Perioperative, Operating Room and Surgical Nursing Commons^™

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 …

Enhanced Recovery After Surgery (Eras) For Cardiothoracic Surgery, Emile Shaw, Samantha Schultz, Taylor Woods, Emma Zollmann, Dwayne Accardo Dnp, Crna, Faana

Doctor of Nursing Practice Projects

Background/Purpose

Enhanced Recovery After Surgery (ERAS) protocols are multi-disciplinary approaches that optimize recovery and reduce surgical outcome variability. This scoping review compares surgical outcomes associated with traditional perioperative care to outcomes associated with an ERAS protocol for patients undergoing cardiothoracic surgery.

Methods

A literature review evaluating traditional perioperative care versus ERAS protocols in cardiothoracic surgical patients was performed to set inclusion and exclusion criteria based on current peer-reviewed journal articles for qualitative data. Group members selected 14 articles based on inclusion criteria and relevance to the PICOT question for review and placed findings in a synthesis table. Findings included compliance …

Implementation Of Purposeful Hourly Rounding To Decrease Fall Rates, Dannette Kizy

Student Scholarly Projects

Practice Problem: Patient falls can lead to an increased length of stay and potentially reduce the quality of life. In addition to serious injury, the patient and the hospital have a significant financial burden. PICOT: On a medical-surgical unit, does incorporating purposeful hourly rounding in the patient care routine compared to no purposeful rounding decrease patient fall rates over eight weeks?

Evidence: Of the 35 articles related to fall prevention and PHR, a final selection of eight articles met the criteria and were of high quality and evidence levels.

Intervention: PHR was implemented to decrease falls over …

Preoperative Skin Preparation Protocol For Patients Undergoing Abdominal And Spinal Surgery, Lia Moyer

The Eleanor Mann School of Nursing DNP Capstone Projects

Surgical site infections are an avoidable complication in surgical patients and one of the most common hospital-acquired infections. Adverse effects of surgical site infections include increased hospital length of stay, increased costs to patient and healthcare system, disability, morbidity, and mortality. The purpose of this quality improvement project was to design a protocol with the objective of decreasing surgical site infections in abdominal and spinal surgery patients. The protocol developed used targeted depilation and antisepsis with a chlorhexidine wipe to mitigate infection risk. Results of the project showed a static hospital length of stay, no increase in preoperative time, and …

Onboarding Advanced Practice Nurses To Pre-Anesthesia Care, Megan P. Abate

Seton Hall University Dissertations and Theses (ETDs)

Onboarding advanced practice nurses to the pre-anesthesia clinic (OBPAC) is a complex process that involves the integration and familiarization of new employees with the workplace. It is considered essential for safe and efficient clinical practice and the achievement of organizational goals. Fostering independence and competency are the overall aims of the onboarding process. The preceptor ensures that new advanced practice nurses (APNs) receive the support and guidance needed when learning new skills (Simone et al., 2016). There is evidence to show that dedicating time to a well-organized onboarding plan, laying clear job expectations with precepting, and continuous mentoring increases precepting, …

Perioperative Pain Control: Evaluating Best Practices In Perioperative Pain Measures, Lisa M. Malakowsky

Doctor of Nursing Practice Projects

Background

Postoperative pain is contributing to the nation's opioid epidemic. Pain is an unpleasant sensation felt by the patient. When it is experienced postoperatively, it is a result of the surgical process. Patients up to 80% worldwide state that their pain is not controlled to their satisfaction. When postoperative pain is not treated adequately, it can contribute to chronic pain.

Purpose

Perioperative pain assessment and treatment policy at a rural critical access hospital and compare it to evidence-based guidelines for best practice. The project assessed the patient's pain treatment effectiveness compared to the pain management policy by using the CDC …

A Quality Improvement Project To Reduce Rates Of Deep Sternal Wound Infections Among Adult Cardiovascular Surgery Patients With A Sternotomy Approach, Cole Gatzke, Samantha Porcher

Nursing DNP Projects

Background: An increase in deep sternal wound infections (DSWI) within the cardiovascular surgery (CVS) department at a large midwestern teaching hospital among adult patients with an open sternotomy approach. Objective: To reduce the DSWI rate within the hospital’s CVS department. Methods: After gathering stakeholder input and observing the perioperative process, an extensive review of current literature was conducted to address the problem. Interventions that had literature support were then reanalyzed with stakeholder input for implementation selection, along with a cost-benefit analysis. A pilot was designed applying the Posthorax™ Pro Sternal Support Vest for adult cardiac surgery patients with a sternotomy …

Development And Implementation Of An Evidence-Based Practice Guideline Regarding Cricoid Pressure, William Carson Ii

Doctor of Nursing Practice Scholarly Projects

Cricoid pressure (CP) has been a standard of practice since the 1960s. The purpose is to reduce aspiration of gastric content into the lungs in high-risk patients undergoing induction of general anesthesia. Aspiration has been identified as the most common cause of airway-related mortality for patients undergoing general anesthesia. The cause of airway-related mortality can be correlated to the application of CP. Incorrect application of CP may lead to adverse clinical events and outcomes. It has been demonstrated that when administering CP in a simulation-based environment, providers are applying pressure to the incorrect anatomical location and/or applying the incorrect amount …

Robotic Team High Reliability Organization’S Communication Evaluation Tool, Joanne F. Mercurio

Regis University Student Publications (comprehensive collection)

Multidisciplinary team communication in robotic surgery presents several safety considerations for the intraoperative surgical patient. It is an important consideration since the surgeon and the operating room team are geographically distanced with the surgeon at the console, and the other team members situated at the patient bedside. Scrubbed team members are performing such functions as positioning the robotic arms as well as exchanging instruments, while the remaining interprofessional team members are coordinating multiple patient care activities. It therefore becomes imperative that the recognition of the potential for miscommunication is of paramount importance, and strategies need to be generated that will …

Nursing Students' Competence With Anesthesia, Mallory Groover

Honors College Theses

Anesthesia management is diverse and complex. As a Registered Nurse (RN), it is imperative that the basic pathophysiology of anesthesia complications is understood in order to provide competent care. The effects of anesthesia can vary greatly depending on factors such as age, sex, health status, and lifestyle. Since there are several variables, it takes years of experience working with a diverse population to anticipate adverse effects and patient outcomes. Preparedness for anesthesia management could be improved through the use of simulations during nursing school relating to post-anesthesia care, as well as more in-depth lectures over the potential complications and pharmacodynamics …

Implementation Of A Probiotic Intervention Among Medical-Surgical Patients: An Evidence-Based Practice Quality Improvement Project, Moncia Bonvicini

DNP Projects

Introduction: Clostridium difficile infection (CDI) is the most prevalent nosocomial infection pathogen responsible for antibiotic associated diarrhea. CDI is a significant cause of morbidity and mortality rates of medical patients and has increased due to frequent broad spectrum antibiotic usage. CDI is associated with a mortality rate of 25% amongst medical patients. At this catholic hospital in the Northeast of the United States, there is currently no official intervention implemented to prescribe a probiotic when patients are started on antibiotics. Evidence supports that probiotics agents have demonstrated modest success in the risk reduction of CDI to patients receiving antibiotic therapy. …

Gender Differences In Administration Of Tpa In Treatment Of Ischemic Stroke, Christina Annerino

CURE Proceedings

As medicine and pharmacology advance through the years, new life-saving treatments are studied or discovered every day, and a medical emergency is no longer a death sentence. Even with conditions as serious as ischemic stroke, there is hope for survival and rehabilitation with the ‘clot-busting’ drug, tissue plasminogen activator, colloquially known as ‘tPA’. tPA is a thrombolytic agent, a substance that acts on fibrin in clots to dissolve them so they can no longer cause ischemia in blood vessels that results in a stroke. (Vega, 2022). tPA is an extremely effective treatment for ischemic stroke, demonstrated in 2013 by a …

Reducing Clabsi Rates Through Education On Maintaining Cvc Dressing Integrity: A Quality Improvement Initiative, Hanna I. Lentine

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units.

LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma …

Using Education To Promote Waste Segregation And Waste Reduction In The Operating Room: A Quality Improvement Initiative, Sarah E. Landgraf

Master's Theses and Capstones

Background: The operating room (OR) is known to be one of the largest producers of medical waste and of the surgical specialties, orthopedic surgery tends to the largest portion of this. Waste from the OR can be mitigated by recycling non-contaminated materials. This reduces the number of raw materials needed to create new products, decreases landfill use, and lowers hospital costs.

Local Problem: It was observed that a gap in knowledge existed related to recyclables in the OR of a large medical center in New England. Also, it was observed that there was potential for waste and recycling to be …