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Investigation and Evaluation of SRNA Barriers to IANA Engagement
Get PDFThe Illinois Association of Nurse Anesthetists (IANA) and American Association of Nurse Anesthetists (AANA) are professional organizations representing Certified Registered Nurse Anesthetists (CRNAs). While AANA membership has risen from 27,000 in 1994 to 45,000 in 2014, there was a 5% decline in CRNAs who are members of the AANA (Farina, Wilson, & FitzSimmons, 2016). Farina et al. (2016) reported that of 5,032 CRNAs who were not AANA members, 2,549 had been CRNAs for less than 10 years. This project involved the development and use of a 21-question survey to identify barriers to involvement in the IANA for student registered nurse anesthetists (SRNAs). Forty-five SRNAs completed the survey, reflecting a 17.5% participation rate. The top three reasons SRNAs reported not using or attending IANA services were: lack of time (59.26%, n=16), stress (48.15%, n=13), and lack of knowledge on IANA and services offered (33.33% n=9). SRNAs reported the top three IANA events that would most interest them were: educational clinics (n=31; 68.89%), happy hours (n=26; 57.78%), and networking opportunities (n=23; 51.11%). The top three activities students reported to motivate them to maintain IANA membership were: hands on educational clinics (70.45%; n=31), lowered meetings/costs (52.27%, n=23), and CEUs offered online (47.73%, n=21)
Improving the Process of Making Preoperative Home-Medication Recommendations
Get PDFImproving the Process of Making Preoperative Home-Medication Recommendations
Many patients presenting for surgery have a list of prescribed medications they take daily to treat various comorbidities. Even though prescription drugs may offer patients therapeutic benefits during the perioperative period, they may also cause adverse effects when used in conjunction with anesthesia during surgery (Marley, Calabrese, & Thompson, 2014). Therefore, identification of medications for the preoperative patient to take or withhold is necessary.
Research indicates that clinicians often make inappropriate decisions regarding preoperative medication management in settings where no guideline exists (Renew, Bolton, Alvarado, & De Ruyter, 2015; Symons & McMurry, 2014). Because of this, a guideline was developed and implemented in order to improve the process of making preoperative home-medication recommendations at a regional hospital in central Illinois. The guideline was transposed onto a color-coded reference tool that nursing staff utilized during preoperative phone calls in order to appropriately instruct patients on which medications to take or withhold during the preoperative period. The nursing staff reported that the implementation of this guideline and reference tool improved the accuracy and efficiency with which they were able to give preoperative medication instructions to their patients. Future projects focusing on improving patient comprehension of instructions may be useful
Safe Sleep Modeling in the Neonatal Intensive Care Unit
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Approximately 3,500 babies die each year due to sleep related deaths. The 2016 American Academy of Pediatrics Policy Statement clearly states that all health care workers should model safe sleep for infants less than 12 months of age prior to discharge from the hospital. However, at a large, Midwest, level IV, University-based neonatal intensive care unit (NICU), safe sleep was not being modeled. The purpose of this project was to increase adherence to the American Academy of Pediatrics recommendations by implementing a unit-based quality improvement project focusing on policy development, staff education, and parent education.
Although starting out as a proposed change on only one unit, the strong acceptance at the Hospital Administration level and the System Board of Directors, the project has grown from a unit-based project to a System-wide project, and finally a state-wide initiative by the Missouri Division of Community and Public Health - to be their first state-wide newborn initiative. This change in implementation setting has delayed the original implementation. The Organization is planning a system-wide “kick-off” for the Safe Sleep Initiative March 1, 2020
Evaluation of obstructive sleep apnea in veterans with coexisting psychiatric symptoms
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There is a growing body of evidence that suggests a correlation between post-traumatic stress disorder (PTSD), nightmares with broken sleep, obstructive sleep apnea (OSA), and worsening of symptoms by OSA, Veterans who received treatment at a Midwest Veteran Affairs (VA) Center for Behavioral Health were often subject to variable wait times between scheduling of behavioral health and primary care providers (PCP). The purpose of the doctoral project was to reduce a Veteran\u27s wait time for evaluation by a PCP after having been identified as at risk for OSA during routine psychiatric evaluation. The project examined Veteran\u27s reports and measures of PTSD (47.82%), anxiety (56.52%), depression (65.21%), nightmares (39.1%), disrupted sleep (73.9%), sleep movement (21.73%), memory/concentration deficits (17.39%), suicidal thoughts (17.39%), Body Mass Index (43.6), hypertension (74.1 %), snoring (88.9 %), witnessed apnea (59.3 %), abnormal breathing/awakening gasping for breath (33.3%), gender (male 93 %; female 7%), age (46.5 years of age), and short neck (52 %). This project provided insight for behavioral health providers, PCPs, pulmonologists, and sleep medicine professionals about the special needs of Veterans at risk for OSA. Data resulting from this doctoral project contributed to the development of an assessment tool designed to more specifically meet the needs of evaluation of OSA in the Veteran with complex psychiatric symptoms by psychiatric providers. By eliminating the need for a secondary referral to primary care, this doctoral project reduced the wait time for diagnosis by 8-21 days
Reducing Emergence Delirium in Combat Veterans Through the Development of a Decision-Tree Utilizing Ketamine and Precedex
Get PDFEmergence Delirium incidences in the combat veteran population warrant unique anesthetic considerations. Examples of these considerations include the exclusion of a benzodiazepine and the use of low dose Ketamine or Precedex infusions. Researching these considerations, an anesthetic decision tree coupled with a screening questionnaire was developed and implemented in a hospital in Southern Illinois. The tool was developed based on a thorough literature review and a need to condense this information into a working knowledge for clinical application. Implementation of the project included staff education on the tool and the management of Emergence Delirium by using Ketamine and Precedex. A brief pre-test was given and then the provider was able to read the education material followed by a post-test. Results indicated an overall starting score of 80.6% that was raised to 95.1% following the education session. The post-implementation survey had eight responses in which all reported anesthetizing a combat veteran after the project implementation. Of the respondents, seven included using the project decision tree and none reported complications or Emergence Delirium. One respondent reported not using the protocol due to anesthetic plan conflict with another provider. This project positively improved patient outcomes while brining a researched anesthesia protocol into practice
Preventing Substance Use Disorder in Anesthesia Providers
Get PDFDeveloping substance use disorder is considered one of the most serious occupational risk factors for anesthesia providers. The purpose of this project was to identify the prevalence and risk factors of substance use disorder within the anesthesia community and to signify the importance of early education and awareness to help prevent the development of substance use disorder through early education, identification, and awareness. The project consisted of an educational PowerPoint that was placed on Southern Illinois University Edwardsville’s (SIUE) wellness website within Black Board. The third-year nurse anesthesia students at SIUE were sent an email on how to access the PowerPoint along with a nine-question online evaluation based on the PowerPoint provided. From the evaluation, nurse anesthesia students demonstrated a need for education regarding substance use disorder within the profession. Anesthesia students also agree that information regarding substance use disorder should be included in the new student orientation. These results correlate closely with the new evidence that early education, early identification, and awareness are key factors in the prevention of developing substance use disorder in the anesthesia provider
DNP Project: Improving No-Show Rates in Primary Care
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This paper explores the factors that contribute to no-show rates in the primary care setting and effective interventions to improve no-show rates. The average no-show rate in the primary care setting is 23%, (Dantas, Fleck, Olivaria, & Humacher 2018). In 2018, the no-show rate at the WeCare Clinic was 50-60%. A literature review was conducted to gather information regarding why patients choose to no-show their appointments, the common causes of high no-show rates, and effective interventions found to decrease no-show rates. We investigated the primary causes of a high no-show rate at the WeCare Clinic by interviewing staff and analyzing contributing factors at the site. We began implementing effective interventions based on our research including transportation resources, consistent front desk staff, and a reliable reminder system. The no-show rate decreased from 38.9 % in January 2019 to 30% in December of 2019. These sustainable and effective interventions have reduced WeCare’s no-show rate below that of the national average in the primary care setting
Improving Health Insurance Literacy Within Our Community Through the Use of Local Libraries
Get PDFLow health literacy is associated with a poorer ability to understand medical information leading to disparities among all ages. Communities play a role in supporting efforts to improve health literacy. Libraries are trusted institutes that offer an environment for all members of the community and serve as places of lifelong learning. A needs assessment approach determined a gap in knowledge regarding health literacy and insurance, specifically the Affordable Care Act (ACA). This project was an exploratory, community improvement project. Information was presented in educational sessions at two local libraries. Participants were also given an informative brochure to accompany the presentation. Surveys were administered before and after to examine the effectiveness of the presentation. The presentation was rated “good” or “excellent” by 87% of the total number of patrons. Before the presentation, only 5.13% of patrons stated that they knew most of the information, while 35.9% stated that they knew none of the information. The results of the post-survey found that 92.3% of patrons found the presentation helpful to very helpful. The postsurvey also revealed additional topics in which future projects can be created depending on the needs of the community at that time
Improving Perioperative Anxiety and Pain: Development of a Music Therapy Protocol
Get PDFPerioperative anxiety is strongly correlated with a higher incidence of post-surgery pain, an increase in the need for analgesics and anesthetics, and delayed recovery and discharge from the hospital (Jimenez-Jimenez et al., 2013; Kuhlmann et al., 2018). Finding multimodal approaches to ease anxiety and discomfort from unfamiliar hospital surroundings is necessary to reduce perioperative anxiety and subsequent physiological complications (Ni et al., 2011). A review of current evidence-based literature revealed that music therapy significantly decreases both perioperative anxiety and pain levels in adult patients undergoing surgery. For this quality improvement project, a music therapy protocol was developed in collaboration with agency stakeholders at a critical access hospital in southern Illinois. After an educational presentation demonstrating the positive impact of music therapy, and the introduction of the music therapy protocol, perioperative staff and anesthesia providers integrated this protocol for adult patients undergoing surgery. Staff were then asked to complete an online survey to evaluate their perceptions of the protocol. Survey results revealed that after using the protocol, staff members perceived patients had decreased levels of both anxiety and pain. Additionally, staff members found the protocol easy to use and showed a strong level of support in continuing to use the protocol
Laryngotracheal Stenosis
Get PDFLaryngotracheal stenosis (LTS) is the luminal compromise at the laryngeal, subglottic, or tracheal level (Gelbard et al., 2014). Various etiologies for LTS exist. Endotracheal cuff over-inflation, inappropriately sized endotracheal tubes, and sudden movements of the tube contribute to injury, as well as anatomical differences(Cardillo et al., 2010; Divatia & Bhowmick, 2005; Medina et al., 2009; Miñambres et al., 2009; Nikolovski et al., 2019; Zaghi et al.,2016). The influence of estrogen may contribute to the development of LTS in women during the third through fifth decades Dedo & Catten, 2001; Poetker et al., 2006; Valdez & Shapshay, 2002). The project goal was to provide an evidence-based presentation to potentially reduce the risk of LTS, at a tertiary care center in central Illinois. A pre- and post-survey was taken by 30 respondents, including nine physicians and 21 certified registered nurse anesthetists (CRNAs). The results of the project showed 100% of the respondents felt more knowledgeable about LTS, and 97% felt the information provided would positively impact practice change. Using a cuff manometer to determine accurate ETTc pressure was not an easily accepted practice change. Future projects could aim to identify specific barriers to cuff manometer use at the facility