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Title: Intraoperative blood glucose management : a quality improvement project
Creator: Baker, Jake (Nurse)
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Perioperative hyperglycemia is associated with a myriad of post-surgical complications including an increased incidence of surgical site infections and prolonged hospital stays. The use of an evidence-based perioperative blood glucose management protocol reduces morbidity and mortality in adult patients undergoing surgical procedures. The project team describes a cost-effective quality improvement initiative aimed at improving protocol adherence by integrating an easy-to-use protocol...
Show morePerioperative hyperglycemia is associated with a myriad of post-surgical complications including an increased incidence of surgical site infections and prolonged hospital stays. The use of an evidence-based perioperative blood glucose management protocol reduces morbidity and mortality in adult patients undergoing surgical procedures. The project team describes a cost-effective quality improvement initiative aimed at improving protocol adherence by integrating an easy-to-use protocol algorithm, order sets, and practice reminders into an existing electronic health record system.
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Title: Improving perioperative nausea and vomiting prophylaxis protocol compliance
Creator: Franz, Allison
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: Postoperative nausea and vomiting (PONV) is a significant concern in anesthesia practice. Evidence-based guidelines have sought to provide recommendations on identifying patients at risk for PONV and mitigating its effect with multimodal antiemetic strategies. An anesthesia department within a large teaching hospital uses the Anesthesiology Performance Improvement and Report Exchange guidelines to identify and manage patients at risk for PONV. These guidelines are intended to integrate best...
Show morePostoperative nausea and vomiting (PONV) is a significant concern in anesthesia practice. Evidence-based guidelines have sought to provide recommendations on identifying patients at risk for PONV and mitigating its effect with multimodal antiemetic strategies. An anesthesia department within a large teaching hospital uses the Anesthesiology Performance Improvement and Report Exchange guidelines to identify and manage patients at risk for PONV. These guidelines are intended to integrate best practices into anesthetic care and improve overall surgical outcomes. The anesthesia department currently has a PONV protocol in place that aligns with the guidelines but has not achieved their compliance benchmark. This evidence-based quality improvement project describes interventions proposed to increase compliance with the PONV protocol. To address poor PONV compliance, an anonymous survey was developed to assess anesthesia provider's current familiarity with the new PONV guidelines and identify misconceptions. A visual feedback system was implemented using a preliminary confidential list that anonymizes staff. This allowed individual providers to identify their own performance in relation to their peers in a non-punitive way. The results of this quality improvement project demonstrate that the proposed interventions increased departmental compliance.
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Title: Development and implementation of an enhanced recovery after surgery protocol for women undergoing a mastectomy
Creator: Braun, Michael
Date: 2022
Collection: Doctor of Nursing Practice Projects
Description: This evidenced-based practice initiative includes the development and implementation of an evidence-based enhanced recovery after surgery (ERAS) guideline with a specific focus on the incidence of postoperative nausea and vomiting (PONV) and opioid administration in the postoperative setting. The clinical question was in adult women, age 18 years or greater, undergoing a mastectomy procedure, does the implementation of an ERAS guideline lower the incidence of PONV and reduce morphine...
Show moreThis evidenced-based practice initiative includes the development and implementation of an evidence-based enhanced recovery after surgery (ERAS) guideline with a specific focus on the incidence of postoperative nausea and vomiting (PONV) and opioid administration in the postoperative setting. The clinical question was in adult women, age 18 years or greater, undergoing a mastectomy procedure, does the implementation of an ERAS guideline lower the incidence of PONV and reduce morphine milligram equivalent (MME) requirements in a post-anesthesia care unit (PACU)? Patients undergoing breast cancer surgery have multiple risk factors and the reported incidence of PONV reaches up to 80%. Over half of post-surgical breast cancer patients develop neuropathic pain syndromes. A mastectomy ERAS guideline was developed then applied to the perioperative course of 22 patients. It was found that following an ERAS guideline reduced the incidence of PONV by 17% and reduced the average MME by 13.5 equivalents. Project implications include potential cost savings, reduced PACU length of stay, and improved patient outcomes.
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