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World Health Organizations Surgical Safety Checklist Project
2018-12-02, Lyons, Amber, 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.
Implementing and Evaluating a Sepsis Algorithm to Mitigate Acute Care Readmissions in an Inpatient Rehabilitation Facility
2020-12-28, Lockett, Michelle L, Lockett, Michelle L
BACKGROUND: Readmissions from post-acute care to acute care hospitals is well documented in the literature. Inadequate management of infection is a top readmission diagnosis and is often preventable. Nurse driven, protocolized treatment is the gold standard for treating sepsis patients in post and acute care settings. A quality improvement (QI) project was implemented in a 58-bed inpatient rehabilitation facility (IRF) to determine if a nurse-driven sepsis algorithm would decrease readmission rates to acute care hospitals, increase nursing staff sepsis knowledge, clinical confidence and communication. METHODS: This QI project was performed during a 3-month period in 2020. Readmission findings were compared before and after the study intervention implementation. Changes overtime in sepsis frequency were assessed through run charts. Pre- and post- survey data of sepsis knowledge, clinical confidence caring for a sepsis patient and care provider and clinician communication was assessed using a Wilcoxon Signed Rank Test. INTERVENTION: By utilizing the Systemic Inflammatory Response (SIRs) criteria, the Situation, Background, Assessment and Recommendation (SBAR) tool and Surviving Sepsis Campaign guidelines, a nurse driven sepsis algorithm was created and implemented in the rehabilitation facility. Additionally, pre-and post-surveys were administered to assess nurses’ knowledge of sepsis, clinical confidence in caring for a patient with suspected sepsis and bedside clinician to provider communication. RESULTS: Results show a decrease in readmissions to acute care hospitals post intervention but no statistically significant change in pre-post survey of sepsis knowledge, confidence or communication. CONCLUSIONS: An additional PDSA cycle of this QI project is needed to determine a true sepsis decrease overtime using the sepsis algorithm. A sepsis pre and post-test, and role play simulations may be key to a change in sepsis knowledge, confidence and communication. Keywords: inpatient rehabilitation facility, IRF, readmissions, sepsis, infection, surviving sepsis campaign, algorithm
Fall Prevention and Injury Reduction Utilizing Virtual Sitters in Hospitalized Patients
2020-12-08, Quigley, Beth, Quigley, Beth
Falls and fall-related injuries occur far too often in hospitals every year. The goal of the quality improvement (QI) project reported here was to reduce the number of falls and fall injuries in hospitalized patients using virtual sitters and continuous video monitoring (CVM) cost effectively. Run charts portray data trends for fall rates and fall related injury rates at the inpatient care facility in two-week increments over a six-month period. Descriptive statistics were collected to characterize the sample and setting, and differentiate components of the falls, falls with injuries and related costs. The literature review noted positive outcomes regarding both cost savings and reduction in fall rates with the launch of virtual sitters. The QI project with the implementation of CVM with virtual sitters depicted a 14% decline in fall rates and a 6% decrease in fall-related injury rates with a cost savings to the hospital. Plans for expansion of the program were underway with integration into the electronic health record. As modalities such as CVM with virtual sitters are adopted by more institutions, additional at-risk patients will be monitored for fall prevention and additional uses continue to prevail. Fall prevention and injury reduction remain at the forefront of quality care, keeping patients safe.
Preoperative Warming for Inadvertent Perioperative Hypothermia
2020-01-01, Zamarelli, Danielle, Yim, Tabitha, Hazan, Einbar
Inadvertent perioperative hypothermia (IPH) is a significant contributor to adverse patient outcomes, and ultimately translates to increased hospital expenditures. Evidence strongly supports the efficacy of prewarming surgical patients to reduce risk of IPH. While various surgical facilities have successfully implemented different methods of warming to reduce the frequency of IPH at their respective sites, the Veterans Affairs Medical Center (VAMC) does not currently have a standardized protocol for prewarming. With input and discussion from site stakeholders and project leaders, the authors developed a data collection tool to record temperatures at five pre/intra/postoperative intervals in 30 patients undergoing robotic procedures. The intervention was a minimum of 10 minutes of forced-air warming prior to surgery. More than half the patients (63%) experienced IPH. These findings suggest that IPH occurrence in a modest-sized patient group exposed to prewarming is not different than the national occurrence of IPH when compared to the national IPH frequency.
Minimizing Obstetric Hemorrhage
2019-12-30, DeLuca, Dena M., Kelly, Ashley D., McGuire, Helen M., Bent, Dawn E., DiDonato, Angela, DeLuca, Dena M., Kelly, Ashley D., McGuire, Helen M., Bent, Dawn E., DiDonato, Angela
Patients undergoing cesarean deliveries are at risk for hemorrhage. In fact, hemorrhage is the leading cause of preventable maternal mortality and accounts for more than 140,000 deaths each year worldwide (O’Brien & Ulh, 2016). Hemorrhage has been associated with a number of well-established risk factors which could be recognized prior to delivery. Women who do not have these risk factors could still experience postpartum hemorrhage, but using a risk assessment tool has been shown to identify 60-85% of women who will experience hemorrhage (Shields, Goffman, & Caughey, 2017). The postpartum hemorrhage (PPH) risk assessment tool, developed by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), identifies women with PPH risk factors. The tool allows clinicians to prepare for possible interventions and close monitoring of women at increased risk of bleeding, to ultimately prevent mortality. At a metropolitan hospital PPH risk assessments were not being discussed during standard pre-procedure huddles. This quality improvement project added the PPH risk assessment tool to the pre procedure huddle sheet. This facilitated interdisciplinary team discussion of PPH risk factors for patients undergoing cesarean deliveries. There were a total of 575 mothers in the study with 297 in the pre intervention period and 278 in the post. There was a statistically significant increase in estimated blood loss (EBL) between the pre and post intervention groups. While the study tool did not result in a decrease in EBL, it increased awareness among the interdisciplinary care team by facilitating discussion about PPH.
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, 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.
Association of Clinical Timing with Self-Efficacy Among Student Registered Nurse Anesthetists
2021-05-01, Le Dang, Diana, Vacca, Kevin, Carrillo, Emily, Le Dang, Diana, Vacca, Kevin, Carrillo, Emily
Objectives: To uncover new findings on how best to implement education and training among students in nurse anesthesia programs. Design and Methods: The target participants are nurse anesthesia students currently enrolled in an accredited Doctor of Nursing Practice (DNP) program that met inclusion criteria. An online survey was distributed to measure self-efficacy using the 10-item Likert-style Schwarzer & Jerusalem General Self-Efficacy Scale. Participants were recruited from a convenience sample of 72 Council of Accreditation (COA) accredited nurse anesthesia programs. Contact was made with program leadership to obtain permission and facilitate the dissemination of the surveys. Inclusion criteria: enrolled in accredited DNP program, integrative or non-integrative curriculum as defined by the study and expected graduation date within 12 months. Sample size, n=847 senior nurse anesthesia students. Independent variable: curriculum structure (integrative or non-integrative). Dependent variable: composite score on General Self-Efficacy Scale, ranging from 10-40. Primary Results: Mean composite scores on the GSE survey were (33.37 ± 3.23) and (33.91 ± 3.52) for integrative and non-integrative programs, respectively. The mean composite score for participants in a non-integrative curriculum was 0.54 (95% CI, -1.69 to 0.60) higher than mean composite score for participants in an integrative curriculum. The independent samples t-test concludes that there was not a statistically significant difference in the mean composite scores between participants in an integrative and non-integrative curriculum t (138) = -0.940, p = 0.35, d= 3.40. Principle Conclusions: There is no statistically significant difference between the reported self-efficacy scores among students in both integrative and non-integrative curriculum.