Perioperative, Operating Room and Surgical Nursing Commons^™

Use Of A Handoff Communication Tool Between Certified Registered Nurse Anesthetists, Anesthesiologists, And Post Anesthesia Care Unit Nurses, Rachel Louise Johnson

Doctoral Projects

Ineffective communication in the post-anesthesia care unit (PACU) is considered to have incidences of increased error, mortality, morbidity, which leads to decrease patient outcomes and quality of care. Therefore, the purpose of this study was to introduce a structured, standardized, and consistent handoff tool to Certified Registered Nurse Anesthetists (CRNA), Anesthesiologists, and Post Anesthesia Care Unit Nurses (PACU) that may result in favorable perception of usage. Without a structured handoff tool, the organization risks the occurrence of increasing errors when the message is not transmitted effectively and efficiently every time. Distractions leave the handoff susceptible to a breakdown during the …

Noise: Its Impact In The Operating Room, Brennon Wesley Sloan

Doctoral Projects

Orthopedic and neurologic cases routinely reach noise levels exceeding 120 decibels (Katz, 2014). Modern equipment and monitors used by anesthesia personnel only reach 85 decibels (Katz, 2014). These monitors can go undetected during peak noise levels creating a serious safety concern for patients that could lead to patient injury or death (Gawande, Zinner, Studdert, & Brennan, 2003). A clinical question was developed to determine if the education of noise levels in the operating room affects change in practice. For operating room managers and staff, does education of noise levels in the operating room compared to no education initiate a change …

Reducing Hypotension In Elective Cesarean Section Patients With Administration Of Ondansetron Prior To Spinal Anesthesia: A Retrospective Chart Analysis, Linsey Erin Phipps

Doctoral Projects

The birth of a child is one of the most memorable moments in a woman’s life, and many women undergo an elective cesarean section, requiring spinal anesthesia. At this time, the patient and the unborn child’s well-being become the anesthetist’s main focus. The ultimate goal of anesthesia providers is to provide the safest care to the patient. Spinal anesthesia has many benefits, but has a common side effect of hypotension, which can also result in nausea. Hypotension, dangerous to mother and child, is often treated with vasopressors, but can also cause nausea, which is treated by the administration of ondansetron. …

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to …

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgical Patients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two …

Opioid Use In The Cesarean Section Patient With The Preoperative Administration Of Intravenous Acetaminophen, Dana Edwards Bernardo

Doctoral Projects

Cesarean sections are one of the most common surgical procedures and there are no current guidelines for the management of postoperative pain control (Darvish, Ardestani, Shali, & Tajik, 2013). Unresolved pain in this population can lead to long lasting problems, such as chronic pain and depression (Booth, Harris, Eisenach, & Pan, 2015). The goal of multimodal therapy with IV acetaminophen for CS mothers was to ensure a rapid and safe recovery process with reduced adverse complications and shortened hospital length of stay. The independent t-test was used to compare the mean time for length of stay, first request of pain …

Effects Of Electronic Health Record Use On The Ambulatory Surgical Services Nurse's Time, Heather D. Taylor

Master of Science in Nursing Final Projects

ABSTRACT

Purpose: The purpose of this study was to determine the length of time the ambulatory surgical services nurse spends on the EHR compared to performing hands-on patient care.

Design: The research design used in this study was a non-experimental descriptive design.

Methods: Twenty-two surgical services nurses at a small not-for-profit hospital located in the southeastern United States were invited to participate in the study. Out of the 16 ambulatory surgical services nurses that completed the study, one participant was omitted due to incompleteness resulting in a total of 15 time-studies that were used for the data analysis, resulting in …

Improving Compliance In The Use Of Catheter Kit Supplied Hand Sanitizer Prior To The Insertion Of An Indwelling Urinary Catheter, Antonette B. Prado

Master's Projects and Capstones

Abstract

More than half of the staff nurses (65% through direct observation and 60% through interview) in the operating room (OR) department do not perform hand hygiene prior to insertion of an indwelling urinary catheter. This performance improvement project aims to educate all OR staff nurses on the practice of hand hygiene prior to the insertion of an indwelling urinary catheter by using the hand sanitizer included in the sterile catheter insertion kit. Two forms of interventions were provided in order to promote this process change. The first one being an education session with a power point presentation and the …

Standardized Blood Transfusion Documentation, Kelly A. Hill

Master's Projects and Capstones

The aim of this project was to improve nurse satisfaction through the use of a standardized blood administration documentation template. The goal was to reduce the time that nurses spend charting by offering a structured documentation template and to ensure that the procedure is correctly recorded in the patient’s electronic record. The leadership theme that supported this project is Information Manager, as the clinical nurse leader (CNL) uses information systems and technology at the point of care to improve health care outcomes. The selected microsystem is a medical/surgical/telemetry unit, which has 38 beds with 38 registered nurses (RNs). When surveyed, …

Effects Of Pediatric Emergence Delirium Education On Analgesic Administration By Pacu Nurses, Melinda C. Nwanganga

Evidence-Based Practice Project Reports

Emergence delirium (ED) is a behavioral disturbance as a result of general anesthesia that commonly occurs in pediatric patients. Adverse effects of ED lead to a complicated recovery from anesthesia due to the risk of self-inflicted injury of patients, the disturbance of surgical incisions, the development of postoperative maladaptive behaviors, and the increased use of sedatives and analgesics resulting in prolonged recovery time and delayed discharge from the post-anesthesia care unit (PACU). Due to the multiple ramifications of ED, appropriate care is needed to promote a safe recovery from anesthesia and an optimum perioperative experience for these patients. As PACU …

Knowledge, Perceptions, And Attitudes Of Certified Registered Nurse Anesthetists Regarding The Use Of Desflurane With A Laryngeal Mask Airway, Rachel Davidson

Doctoral Projects

Abstract

The purpose of this capstone project is to evaluate the knowledge, perceptions, and attitudes of currently practicing, nationally board certified, registered nurse anesthetists regarding the use of desflurane with laryngeal mask airways. This research was conducted by developing a questionnaire and administering it to current nurse anesthetists. A literature review was completed to establish a theoretical framework, summarize and describe the current state of science, and determine the nature and design of this study. Although there are studies regarding desflurane use during the maintenance of general anesthesia using a laryngeal mask airway, there is no current perception-based research regarding …

The Structure Of Multidisciplinary Rounds And The Effects On Patient Perceptions, Frank Alagna

Nursing Theses and Capstone Projects

Daily rounds is one strategy to improve communication between caregivers and engage patients and families in care decisions. The purpose of this study was to determine if the structure of multidisciplinary rounds affected the patient's perception of care. King's Theory of Goal Attainment guided this study related to the relationship of interaction and outcomes three medical surgical units were identified as using different structures for patient rounding: tabletop rounds, nurse-led rounds, and team-based rounds. Patient perceptions were collected from the Professional Research Consultants (PRC) database, a nationally recognized patient satisfaction survey. Over a six month period, survey data was analyzed …

Implementing Prophylactic Amiodarone In Heart Surgery To Reduce Post -Operative Atrial Fibrillation, John M. Russell Msn, Apn, Fnp-Bc, Denise Wilson Phd, Apn, Fnp, Cde

Theses and Dissertations

Purpose: The purpose of this project is to evaluate a practice change of implementing peri-operative amiodarone infusion for cardiac surgical patients at a large northern Illinois hospital to reduce the incidence of post-operative atrial fibrillation. Evidence supports use of prophylactic amiodarone as a strategy to reduce its incidence. The sequelae of untreated post-op atrial fibrillation include increased risk of embolic stroke, extended hospitalization, and increased healthcare costs.

Data Sources: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgical Database is a validated research tool used to collect comprehensive data on its member surgeons. A pre/post intervention case-controlled retrospective study design …

Obstructive Sleep Apnea: Emphasis On Discharge Education After Surgery, Arbert Almoite Nazareno, Cresilda Newsom, Esther Lee, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to evaluate the effectiveness of discharge education (DCE) on obstructive sleep apnea (OSA) for increasing continuous positive airway pressure (CPAP) compliance after surgery among adult surgical patients diagnosed with OSA, who use CPAP.

Background & Evidence for Problem: In the United States, the prevalence of OSA in the adult population is approximately 20%. Over half of the surgical patients with OSA are predisposed to increased incidence of perioperative complications. Based on recent evidence, obstructive events are at the highest on the third day after surgery, which predisposes them for postoperative complications. …

The Development Of Standardized Patient Controlled Analgesia Documentation To Improve Patient Care, Collyn West

Master's Projects and Capstones

On a 28 bed post-surgical unit, reviewing patient records revealed only 26% had thorough patient controlled analgesia (PCA) documentation. A pre-quiz no staff knew all of the required components for documentation or which policies to reference and, on average, the staff were only able to correctly answer 30% of the questions. Therefore, a project utilizing the clinical nurse leader improvement theme of clinical outcomes management was initiated to standardize the documentation of PCA medication administration to improve post-operative pain management, improve patient satisfaction, and improve patient safety.

The current process was determined using a fishbone diagram, a SWOT analysis was …

Breast Cancer Specimen Collection, Handling & Adherence To Asco/Cap Guidelines, Vicki F. Rocconi

Master's Projects and Capstones

Breast Cancer Specimen Collection, Handling & Adherence to ASCO/CAP Guidelines

Background

Specimens removed from their blood supply begin to degrade immediately. Specimens are placed in formalin to halt the process of degradation. Under or over-exposure of specimens to formalin can result in false positive or false negative test results for estrogen receptors, progesterone receptors & Her-2/neu receptors.

Goals & Objectives

Improve the process of breast cancer specimen collection & handling and insure that the process is consistent with ASCO/CAP Guidelines (College of American Pathologists, 2013). The objectives included: Documentation of the time the specimen was removed from the blood supply. …

Improving Patients' Pain Management Through Proper Documentation, Virzen Merina

Master's Projects and Capstones

The aim of this project was to improve pain documentation on the Surgical Unit as a means to enhance caregiver communication on finding the best methods to manage patients’ pain. Effectively managing patients’ pain leads to better patient outcomes, increased patient and nurse satisfaction, and decreased length of hospitalization. The setting is a not-for-profit hospital in Southern California. The microsystem selected is the 32-bed capacity Surgical Unit that mainly admits pre- and post-surgical patients, but also accommodates non-surgical, telemetry, and trauma cases.

To improve pain assessment documentation, collaboration was sought with the multidisciplinary team (IT department, clinical nurse specialists, and …

Preventing Hapus In High-Risk Cardiac Cath Patients Using Foam Dressing Protocol, Charles Jasper

Master's Projects and Capstones

The purpose of this project is to implement an evidence-based change in practice resulting safer procedures as evidenced by zero hospital acquired pressure ulcers (HAPUs). It is relevant to nursing as it provides an ethical perspective regarding patient safety and contributes to our present understanding of HAPU prevention. In spite of having already decreased the total number of HAPUs by 50% in 2015, the cardiac catheterization lab (CCL) was implicated in 30% of those reported. My objective is to improve patient safety by reducing the number of HAPUs acquired in the CCL to 0% by three months using a prophylactic …

Operating Room Nurse To Post Anesthesia Care Unit Nurse Handoff: Implementation Of A Written Sbar Intervention, Erin Long

Evidence-Based Practice Project Reports

The lack of standardized handoff from the operating room (OR) nurse to the post anesthesia care unit (PACU) nurse may result in the miscommunication or omission of patient information, which increases the risk of patient safety events. The goal of this EBP project was to standardize OR to PACU nurse handoff in order to reduce risks to patient safety. A literature review revealed guidelines for handoff which included implementing a standardized protocol and using a mnemonic phrase. The Iowa Model of Evidence-Based Practice and Lewin’s Model of Change guided the EBP project. Handoff quality was evaluated by OR and PACU …

Preprocedure Warming To Prevent Intraoperative Hypothermia, Kathy C. Anders

Nursing Theses and Capstone Projects

Maintaining homeostasis during surgery is vital to preserving health and preventing postoperative complications. Research supports the benefits of preprocedure warming in preventing or reducing intraoperative hypothermia. Better postoperative outcomes are linked to intraop normothermia such as a reduction in the occurrence of surgical site wound infection, reduced bleeding, and faster recovery from anesthetics. However there were barriers to prewarming at the researcher’s institution such as cost, convenience, and compliance. The purpose of this research project was to study the impact of prewarming in the high risk population of surgical spine fusion patients. The researcher also hoped to examine and raise …