Introduction of a Spinal Care Pathway Triage Protocol in the Secondary Care Setting

Background: Back pain is considered the leading cause of disability worldwide. Providing effective multidisciplinary care for clients with chronic back pain (CBP) has been an ongoing issue globally. Improper care management of CBP creates personal, economic, and societal burdens that significantly affect patients, their families, and the healthcare system. Purpose: This quality improvement project aimed to successfully integrate a spinal care pathway (SCP) electronic decision support tool (e-tool) into a multidisciplinary spinal care program, to improve providers’ satisfaction with care delivery and their satisfaction with CBP patient outcomes. Methods: This DNP project used an evidence-based quality improvement (EBQI) design to introduce an SCP e-tool into a multidisciplinary spinal care program, a secondary healthcare setting. The Institute for Healthcare Improvements’ Plan-Do-Study-Act cycle was used as the pilot change process to evaluate the effects of an SCP use on CBP patients’ delivery of care and healthcare providers’ satisfaction rates. Results: Of the NSI staff who participated in the surveys, 57.14% agreed, and 42.86% highly agreed that the SCP e-tool is and will be helpful in collaboratively triaging their CBP patients to the most appropriate care modalities to decrease pain and increase functionality, which is a critical metric indicator. (N=7). Conclusion: The SCP e-tool is a novel electronic clinical decision support tool that will provide an evidence-based method to improve the quality and delivery of care for CBP patients. The results of this EBQI project revealed clinical relevance to support the integration of the SCP e-tool into the NSI’s secondary clinical practice setting

Hyperoxemia Education to Nurses to Increase the Adherence to Oxygen Weaning Goals in Inpatient COPD Patients.

Hyperoxemia in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at risk for increased hospital stay, mechanical ventilation, and increased risk of death. Literature supports that establishing increased education to nursing staff on the risks of hypoxemia to increase adherence to oxygen weaning protocols has the potential to improve future practice. Oxygen weaning protocols are often not followed for concern of patient care. Nurses may believe to be helping patients when increasing oxygen, when they could actually be potentially harming them. Increased education on hypoxemia in COPD patients for the nursing staff will assist them to feeling more comfortable following oxygen weaning goals to achieve ordered O2 saturation for their patients. This DNP project focused on evidence based data for hyperoxemia in AECOPD patients with education for nurses to enhance their knowledge. The nurses were presented with an educational poster presentation and a post test to evaluate their hyperoxemia knowledge in AECOPD patients. The educational goal for improvement was to have the nurses to score 80% or higher on the post test. This goal was achieved, implying it was a successful strategy for improvement of knowledge. For future projects in this topic, it would be beneficial to have include a pre and post chart audit to evaluate if the education is being implemented into nursing practice

Art as Experienced by a Female Combat Veteran Using the El Duende Process Painting.

This single-participant phenomenological case study seeks to determine how a female combat veteran experiences art therapy. The case study participant is a female veteran who served in Iraqi Freedom and Enduring Freedom. While painting on a single canvas, the participant followed Miller’s El Duende process painting procedure (2012) and kept a written and pictorial journal of the experience. The research involved five sessions during which the participant annotated her thoughts and feelings on the experiential expressions chart for each session. These charts were analyzed to identify the mechanism of change in art therapy for the participant. The participant’s journals indicated initial tension followed by insight and relaxation by the end of each session, signifying that the process provided a means for emotional release as the veteran explored her inner feelings and memories by painting them into her artwork

Utilizing the Anatomage Virtual Dissection Table for Learning Neuroanatomical Structures in Nurse Anesthesia Programs

Certified registered nurse anesthetists are responsible for developing expertise in neuraxial anesthesia. A thorough understanding of anatomy and physiology is essential in the performance of subarachnoid and epidural blocks. Although cadaveric dissection is considered the gold standard for learning anatomy, student use of cadavers can become limited due to supervisory, ethical, accessibility, and financial constraints (Periya and Moro, 2019). In recent years, the evolution of technology has produced a virtual option for cadaver dissection (Washmuth et al., 2020). The anatomage virtual dissection table is a tool that could be used to increase knowledge of neuroanatomical structures and their spatial relationships in place of cadaveric dissection. Learning modules were developed utilizing the anatomage table to learn and review anatomy pertinent to neuraxial anesthesia. Second-year anesthesia students at the host Nurse Anesthesia Program in their Fall 2022 semester participated in implementing these modules. Pre- and post- surveys analyzed with a Paired Two Sample t-test demonstrated significant improvement in the student’s knowledge and confidence when administering neuraxial anesthesia after completing the provided modules. The improvement in knowledge in neuroanatomy leads to greater success and patient satisfaction when performing epidural or spinal anesthesia. Keywords: virtual dissection, neuraxial anesthesia, anatomage tabl

Improving Traumatic Brain Injury Outcomes: Early Identification and Management of Paroxysmal Sympathetic Hyperactivity

Abstract Background: Paroxysmal sympathetic hyperactivity (PSH) can occur in patients with acutely acquired brain injury and is associated with mortality, poor clinical outcomes, prolonged hospitalizations, physical disability, and increased healthcare costs. The most common cause of PSH syndrome is traumatic brain injury (TBI). Symptoms consist of hyperthermia, diaphoresis, arterial hypertension, tachycardia, tachypnea, and extremity motor dystonic posturing, often in response to evoked stimuli and occurs in 8% to 33% of TBI patients. Critical care nurses are at the forefront of providing direct patient care to TBI patients and are often the first to identify PSH. Purpose: The objective of this quality improvement project (QI) was to comprehensively evaluate the literature and provide evidence-based information regarding PSH to nurses, advanced practice providers, residents, and trauma/surgical critical care attendings who deliver care to TBI patients in a surgical trauma intensive care unit (ICU). Methods: An integrative literature review was performed, PowerPoint was created to conduct seminars, and pre-and post-test analyses were obtained to evaluate knowledge attainment of the management of PSH. The overall goal of the educational seminars was to increase scores by \u3e20% for adequate knowledge attainment, which was obtained. Limitations: high acuity patients, staffing schedules, seminar timing, and lack of perceived educational need by providers. Conclusion: This QI project identified a gap in clinical knowledge and practice surrounding PSH in TBIs. Continuous education on PSH is imperative to promote early identification and timely management for prevention of secondary brain injury and worsening healthcare outcomes in this complex patient population. Author Contact Information Randi Rockwell [email protected]

Foley Catheter Algorithm

Urinary catheterization, indwelling and intermittent are simple and common procedures performed in hospitals, emergency rooms, nursing homes, and clinics to ensure adequate urinary output in patients who cannot void efficiently or closely monitor fluid intake and output. Though simple and straightforward in most cases, catheterization can become a challenging procedure with complications in the absence of a standardized protocol for difficult catheterization (Ghaffary et al., 2013). This Quality Improvement Project aimed to develop a standardized Foley catheter algorithm/ flow chart available in our institution\u27s intranet and laminated charts in nursing stations and procedure rooms with Foley catheter insertion indications, types, sizes, mindful patient history, and indications to consult with the urology team to decrease complications and morbidities due to catheterization in patients as well as to decrease healthcare financial burden. Data collection for the project was done in the level one emergency room through a pretest to identify the areas of knowledge deficit, followed by a 20-25 minutes educational PowerPoint presentation for the staff (nurses, advanced practice providers, and physicians) in the emergency department followed by a posttest questionnaire to evaluate the efficacy of the education. The data were analyzed using the Wilcoxon signed-rank test, which showed that the 20-25 -minute presentation on Foley Catheters elicited a statistically significant change in participants\u27 knowledge on catheter

Remifentanil in Labor Analgesia

Labor has the potential to be the most excruciating and intense physical pain a woman experiences in her life. Neuraxial anesthesia, which includes epidural, spinal, or combined spinal-epidural technique, is the gold standard for pain control in laboring patients (Lee et al., 2017). Seemingly forgotten, a subset of parturients cannot experience the benefits of neuraxial anesthesia due to several absolute and relative contraindications. These women rely on other options for labor pain control. Remifentanil has emerged as a preferred opioid option for labor and delivery due to its rapid onset (peak effect in 1.1 minutes) and rapid metabolism by non-specific plasma esterases (Glass et al., 1999). The purpose of this project was to educate obstetrical anesthesia providers, obstetricians, residents, and pharmacists at a level 3 perinatal center in Central Illinois on remifentanil patient-controlled analgesia (PCA) for laboring parturients as an alternative to neuraxial analgesia. An evidence-based remifentanil PCA dosing regimen was also recommended. The results of the project implied that there was an increased understanding of remifentanil and an increased buy-in for the implementation of a remifentanil PCA at the facility. A recommendation is to follow up to determine if a remifentanil PCA standardized protocol has been implemented

Implementing the Timed Up and Go Test to Prevent Falls

Falls are the most reported injury within the geriatric population. Behavioral health patients have the most injurious falls, with falls impacting multiple things such as staffing, cost, injury, and quality of life for the patient (Ocker et al., 2020). Currently, the standardized fall assessment for new patients upon admission is the Morse Fall Scale (MFS). This fall assessment was intended to assess the level of fall risk for patients who are on an acute medical floor during their hospital stay. The Timed Up and Go test (TUG) is a fall assessment that has been used in geriatric patients to assess their level of fall risk but has not been specifically used in a psychiatric geriatric setting to determine if the assessment tool would be more suitable than the MFS. The purpose of this project is to determine if the TUG is a more appropriate tool to aid in identifying fall risk amongst the inpatient psychiatric geriatric population in addition to using the MFS. After the demonstration, education, and implementation of the TUG test by nurses, a survey was conducted with the nurse to determine if the TUG test would be beneficial to use in the mental health geriatric unit. The survey suggests that 20 nurses (95.24%) think that the screening tool is effective in identifying falls. There are 2 nurses (9.52%) that believe the TUG screening tool can be used independently when screening for falls. Twenty-one nurses (100%) reported that one of the benefits of the TUG screening was that it is directly aimed at the geriatric population. Sixteen nurses (80%) reported the benefit of having an extra tool to assess patients for falls upon arrival. Fifteen nurses (71.42%) reported that one of the biggest challenges is the decreased length of hospital stay, so the tool is not used often related to longer hospitalizations. Twenty nurses (95.24%) reported that the TUG screening tool is easy to follow and comprehend, and 21 nurses (100%) reported that the screening tool is time efficient while doing an admission or assessing a patient post-fall. If the nurses continue to use the TUG test on the unit, there could be data collected from the fall rates that sshowimprovement in patients’ falls

Prophylactic Tranexamic Acid Administration to Prevent Postpartum Hemorrhage After Cesarean Delivery in Patients at High Risk of Severe Postpartum Bleeding

Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Cases of PPH are increasing in the United States, and despite current treatment recommendations, mortality remains high. This project included a review of the research on the use of prophylactic tranexamic acid (TXA) administration to prevent or reduce blood loss after cesarean delivery. Statistics regarding the impact of PPH and the pharmacology of TXA were reviewed in detail. Evidence shows that TXA is safe for parturients and nursing infants. Further evidence shows prophylactic TXA administration is associated with a modest reduction in blood loss, the need for blood transfusion, and post-delivery drop in hemoglobin and hematocrit after cesarean delivery. This information was shared with obstetric and anesthesia staff at a level III perinatal center in central Illinois as an informative PowerPoint presentation. Thirteen pre and post-test surveys were collected from staff which showed an improvement in knowledge regarding the use of TXA as a prophylactic measure in the management of PPH. The goal of this project was to ensure that the individuals providing direct patient care are aware of up-to-date research findings on this therapy which may clinically benefit their patients