Evidence-Based Guideline on the Anesthetic Management of Patients in Recovery Programs for Substance Use of Opioids

Anesthesia providers tailor intraoperative management of patients to their specific needs when maintaining amnesia and analgesia throughout surgical procedures. However, providers are challenged to meet the needs of patients in active recovery for a substance use disorder, specifically opioids. An evidence-based, standardized guideline may be critical to assist anesthesia providers caring for patients with substance use disorder. Critical actions might avoid adverse effects of medications and anesthetics and prevent patients’ relapse of substance use. This doctoral project created an evidence-based guideline for anesthesia providers that is intended to prevent harm to patients undergoing surgery in recovery for an opioid-use disorder

Evidence-Based Cognitive Aid for Correct Patient Positioning in the Operating Room

All members of the perioperative team share responsibility to prevent patients from iatrogenic complications, particularly during patient positioning in the operating room. Incorrect patient positioning during surgery can have permanent and life-altering implications, specifically related to peripheral nerve injuries (PNIs). This Doctor of Nursing Practice project focused on the creation of an evidence-based cognitive aid to educate and assist the perioperative health care team members (PHTMs) to properly position patients for surgical procedures to enhance patient safety and assist in the prevention of the development of a peripheral nerve injury. Based on multiple in-depth conversations with anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs) and Morbidity and Mortality conferences, there appears to be a need to focus on the prevention of PNIs in the perioperative period

Effects of a Virtual Nurse Pilot Implemented on a Medical-Surgical Hospital Unit

The 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

Patients 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

Development of an Evidence-Based Teaching Plan for a Simulation Program on Mock Codes for Interdisciplinary Teams in Acute Care Facilities

Over 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

Evidence-Based Cognitive Aid for Anesthesia Providers on Preventing Perioperative Myocardial Infarction During Non-Cardiac Surgery

Perioperative 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

Development of an Evidence-Based Teaching Plan on Sharps Safety for Anesthesia Providers

Anesthesia providers are at high risk of sharps injury, which creates the potential for increased morbidity and mortality related to blood borne pathogens. An evidence-based Teaching Plan related to anesthesia practice is imperative to enhance preventive measures and reduce incidence of sharps injuries

Evidence-Based Cognitive Aid on Rapid Sequence Induction for Non-Anesthesia Care Providers Outside of the Operating Room

Rapid 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

The Effectiveness of a Centralized Telemedicine ICU on Mortality and Length of Stay in an Adult ICU

The 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

Targeting TGF-β During Epithelial-to-mesenchymal Progression as an Effective Therapy Against Colorectal Cancer

Colorectal cancer is one of the most common cancers worldwide. Understanding the mechanisms of colorectal cancer progression is crucial for the development of effective therapeutics. Epithelial-to-mesenchymal transition is a hallmark feature of cancer and is defined as the loss of epithelial cell features, such as apical-basal polarity and high expression of cell adhesion molecules, and the development of mesenchymal features, such as lack of polarity and increased cell mobility. Epithelial-to-mesenchymal is essential for cell migration, proliferation, and tumor growth. Both the TGF-β and SMAD pathway are associated with colorectal cancer progression. TGF-β is crucial to the cellular mechanism of cell differentiation and regulation. LY210976, a TGF-β inhibitor, has been proposed as a potential therapeutic for metastasis. The three studies reviewed here collectively demonstrated that LY2109761 is effective in reducing cell migration, invasion, and metastasis in mice and rabbit models. Combined with transcatheter arterial chemoembolization, inhibition of LY2109761 led to increased E-cadherin expression, indicating the maintenance of the epithelial cell phenotype, and suppressed tumor growth in rabbits. Together, these results suggest that LY2109761 is a strong candidate for inhibiting colorectal cancer spread. Future studies should continue to explore LY2109761 in preventing metastasis, especially in combination therapies in humans