Perioperative, Operating Room and Surgical Nursing Commons^™

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.

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) …

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, …

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 …

Operating Room Acquired Pressure Injury Prevention, Audrey E. Dillon, Lexi K. Johnston, Grace L. Johnston, Amy N. Cochran

SPARK Symposium Presentations

Our change project focuses on preventing pressure injuries in OR patients using an alternating pressure overlay and gel pad system during surgery and recovery. Pressure injuries cost the healthcare system upwards of $26 billion annually, and surgery patients are at high risk due to prolonged immobility, constant pressure on one area, hemodynamic changes, and excessive moisture. Nurses can play a critical role in reducing healthcare costs and improving patient outcomes by utilizing proper training and outcome tracking. The estimated cost of implementing this system is $37,000, significantly lower than the long-term cost of pressure injuries. Key
stakeholders include nurse managers, …