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Evidence-Based Cognitive Aid on Rapid Sequence Induction for Non-Anesthesia Care Providers Outside of the Operating Room
Full text linkRapid Sequence Induction (RSI) outside of the operating room has been associated with life threatening complications, such as pulmonary aspiration, acute hypoxemia, and hemodynamic instability that can lead to cardiac arrest. Adverse events related to RSI occur due to inadequate knowledge surrounding airway emergency management strategies, induction medications, emergency airway equipment, and effective communication. This Doctor of Nursing Practice project intends to recommend important additions to cognitive aids for non-anesthesia providers to utilize in the intensive care unit (ICU) and emergency department (ED), with the goal of reducing complications that occur during rapid sequence induction
A Post-Intervention Assessment of Emergency Department Nurses\u27 Perception of Safety Following a Workplace Violence and De-escalation Training Program
Full text linkEvidence-Based Educational Module on Management of Multi-Modal Analgesia for Perioperative Providers
Full text linkInadequate perioperative pain management and reliance on opioids postoperatively has been associated with poor short- and long-term patient outcomes. A focus on provider education related to effective multimodal therapy preoperatively is essential to direct care for optimal postoperative patient outcomes
The Effectiveness of a Centralized Telemedicine ICU on Mortality and Length of Stay in an Adult ICU
Full text linkThe escalating number and complexity of critically ill individuals, aging population, and improved life-sustaining treatments have increased the demand for critical care beds. The projected intensive care nursing and intensivist shortage threatens the ability to provide safe, standardized care. Studies have shown favorable outcomes with the implementation of telemedicine ICU (tele-ICU). Significant costs are associated with adding human resources and technology to traditional care. A reduction in mortality and LOS is needed to demonstrate the return on investment of a tele-ICU model. This Doctor of Nursing Practice quality improvement project aims to measure the effectiveness of tele-ICU on mortality and LOS in adult ICU patients. The project employed a retrospective pre-post comparison of independent groups, utilizing a convenience sample from two ICUs at a tertiary hospital. The pre-intervention group (N = 394) received traditional ICU care, while the post-intervention group (N = 413) received traditional care supplemented with tele-ICU. Tele-ICU services were limited to 6:30 p.m. until 7:00 a.m. Data for the pre-intervention period were collected from April 16, 2023, to May 29, 2023, and for the post-intervention period during the same dates in 2024. A t-test for independent samples revealed no significant difference in LOS between the groups. Additionally, a chi-square test showed no association between tele-ICU implementation and mortality rates. Further investigation is necessary to assess the effectiveness of tele-ICU on LOS and mortality rates as it is adopted in other ICUs within the health syste
Evidence-Based Teaching Plan on Implementing LAST (Local Anesthetic Systemic Toxicity) Response Protocol
Full text linkLocal anesthetics are widely used in practice to control patients’ pain; however, local anesthetic systemic toxicity (LAST) is a potentially fatal risk factor that may occur after local anesthetic administration. Evidence-based education for providers could prevent the deaths of patients by increasing knowledge of pathophysiology, identifying varying signs and symptoms of local anesthetic toxicity, and implementing timely treatment. This doctoral project created an evidence-based teaching plan to educate perioperative providers on how to identify and more effectively respond to LAST
Evidence-Based Cognitive Aid for Anesthesia Providers on Preventing Perioperative Myocardial Infarction During Non-Cardiac Surgery
Full text linkPerioperative myocardial infarction has become the leading cause of mortality within 30 days of non-cardiac surgery, and equates to over one-third of perioperative deaths. Despite the significance of perioperative myocardial infarction, there is a lack of research on preventative strategies, and there is a knowledge gap among anesthesia providers on the identification of patients at a higher risk for developing myocardial ischemia, and the hemodynamic and pharmacological strategies aimed at preventing myocardial insult. Improvement in the recognition of high-risk patients and targeted anesthesia care is crucial to decreasing adverse patient outcomes secondary to myocardial ischemia. This Doctor of Nursing Practice project aims at reducing the knowledge gap observed on the prevention of perioperative myocardial infarction amongst anesthesia providers
Creation Of An Evidence-Based Cognitive Aid To Decrease Anesthesia-Related Adverse Respiratory Events In Non-Operating Room Areas Within Hospital Settings
Full text linkThe administration of anesthesia outside traditional operating room settings is a rapidly expanding practice that enables various procedures to be performed in non-operating room environments. Despite this growth, anesthesia providers face challenges due to the increasing complexity of cases, diverse patient comorbidities, production pressures, unfamiliar environments, and limited resources in emergencies, all of which greatly compromise patient safety. This Doctor of Nursing Practice project aims to identify essential components for a cognitive aid to support anesthesia providers in these non-operating room settings
Development of an Evidence-Based Teaching Plan for a Simulation Program on Mock Codes for Interdisciplinary Teams in Acute Care Facilities
Full text linkOver 200,000 cardiopulmonary arrests occur annually in medical centers. These events, frequently referred to as “Code Blue” medical emergencies, are responsible for significant morbidity and mortality in the hospital setting. Code Blue events require healthcare providers to respond swiftly and effectively in an attempt to improve outcomes and reduce patient safety threats, providers must be fully prepared to respond to Code Blue hospital events. To facilitate this preparation, an evidence-based mock-code teaching plan through structured simulation sessions was developed for hospital-wide distribution
Effects of a Virtual Nurse Pilot Implemented on a Medical-Surgical Hospital Unit
Full text linkThe Nation is experiencing the worse nursing shortage in its current history. Moreover, novice RNs that replace experienced RNs do not possess the experiential knowledge to identify subtle indicators of patient deterioration, leading to higher mortality rates in the hospital. New to practice RNs struggle with time management, organization and prioritization, competence, stress management, and confidence. Virtua Health leaders identified the risks associated with inadequate nursing staffing, level of RN experience, and the additional support required for increasing the nursing workforce with newer to practice RNs. This Doctor of Nursing Practice DNP project evaluated the outcomes of the Virtual Nurse Pilot program on a medical-surgical unit. Experienced Virtual Nurses partnered with less experienced bedside nurses to provide comprehensive safe care to their patients. The project used a before and after design and measured nursing quality outcomes, RN satisfaction, and patient satisfaction with nursing communication to determine if the pilot produced a positive effect for patients and RNs. Weekly Virtual Nurse Pilot quality and safety meetings were conducted via a Microsoft video conferencing tool (Teams) with steering committee RNs and nurse leaders during the pilot quality improvement project, which addressed concerns about operational processes such as most effective modes of communication and efficiency of certain virtual tasks that resulted in modifications made in real-time. Results of nursing quality indicators, RN satisfaction, and patient satisfaction with communication did not demonstrate any statistically significant improvements, however, average length of stay showed a 0.53-day reduction from before and after data collected. Virtua Health is in the process of expanding the pilot to all medical-surgical units in two divisions within the year. Plans are to end the pilot project in 2025, and transition Virtual Nursing as the Nursing Care model practiced on all medical-surgical units
An Evidence-Based Guideline for Patients Receiving Sedation with Obstructive Sleep Apnea During the Intraoperative Period
Full text linkPatients with obstructive sleep apnea who receive sedation intraoperatively are at an underestimated risk of serious injury such as anoxic brain injury, difficult intubation, and death throughout their perioperative period. A standardized, intraoperative guideline for patients with obstructive sleep apnea can be utilized to decrease risk for anesthesia-related complications. Evidence based strategies have the potential to reduce recovery time, improve resource utilization, lower costs, and most importantly, decrease risk for harm to patients. The goal of this DNP project is to develop a clinical practice guideline using best practices for anesthesia providers caring for patients with OSA