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Now showing 1 - 10 of 40
  • Publication
    Measuring Nurses’ Graph Literacy
    (2020-01-01) Villalba, Cyd Charisse
    Increasingly, healthcare data used in nursing practice is visualized using graphs. However, studies show that low graph literacy is found in significant numbers in both the general population and in nurses. Even so, the concept of graph literacy is relatively unknown within healthcare and measuring baseline graph literacy isn’t standardized. The 4-item GLS questionnaire is a brief, validated, healthcare-domain-specific scale developed by Galesic and Garcia-Retamero (2011), and assesses graph literacy by measuring comprehension of four frequently used graphs (simple pie, bar and line charts and icon array). Along with measuring baseline graph literacy, a video tutorial reviewing the four graphs and a re-designed graph used to test usability and utility were implemented to better understand and enhance graph comprehension in recently onboarded, entry-level, hospital nurses. The self-selecting, small sample size garnered enough data to run non-parametric tests, and although there were no statistically significant findings in tests for differences or correlations, measuring baseline graph literacy and identifying ways to enhance graph comprehension remain clinically significant. The qualitative and quantitative analysis challenged assumptions and will inform future graph literacy studies in hospital nurses.
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    Advance Care Planning Provider Education: Solution to Improve Provider Self-Efficacy
    (2021-06-17) Lloyd Doherty, Caroline L
    Healthcare providers are not comfortable having Advance Care Planning (ACP) conversations with patients and families. This project aimed to determine if ACP education modules improve self-efficacy with ACP. The project was a pre-/post-implementation design utilizing the validated ACP Self-Efficacy (ACP-SE) survey. Participants completed the pre-test ACP-SE followed by four Center to Advance Palliative Care (CPAC) ACP education modules and a Project-Lead-developed state-specific advance directive (AD) module that were accessed on-demand electronically. Participants were Advanced Practice Providers (APPs; n=21) on the inpatient heart failure service at an urban academic medical center. Thirteen APPs had complete pre and post-test and surveys data (61.9%). The majority of participants were white (95%), female (92%), aged 20-39 (83%), and NPs (62%) with 0-5 years of experience. The Wilcoxon Signed Rank Sum Test was used for median sum ACP-SE score comparisons for paired pre/post data. There was a significant median increase in ACP-SE scores pre and post intervention (W=2.9; p=0.002). The number of ACP conversations post-education modules ranged from 0-11 with a mean of 3.2 per APP, and a total of 68 conversations for all APPs during the month after the intervention. With increasing comfort and self-efficacy for discussing ACP, the desired effect is that ACP discussions will become a routine component of patient care.
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  • Publication
    Intravenous Magnesium Sulfate Use in Hip Arthroscopy Patients and Anesthesia Provider Satisfaction with Patient Care at an Ambulatory Surgery Center
    (2021-06-28) Song, Naomi; Yi, Erica; Bagley, Julianne
    Hip arthroscopy patients experience high levels of postoperative pain. Intravenous (IV) magnesium sulfate is widely used in anesthesia practice as a multimodal analgesic but is infrequently utilized at Penn Presbyterian Medical Center (PPMC). Does the option of adding intravenous magnesium sulfate to the current pain pathway increase provider satisfaction with patient care and magnesium use? The purpose was to add IV magnesium sulfate to the multimodal analgesic pathway for hip arthroscopy patients to evaluate anesthesia provider satisfaction and use of IV magnesium sulfate. The Middle Range Theory of Acute Pain was used to provide a theoretical framework. The conceptual framework utilized was the Plan-Do-Study-Act cycle. Anesthesia providers were refamiliarized with IV magnesium sulfate's analgesic properties to encourage its administration in hip arthroscopy procedures yielding high levels of postoperative pain. A survey was distributed to assess provider satisfaction using the Accessibility of Intervention Measure (AIM) and magnesium use. Frequency counts were used to determine provider satisfaction with patient care and a run-chart was created to analyze changes in IV magnesium sulfate usage before and after implementation. Compared to the pre-implementation phase, there was an 85.7% increase in IV magnesium use among anesthesia providers. Over 12 weeks, ten CRNAs participated in a total of fourteen hip arthroscopy cases. Nine out of ten providers would consider using magnesium in future practice. The project served to re-introduce IV magnesium sulfate as an analgesic adjunct for many surgical procedures and hoped to promote a culture that utilizes IV magnesium sulfate readily.
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    The Use of Liposomal Bupivacaine in Interscalene Nerve Blocks
    (2021-07-05) Begley, Kirby; Aboff, Alyssa; Nasritdinova, Dilnoza
    This paper outlines an educational research project at an urban hospital concerning the standardization of the use of liposomal bupivacaine (LB) for an interscalene block (ISB). The PICOT question guiding this project was: In adult surgical patients (P), how does the use of LB for shoulder peripheral nerve blocks, (I) compared to the administration of plain bupivacaine (PB) for shoulder peripheral nerve blocks, (C) affect postoperative pain scores (O) within 48 hours after surgery (T)? Using the numerical rating scale (NRS) for pain, a validated and reliable tool, patients who received LB had their 48-hour pain scores measured and compared to those patients who received PB. Satisfaction scores at 48 hours, a secondary project outcome, were assessed using a single question with a response scale of agree very much – disagree very much. Data was collected over a period of four weeks in those who were appropriate for the project. Data was collected by telephone and recorded on a data collection tool. Both PB and LB had the same mean immediate postoperative pain score (mean = 0.57), however, the mean 48-hour postoperative pain score was lower for those who received LB (mean = 3.29) compared to those who received PB (mean = 6.86). Patients who received LB were more satisfied with their anesthetic care (100% agree very much) compared to those who received PB (57.14% agree very much). From this data, it was concluded that LB provides a superior postoperative analgesic and surgical experience in comparison to PB.
  • Publication
    Sphenopalatine Ganglion Block Competency Based Education
    (2021-01-01) Andreanidis, Cathryn; Huang, Stephanie; Collard, Meredith L
    Abstract The sphenopalatine ganglion (SPG) block is underutilized as an intervention for treatment of craniofacial pain at the National Institute of Health (NIH) in Maryland. This project aimed to increase knowledge and competence of anesthesia providers by implementing a comprehensive educational seminar on the SPG block to answer the question “in anesthesia providers at the NIH, does an educational intervention improve knowledge on the SPG block immediately after the training and two months later compared with the pre-intervention period?” Both a theoretical framework, Miller’s Pyramid of Clinical Competence, and a conceptual framework, Train the Trainer, provided guidance for the development of the clinical educational program. A two-part educational seminar including an online module and in-person hands on simulation training was conducted between January to May 2021. Percentage scores from pre-test, post-test, two-month post-test questionnaires, and simulation evaluation were used to assess knowledge improvement, retention, and competency, respectively. Secondary measures included role, perceived knowledge and comfort level of SPG block administration. Results supported a significant difference between pre-test and post-test knowledge scores and between pre-test and two-month post-test (p=0.002), but no significant difference between post-test and the two-month post-test intervention (p=0.024). This indicated that there was an increase in knowledge following the intervention as well as knowledge retention. Furthermore, anesthesia providers demonstrated competency following simulation-based training. A didactic and simulation-based approach to education on the SPG block effectively provides both knowledge and competency. Keywords: sphenopalatine ganglion block, simulation, competency-based education, craniofacial pain
  • Publication
    Does Administration Timing of Ondansetron, a 5-HT3 Receptor Antagonist, Affect Inhibition of the Bezold-Jarisch Reflex in OB C-section Patients Receiving Spinal Anesthesia
    (2021-08-03) Zaharie, Spenser; Rowley, Matthew
    Ondansetron (a 5HT-3 receptor antagonist) has been shown in multiple randomized controlled trials (RCT’s) and meta-analysis to inhibit activation of Bezold-Jarisch Reflex (BJR) in response to spinal anesthesia for elective cesarean section patients. Studies have not determined whether the timing of administration changes the inhibitory affect of ondansetron in this patient population. This project addressed the following question: Does administration timing of Ondansetron, a 5-HT3 receptor antagonist, affect inhibition of the Bezold-Jarisch Reflex in obstetric cesarean section patients receiving spinal anesthesia? De-identified aggregated electronic medical record data for a one-year period was obtained. Data was grouped by ondansetron administration timing prior to spinal administration: ≤ 15 minutes (G1), > 15 minutes and ≤ 30 minutes (G2), > 30 minutes (G3). Blood Pressure (BP) data, including systolic, diastolic and mean arterial pressure (MAP), was included for four time points: pre spinal, 5-, 15- and 30-minutes post spinal. Change in BP from baseline were used for analysis. Total vasopressor usage was also included for analysis. Sixty-six obstetric cases were included, (G1 n=24), (G2 n=24) and (G3 n=18). Data was analyzed using the one-way ANOVA test for BP change scores and the Kruskal-Wallis for evaluating vasopressor use. No statistical significance between groups was found in BP change scores or vasopressor use. However, G3 did show greater drops in BP and increased vasopressor usage compared to G2 and G1. Further evaluation is recommended through either a large-scale retrospective study or randomized control trial (RCT).
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    Postpartum Hemorrhage Management Educational Quality Improvement Initiative
    (2019-01-01) Adams, Zach; Blanco, Benjamin; Roda, Adele
    Objective: To develop a multidisciplinary educational program to increase management and preparedness relating to postpartum hemorrhage (PPH). Design: In-person didactic lecture consisting of ten hemorrhage-related components in combination with a pre-test and post-test. Setting/Local Program: The project was conducted at a newly built mother-baby unit in a suburban, community hospital. Roughly 1,500 deliveries occur each year in which 12 were classified as PPH. Due to the unfamiliarity with the new obstetric population at this institution, a need was identified to implement education which consisted of improving PPH readiness, response, and recognition. Participants: The 39 participants, including an assistant partner, surgical technicians, and registered nurses with varying levels of education in the hospital’s perioperative and mother-baby unit, completed the educational PPH program. Intervention/Measurements: The program included a didactic lecture incorporating ten aspects of PPH management led by trained student registered nurse anesthetists. A prerequisite to the didactic portion was a pretest, which was then followed by a post-test. Results: The post-test indicated a 30% increase in scores compared to the pre-test and p < .01. The participants expressed an increase in knowledge and confidence related to caring for PPH management after the completion of the program. Conclusion: The multidisciplinary program which included didactic lecture and testing of knowledge retention improved the team’s confidence and knowledge of PPH management recognition, response, and readiness.
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    World Health Organizations Surgical Safety Checklist Project
    (2018-12-02) Lyons, Amber
    Medical error, especially in the operating room, claims the lives of patients and contributes to complications. A project was conducted to investigate the effectiveness of the World Health Organizations Surgical Safety Checklist. Communication, teamwork, and the readiness of use by the operating room team was measured. The project design was descriptive utilizing the Surgical Safety Checklist and a modified version of the Safety Attitudes Questionnaire Operating Room. Post-implementation responses to the Safety Attitudes Questionnaire Operating Room survey revealed a significant improvement in the surgical teams’ perception of teamwork and communication. Results show the World Health Organizations Surgical Safety Checklist improves teamwork and communication, and improves awareness of patient safety factors when consistently implemented before each operation.
  • Publication
    Opioid Prescriptive Practices in Adolescents
    (2019-01-01) Gewirtz, Justin; Carilo, Zyril