Standardized Handoffs For Anesthesia Students

Communication between healthcare providers is an essential aspect of caring for patients. Effective communication is vital during the patient handoff process. The patient handoff process involves exchanging patient’s medical information between a provider currently caring for the patient and the provider assuming care of the patient. If the information exchanged during the handoff process is inaccurate or essential information is omitted, that could potentially lead to harmful consequences for the patient. Currently, no standardized handoff tool exists for student registered nurse anesthesia students (SRNAs) in clinical practicum at the local level one trauma center. The lack of a standardized handoff tool at this facility suggests an increased likelihood of communication errors during the handoff process. The purpose of this quality improvement project is to implement a standardized handoff tool called the AneSBAR tool that SRNA students can utilize in their practice to ensure proper and effective handoffs in the post-anesthesia care unit (PACU) and the intensive care unit (ICU). The inclusion criteria for the project are 2nd or 3rd-year SRNA students currently enrolled full-time in the local Certified Registered Nurse Anesthetist (CRNA) program. The quality improvement project will follow a Plan-Do-Study-Act (PDSA) model. Both qualitative and quantitative data will be collected to determine the impact of the standardized handoff tool. Data collected from surveys and simulations will determine if the PDSA cycle needs repeated or if the QI measure is ready for implementation

Educating Student Registered Nurse Anesthetist on Malignant Hyperthermia Using an Objective Structured Clinical Examination

Malignant hyperthermia (MH) is a low-frequency, high-impact event that many student registered nurse anesthetists (SRNA) may be unprepared to manage due to limited exposure in clinical practice (Hackl et al., 1990). Lack of preparation for dealing with such low frequency, high impact events can lead to unfortunate adverse events resulting in death (Hackl et al., 1990). Thus, students should be are prepared to handle these situations if an event should occur. An objective structured clinical examination (OSCE) is a structured method used to assess certain skills and underpinning knowledge required for practice (Harden & Gleeson, 1979). Students are allowed to demonstrate their competence in a given topic under a variety of simulated conditions. The purpose is to evaluate students objectively and independently of the examiner which eliminates bias (Smrekaret al., 2017). The purpose of this doctoral project is to provide an evidenced-based objective structured clinical examination to The University of Sothern Mississippi (USM) Nurse Anesthesia Program (NAP) using the Malignant Hyperthermia Association of the United States’ (MHAUS) MH protocol. Thus, an OSCE template was created based on the best recommendations supported by MHAUS. The template includes outcomes, objectives, a case scenario, grading rubric, and debriefing form. Further, a demonstration video based on the written protocol was conducted in USM’s simulation lab. The items along with a questionnaire were disseminated through Qualtrics©to a designated panel of experts. Data collected yielded that implementation of the MH OSCE will be beneficial to USM’s NAP program for the usage of faculty and students for the examination tool

Predicting the Risk of Obstructive Sleep Apnea and Difficult Endotracheal Intubation in a Surgical Population in a Rural Community Hospital Setting

Purpose: The purpose of this paper is to provide a theoretical framework with practical application for facilitating patient flow through the operative process using the Lean philosophy to minimized delays and cancellations. Theoretical orientation: Efficient, quality patient care has always been the hallmark of Nurse Anesthetist practice. Lean healthcare introduces continuous quality improvement (CQI) processes used in Lean manufacturing to the healthcare system. The principal aspect of Lean healthcare is the concept of a value stream where work is standardized, work flow is streamlined and waste is eliminated, thus creating value. Nature of Review: In the surgical suite waits, delays and cancellation are endemic. Lean healthcare views these as waste in the system. They must be eliminated to provide value to the patient, who is the ultimate customer. Managing the flow of the patient successfully through this process will increase the quality of patient care ( value ), increase patient and provider satisfaction, increase operating room efficiency and reduce cost. Nurse Anesthetists are uniquely positioned in the operative arena to accomplish this. The greatest opportunity to reduce delays and cancellations is seen with smoothing the inter-daily workload. Successful interventions to accomplish this include: 1) maximizing the preoperative anesthesia assessment, 2) standardizing and streamlining work during the perioperative phase to minimize turn over time, and 3) adequate staffing levels to optimize postoperatively care

Simulation in Nursing: Historical Analysis and Theoretical Modeling in Support of a Targeted Clinical Training Intervention

The use of simulation is widespread in healthcare education, and the potential impact of its use large. This is especially true for nursing education as we look to address problems with obtaining clinical experiences, develop critical thinking skills and create methods to measure the impact of simulation interventions. There is substantial empirical evidence in support of predictive relationships between simulation training interventions and knowledge acquisition. This has been extensively demonstrated with the use of a variety of simulation training modalities from standardized patients to human patient simulators. However, data to support changes in clinical practice and improved patient outcomes are quite limited, including attempts to measure the impact of simulation education on retention and transference of knowledge and skill for more complex healthcare process. Additionally, literature searches reveal that only a handful of authors have engaged in the types of foundational work that any emerging science needs. For example, while pieces of the simulation process have been examined in detail, few have attempted to describe what the process of simulation entails at a macro level. Within the past few years some researchers have begun to ask whether there is a causal or predictive relationship present, but few have explored what these associations may look like structurally and what the evidence for them is. The overall objectives of this current research were to: 1) perform an historical review of simulation in healthcare; 2) use this review to outline a new theoretical model of healthcare simulation; and, 3) conduct a small-scale study aimed at pilot-testing and describing part of that model. Hierarchical Task Analysis (HTA) was used to derive an optimum task set for the standard induction of general anesthesia (OTS-SIGA). New Student Registered Nurse Anesthetists (SRNAs) were trained to this task set, and their adherence to the process steps in the clinical setting was then assessed. We also attempted to measure whether repeating the HTA-derived OTS-SIGA simulation training would have an impact on knowledge and transference of simulation-developed skills to the clinical environment. These measures necessitated the development of associated data collection tools and processes for rater training

Developing a labour and birth orientation program

Purpose and Background: The purpose of this practicum was to re-develop the labour and birth orientation program at the Queen Elizabeth Hospital in Charlottetown, PE. The need for this practicum was identified following a substantial staff turnover. This potentiated a need for orientation of a number of registered nurses to labour and birth. During orientation, presentation of program content consisted of two days of traditional classroom style teaching followed by a six-week preceptorship, where the majority of labour and birth knowledge and content would be acquired during this time and facilitated by the preceptor. This led to inconsistencies in information provided to new learners. Evaluation was determined by a written exam and preceptor feedback; inconsistencies were noted by unit leaders and preceptors with these methods of evaluation. Methods: A literature review was undertaken to explore the theoretical underpinnings for the program, Kolb’s Experiential Learning theory, and to explore the literature on the benefits and orientations programs. Also, a consultation plan and report was conducted, which provided a theoretical and evidence-based framework program development. Conclusion: The final program describes methods by which labour and birth content is presented to orientees, and includes 16 learning modules; 15 of which were developed. Additionally, the formal orientation process, method for evaluation of the orientee, and methods for remediation for individuals who are having difficulties with the orientation process are described throughout the program

Simulation-based development: shaping clinical procedures for extra-uterine life support technology

Background Research into Artificial Placenta and Artifcial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and inte‑ grate the user perspectives in the early design phase of a protocol for this novel procedure.Methods Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task specifc feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.Results Physical simulation with the active participation of clinicians led to the difusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.Conclusion This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professional

Simulation-based development: shaping clinical procedures for extra-uterine life support technology

Background Research into Artificial Placenta and Artifcial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and inte‑ grate the user perspectives in the early design phase of a protocol for this novel procedure.Methods Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task specifc feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.Results Physical simulation with the active participation of clinicians led to the difusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.Conclusion This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professional

Alternative site for the placement of totally implantable vascular access device (TIVAD). A case report of two successful TIVAD implantations in the thigh after femoral vein catheterization

Background: Totally implantable venous access devices (TIVADs) have improved the quality of life for seriously ill and cancer patients. These devices represent a convenient option when long-term venous access is indicated. The Subclavian and Internal Jugular Veins are the vessels of choice for catheterization [1]. However, if it is not possible to catheterize them, an alternative vein should be sought for [2]. Femoral vein can be used in such cases [3].Clinical problem: In 2 cases, it was not possible to catheterise any vein ending in the Superior Vena Cava and implant a TIVAD in the chest wall, although this was very necessary for them. Femoral vein was chosen despite higher risk of complications.Case 1: A 47 years old female with a metastatic breast cancer and infected ulcerations of the anterior chest wall. Veins in both arms were occluded. Her implanted TIVAD could not be used. Case 2: A 44 years old female who had a newly diagnosed lung cancer and Superior Vena Cava Syndrome. She was treated by a high-dose anti-coagulants.Surgical intervention: The catheter was inserted in the left femoral vein using ultrasound-guided percutaneous technique. After making a small incision, PORT-A-CATH® II POWER P.A.C. single-lumen standard port was implanted subcutaneously in the anterior surface of the left thigh. Verification of the catheter’s tip intra-operatively was difficult in Case 1 due to fluoroscopy problems. Prior consideration of the required instruments prevented the occurrence of a similar problem in Case 2. We performed these operations in the University Hospital of Norrland in Sweden in 2013.Follow-up: Apart from later adjustment of the catheter positioning in Case 1, we did not get any complications or problems with the use of the TIVAD. Frequent flushing of the device was recommended. Patients’ and staff’s satisfaction were good. Conclusion: Placement of TIVAD in the thigh is to be considered when the veins of the neck and upper arm are not accessible or the area on the chest wall is not appropriate for implanting the device. Experience improves with more cases.References: 1- Di Carlo I, Toro A. Choice of venous sites. Surgical Implant/technique. Springer-Verlag, Italia, 2011;43-54. 2- Toro A, Mannino M, Cappello G et al. Totally implanted venous access devices implanted in saphenous vein. Relation between the reservoir site and comfort/discomfort of the patient. Ann Vasc Surg 2012;26(8):1127.e9-1127.e13. 3- Chen SY, Lin CH, Chang HM, Hsu HM, Yu JC. A safe and effective method to implant a totally implantable access port in patients with synchronous bilateral mastectomies: modified femoral vein approach. J Surg Oncol 2008;98(3):197-199

Handbook for the Rural Anesthesia Provider: How to Develop and Manage an Anesthesia Department

Purpose: Certified Registered Nurse Anesthetists (CRNAs) working in rural facilities may have limited resources to develop and manage anesthesia departments. Literature demonstrates a lack of consolidated information available for anesthesia department managers. Information necessary for a functional and efficient anesthesia department is available; however, it is dispersed over multiple data systems and is often difficult to find. The purpose of this project was to develop a resource handbook to assist the nurse anesthesia provider in developing and managing a functional anesthesia department in rural facilities. This project is intended to benefit the CRNA manager by placing the information in a single handbook for use as a reference. Methods: The compilation of referential information and recommendations made in this handbook are based on evidence found through a literature search of professional journals and websites, relating to the areas being discussed. This book addresses recommendations regarding department layout and use of personnel, interdepartmental cooperation, policy development, government and independent agency credentialing, equipment requirements, and practice tips. A qualitative survey of rural anesthesia providers was conducted to assess areas of knowledge deficit among this group of anesthesia practitioners. Results: The majority of anesthesia providers surveyed (77.27%) indicated a desire for a consolidated resource to aid in managing an anesthesia department. They indicated accreditation issues (68.75%) and solo provider issues (62.5%) as the primary areas of knowledge deficit. The majority (93.75%) indicated they were unable to locate a single consolidated source for all the information. These results were combined with the literature search to develop a resource handbook. Conclusions: A detailed literature search combined with results of a qualitative survey determined a lack of a consolidated resource handbook for nurse anesthesia department managers. A resource handbook was developed with evidence-based recommendations to aid managers in developing and managing anesthesia departments in rural facilities. Data sources: Mayo Clinic and University of Michigan, Flint libraries. Databases included CINAHL Complete, Embase, PubMed, Scopus, Google Scholar, UpToDate and the Cochrane Library. Key words: Anesthesia department management, interdepartmental cooperation in healthcare, government healthcare regulations, healthcare regulating agencies, anesthesia credentialing organizations, state nursing boards, anesthesia equipment, rural anesthesia, and EMR.Doctor of Anesthesia Practice (DAP)Doctor of Anesthesia PracticeUniversity of Michigan_Flinthttps://deepblue.lib.umich.edu/bitstream/2027.42/136648/1/Walter2016.pdfDescription of Walter2016.pdf : Thesi