The COVID-19 pandemic has highlighted the need for additional health precautions in medically fragile populations. COVID-19 is a respiratory virus demonstrating increased mortality in individuals with risk factors such as pulmonary and cardiac disease. Pulmonary arterial hypertension, WHO group 1, is a rare condition that leads to cardiopulmonary symptoms. Pulmonary arterial hypertension, WHO group 1 (PAH), leads to constriction of the pulmonary vasculature which increases pressure in the right ventricle, and eventually leads to right heart failure. Additional research is needed to understand the risk PAH patients have with COVID-19 and if they are at a greater risk for disease worsening as evidenced by increased need for medical intervention, hospitalization, or even death. This project explores the relationship between the COVID-19 pandemic and pulmonary arterial hypertension, WHO group 1, patients at a single center. Adult patients diagnosed with PAH prior to March 1, 2019, at the Ascension St. Vincent Pulmonary Hypertension Clinic will be included in the study. A retrospective chart review will index hospitalization events, markers of disease worsening, and mortality in established patients and compare if there is statistical significance between the pre-pandemic period of March 1, 2019, through February 29, 2020, and during the COVID-19 pandemic period of March 1, 2020, through February 28, 2021. This study will increase the information known about the impact of COVID-19 on patients with PAH.
The United States Preventative Services Task Force (USPSTF) recommends initiating colorectal cancer screening for asymptomatic, average-risk individuals at age 45, which is a new update to the previous recommendation of age 50. Early detection of colorectal cancer reduces mortality compared to treatment in advanced stages of disease. Strategies shown to increase screening rates include the discussion of multiple modalities for screening, a systematic approach to identifying eligible patients, healthcare provider recommendation and teaching for screening, and overcoming individualized patient barriers to screening. This project was conducted in partnership with the Coalition of Advanced Practice Registered Nurses of Indiana (CAPNI) to better understand the knowledge and recommendation practices of Indiana nurse practitioners. A survey based on a previous study of primary care physicians by Chapman et al. (2012) was distributed to CAPNI membership regarding recommendation practices and utilization of screening guidelines. Colonoscopy was the most commonly recommended screening modality, followed by fecal immunoassay testing with DNA testing (FIT-DNA). No statistically significant difference was found in completion rates between colonoscopy and stool-based tests, as reported by providers. Most participants utilized guidelines from a professional organization to guide their recommendations for screening, but only 37.25% utilized those from the USPSTF. The majority of providers indicated they utilized a chart notification system to identify patients for screening and would offer additional modalities for screening if patients declined their first-recommended modality. USPSTF guidelines changed during the implementation of the project, influencing responses. Additional research with a larger sample size may aid in targeted educational opportunities to increase screening.
Background: Many patients seek the advise from their primary care providers (PCPs) to provide insight into alternative treatment options, however, little is known about the practices of primary care providers (PCPs) and the referring of Complementary and Integrative Medicine (CIM) treatments for patients with migraine pain. CIM is the practice of evidence informed modalities such as traditional Chinese medicine and mindbody strategies to assist in the health and healing processes.
Purpose: The purpose is to determine if Ascension St. Vincent Indianapolis PCPs are referring CIM treatments to their migraine patients, and if not, what prohibits providers from utilizing these treatments with their migraine patients.
Methods: A 10-question survey was distributed to 243 primary care providers (PCPs) of the Ascension St. Vincent Indianapolis network.
Implementation Plan: The 10- question survey was distributed to the PCPs of Ascension St. Vincent Indianapolis via their Ascension emails. The collection and analysis was conducted through the online database, REDCap from September 29 to October 31,2021.
Results: 29 responses were received (11.90%). There was no significant correlation between the provider’s professional background and their perceptions of CIM. There was a significant correlation between the provider survey responses and the provider’s gender.
Background: A child’s pain is different from pain experienced as adults. Different emotional and psychological factors can affect the child’s pain comprehension and stimulate their response to pain. Procedural pain can have long-term negative effects on children. It may cause increased pain sensitivity, fear, and avoidance of healthcare as adults. Parents may also experience anxiety during their child’s procedure, which may increase their child’s perceived pain.
Problem: This DNP project aimed to implement and evaluate the usage of the Buzzy device during painful procedures of children ages three through six years at this pediatric hospital. Distraction can be used to decrease pain perceptions in children and parents, which could positively affect long-term memories.
Interventions: The nurses utilized Buzzy with children aged three to six years of age needing venipuncture. Staff provided a pain survey to each patient who received Buzzy before and during a painful procedure. Parents were contacted at 2 weeks and 1-month post-procedure to assess pain perceptions. Results: Ninety-six patients participated in the study. An 84.6% response rate was acquired from the surveys. Ninety-seven percent of parents and patients surveyed reported decreased pain with venipuncture using Buzzy. Pain perceptions decreased with the use of Buzzy both short-term and long-term.
Conclusion: The positive response from patients and parents demonstrates Buzzy may be used to decrease pain perceptions in children and families. The success rate shown in this study will aid in distraction techniques used as pain management to be added to evidence-based practice in the future.
Background and Review of Literature: A surgical site infection after posterior instrumented spinal fusion can negatively affect the patient and increase healthcare costs. Spinal fusions are becoming increasingly common as a surgical intervention to correct a variety of spinal pathologies. Infection in this population poses a significant problem as infection can lead to additional surgeries, debility, or mortality. Purpose: A group of neurosurgeons implemented a novel protocol to prevent surgical site infection, including irrigating the wound with Clorpactin and applying vancomycin powder intrawound before closing. This investigation seeks to identify surgical site infections and compare infection control measures. Methods: A retrospective chart review was conducted on patients who underwent posterior instrumented spinal fusion between August 2017 and December 2020. Data was collected from the Electronic Medical Records. The data was analyzed using statistical software. Implications/Conclusion: The results significantly reduce postoperative infections in the group exposed to the Clorpactin/vancomycin infection control protocol.
In 1984, Ultrasound-Guided (USG) Intravenous (IV) access was first used to place central venous catheters (CVC) in real-time. This led to increased success rates, reduced procedural times, decreased site associated complications, and a standard of care. As USG technology and teaching methods for CVC placement have improved, studies suggest this technique could also be translated into peripheral intravenous (PIV) placement. A retrospective chart review was conducted at an emergency department within a large healthcare facility to determine the reliability of USG PIVs when compared to landmark PIVs. The principal investigator reviewed the charts of adult inpatients admitted into the hospital from the Emergency Department (ED) comparing those who acquired landmark IV verses USG IV access to assess overall reliability. The data included IV survival rates, success rates, and site complications. 30 landmark and 17 USG PIVs were reviewed. Among the landmark PIVS, survival rates and success rates could not be measured. No site complications for landmark PIVs could be found. Among the USG PIVs, survival rates of only three could be found out of 17. No success rates could be measured. Only four site complications or reasons for PIV discontinuation could be found, including two counts of occlusion, one expiration, and one catheter damaged. In conclusion, due to limitations and lack of data found in this review, significance between variables could not be determined.
BACKGROUND 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.
Background 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 cmH2O 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.
Background 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.
Background: 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.