Perioperative, Operating Room and Surgical Nursing Commons^™

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Reducing Same-Day Case Cancellation By Implementing 72 Hours Preop Phone Calls, Debbie Sharon Centeno

Master's Projects and Capstones

Problem: The increased frequency of same-day surgical cancellations affects patient care quality, causes loss of expenses for patients and facilities, and causes non-compliance with block utilization against regional standards.

Context: A collaborative effort was undertaken to reduce same-day case cancellations in the Ambulatory Surgery Unit (ASU). Patients received preoperative instructions 24 hours before surgery through email or phone call. Data collection revealed that the common causes of same-day cancellations were avoidable reasons (not NPO, patient ill, request for another schedule, no ride), indicating the need for improvement in delivering preoperative phone calls.

Interventions: This included educating preoperative nurses, creating a …

An Initiative To Improve Ssi Bundle Metrics Adherence Specific To Post-Op Warming And Temperature Documentation Practices In The Post-Anesthesia Care Unit, Dorothy Vergel

Master's Projects and Capstones

Abstract

Problem: Over the past year, the department failed to meet SSI Bundle Metrics scores consistently due to process identification failures and documentation lapses.

Context: The post-op warming temperature documentation and practices project focused on addressing critical quality issues related to documentation and education gaps in the post-anesthesia care unit (PACU) microsystem. This project took place in a 249-bed hospital in Northern California, which includes 15 post-surgical bays. The PACU primarily serves patients needing acute care post-surgery, with surgical cases handled, including general surgery, plastic surgery, neurosurgery, orthopedic and spine surgery, vascular surgery, and urology.

Interventions: The design …

A Nursing Education Intervention For Delirium Prevention, Sarah Eckles

Doctor of Nursing Practice Projects: College of Nursing

Background

At a large, tertiary care hospital in the Midwest, it had been anecdotally noted that delirium or acute encephalopathy cases were increasing. Specifically, inpatient neurology consultations for delirium were on the rise. This data had been confirmed by hospital administration. Delirium has been identified as a well-known problem in elderly, hospitalized adults—most notably in elderly, postoperative adults. It can cause a cascade of additional complications for elderly patients. Delirium prevention is known to be the best method to combat delirium incidence. Prevention has been proven to occur by way of non-pharmacologic, early interventions by nursing. Bedside nursing staff must …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

Smoke Evacuation In The Operating Room, Meghan Holley, Mckenzie Moon

Nurse Residency

In perioperative staff, does mandating the use of smoke evacuation in the surgical setting compared to no smoke evacuation decrease the amount of exposure to toxic byproducts found in surgical plume for each surgical case?

Improving First Case On-Time Starts In The Operating Room, Lojy Koshy

Master's Projects and Capstones

Problem: A timely first-case start in the operating room (OR) is critical for optimizing departmental efficiency and resource utilization. Persistent delays in first-case start times disrupt the surgical schedule, leading to suboptimal OR use, diminished patient and staff satisfaction, reduced operational efficiency, and decreased overall productivity. Addressing these delays is essential to enhance the quality and efficiency of surgical services.

Context: The microsystem for this project is a Northern California operating room that handles a high volume of surgical procedures. There are 10 operating rooms, and the goal is to have 70% of first cases in the operating room on …

Improving Mental Health Outcomes For Amputees, Zachary Elmore

Dissertations

Problem: depression, anxiety, and other mental health disorders are more commonly diagnosed in the amputee population related to changes in mobility, activities of daily living, and quality of life (Turner et al., 2020.) As the amputation population is projected to reach over 3 million Americans in the next 25 years, additional screening is imperative to identify patients at high-risk for mental health deterioration (Ziegler-Graham et al., 2018).

Methods: this was a project that included screening all patients with the Personal Health Questionnaire for Depression (PHQ-8) meeting the inclusion criteria of being admitted to 7500 Vascular Surgery at Barnes-Jewish …

Management Of Post-Extubation Dysphagia Using The Yale Swallow Protocol, Nicole West

Dissertations

Abstract

Problem: Post extubation dysphagia (PED) increases the patient’s risk for long term complications contributing to increased healthcare cost. Intensive care settings rarely use standardized swallow screening assessments for patients post extubation leading to variation in the evaluation of PED. Variation in the assessment of swallowing post extubation can lead to the missed diagnosis of patients with dysphagia.

Methods: This quality improvement (QI) project was a prospective cohort study implementing an evidence-based swallow screening protocol, the Yale Swallow Protocol (YSP), in an intensive care unit. This study was conducted over four months, which included a pre survey, education, implementation, and …

Safety Project To Prevent Unintentional Retained Surgical Items, Sherri Bobo

Electronic Theses and Dissertations

Abstract

Fifty million surgeries are performed annually in the United States with an estimated 5,000 patients affected by unintentionally retained surgical items (RSIs) due to errors in the operating room. Surgical items inadvertently left inside patients may include sponges, instruments, needles, or small miscellaneous parts. It is not well understood why the surgical counting process fails to prevent the incidence of unintentional RSIs. The proposed educational curriculum was intended to enhance the knowledge and self-efficacy of surgical nurses and technicians to minimize errors and eliminate RSIs. Evidence-based strategies to complement existing knowledge of unintentional RSIs were introduced through didactic and …

Reducing Maternal Morbidity From Peripartum Hemorrhage In Cesarean Delivery, Jennie Lee

Dissertations

Background/Purpose: Maternal hemorrhage is the second highest cause of direct maternal death and the leading cause of morbidity and mortality in the United States. This public health crisis is highlighted by the economic burden of over $30.8 million annually in the United States. The greatest tragedy in the review of maternal mortality is that 84% of pregnancy-related deaths were determined preventable. Identifying trends of factors that predispose women to hemorrhage can mitigate rates of severe maternal morbidity and mortality. This study describes relationships among demographic factors (maternal age, race, and ethnicity), clinical and physiologic factors, which include coexisting medical conditions …

Enhanced Bariatric Surgery Preoperative Support To Improve Postoperative Surgical Outcomes, Jeffrey Eavey

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Abstract

Bariatric surgery is a procedure known to eradicate disease and improve the quality of life for patients suffering from obesity. The pathway to bariatric surgery is a comprehensive and lengthy process; therefore, patients require additional support from the multidisciplinary healthcare team and their support system. The accrediting body of an academic medical center bariatric surgery program (BSP) requires the program to limit and reduce 30-day all cause postoperative emergency department (ED) visits and 30-day all cause postoperative readmissions. A telemedicine visit within two weeks prior to surgery was added with the intent to assess patients for knowledge deficits and …

Dnp Final Report: Double Gloving As Part Of The Surgical Site Infection Prevention Bundle For Colorectal Surgeries, Dave P. Calubaquib

DNP Final Reports

Surgical site infection (SSI) is the costliest healthcare-acquired infection that encompasses around three to ten billion dollars annually. The costs do not include the societal challenges and personal losses that patients endure when they have SSI. The evidence-based project revolves around decreasing SSI among colorectal surgical patients with a PICOT question: In patients having colorectal surgery, how does an educational project regarding double gloving for reducing SSIs, compared to no educational project, improve compliance rates for double gloving? The evidence recommends that double-gloving techniques among surgical members (surgeon, surgical assistant, and scrub techs/nurses) during surgery prevent SSI. The project utilized …

Local Anesthetic Systemic Toxicity: Last Protocol Development, Implementation, And Evaluation For Healthcare Providers, Rachel Vaughn

Doctor of Nursing Practice Projects

LAST is an uncommon but deadly complication of local anesthetic administration. Healthcare facilities benefit from protocol implementation to help streamline best evidence-based practice. The American Society of Regional Anesthesia and Pain Medicine warrants a LAST emergency protocol for any healthcare facility practicing regional anesthesia. Healthcare personnel encountering patients at risk for LAST must understand the symptoms and treatment of LAST to improve response time and patient outcomes. The project implemented a LAST protocol at a rural hospital in Southern Illinois in July 2023. The investigator held an educational service to discuss the new LAST protocol and implementation. The educational service …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Procedural Oxygen Mask Use For Inpatient Bariatric Endoscopy: A Scoping Review, Makinlee Meadows, Marion Millette, Brittany Morgan, Lauren Pegrim, William Collier Phillips, Dwayne Accardo Dnp, Crna, Faana, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Hypoxia is a severe adverse event that is often associated with sedated endoscopy procedures, and bariatric patients have a significantly higher risk for complications related to oxygenation during sedation due to pathophysiological changes to the respiratory system. This scoping review compares the rate of hypoxemic events with the use of a binasal cannula versus a procedural oxygen mask during inpatient endoscopic procedures in patients aged 19-64 with a BMI greater than 40.

Methods

The scoping review includes control trials with and without randomization, case-control/cohort studies, systematic reviews, and qualitative/descriptive studies. With limited research regarding the PICOT, extending the age …

Comparing The Effects Of The Induction Of Anesthesia With Etomidate To The Induction Of Anesthesia With Midazolam On The Incidence Of In-Hospital Mortality: A Scoping Review, Madison Hayes Bsn, Rn, Ashley Lynch Bsn, Rn, Scott Jamison Bsn, Rn, Mary Joiner Bsn, Rn, Gray Seymour Bsn, Rn, Dwayne Accardo Dnp, Aprn, Crna, Tracy Mcclinton, Dnp, Aprn, Agacnp-Bc, Epb-C

Doctor of Nursing Practice Projects

Purpose/Background

The induction of anesthesia using hypnotic sedatives, such as etomidate and midazolam, is common practice. Etomidate and midazolam are commonly employed in the induction of anesthesia in the septic patient population, each with its unique advantages and drawbacks. This scoping review aims to synthesize evidence on the effects of anesthetic induction with etomidate versus midazolam in adult septic patients, focusing on the incidence of mortality and associated adverse effects during hospitalization. The purpose is to establish a standard of care for anesthetic induction in this population.

Methods

A literature review was conducted from September 2022 to March 2023 utilizing …

The Effectiveness Of Dexmedetomidine As An Adjunct In Spinal Anesthesia For Pain Relief In Cesarean Patients: A Scoping Review, Tyler Polanco Bsn, Rn, William Riley Bsn, Rn, Michelle Russell Bsn, Rn, Christina Samson Bsn, Rn, Bria Sharp Bsn, Rn, Dwayne Accardo Dnp, Ccrna, Faana

Doctor of Nursing Practice Projects

No abstract provided.

Antibiotic Prophylaxis In Surgical Patients, Rebekah Muselin

ONU Student Research Colloquium

Problem: Post operative surgical site infections continue to be an issue that hospitals face. Although there is not one specific root cause of postoperative surgical site infections, there are steps that can be taken that potentially decrease the risk of acquiring an infection. By initiating prophylactic antibiotics prior to surgery, the incidence of postoperative infections may be decreased. Purpose:The purpose of this project is to compare the occurrence of postoperative surgical site infection rates when using prophylactic preoperative antibiotics to postoperative antibiotics. Methods: This project will be a retrospective chart review. There will be a review of the rate of …

Cultural Education Interventions Impact On Cultural Competence, Kaylie V. Griffin Ms

ONU Student Research Colloquium

Problem: In the United States, there is a substantial increase in diversity. This increase in diversity poses multiple challenges for healthcare workers and healthcare systems. Because nurses care for patients with various cultural backgrounds, health beliefs and practices, and languages, cultural competency plays a pivotal role in providing patient-centered care. There is a need to enhance cultural education for healthcare workers to ensure that healthcare workers have the skills and knowledge to effectively engage with all patient populations. Implementing cultural education interventions seeks to increase healthcare workers' competency, communication, and patient outcomes. Purpose: The purpose of this research question is …