Perioperative, Operating Room and Surgical Nursing Commons^™

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Drug Diversion Education For The Anesthesia Provider Plus One, Denise M. Christie

DNP Projects

The purpose of this quality improvement project was to determine awareness, knowledge, and the value of educating both the anesthesia provider and their spouse/significant other/family member/close friend (plus one) on the risks of drug diversion. Surveys revealed only 20% of plus ones had received previous education on drug diversion. After the educational session, anesthesia providers and plus ones showed increased awareness of the risks of drug diversion (p 0.08), increased knowledge of signs and symptoms, and perceived protection from diversion through education of the plus ones (p 0.08). Further investigation of the persistence of these effects is warranted.

Improving Postoperative Breast Augmentation Patient Education Delivery., Madison Callery

Doctor of Nursing Practice Papers

Background: Effective patient education promotes successful postoperative outcomes. Nurses in an outpatient surgery center lacked consistent patient education practices and materials.

Purpose: The purpose of the project was to implement an evidence-based multimodal educational strategy for patients who undergo breast implant surgeries.

Methods: At an outpatient plastic surgery center, pre- and post-intervention phone calls were tracked; post-intervention education, documentation, and patient satisfaction data were recorded. Nurses were educated on the new materials, delivery procedures, and electronic health record (EHR) documentation. All patients undergoing breast implant surgery received multimodal education at each postoperative appointment. Outcomes included (1) the number of patient …

Establishment Of Unit-Based Council Using A Shared Governance Toolkit For Surgical Clinics, Fica Etienne

Student Scholarly Projects

Practice Problem: Shared governance (SG) is an organizational framework that empowers healthcare professionals by granting them authority over their own professional practice. The absence of a unit-based council (UBC) has been identified as hindering collaborative decision-making and problem-solving approaches.

PICOT: In four surgical clinics requiring a Unit Based Counsel (UBC) structure (P), what is the impact of implementing a Shared Governance (SG) toolkit (I) compared to not implementing an SG toolkit (C) over eight weeks? (T)

Evidence: The existing literature strongly indicates that shared governance (SG) empowers nurses to collaborate as equal partners with nursing leaders within …

Amniotic Fluid Embolism Diagnosis & Treatment Pathway, Jeremy May

Doctor of Nursing Practice Projects

Access to care in rural areas can prove difficult for any patient, but especially for the expecting mother. Healthcare providers in these rural settings often lack the staffing and experience to effectively recognize and treat rare obstetric emergencies. Amniotic fluid embolism (AFE) is a rare medical emergency that requires healthcare providers to rapidly diagnose, monitor, and treat the sequela of resulting symptoms in the obstetric patient. After a literature review, a teaching session was developed and implemented as part of the annual training for 20 nursing staff at a small 50-bed rural hospital in central California. An 8-question pre-test was …

The Future Of Cognitive Dysfunction In Elderly Patients: A Clinical Perspective With Recommendations, Laura Taylor

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

Standardization Of Perioperative Management Of The Breastfeeding Women, Amrutha Panakkal

Doctor of Nursing Practice Projects

Mother's milk is the optimal nutrition for the term and preterm neonates. The psychological and physiological stressors in the perioperative setting can impede a lactating mother's ability to breastfeed in the postoperative setting successfully. A best-practice guideline incorporating a stoplight color-coding chart and categories such as "safe," "caution," and "consider avoidance" was used to group medications according to their safety for anesthesia providers in a large urban academic medical center in Pennsylvania. The evidence-based guideline also provided links to the hospital policy, LactMed, and Hale database to streamline resources and aid in the rapid decision-making of anesthesia providers in identifying …

Utilizing Gastric Point-Of-Care Ultrasound Assessment For Patients With Questionable Npo Status, Carolina Botero

Doctor of Nursing Practice Projects

Perioperative aspiration is a rare but serious complication with high morbidity and mortality for patients. This event often occurs from anesthetic depression of protective airway reflexes. NPO guidelines are implemented before anesthesia to eliminate the presence of any gastric contents. However, patients with certain comorbidities may still persist with a full stomach before an anesthetic. Patients may complicate matters further by not following NPO instructions, the patient’s NPO status may be unknown, or the timing of surgery may prevent adequate NPO times. In these situations, the anesthesia provider is faced with the difficult decision to alter, delay or potentially cancel …

Foley Catheter Algorithm, Chary Mathew

Doctor of Nursing Practice Projects

Urinary catheterization, indwelling and intermittent are simple and common procedures performed in hospitals, emergency rooms, nursing homes, and clinics to ensure adequate urinary output in patients who cannot void efficiently or closely monitor fluid intake and output. Though simple and straightforward in most cases, catheterization can become a challenging procedure with complications in the absence of a standardized protocol for difficult catheterization (Ghaffary et al., 2013). This Quality Improvement Project aimed to develop a standardized Foley catheter algorithm/ flow chart available in our institution's intranet and laminated charts in nursing stations and procedure rooms with Foley catheter insertion indications, types, …

A Comparison Of Erector Spinae Plane Block And Epidural Analgesia For Major Abdominal Surgery, Charles Serrano

Doctor of Nursing Practice Projects

A large tertiary care center in central Illinois saw an increase in erector spinae plane (ESP) block administration for abdominal surgery patients, but many anesthesia providers at the facility were not acquainted with the ESP block. This project aimed to develop a comprehensive educational program concerning the ESP block compared to thoracic epidural analgesia for major abdominal surgery patients and ultimately improve patient care. The program introduced the relevant anatomy, indications, technique, advantages, and disadvantages of ESP block and epidural analgesia. Additionally, the risks, benefits, and costs of both adjunctive therapies were compared. The current literature shows that the thoracic …

Tranexamic Acid Protocol For Lower Extremity Total Joint Arthroplasties, Autumn Cullison

Doctor of Nursing Practice Projects

Abstract

Bleeding is a risk associated with surgery, and complications, such as hypotension, anemia, and decreased oxygen-carrying capacity, can occur. Blood transfusions have been the mainstay treatment for excessive surgical blood loss; however, transfusion has associated risks including infection, volume overload, immunological reactions, and increased morbidity and mortality (Sahu et al., 2014). Interventions to decrease surgical blood loss are essential components to improving surgical outcomes. The antithrombolytic, tranexamic acid (TXA), decreases surgical blood loss and blood transfusion requirements, thereby decreasing transfusion-related complications (Gausden et al., 2017). Despite frequent use, variance exists surrounding the administration of TXA. Current evidence and guidelines …

Best Practice For Post-Operative Surgical Site Infection Prevention, Scott Cavinder

Evidence-Based Practice Project Reports

It is estimated that 300 million surgical procedures take place annually throughout the globe (Gillespie et al., 2021). However, the incidence of surgical site infections (SSI) developing in surgical patients within 30 days of surgery have been estimated to be upwards of 11% (Gillespie et al., 2021). The purpose of this evidence-based practice project was to address the PICOT question: In patients who have undergone cardiothoracic or vascular surgery (P) does implementation of an evidence based post-operative care bundle (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period …

Implementation Of A Standardized Universal Protocol Process At A Large Academic Medical Center, Lisa Ann Heard

Doctor of Nursing Practice Scholarly Projects

Background: Decreasing the risk of wrong site, wrong procedure and wrong patient surgery is an essential healthcare safety initiative. The Joint Commission’s Universal Protocol along with the World Health Organization (WHO) Safe Surgery Checklist were designed to aid in this patient safety effort and have been implemented in hospitals worldwide.

Local Problem: Perioperative and procedural areas at the project hospital areas have adopted the Universal Protocol and Safe Surgery Checklist. Despite agreement in their importance, there is a lack of uniform application of all components. This leads to variation in practice which may impact team compliance with the protocol and …

Implementing An Augmented Perioperative Obstructive Sleep Apnea Pathway For Improvement Of Perioperative Management In Patients Undergoing Elective Orthopedic Surgery, Michelle Dwyer

Doctor of Nursing Practice Scholarly Projects

Background: Obstructive sleep apnea (OSA) in the perioperative period is a frequently encountered complex clinical challenge that increases the risk for post-operative complications. Patients undergoing elective orthopedic surgery may be untreated for OSA or unaware of an increased risk for OSA at the time of scheduling an elective surgical procedure. Appropriate intervention for these patients is needed to decrease the risk of postoperative complications and increased morbidity and mortality.

Methods: The objective of this improvement project was to improve the care across the perioperative experience for patients with obstructive sleep apnea or at a high risk for obstructive sleep apnea …

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 …

Does The Enhanced Recovery Pathway Decrease Length Of Stay And Readmission Rates In Patients Undergoing Gynecologic Surgery?, Trinh T. Nguyen

Doctoral Projects

The Enhanced Recovery After Surgery (ERAS) pathway promotes an early recovery after surgery using an evidence-based multidisciplinary approach. The ERAS protocol is aimed at standardizing care to improve patient outcomes. There is consistent evidence that ERAS pathways reduce hospital length of stay (LOS) and readmission rates, decrease healthcare costs, and improve patient satisfaction and outcomes. By attenuating the surgical stress response and supporting the return of physiological function, the ERAS pathway achieves its effectiveness. This scholarly project aimed to evaluate how ERAS improves patient outcomes in gynecology patients at a county hospital. A standardized method for improving patient recovery was …

Breastfeeding After Maternal Anesthesia: A Guideline Development, Megan Berens

Doctor of Nursing Practice Scholarly Projects

Postoperative breastfeeding recommendations for lactating mothers by anesthesia providers are inconsistent and often inaccurate. Inappropriate recommendations have led to withholding of breastmilk to the infant, unnecessary disposal of breastmilk, surgical delay, exposure of an infant to high levels of drugs in breastmilk, and early cessation of breastfeeding. The purpose of the scholarly project was to develop a set of evidenced-based practice guideline recommendations and a proposed implementation plan for anesthesia providers to use in support of breastfeeding mothers who recover from surgery. Many studies in the literature indicate that there are inconsistencies in postoperative breastfeeding recommendations by anesthesia providers. When …

Development And Implementation Of An Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Program For Student Registered Nurse Anesthetists, Nicholas Colangelo, Zachary Wise

Doctor of Nursing Practice Scholarly Projects

The American Association of Nurse Anesthetists (AANA) has defined the scope of nurse anesthesia practice to include services in acute, chronic, and interventional pain management, as well as the use of ultrasound (U/S) and other diagnostic technologies. However, there are no standard curriculum requirements in place that mandate graduate programs to educate student nurse anesthetists in U/S-related modalities. In addition to the AANA, the use of U/S in nurse anesthesia practice has recently been adopted by The Council on Accreditation of Nurse Anesthesia Educational Programs (COA), which characterizes U/S use by its clinical impact on the reduction in complications, increased …

An Integrative Review: Best Practices For Educating And Engaging Care Partners Of Patients With New Ostomies, Lauren Flook Brown

Master of Science in Nursing Final Projects

PURPOSE: The purpose of this integrative review was to identify and synthesize the best practices of engagement and education for care partners of patients with new ostomies to support adaptation.

METHODS: Five-stage integrative review process: (1) problem identification, (2) systematic literature search, (3) data evaluation, (4) data analysis, and (5) presentation.

RESULTS: Four themes with sub-themes emerged to understand effective engagement and education of care partners: (1) care partner influences on patient outcomes; (2) care partner needs; (3) barriers to care partner adaptation; and (4) diverse engagement strategies. Each theme and sub-themes related to care partners could not be separated …

Digital Patient Engagement At A Perioperative Surgical Home Implemented Community Hospital, Srinivasan Sridhar, Amy Mount Hunter, Bernadette Mccrory

Patient Experience Journal

Patients in rural areas typically require more perioperative ‘optimization’ for surgery. The rural healthcare systems often overwhelmed with coordinating perioperative services and deliver less than optimal surgical outcomes. This is due to limited supporting microsystems and ability to effectively engage and track patients over the 120-day perioperative period to limit post-surgical complications. The study assessed longitudinal patient engagement within a newly established Perioperative Surgical Home (PSH) at a rural community hospital serving 10+ surrounding counties to identify barriers and best practices for engagement. A digital patient engagement platform was implemented and used to assess longitudinal patient outcomes and engagement from …