting (PONV) remains a common complication affecting surgical patients after receiving anesthesia. Prevention of PONV is important in an ambulatory surgical setting where patient access to rescue treatment is limited after discharge. A quality improvement (QI) project introduced a simplified PONV prevention strategy to decrease the incidence of PONV at a Veterans Health Administration ambulatory surgery center. A retrospective chart audit of all facility surgical patients receiving anesthesia care (n = 94), excluding ophthalmology patients, was conducted prior to COVID-19 restrictions to establish baseline PONV incidence. An evidence-based, simplified PONV prevention protocol was developed and implemented. …

Opioid Free Anesthesia, Sarah Medina

Doctor of Nursing Practice Projects

Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

A Systems Approach To Increase The Icu Nursing Workforce During A Pandemic, Jennifer Mendenhall

Master's Projects and Capstones

A Systems Approach to Increase the ICU Nursing Workforce During a Pandemic

Abstract

In early March 2020 an intensive care unit (ICU) patient died of COVID-19 in an integrated healthcare system hospital in Northern California. Data from China and the CDC indicated that more healthcare members would require intensive care and could overwhelm the 21 acute care hospital macrosystem. A microsystem pilot program to upskill peri-anesthesia care unit (PACU) RNs to care for ICU patients was initiated. Concurrently the upskill pilot program was reviewed by macrosystem nursing leadership. Over a three-week period, the program was standardized, disseminated and implemented across …

Policy Analysis: Appropriate Opioid Prescribing Practices For Post-Surgical Patients, Joan S. Daversa

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The pervasiveness of legally prescribed opioids in the United States has led to increased post-surgical patients succumbing to opioid dependence. There is a vast disparity in pain management practices across clinical settings. The lack of well-defined policies specifying opioid prescribing practices for post-surgical patients has created inconsistency among providers. This situation creates a risk for misuse and long-term opioid dependence for patients. This policy analysis aims to implement an evidence-based opioid prescribing policy for post-surgical patients to improve current opioid prescribing practices and implement a best practice culture to reduce excessive opioid practices. Collins (2005) health policy analysis adapted from …