Perioperative, Operating Room and Surgical Nursing Commons^™

Red Room Redesign: Improving Operating Room Workflow For Urgent And Emergency Procedures, Hipolito Jamilan

Master's Projects and Capstones

Problem: Limited operating room (OR) availability is a significant challenge in many healthcare facilities. Overbooked or understaffed ORs can lead to delays in surgical procedures, which are particularly detrimental in urgent and emergency situations (Cholewa et al., 2024). The OR is among the costliest areas in a hospital; it is essential to improve efficiency in surgical throughput to deliver timely care for urgent and emergent cases, enhance patient outcomes, and manage healthcare costs effectively.

Context: The microsystem for this project is a Northern California OR that handles a high volume of surgical procedures. There is a dedicated red room for …

Development And Implementation Of An Ob/L&D Sbar Framework To Enhance Communication Between Obstetric Nurses And Anesthesia Providers: A Quality Improvement Initiative, Jenna E. Bigam, Laina J. Uzarski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication between obstetric (OB) nurses and anesthesia providers is critical to ensure patient safety during epidural placements in labor and delivery (L&D) settings. At a large teaching hospital, communication gaps were identified when OB nurses requested anesthesia for epidural placements without consistently providing vital patient information. The lack of structured communication can result in important details being overlooked, which may lead to delays in care and potential patient harm. To address this, the SBAR (Situation, Background, Assessment, Recommendation) communication framework was implemented to standardize and improve information exchange. This Doctorate of Nurse Anesthesia Practice (DNAP) project aimed to enhance …

Optimizing Pressure Injury Prevention: Implementation Of The Sskin Bundle In Acute Care, Joycelyn Mccall

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: Hospital-acquired pressure injuries (HAPIs) contribute to increased morbidity, extended hospitals stay, and significant healthcare costs. At the project site in northwest, Indiana, HAPI rates averaged 6.29%, which significantly higher than the national benchmark of 2.24%. Inconsistencies in documentation, a lack of standardized preventive practices, and variable staff engagement contributed to these increased rates. Despite the use of the Braden Scale, staff inconsistently implemented preventive interventions.

Aim of the Project: The aim of the project is to reduce HAPI incidence by 30% over 10 weeks by implementing the surface, skin inspection, keep moving, incontinence/moisture management, and nutrition (SSKIN) bundle and …

2024 Nursing Annual Report, System Of Texas Children's Health

2024

No abstract provided.

The Influence Of Perioperative Education On Postoperative Digestive Restoration, Christian Cedeno

Doctor of Nursing Practice Scholarly Project

The human body often needs encouragement to return to its natural state of functioning following intraoperative and postoperative drug therapy. Anesthesia can sedate the gastrointestinal tract and frequently requires medical and physical interventions to allow the body to return to full functionality. There are several methods thought to be beneficial in overcoming of this condition, and some have proven their significance more so than other methods. This project seeks to measure the power-of-knowledge methodology via a chart review of individuals specifically educated on what they can expect in the postoperative phase of care compared to those that receive routine education. …

Optimizing Pediatric Peri-Anesthesia Care: A Donna Wright Nursing Competency Framework, Marisa Elise Gauna

Master's Projects and Capstones

Problem: Preventable hospital errors are often associated with inconsistent nursing competency, especially in high-acuity areas such as pediatric peri-anesthesia units. Traditional evaluation tools like checklists have limited effectiveness, as they frequently fail to engage staff or adapt to changing clinical demands (Wright, 2005). Context: At a Bay Area children’s hospital, baseline data from August 2024 revealed that only 65% of peri-anesthesia nurses reported feeling “very” or “somewhat” comfortable with key clinical skills. To address this, a quality improvement project was launched with the goal of increasing comfort levels by 15% using the Donna Wright Competency Model, which emphasizes staff engagement, …

The Wright Way: Advancing Pediatric Perianesthetia Nursing Competencies, Marisela E. Acevedo-Padilla

Master's Projects and Capstones

Objective Implementing the Donna Wright Competency Model at a Bay Area Children’s Hospital in its peri-anesthesia units. Throughout available literature it was possible to observe the positive effects of implementing a competency model such as the DWCM has on the confidence of nursing staff and patient outcomes. An important point shown by literature was addressing more than technical skills and incorporating critical thinking and ethical considerations regarding patient care. Aim We aim to improve nurse competency in pediatric peri-anesthesia units at a Bay Area Children's Hospital by implementing Donna Wright’s Competency Model. Data obtained in August 2024 from a series …

Strategic Policy Development To Reduce Same-Day Cancellations: A Nurse-Led Preoperative Approach, Amanda Kuelz

Doctor of Nursing Practice Final Manuscripts

Background: Same-day surgical cancellations are a persistent and costly issue within outpatient surgery centers, accounting for approximately 5% of elective cases. These disruptions result in inefficient utilization of operating room (OR) time, increased staffing burdens, lost reimbursement, and diminished patient satisfaction. Unanticipated cancellations undermine scheduling reliability and workflow efficiency, contributing to care fragmentation and increased financial strain on health systems. A growing body of evidence suggests that nurse-led, structured preoperative screening has the potential to mitigate these challenges by identifying risk factors in advance and facilitating timely interventions. Nurses' clinical acumen and communication expertise uniquely position them to lead such …

Sugammadex For Reversal Of Neuromuscular Blocking Agents Versus Neostigmine - Safety Comparison, Amanda K. Butler, Daniel Belu, Bailey Accardo, Courtney Ayana Bullard, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Sugammadex and neostigmine are two common drugs used to reverse neuromuscular blockade in anesthesia, but they differ in mechanism of action, side effects, and cost.

Sugammadex provides rapid reversal, has fewer side effects, and has a lower risk of bradycardia than neostigmine. This scoping review examines the frequency of bradycardia in adult surgical patients receiving sugammadex versus neostigmine.

Methods

A scoping review was completed of peer-reviewed articles comparing the incidence of bradycardia in adult surgical patients after the administration of sugammadex and neostigmine for neuromuscular blockade reversal. Findings indicate that sugammadex resulted in fewer adverse events, including bradycardia, than …

Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen

Doctor of Nursing Practice Scholarly Projects

Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler

Doctor of Nursing Practice Scholarly Projects

A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …

A Four-Year Longitudinal Study Of Effectiveness Of Evidence-Based Bundle Practices For Preventing Catheter-Associated Urinary Tract Infections In An Academic Health Care Center, May Mei-Sheng Riley

Doctoral Projects

Catheter-associated urinary tract infections (CAUTIs) significantly contribute to morbidity, prolonged hospitalization, and elevated healthcare costs, underscoring the crucial need for prevention to ensure patient safety. Despite ongoing mitigation efforts, CAUTI prevalence remained a concern in our facility at the time of this study. Catheter insertion and maintenance bundles, a recognized framework utilizing teamwork, collaboration, and focused interventions, were implemented to reduce CAUTIs and improve patient safety. This study evaluated the effectiveness of these bundles in reducing CAUTIs and catheter utilization to identify best practices for enhanced catheter management and care quality.

Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl

Doctor of Nursing Practice Scholarly Projects

Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …

Dexmedetomidine As An Adjunct To Local Anesthetics In Neuraxial Anesthesia: A Scoping Review, Meaghan Elrod, Jacob Flake, Sarah Eggers, Kieraney Coston, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Neuraxial anesthesia is key for pain management and comfort during surgery. While local anesthetics and opioids have notable side effects, Dexmedetomidine (DEX) offers a promising alternative. Early studies suggest DEX improves pain control, prolongs anesthesia duration, and reduces opioid-related side effects. This review explores the benefits of incorporating DEX into neuraxial anesthesia for better patient safety and comfort

Methods

This scoping literature review took place from August 2023 to April 2024, utilizing PubMed, CINAHL, Cochrane Library, and Google Scholar for sources. After reviewing over 2,000 abstracts, 25 articles met the inclusion criteria, with nine selected as most relevant. Four …

Cardiac-Surgical Advanced Life Support (Cals-S), Rachel Hewett, Lois Lenzmeier, Amber Martin

Nursing Posters

Improve resuscitation outcomes of cardiovascular surgery patients through the adoption of the Cardiac Advanced Life Support-Surgical (CALS-S) algorithm for cardiac arrest.

A Tapestry For Sustaining Perioperative Participation, Larry Asplin, Joanne Oliver-Coleman

Nursing Posters

Perioperative nursing shortages are becoming critical. Many baby boomers are retiring. As a result, this team was tasked to create some basic principles that will help sustain the value of perioperative nursing by utilizing a multigenerational approach.

Perioperative Resources Nurses are pivotal in enhancing the quality and efficiency of care within surgical settings. These nurses operationalize evidence-based standards for healthy work environments and promote creativity in implementing these standards. They can be full-time, part-time, virtual, or volunteer.

Consistent Inventory Of Sterilized Instruments Ensures A Safe And Uncompromised Supply Of Instruments For Procedural Use, Tiffany Tammen, Amber Eckstein, Ellen Simonson

Nursing Posters

CentraCare Rice Memorial Hospital received a regulatory citation related to sterile instrument integrity and storage. Infection Prevention and Control (IPC) created a systematic approach to assess instrument inventory and integrity to ensure an uncompromised supply of instruments for procedural use.

Ultrasound-Guided Epidural Placement Vs. Conventional Technique - Evaluating Effectiveness: A Scoping Review, Skylar R. Kuehn, Bsn, Rn, Ccrn-Cmc, Jacob B. Morphis, Bsn, Rn, Sarah D. Price, Bsn, Rn, Katherine E. Pritchard, Msn, Rn, Jordan Isaac Dnp, Crna, Sharon Little Dnp, Aprn, Fnp-Bc, Tracy Mcclinton

Doctor of Nursing Practice Projects

Purpose/Background

Epidural anesthesia is a cornerstone of perioperative pain management, offering effective analgesia and reduced opioid dependency. However, traditional landmark-based epidural placement (EP) techniques often result in variable first-pass success rates (FPSR) and increased risks of complications. Ultrasound-guided (USG) EP has emerged as an alternative, providing real-time anatomical visualization to improve accuracy and safety. This scoping review synthesizes evidence on the comparative efficacy of USG EP and conventional techniques in adult patients undergoing perioperative epidural anesthesia.

Methods

This review commenced September 2023 and included full-access, peer-reviewed journal articles published in English between 2014-2023. Databases searched included PubMed, CINAHL, Cochrane Library, …

Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle

Doctor of Nursing Practice Scholarly Projects

With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) …

Efficacy Of Aprepitant And Ondansetron In Managing Postoperative Nausea And Vomiting In Perioperative Obese Patients, Jada Stewart, Reagan Revon, Samantha Castellaw, Ashlee Roberts, Dwayne Accardo Dnp, Crna, Faana, Bobby Belflower Dnsc, Nnp-Bc, Faanp, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Postoperative nausea and vomiting (PONV) is a common adverse event that occurs during the recovery period following anesthesia. PONV has been reported to affect nearly 80% of patients, leading to prolonged hospitalization, increases in cost of care, patient dissatisfaction, dehydration, electrolyte imbalances, acute kidney injury, and pulmonary aspiration. Certain risk factors, including obese patients, female gender, and nonsmoker status, increase the risk of PONV. Traditionally, for all patients going under anesthesia, a prophylactic antiemetic regimen is administered; however, since obese and other high-risk patients are at increased risk of experiencing PONV despite traditional regimens, anesthesia providers should administer multiple …

Assessing The Efficacy Of Tranexamic Acid In Adjunct To Oxytocin In Reducing Blood Loss During Cesarean Deliveries: A Scoping Review, Hilary Clair Ray Bsn, Rn, Shelbie Freeman Hendrix Bsn, Rn, Lauren Elizabeth Hubbard Bsn, Rn, Helen Maisen Conley Bsn, Rn, Dwayne Accardo Dnp, Ccrn, Faana

Doctor of Nursing Practice Projects

Purpose/Background

Globally, postpartum hemorrhage (PPH) is the leading cause of morbidity and mortality during the peripartum and postpartum period in delivering people. Emerging evidence suggests that combining second-line uterotonics with tranexamic acid (TXA) improves maternal outcomes, reduces blood loss, and lowers morbidity and mortality related to PPH (Jones et al., 2023; Al-dardery et al., 2023). TXA, an antifibrinolytic, enhances clotting, reduces blood loss, transfusion needs, hemoglobin drop, and the use of additional uterotonics (Bellos & Pergialiotis, 2021). This review highlights the benefits of TXA.

Methods

A scoping review required a literature search conducted from August 2023 to February 2024 using …

Capturing Women's Birth Experiences Through Photos, Kristen Montgomery, Betsy Crabtree, Samantha Grayson, Alyssa Harmon, Rachael Robbins, Sarah Shelton, Hannah Sobas, Alexis Taliaferro, Nolan Willard

Epsilon Sigma at-Large Research Conference

Purpose: Each year 3.5 to 4 million women give birth in the United States. Childbirth is a life-changing event that induces various emotions in women. Many women report having a negative experience due to short staffing, inadequate care, and a loss of autonomy. Aims: The aim of the study was to understand what factors contribute to a positive or negative birth experience.

Methods: A descriptive qualitative study was conducted using photo elicitation. Photos were collected from participants and included a description of how the photo represented the participant’s experience. Demographic data were collected through a survey. Participants …

Clinical Education Program For Hair Removal To Reduce Surgical Site Infections, Madison Smith, Dana Todd

Student Scholarship & Creative Works

Abstract

Surgical site infections (SSIs) significantly impact surgical patients and with one contributory to their development is hair removal method, education about surgical hair removal methods is minimal in continued educational programs. The purpose of this project was to provide an educational program that discussed hair removal methods to reduce surgical site infections. The staff was educated on methods for hair removal in surgical patients, recommendations from manufacturers of the product, hospital policies regarding hair removal and governing organizational guidelines. Over two days for a 10-hour shift each day, a poster board and a 15-30-minute presentation then a pre/post-test was …

Improving Nursing Processes To Reduce Hospital-Acquired Venous Thromboembolism In Adult Surgical Patients, Stephanie Masson

Doctor of Nursing Practice Final Project Abstract

INTRODUCTION Hospital-acquired venous thromboembolism (VTE) is a preventable outcome that can increase morbidity and mortality. This quality improvement (QI) project aimed to evaluate and improve the nursing prophylaxis processes to reduce the VTE outcome. The project was implemented in a Level I Trauma Center in the Texas Medical Center, Houston, Texas.

METHODOLOGY The QI project was structured using the Lean Six Sigma methodology. Data was collected and analyzed from reports built within the electronic medical record (EMR). A multidisciplinary team evaluated the current state of clinical practice and the electronic workflow for mechanical VTE prophylaxis. The team worked to redesign …

Surgical Smoke Evacuation Quality Improvement Project, Angela Howell

Graduate Theses, Dissertations, and Capstones

Abstract

Background: Surgical smoke is a byproduct produced during surgical procedures when high-energy producing devices are used to vaporize tissue. This smoke poses health risk to anyone present in the operating room.

Purpose: The purpose of this quality improvement (QI) project was to educate and minimize the exposure of both staff and patients to the hazardous toxic fumes and vapors produced by energy-generating electrocautery devices.

Methods: The intervention based on the Kim Ball Smoke Evacuation Compliance Model was implemented in a large military hospital with 20 operating rooms and three labor and delivery suites. Implementation included formal education strategies, equipment …

Evidence-Based Practice Guidelines For Perioperative Insulin Pump Usage And Glycemic Control During The Perioperative Period, Duane Robinson

Doctor of Nursing Practice Scholarly Projects

According to the International Diabetes Federation, Diabetes Mellitus (DM) affects approximately 537 million people, representing approximately 10% of the worldwide population aged 20 to 79. Approximately 400,000 people with DM use continuous subcutaneous insulin infusion (CSII) pumps. CSII pump therapy mimics pancreatic insulin release, aiding in maintaining adequate insulin levels. Individuals with DM are more likely to require surgery than individuals without the disease. Among diabetics, people with Type 1 DM (T1D) are more likely to need medical interventions than individuals with Type 2 DM (T2DM). CSII therapy maintains blood glucose levels within a programmed range and decreases blood glucose …

Dnp Final Report: An Evidence-Based Initiative To Improve Bowel Preparation Quality For Colonoscopy, Jennifer L. Gassett

DNP Final Reports

Good colonic bowel preparation (CBP) is an important component of colonoscopy but is often inadequate. Improving CBP can help increase detection of precancerous polyps, prevent procedures from being canceled or repeated, and decrease medical expenses. A quality improvement project was implemented to increase adequate CBP rates at an ambulatory surgery center specializing in endoscopy. Several factors correlate with suboptimal CBP, but the practice question focused on patient education. The PICOT question guiding evidence synthesis was posed: In adult patients preparing for outpatient colonoscopy, how do revised instructions with visual aids compared to written instructions affect CBP adequacy and patient satisfaction? …

Improving Medication Adherence For Post-Operative Pediatric Patients With Spanish-Speaking Caregivers Using A Written Medication Action Plan, Carissa Vicente

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This project aims to improve written discharge education, medication adherence for pediatric patients, and medication education retention for Spanish-speaking caregivers.

BACKGROUND

The project was implemented in a children’s hospital in the Pediatric Post-Anesthesia Care Unit. The discharge process for post-operative pediatric patients lacked appropriate written medication education for Spanish-speaking families, placing patients at an increased risk for improper medication use.

METHODOLOGY

A quality improvement method utilizing Plan-Do-Study-Act (PDSA) cycles was used for implementation, with three cycles completed. A written Spanish-translation medication action plan (MAP) was implemented during discharge for Spanish-speaking caregivers, including adaptions to an electronic health record version …

Improving Recovery Nurses’ Satisfaction With Postoperative Transfer Of The Anesthetized Patient With The Utilization Of A Standardized Handoff Checklist, Gemma Nilsson

Scholars Week

Aim: To evaluate the effectiveness of using a standardized tool during patient handoff, addressing the lack of an organized structure for patient transfers and the risk of miscommunication. Poor communication is a leading cause of medical errors in the hospital and the transfer reports of postoperative patients in the post-anesthesia care unit are often inaccurate or incomplete (Milby, 2014; Salzwedel, 2012).

Design: A handoff tool was developed for anesthesia providers to use during postoperative patient transfers. Using descriptive statistics, the project evaluated subjective survey responses from registered nurses before and after the implementation of the tool. Perception of the tool’s …