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Pope Francis’ Theology of Young People: The Impact it Will Have for Catholic Youth and Young Adult Ministry in the United States
No full textPreoperative Administration of Acetaminophen for Women Undergoing Hysterectomy Reducing Opioid Consumption in the Postoperative Setting
Get PDFThere has been increased attention to pain control as well as patient satisfaction following surgical procedures. The interest in pain control coupled with the growing opioid epidemic has prompted anesthesia providers to utilize protocols that consist of multimodal techniques during the perioperative period to reduce post-surgical pain and improve patient outcomes. The postoperative consumption of opioids among adult patients that received preemptive acetaminophen (Ofirmev) were compared to those that did not to determine the impact of preoperative analgesics. This pain management implementation was measured among female patients that underwent hysterectomies. The sample included 39 female patients that received a hysterectomy (laparoscopic or open). Among the patients studied, there was no clear reduction in postoperative pain medications for those that received preoperative acetaminophen (Ofirmev) as the sole adjunct compared to those that did not receive Ofirmev preoperatively. There was also no definitive decrease in the pain scores or time to first dose of medication in the postoperative period for patients that received Ofirmev compared to those that did not. Data trends prove there is a need for postoperative opioid dosing education among PACU nurses that are administering opioids. There needs to be additional studies with more participants and defined controls to determine the true impact of this new multimodal approach
Assessing Anesthesia Provider Recognition and Compliance of the World Health Organization Five Moments of Hand Hygiene in the Operating Room
Get PDFBACKGROUND AND LITERATURE REVIEW: Hand hygiene (HH) is the number one way to reduce healthcare associated infections (HAI). These infections account for increased morbidity and mortality and are linked with poor HH among anesthesia personnel. Anesthesia provider HH compliance is low, and with solid HH guidelines available, increasing their compliance is paramount in reducing HAIs. PURPOSE: This study aims to assess anesthesia provider HH recognition and compliance among student registered nurse anesthetists (SRNA) at Marian University and certified registered nurse anesthetists (CRNA) at a large urban academic hospital in St. Louis, Missouri. METHODS: A one-time eleven question survey will be administered online through Qualtrics assessing knowledge and compliance of the WHO five moments of HH in the operating room (OR). The survey is based on a validated survey instrument and consists of five questions regarding moments to perform HH and six questions regarding demographics. IMPLEMENTATION PLAN/PROCEDURE: Over four weeks, the survey will be administered to 170 anesthesia providers to include 101 CRNAs, 68 SRNAs, and 1 MDA. Qualtrics will be utilized to deliver the survey link to respondent emails and collect responses electronically. This project is supported by Marian University, Leighton School of Nursing, Department of Nurse anesthesia faculty. IMPLICATIONS/CONCLUSIONS: Increasing HH among anesthesia providers will reduce HAIs and increase patient outcomes. Multimodal strategies work best, including increased access to HH products and those that include an education element. Long term success of these interventions is related to sustainment efforts of the institution and will likely decrease over time without them. Understanding current HH recognition and compliance is the first step to increasing HH performance rates and is the focus of this study
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
Get PDFBackground 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
Intraoperative Cuff Pressure Monitoring of Airway Devices: An Evidence-Based Educational Intervention
Get PDFBackground and Review of Literature: Subjective methods for assessing airway device cuff pressures (CP) remain in use to determine correct inflation, despite evidence indicating inadequate sensitivity for identifying under and overinflation. Inadequate CP can cause tissue ischemia, mucosal ulcers, stenosis, and aspiration. Recommendations for endotracheal tubes (ETT) CP are 20 to 30 cm H2O and ≤ 60 cmH2O for supraglottic airway (SGA) devices. Currently, there are no guidelines for intraoperative monitoring of airway devices. Manometers are the most accurate and accepted method for assessing CP; however, they are underutilized intraoperatively.
Purpose: The project goal was to promote CP assessment intraoperatively with manometry and create a practice guideline for measuring and monitoring CP.
Methods: A literature review was performed to evaluate recent evidence on CP assessment for airway devices to develop practice guidelines for intraoperative monitoring of CP. A group of 23 licensed anesthesia providers participated in the project. Pre-and post-surveys were utilized. Evaluation of current knowledge, methodology, rating of importance, and willingness to adopt manometry for CP intraoperative monitoring was obtained. Education on CP monitoring was discussed with participants, followed by post-survey. Pre-survey was used to evaluate participants’ current methods for ETT and SGA CP assessment. During routine intubation, participants were asked to inflate an airway device using their preferred technique to determine adequate CP. Readings for CP were measured using a manometer device approved by the Food and Drug Administration (FDA). Data for their corresponding CP reading was shared with participants, and educational information reflecting current evidence for CP monitoring. Post-survey was then performed to evaluate the participants’ willingness to adapt CP assessment with manometry into their practice.
Conclusion: Intraoperative CP was predominantly performed with subjective techniques. Anesthesia providers expressed a willingness to assess CP with manometry, posing education as a possible foundational step for future implemention of CP monitoring in the operating room (OR). Lack of guidelines for CP monitoring intraoperatively and variability in monitoring CP due to subjective assessment methods emphasized the need for standardization and the increased availability of manometry devices for intraoperative use
Inadvertent Perioperative Hypothermia: A Retrospective Chart Review
Get PDFBackground: Inadvertent perioperative hypothermia (IPH), defined as recorded temperature at or below 36°C (96.8°F), is a common adverse effect that can occur during any surgical procedure, leading to increased postoperative morbidity and mortality. The data was analyzed for statistical significance and plotted on a graph to show the mean and median temperatures, along with the highest and lowest during each phase of care.
Purpose: The purpose of this project is to examine core temperatures in total knee arthroplasty (TKA) patients at four different phases of care: preoperatively, procedure start time, procedure stop time, and postoperatively.
Methods: A retrospective chart review will be completed to collect temperatures for using the 3M Spot-On core temperature monitoring device on 38 patients undergoing TKA procedures.
Implementation: The data will be analyzed plotted on a graph to show the mean temperatures, along with the highest and lowest temperatures during each phase of care.
Conclusion: Patients were found to be hypothermic at the beginning and end of the procedure. On average, patients were 95.5°F at the start of the procedure and 96°F at the end. Preoperatively, patients were 98°F and 97.3°F in the recovery room
Comparing postoperative pain scores and opioid consumption in patients receiving Lumbar Plexus block versus Fascia Iliaca block after undergoing hip arthroplasty
Get PDFBackground and Review of Literature: Lumbar plexus block and fascia iliaca block are two commonly used anesthesia modalities for patients underdoing hip arthroplasty at Union Hospital in Terre Haute, Indiana. Currently, there are not any studies that demonstrate which block is more effective at reducing postoperative pain and opioid consumption after hip arthroplasty. Review of literature demonstrates that both blocks have their advantages and disadvantages for providing postoperative pain relief.
Purpose: To determine which block is more effective at reducing postoperative pain, opioid consumption, and length of stay in hospital after hip arthroplasty procedures. These findings will then be presented to anesthesia staff at Union Hospital.
Methods: A retrospective chart review will be conducted on 25 patients that received a lumbar plexus block and 25 that received facia iliaca block. Pain scores and opioids consumed will be calculated for each patient in each group to determine which block provides superior pain relief. Overall length of stay will be calculated for each block group as well. Microsoft Excel and SigmaXL were utilized to analyze the data. ClinCalc opioid equivalent calculator was utilized to convert all opioids administered into intravenous morphine milliequivalents
Conclusion: This project demonstrated that the fascia iliaca block was superior at reducing postoperative pain (P = 0.045) in PACU as well as reducing overall opioid consumption (P = 0.0056) when compared to the lumbar plexus block. However, length of stay in hospital and pain score at 24 hours were similar. Difficulty of block and anesthesia provider experience must also be considered
Metacognition: The Best Tool to Improve Learning!
Get PDFToday’s students come to college with widely varying academic skills, approaches to learning, and motivation levels. Many students have found it particularly difficult to learn remotely and have lost motivation. This session focused on the importance of helping students acquire simple, but effective, learning strategies based on cognitive science principles. The audience engaged in interactive reflection activities that allowed attendees to experience strategies that significantly improve student success by transforming students’ attitudes about the meaning of learning. Some of you may recall Dr. McGuire’s book, Teach Students How to Learn, which was read for the CTL book club in spring 2020 and is a Stylus Publishing bestseller. Dr. McGuire is the Director Emerita of the Center for Academic Success and retired Assistant Vice Chancellor and Professor of Chemistry at LSU
Sara
Get PDFThis novel is a semi-autobiographical work of fiction by Sara Cornelius Allison, wife of Indianapolis businessman and co-founder of the Indianapolis Motor Speedway James Allison. The work details the tumultuous relationship of the Allison family set within the the city of Indianapolis, on the Allison estate which is now owned by Marian University