DNP Final Project Depository
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Last Updated: 2021-10-04
Works (93)
81. Quantitative Train-of-Four Monitoring and the Assessment of Train-of Four Count
- Title Tesim:
- Quantitative Train-of-Four Monitoring and the Assessment of Train-of Four Count
- Creator:
- Meyer, Clifton
- Description:
- <b>Background</b>: Many surgical procedures require muscle paralysis of the patient to ensure optimum operating conditions. Monitoring the level of paralysis is an important responsibility of the nurse anesthetist throughout the entire procedure. At the conclusion of the procedure, the paralysis is reversed with reversal medications, the doses of which are determined by the level of muscle response to an electronic stimulus. The most frequently used method of assessing this response is a subjective method requiring the nurse anesthetist to visualize and/or feel the muscle movement and base their reversal dose off this interpretation. This method is known as peripheral nerve stimulation (PNS). If, in fact, the strength of the results is misinterpreted, the patient may be underdosed with reversal agent and suffer residual neuromuscular blockade symptoms (RNMB) in the Post Anesthesia Care Unit (PACU). Newer technologies have evolved to provide the nurse anesthetist with a quantitative approach to assessing the return of muscle strength, clinically referred to as the Train-of-Four Ratio (TOFR). This technique removes subjectivity, provides objectivity, and has been shown to decrease RNMB symptoms in recovering patients. <b>Purpose</b>: The purpose of this project was to assess whether the use of subjective PNS accurately correlates with the data provided by the objective quantitative data from electromyographic neuromuscular monitoring (EMG). A second aim was to assess whether quantitative neuromuscular monitoring use aids in decreasing RNMB symptoms in PACU. <b>Methods</b>: This project utilized a quality improvement design. Quantitative data was collected on surgical patients undergoing muscle paralysis. Numerical data from the EMG device was then compared to the clinician’s PNS rating at the time of reversal of paralysis. A second EMG reading was taken immediately after the patient was extubated to assess the TOFR value. Data was analyzed using descriptive statistics to assess the validity of the data as well as statistical significance. <b>Implementation Plan/Procedure</b>: The project took place at Putnam County Hospital. Fifteen surgical patients requiring muscle paralysis were monitored with EMG monitoring and PNS monitoring. EMG data was be hidden from the anesthesia provider during the project.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- Quantitative neuromuscular monitoring, residual neuromuscular blockade, qualitative neuromuscular monitoring, peripheral nerve stimulator, electromyography, and neuromuscular blockade reversal
- Date Created:
- 2023
82. Reducing Anesthesia Workstation Contamination
- Title Tesim:
- Reducing Anesthesia Workstation Contamination
- Creator:
- Moncada, Kristine G.
- Description:
- In the intraoperative setting, the intersection of hand hygiene practices and contamination of the anesthesia workstation presents a critical juncture for reducing hospital acquired infections that ultimately lead to increased patient morbidity and mortality. Microbiological contamination of the anesthesia workstation, most notably during routine tasks such as induction and airway management, has been directly linked to an increase in patient morbidity and mortality. The absence of standardized protocols to minimize contamination of the anesthesia workstation signals a crucial opportunity to improve the anesthetic workflow. This Doctor of Nursing project focused on educating student registered nurse anesthetists about intraoperative hand hygiene and ways to counter the contamination of their workstation, such as double gloving during induction and airway management. A pre-test survey was created to assess baseline knowledge of the topic and current hand hygiene practice during airway management. An evidence-based PowerPoint presentation was provided as an educational intervention, followed by a post-test survey to assess retention of knowledge and willingness to apply suggested methods to reduce contamination. The results showed that there was a significant improvement in the students’ awareness, confidence, and willingness to apply the recommendations to reduce contamination of the anesthesia workstation. This project underscores the importance of targeted educational interventions in elevating healthcare quality through an improved anesthetic workflow that includes better hand hygiene and workstation cleanliness.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- intraoperative hand hygiene practices, anesthesia workstation contamination, microbiological contamination, induction and airway management, standardized protocols, anesthetic workflow, and educational interventions
- Date Created:
- 2024
83. Referring Palliative Care Patients: A Process Improvement Project
- Title Tesim:
- Referring Palliative Care Patients: A Process Improvement Project
- Creator:
- Davis, Shantrece
- Description:
- Background: The lack of palliative care (PC) services poses a significant risk for PC patients. Research indicates that patients' needs often go unmet when PC referral processes are not well established within a health system. Furthermore, PC patients have higher readmission rates, thus increasing health care costs. PC referrals improve the quality of care while also reducing readmissions. Purpose: The purpose of this project was to determine whether PC referrals impacted the readmission rates of chronically and terminally ill patients. Methods: A 2018 practice assessment of an Indiana community hospital revealed a high rate of readmissions among chronically and terminally ill patients. An evidence-based process improvement project was implemented, guided by the Iowa model, in which a sample of 22 terminally and chronically ill patients were identified and referred for PC. Following PC training, risk assessment scores were used to identify PC patients appropriate for referral, after which case managers provided follow-up over the course of six months. Results: Six months before implementation, the sample (n = 22) recorded 19 Emergency Department (ED) visits and 65 total admissions, with some being direct admissions. Results showed that 89% of ED visits resulted in admission. Post-intervention, there were six (27%) ED visits for the same sample (n = 22), only 0.04% of which resulted in actual admission. Conclusions: Educating staff and implementing a PC referral process chronically and terminally ill patients may be an effective method of reducing readmission rates, thereby decreasing costs.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Keyword:
- referral, readmission rates, and palliative care
- Date Created:
- 2019
84. A Retrospective Chart Review Comparing Ultrasound Guided Verses Landmark Intravenous Access
- Title Tesim:
- A Retrospective Chart Review Comparing Ultrasound Guided Verses Landmark Intravenous Access
- Creator:
- Ertel, David R.
- Contributor:
- Fox, Tara
- Description:
- In 1984, Ultrasound-Guided (USG) Intravenous (IV) access was first used to place central venous catheters (CVC) in real-time. This led to increased success rates, reduced procedural times, decreased site associated complications, and a standard of care. As USG technology and teaching methods for CVC placement have improved, studies suggest this technique could also be translated into peripheral intravenous (PIV) placement. A retrospective chart review was conducted at an emergency department within a large healthcare facility to determine the reliability of USG PIVs when compared to landmark PIVs. The principal investigator reviewed the charts of adult inpatients admitted into the hospital from the Emergency Department (ED) comparing those who acquired landmark IV verses USG IV access to assess overall reliability. The data included IV survival rates, success rates, and site complications. 30 landmark and 17 USG PIVs were reviewed. Among the landmark PIVS, survival rates and success rates could not be measured. No site complications for landmark PIVs could be found. Among the USG PIVs, survival rates of only three could be found out of 17. No success rates could be measured. Only four site complications or reasons for PIV discontinuation could be found, including two counts of occlusion, one expiration, and one catheter damaged. In conclusion, due to limitations and lack of data found in this review, significance between variables could not be determined.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- site complications, ultrasound-guided peripheral venous access, landmark peripheral venous access, and ultrasonography
- Date Created:
- 2021
85. A Retrospective Study on the Use of Intraoperative Subhypnotic Propofol Infusion in Conjunction with Volatile Anesthetics to Decrease PONV
- Title Tesim:
- A Retrospective Study on the Use of Intraoperative Subhypnotic Propofol Infusion in Conjunction with Volatile Anesthetics to Decrease PONV
- Creator:
- Paris, Kerri Ann
- Description:
- Background and Review of Literature: Postoperative nausea and vomiting (PONV) frequently occur in patients after anesthesia, significantly impacting patient satisfaction and potentially leading to untoward complications. Multimodal PONV prophylaxis for patients with increased risk factors should be implemented to decrease stay in the PACU and healthcare cost. While research has been extensively conducted on the use of multimodal prophylaxis using antiemetics, such as ondansetron and dexamethasone, research on combining those therapies with a subhypnotic propofol infusion during anesthesia with a volatile anesthetic has been insufficient. Purpose: This DNP project was designed to determine whether the addition of a continuous subhypnotic propofol infusion in conjunction with a volatile anesthetic decreases the incidence of PONV. Methods: This project utilizes a quality improvement design by the evaluation of a practice intervention to improve the guidelines on preventing PONV after anesthesia. A retrospective chart review was conducted, and Microsoft Excel was used to perform all statistical analyses. Implementation Plan/Procedure: A total of 60 patient EMRs met the criteria for this project and were utilized in this study. The patient EMRs were separated into a control and experimental group. Those in the experimental group all received a subhypnotic propofol infusion at 0.1-0.5 mg/kg/hr. The incidence of PONV in the PACU was recorded and compared for both groups. Implications/Conclusion: The results of this study concluded that the addition of a continuous subhypnotic propofol infusion in conjunction with a volatile anesthetic presents no added benefit in decreasing the incidence of PONV in the PACU.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- Subhypnotic Propofol Infusion, PONV, and Volatile Anesthetic
- Date Created:
- 2022
86. A Retrospective Study on the Use of Rescue Pain Medication in Patients Who Receive Transabdominal Plane Blocks Post Caesarean Sections
- Title Tesim:
- A Retrospective Study on the Use of Rescue Pain Medication in Patients Who Receive Transabdominal Plane Blocks Post Caesarean Sections
- Creator:
- Ramey, Nicholas
- Description:
- <b>Background and Review of Literature</b>: Caesarean sections are one of the most performed procedures in the operating room. Managing pain for these patients is vital to ensure a positive birthing experience for mothers and facilitating bonding post-surgery. Regional anesthesia, specifically transabdominal plane (TAP) blocks, have shown to improve pain perception and reduce the need for opioid pain medications. <b>Purpose</b>: This DNP project was designed to validate that performing TAP blocks on patients who have a caesarean section reduce the need for rescue pain medications. Reducing the need for these medications negates the side effects they have and promotes a positive birthing experience. <b>Methods</b>: This DNP project will be retrospective chart review on patients who required a caesarean section and the use of rescue opioid medications. Charts will be reviewed in a 4-week period in the Spring of 2023 at a Midwest community hospital. <b>Implementation Plan/Procedure</b>: Charts reviewed will be divided into two groups who received a caesarean section. Group 1 will be those who did not receive a TAP block. Group 2 will be those who did receive a TAP block. Both groups' charts will be reviewed for use of rescue medications and compared to one another using a Chi-Square Test. <b>Implications/Conclusions</b>: This study concluded that there was no statistical reduction in the use of rescue opioid pain medications in the 24 hours following a caesarean section when a TAP block was performed.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- TAP Block, Opioid use, and Caesarean Section
- Date Created:
- 2023
87. Simulation-Based Training for Anesthesia Machine Set-up
- Title Tesim:
- Simulation-Based Training for Anesthesia Machine Set-up
- Creator:
- Keesler, Nicholas
- Description:
- Background and Review of Literature: The presurgical anesthesia machine check is a critical procedure that all anesthesia providers must be capable of performing. Failing to perform an anesthesia machine check increases morbidity and mortality during patient care. Simulation training for anesthesia providers is a safe and effective educational pathway allowing providers to improve their skills prior to beginning clinical practice. Optimizing learning by modifying simulation practices to follow INACSL practice standards will enhance the learning for future anesthesia providers. Purpose: This DNP project was a quality improvement project to examine the effect on SRNA knowledge, confidence, and satisfaction of learning when comparing anesthesia machine checklist versus simulation-based training. Methods: This DNP project utilized a quality improvement design and was evaluated by the Student Satisfaction and Self-confidence in Learning instrument and a post-test knowledge assessment. Implementation Plan/Procedure: A total of 24 SRNA’s enrolled in Marian University’s nurse anesthesia simulation course were divided into 2 groups. Group one participated in the current practice of an anesthesia machine checkoff, while group two participated in the current practice and the anesthesia machine set-up simulation. Both groups underwent the same checkoff for the current anesthesia machine checkoff. Both groups were given a post-test of the Student Satisfaction and Self-confidence in Learning instrument. Finally, both groups also completed a post-test knowledge assessment. Implications/Conclusion: Overall, the participants in the experimental group scored higher in agreement in the satisfaction (U = 28.0 , p = 0.032 ) and self-confidence of student learning (U = 43.5 , p = 0.273). The experimental group scored higher in the knowledge section. If current practice is modified to incorporate INACSL best practice standards for simulation, nurse anesthesia educational programs will be able to increase confidence and safety of SRNAs as they progress through their anesthesia training.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- INACSL, Anesthesia Machine, Simulation, SRNA, and Jeffries Simulation Model
- Date Created:
- 2022
88. Simulation-Based Training for Student Registered Nurse Anesthetists Managing Malignant Hyperthermia
- Title Tesim:
- Simulation-Based Training for Student Registered Nurse Anesthetists Managing Malignant Hyperthermia
- Creator:
- Aveja, Hilda
- Description:
- Background: Malignant hyperthermia is a disorder of the skeletal muscle that can present as a hypermetabolic response to triggering agents. Anesthesia providers frequently administer these triggers in the operating room. Therefore, it is imperative for providers to receive comprehensive education on malignant hyperthermia. Simulations help ensure their competence in the event of encountering a crisis. Purpose: This project’s purpose was to improve malignant hyperthermia knowledge among student registered nurse anesthetists (SRNAs) at a small university in the Midwest through a lecture and simulation of a crisis. Methods: The university’s SRNAs were invited to participate in this project via email. The project consisted of an educational intervention through a lecture and simulation, which took place in the university’s simulation center. Qualitative data was collected with malignant hyperthermia key action checklist. The investigator also collected qualitative data using a pretest and post-test interventional design. Implementation: Ten educational sessions provided to participants (n = 32). Participants took a pre-test to assess their baseline knowledge. Then, they received a lecture, simulation, debrief, and post-test one. Post-test one was given to assess knowledge improvement. Six to eight weeks later, participants received an email to take post-test two, which assessed knowledge retention. Conclusion: Participants collectively received a mean score of 29.1 out of 30 on the key action checklist. The pre-test was assessed against each post-test using a paired samples t-test. Participants showed knowledge improvement from the pre-test to the post-test one (p > 0.05).This knowledge improvement was retained from the pre-test to post-test two (p > 0.05).
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- malignant hyperthermia, simulation, mock drill , anesthesia, anesthetist, and SRNA
- Date Created:
- 2024
89. Spinal Induced Hypotension Prophylaxis: Indiana CRNA Techniques
- Title Tesim:
- Spinal Induced Hypotension Prophylaxis: Indiana CRNA Techniques
- Creator:
- Thomas, Kristen M.
- Description:
- Anesthesia providers who give spinal anesthetics in obstetric anesthesia commonly witness spinal induced hypotension (SIH) in patients due to the sympathetic blockade after injection. This DNP project evaluated Indiana Certified Registered Nurse Anesthetists (CRNAs) and their utilization of preventative treatment for SIH after the administration of spinal anesthesia in healthy pregnant women undergoing elective cesarean sections. A needs assessment depicted a lack of research specifically concerning Indiana CRNAs and their prophylaxis practices when addressing SIH. This project design was a descriptive study and yielded a 13.27% response rate. By utilizing the Indiana Association of Nurse Anesthetists (INANA) email contact list of five hundred and sixty-five (565) members, an information sheet including implied consent, and an anonymous link to a 7-question Qualtrics self-assessment survey was administered. Survey questions included general demographics, prevention options, and treatment options utilized to prevent SIH in obstetrics. The select all that apply survey question regarding SIH prophylactic and rescue methods resulted in 296 responses from 75 Indiana CRNAs. After conducting data analysis, the most common practices of these 75 Indiana CRNAs were exposed. Data collection and analysis indicated the following results: 71 CRNAs reported administering an intravenous crystalloid infusion to reduce SIH (23.99%), 52 CRNAs reported administering intravenous ondansetron (17.58%), 48 CRNAs reported administering ephedrine boluses (16.22%), 47 CRNAs reported administering phenylephrine boluses (15.88%), and 37 CRNAs reported decreasing the height-based dosing of their spinal anesthetic (12.5%). This project assesses Indiana CRNA approaches to reduce SIH compared to current, published anesthesia practice guidelines.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- spinal anesthesia, hypotension, cesarean, and prevention
- Date Created:
- 2023
90. Supplemental Intraoperative Intravenous Fluid Administration among Patients Undergoing Surgical Procedures and General Anesthesia for the Prevention of Postoperative Nausea and Vomiting: A Retrospective Chart Review
- Title Tesim:
- Supplemental Intraoperative Intravenous Fluid Administration among Patients Undergoing Surgical Procedures and General Anesthesia for the Prevention of Postoperative Nausea and Vomiting: A Retrospective Chart Review
- Creator:
- Gum, Andrea
- Description:
- Background and Review of Literature: Postoperative nausea and vomiting (PONV) is one of the most common patient complications following general anesthesia. Recent literature supports the practice of supplemental intravenous fluid administration to patients receiving general anesthesia with no risk of fluid volume overload. Purpose: The purpose of this DNP project was to assess the overall occurrence of PONV and to determine if patients who experienced PONV after receiving general anesthesia, were administered supplemental intravenous fluids during the intraoperative period. Methods: The project consisted of a retrospective chart review. A total of 342 electronic health records (EHRs) were reviewed and 57 patients were included in the DNP project. Implementation Plan: A project site was identified; a retrospective chart review was conducted, examining one month of patient EHRs who underwent general anesthesia. Data was collected and analyzed via Microsoft Excel, which included the amount of intravenous fluids received during the intraoperative period, weight, gender, surgical procedure, and ASA physical status. Implications/Conclusions: At the completion of the retrospective chart review, it was discovered that 57 (17%) out of 342 patients who underwent general anesthesia were treated for PONV. Of the 57 patients, 50 (88%) did not receive intraoperative supplemental intravenous fluids. Only 7 (12%) patients received greater than 15mL/kg of intravenous fluid during the intraoperative period.
- Rights statement:
- http://rightsstatements.org/vocab/InC/1.0/
- Language:
- English
- Type:
- Research Paper
- Keyword:
- Intraoperative supplemental intravenous fluids and postoperative nausea and vomiting
- Date Created:
- 2021