Perioperative, Operating Room and Surgical Nursing Commons^™

An Evidence-Based Practice Handbook For The Reduction Of Perioperative Pressure Injuries: An Implementation Guide, Krystal Dopson

Student Scholarly Projects

The Association of Perioperative Nurses (AORN) Prevention of Perioperative Pressure Injury Tool Kit is a comprehensive set of evidence-based practices that can reduce the development of pressure injuries (PI) (AORN, 2022). A bundled set of prevention strategies is positively associated with reducing the development of injury or ulceration and improved patient outcomes. To effectively implement this Prevention of Perioperative Pressure Injury Tool Kit, there are evidenced strategic practices to support change readiness, including engaging stakeholders around the reasons for the change, gaining leadership support, assembling an interprofessional implementation team, providing compelling information that highlights the need for the change, and …

Prophylactic Administration Of Steroids And The Effect On Post-Extubation Stridor: A Scoping Review, Chelsey Benson Bsn, Rn, Karlene Ferraro Bsn, Rn, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl

Doctor of Nursing Practice Projects

Purpose/Background Stridor occurs due to laryngeal edema which arises when a patient has been intubated for an extended period of time. There are several factors that affect the degree of swelling. Post-extubation stridor signals that a patient requires reintubation because the airway is no longer patent. Corticosteroids, such as dexamethasone, can be used prior to extubation to minimize complications and overall length of stay if a patient is at high risk for stridor. This scoping review will evaluate the literature and the association between the use of prophylactic steroids on mechanically ventilated adult patients and the occurrence of post-extubation stridor. …

The Anxiolytic Effects Of Aromatherapy On Preprocedural Anxiety: An Integrated Review, Rebekah Smith

Senior Honors Theses

Anxiety before procedures can negatively impact patients by increasing cortisol levels which delays wound healing and increases infection risk, increasing pain and sedation medication needs, and increasing hospitalization time. This review was conducted to find how inhaled essential oils affect pre-procedural anxiety of adults in acute care settings. Nine databases and some gray literature were searched within the past ten years, and documented using the PRISMA flow chart. Ten articles fitting the inclusion criteria were retrieved. Nine of the articles found a significant difference between the aromatherapy group and control group and pre- and post- intervention anxiety scores, and none …

Open All Hours!: Bariatric Surgery Patients Love Csc, Naomi Schneider, Mallory Mondloch

Nursing Posters

During the fall and winter of 2020, St. Cloud Hospital saw a dramatic increase in the number of COVID-19 patients. Additionally, elective surgeries in Minnesota were on hold during the early months of the pandemic, and later in 2020 there was a significant backlog of these patients, waiting for their procedure. To serve patients and their families, St. Cloud Hospital teams planned for a way to safely and professionally offer surgical care needs to Central Minnesota.

Perioperative Glucose Monitoring Protocol, Nicole Helgeson

Nursing Posters

Currently, there is no established glucose management protocol for our surgical patients. Poor outcomes related to hyperglycemia may include increased morbidity/mortality, surgical site infection (SSI), sepsis, renal, and cardiac concerns. The purpose of this protocol is to improve the care and outcomes for surgical patients through a consistent standardization of glucose management.

Preoperative Weight Loss For Patients Undergoing Lumbar Spine Surgery Utilizing Motivational Interviewing To Decrease Postoperative Complications: A Quality Improvement Project, Amanda Welle

Nursing Posters

Do patients who are obese, based on BMI>30 and are offered lumbar spine surgery, who undergo preoperative MI via telehealth to lose weight, compared to those who don’t undergo MI have decreased postoperative complications at 30 days postoperatively?

Conclusions/Implications:

• Results from this QI project suggest a higher BMI class is associated with postoperative complications-wound infection.
• However, given the small sample size no conclusions could be drawn
• This QI project should be replicated on a larger scale
• The process for recruitment and intervention is established. The Neurosurgical providers are supportive of the continued study.

Use Of Academic Detailing To Improve Reporting Of Peri-Operative Events, Allyn Sara Miller-James

Doctor of Nursing Practice Projects

Problem: Four million people worldwide die within thirty days of surgery. The EPIC Corporation has created the opportunity to collect and analyze data on the peri-operative care of patients. Initially, implementation of the program has identified barriers to event reporting by anesthesia providers. Barriers identified in the literature and in semi-structured interviews are fear of liability and retribution by patients, employers, and governing bodies. Significance: Despite national efforts to increase the reporting of medical errors, they remain grossly under- reported. The integration of the National Anesthesia Clinical Outcomes Registry (NACOR) events data collection tool into the EHR for anesthesia providers …

Perioperative Malignant Hyperthermia, Mitchell Mccorkle

Nursing Student Class Projects (Formerly MSN)

Abstract

Malignant Hyperthermia (MH) is a rare inherited disorder in which exposure to triggering agents such as volatile anesthetics or depolarizing neuromuscular blockers causes a hypermetabolic reaction leading to patient fatality. MH susceptible patients have a genetic mutation on the ryanodine one receptor (RYR1) in skeletal muscle, allowing uninhibited calcium release (Smith, Tranovich, & Ebraheim, 2018). Increases in free calcium result in an uncontrollable sustained muscle contraction through the excitation-contraction coupling of myosin and actin. Sustained muscle contraction rapidly consumes adenosine triphosphate stores and stimulates conversion to lactate producing anaerobic metabolism (Smith et al., 2018). Immediate recognition and treatment of …

Implementation Of Standardized Handoff Reporting To Improve Communication Among Certified Registered Nurse Anesthetists And Postanesthesia Care Unit Nurses In The Postanesthesia Care Unit, Lauryn G. Macfawn

Graduate Theses, Dissertations, and Problem Reports (ETD)

Standardization of handoff reporting has been proven to increase the quality of information being transferred and improve patient safety. Poor quality handoff between providers increases morbidity and mortality, hospital length of stay, healthcare costs, as well as decreases patient satisfaction The aim of this Doctor of Nursing Practice quality improvement (QI) project was to implement the situation, background, assessment, recommendation (SBAR) handoff reporting tool in the postanesthesia care unit (PACU) at a hospital in Western Maryland. There was no standardized handoff process in place between certified registered nurse anesthetists (CRNAs) and PACU registered nurses (RNs) at the facility. The participants …

Huddle Implementation In The Perioperative Setting, Tina Thomas

DNP Projects

Background: Communication is essential for safe and effective patient care. In the perioperative setting, information sharing is critical to care coordination. Lack of communication between caregivers can lead to medical errors. Evidence shows that huddles lead to increased communication, satisfaction, and engagement between team members resulting in better patient outcomes. Huddles are short, less than 10-minute gatherings that focus on the daily schedule, identify potential obstacles, explain unique needs, and discuss preceding day issues.

Objectives: This project aimed to evaluate the effectiveness of huddles on employee satisfaction, engagement, and communication of healthcare workers while also determining if huddles were …

Examining The Impact Of A Protein Intervention To Improve Outcomes In Frail Perioperative Candidates: A Feasibility Study, Anna M. Rose

DNP Projects

Background: Frailty is a syndrome or grouping of clinical characteristics that collectively increases one’s vulnerability to acute and external health stressors. Higher rates of frailty are present in oncology surgical patients and is a predictor of postoperative complications, as well as increased morbidity and mortality. Long- and short-term survival of surgical oncology patients is worse in frail patients than robust patients. Prehabilitation interventions during the planning phase of surgical intervention may serve to mitigate already known health concerns prior to inflicting the stressor that is surgical intervention.

Purpose: To measure the feasibility of an educational prehabilitative nutritional intervention aimed at …

Describing And Predicting Preprocedural Anxiety In Patients Scheduled For Advanced Gastrointestinal Endoscopy During The Covid-19 Pandemic, Dawn Profit

Theses and Dissertations--Nursing

Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently with little attention given to a patient’s preprocedural anxiety issues. Preprocedural anxiety is an anticipated problem with any surgery or invasive procedure and if sustained or experienced excessively, is associated with negative clinical factors and complications.

In the beginning of 2020, the United States was met with a global pandemic caused by the coronavirus SARS-CoV-2, termed COVID-19. There were recommendations to decrease medical procedural case volume in order to slow the spread of the virus, protect staff and patients from getting the virus, …

Educational Intervention With Visual Cues To Increase Compliance With Postoperative Warming, Michael J. Domingo

Doctoral Projects

Millions of operations are performed annually in the United States. However, postoperative hypothermia still affects surgical patients who are not thermoregulated and can occur among them during the postoperative period. Postoperative warming compliance rates across countries and institutions are generally poor (Koh et. al, 2021). Therefore, the focus of the DNP project was to assess how providing education on postoperative warming and providing visual cues to the PACU RNs would increase postoperative warming compliance. The PACU RN participants were provided postoperative warming education with visual cues. Specifically reviewed with the PACU RNs was taking the patient’s temperature, connecting the patient …

A Quality Improvement Initiative For Intraoperative Low Dose Ketamine Utilization In Thoracotomy, Jason Wampler

Graduate Theses, Dissertations, and Problem Reports (ETD)

The challenge of postoperative pain control following a thoracotomy is well noted among anesthesia providers. The intraoperative utilization of low-dose ketamine in several patient populations, including those undergoing a thoracotomy, has been deemed a viable intervention in the multi-modal analgesia plan at not only reducing postoperative pain scores for patients, but also reducing opioid consumption. This quality improvement project sought to increase provider awareness of this intervention among anesthesia providers in a community hospital with a goal to influence a practice change. This was completed using a pre-post design centered around an educational in-service, with an additional 60-day follow-up survey …

A Preoperative Intervention To Improve Glycemic Control In Surgical Patients With Diabetes, Kelsey L. Boyd

Graduate Theses, Dissertations, and Problem Reports (ETD)

Perioperative hyperglycemia is reported in 20-40% of patients undergoing general surgery and is an independent risk factor for negative surgical outcomes. Patients with diabetes presenting to a local community hospital are at risk for negative surgical outcomes due to the lack of strategies to prevent perioperative hyperglycemia. This project aimed to implement and evaluate the usefulness of succinct diabetes education for preoperative total joint surgical patients with diabetes. The intervention was a nurse-led, face-to-face diabetes education session provided to total joint surgical patients with diabetes during a preoperative evaluation appointment, compared to usual care (no preoperative diabetes education). This project …

Implementation Of Lean Principles During Operating Room Turnovers, Makenzie Marshall

Doctor of Nursing Practice Projects

Background

Many operating rooms across the country face the daunting task of making their turnovers between surgical patients quicker and more efficient. Turnover time is defined as the time it takes to clean an operating room and set up the next sterile field between surgical patients. The time begins when the patient leaves the operating room suite and stops when the next patient enters the same suite. Running an operating room is a complex and costly endeavor, and even small shortfalls can have a snowball effect, leading to delays, wasteful spending, and substandard patient outcomes; therefore, it is imperative to …

Massive Blood Transfusion Practises: A Survey Of Level 1 Trauma Centers, Rebecca C. Parker

DNP Research Projects

Abstract

Background: Traumatic injury is the leading cause of death for individuals under the age of 45 years old, regardless of race, origin, or sex (CDC, 2019). Among patients who sustain traumatic injury, hemorrhage remains the leading cause of death (American College of Surgeons [ACS], 2014). Hemodynamic stability may be achieved through administration of blood products such as packed red blood cells (PRBC), plasma, and platelets (PTL). Patients with severe exsanguination may require administration of blood products in large quantities, also known as a massive blood transfusion (MBT).

Local Problem: Nationally, traumatic injury accounts for over 150,000 deaths annually (American …

Improving Patient Safety In The Post-Anesthesia Care Unit By Identifying Nurses’ Perceived Barriers To The Implementation Of Barcode Medication Administration, Colleen Gauvin

Master's Theses and Capstones

Background: In the landmark report To Err is Human: Building a Safer Health System published by the Institute of Medicine in 1999, it was estimated that 98,000 Americans die annually due to medical mistakes (Institute of Medicine et al., 2000). Since then, major advancements have been made to improve patient safety in the United States relating to safe medication administration. Barcode medication administration (BCMA) is a technology that was designed to help decrease medication errors by automating the five rights of medication administration (Thompson et al., 2018). BCMA was first utilized at a Veteran Affairs (VA) Medical Center in …

Increasing Perioperative Nurse Knowledge Of Preoperative Urine Pregnancy Testing: A Quality Improvement Project, Brooke K. Hall

Master's Theses and Capstones

Background: Nurses in the perioperative environment are responsible for assessing patients prior to undergoing surgery. Preoperative urine pregnancy testing is utilized to determine the pregnancy status of patients. Various risks of anesthesia and surgery exist for pregnant patients and the fetus. The perioperative nurse must be knowledgeable about these risks and ensure preoperative urine pregnancy tests are obtained when appropriate.

Local Problem: Within this microsystem, a gap in knowledge of perioperative nurses related to the nature and significance and institutional policy for preoperative urine pregnancy testing was identified.

Aim: The aim of this project was to increase knowledge of preoperative …

Improving The Patient Repositioning Process: A Quality Improvement Project, Sydney Elizabeth Mcgough

Master's Theses and Capstones

Background: Research has shown that visual turn reminders can improve patient repositioning to prevent pressure injuries. The aim of this quality improvement project was to improve adherence to repositioning by increasing the perceived usefulness of the visual turn reminder.

Methods: A pre-intervention survey was distributed to 70 staff members with 22 responses. Staff were given the opportunity to recommend changes to the visual reminders and were informed that feedback would lead to the identification of common themes. Based on feedback, high visibility turn reminders were developed and implemented on the unit. A post-intervention survey was distributed to the same 70 …