An educational module comparing decontamination strategies for the safe utilization of post-decontaminated N95 filtering facepiece respirators by anesthesia providers.

Title An Evidence-Based Comparison of Decontamination Strategies for the Safe Utilization of Post-Decontaminated N95 Filtering Facepiece Respirators by Anesthesia Providers Background/Purpose/Question Because the current pandemic threatens a limited supply of N95 filtering facepiece respirators (FFRs), many anesthesia providers have resorted to the decontamination and reuse of single-use FFR. There is little evidence of the relative safety and efficacy of the different decontamination methods. The lack of concrete evidence and guidance regarding the reuse of FFR is a cause for concern for anesthesia providers, who are at constant risk of exposure to airborne diseases. This evidence-based review seeks to answer the proposed question, “In anesthesia providers, does the reuse of post-decontaminated N95-type FFRs increase the risk of airborne diseases compared to anesthesia providers who use one-time disposable use N95-type FFRs?” Methods/Evidence Search An electronic search was conducted in the Cumulative Nursing and Allied Health Literature (CINAHL), Embase, and MEDLINE/PubMed. The search parameters included articles written in English and published in 2014–2021. The following search terms were used: “anesthesia providers,” “reuse,” “post decontaminates,” “N95 FFR,” and “risk of airborne disease.” The search initially resulted in 140 articles. Duplicate articles and titles with abstracts deemed irrelevant were then eliminated from the review. The inclusion criteria for research articles were based on the article’s applicability to the comfort level of N95 FFR wearers after decontamination, the concerns of N95 FFR wearers after decontamination, and determining which decontamination methods would be most practical and safe considering the available resources. An educational module containing both a pre and post assessment was created based on findings from literature review. Synthesis of Literature/Results/Discussion Thirteen sources met the inclusion criteria for the evidence-based review. The literature revealed that solution-based decontamination methods such as hydrogen peroxide and bleach should be avoided because they degrade the masks’ integrity and efficiency. Heat minimally alters the integrity of the mask; however, after 20–50 cycles, there was evidence of decreased efficiency and mask degradation. Other factors, such as multiple donning, also affected the integrity of the FFR. Statistical analysis showed that the fit gradually decreased after donning the FFR 5 times. The most effective methods noted within this evidence-based review were ultraviolet germicidal irradiation (UVGI), moist heat, dry heat, and hydrogen peroxide vapor (VHP). Data analysis of the pre and post-assessment from the educational module indicate an increase in provider knowledge on reuse of decontaminated N95-type FFRs. Because the pandemic continues due to the spread of different strains, mask integrity should continue to be researched to assist anesthesia providers and their employers in making informed decisions regarding personal protective equipment for anesthesia providers. Conclusion/Recommendations for Practice Anesthesia providers are at increased risk of acquiring airborne pathogens. If the reuse of post-decontaminated N95 FFRs remains a practice used to conserve mask supply during a pandemic, then appropriate information regarding the potential risks of reuse and decontamination should be available. Studies seem to indicate that the reuse of N95 FFRs can conserve the supply of N95 FFR in times of short supply. However, this conservation method must be studied further to determine the risk to anesthesia providers. Much remains unknown, which can pose an increased risk to providers who have no choice but to adopt these practices. It is also essential to consider the feasibility of the selected decontamination method and its cost-effectiveness. Organizations should consider the N95 FFR models they provide when instructing providers to conserve supplies by decontaminating and reusing FFRs. Conflict of Interest The authors have declared they have no financial relationships with any of the commercial interests related to the content of this review. There is no conflict of interest

An Educational Module on the Utilization of Chlorhexidine Impregnated Surgical Attire in Operating Room Staff to Decrease Surgical Infections.

Surgical site infections (SSIs) are a significant concern due to the harmful consequences they can cause a patient after a surgical procedure. Surgical site infections rank the highest type of hospital-acquired infections causing adverse patient outcomes by increasing length of stay and increasing morbidity and mortality. Specific surgical procedures have been associated with a higher risk of infection. Orthopedic and abdominal surgeries have the highest risk of post-operative infections. Patients experiencing an SSI can undergo various complications such as additional surgeries, antibiotics, increased length of stay, and even death. There are modifiable and unmodifiable risks that can increase the chance of SSIs in combination with high-risk surgeries. Surgical attire worn by the surgical staff may contribute to the possible contamination of a surgical wound. The healthcare team provides care to all their patients during their shifts without changing attire. This quality improvement plan tested the knowledge of a group of Certified Registered Nurse Anesthetists (CRNAs). An educational module was presented and their understanding regarding SSIs and chlorhexidine impregnated scrubs was analyzed utilizing a pretest and posttest

Advantages of Intravenous Administration of Amisulpride Over Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting: An Educational Module

Title: Advantages of Intravenous Administration of Amisulpride Over Ondansetron for Prophylaxis of Postoperative Nausea and Vomiting: An Educational Module Impact Statement: In patients undergoing general anesthesia, the administration of intravenous amisulpride has proven to be effective in preventing Post Operative Nausea and Vomiting (PONV) while having a safer profile when compared to ondansetron. Background: PONV is, after pain, the second most frequent complaint after surgery, and it may contribute to severe complications, decrease patient satisfaction, extend the hospital stay and increase healthcare costs. Despite the potential for serious side effects, ondansetron remains the preferred drug used to prevent PONV. Objective: This project aims to compare the effectiveness and safety profile of ondansetron and amisulpride as a prophylaxis for PONV and present the findings through an educational module to anesthesia providers and assess the degree of knowledge gained. Method: We conducted a literature review comparing amisulpride and ondansetron as prophylactic agents for PONV. We created an online educational module to present to anesthesia providers and a pre and post surveys to assess the degree of knowledge acquired. The project was developed in a large level 1 trauma center, using anonymous and online platform for survey and module delivery and data collection. Results: We found amisulpride to be effective as a prophylactic drug for PONV; it also decreases the severity of nausea in the high-risk patient. Amisulpride has a safer profile and fewer potential for side effects when compared to ondansetron. Discussion: Data from surveys shows anesthesia providers increased their knowledge about PONV and effective prophylaxis treatments after the educational module. Small sample size, short duration of this project, and the use of online platform were limitations of this project. Conclusion: The educational module improved anesthesia providers’ knowledge and attitude about Postoperative Nausea and Vomiting and the administration of intravenous amisulpride as an effective and safe prophylactic alternative

Improving Clinical Knowledge on the Efficacy of Brachial Plexus Blocks with Perineural Dexmedetomidine as an Adjunct Agent to Ropivacaine Compared to Brachial Plexus Blocks with Ropivacaine as a Sole Agent: An Educational Module

ABSTRACT Impact Statement: Ultrasound-guided Brachial Plexus Nerve Blocks (BPNBs) using Ropivacaine and Dexmedetomidine have been proven to shorten the block’s onset, prolong the duration of action, and enhance the analgesic efficacy. Background: Ultrasound-guided Brachial Plexus Nerve Blocks (BPNB) are commonly used as an alternative to general anesthesia. Research suggests that adding Dexmedetomidine 1mcg/kg to 15ml of 0.5% ropivacaine shortens the onset and prolongs the duration of the block. Methods: A concise search strategy was implemented to identify suitable studies using Cumulative Index to Nursing and Allied Health (CINAHL) and PUBMED. Eleven articles remained, of which 6 studies met all the specifics of the literature review objectives. A virtual educational module was delivered to Florida International University’s alumni CRNAs, along with a pre and post survey to evaluate gained knowledge. Results: Of the 8 total participants (N = 8), 50% (n = 4) demonstrated gained knowledge, 25% (n = 2) had no change, and 25% (n = 2) exhibited a decrease in understanding. The results are neither favorable nor unfavorable. Discussion: There was a significant improvement on the likelihood of considering perineural dexmedetomidine. The small sample size, the project’s cybernetic dependence, and the virtual aspect of delivery were limitations of this project. Conclusion: Considering the ambiguity of the results and the project’s limitations, it is recommended that further research is conducted to educate, guide, and possibly alter current practice standards. Keywords: brachial plexus block; supraclavicular; interscalene; infraclavicular; neuraxial dexmedetomidine; precedex; perineural dexmedetomidine; ropivacaine, regional anesthesia

The Use of Intranasal Dexmedetomidine Compared to Oral Midazolam in the Pediatric Pre-operative Population for Separation Anxiety. An Educational Module

This quality improvement project aimed to identify anesthesia providers’ knowledge of current and alternative methods to effectively treat perioperative anxiety in the pediatric population. Background: Pediatric perioperative anxiety is a prominent complication that anesthesia providers face daily. Methods: A literature review was conducted utilizing PubMed, Google Scholar, and the Cochrane database to research the PICO question. A project intervention was provided to both physician anesthesiologist as well as certified registered nurse anesthetists (CRNAs) that included a pre-intervention test, an interventional educational module, and a post-intervention survey. Statistical analysis was completed to assess the outcomes of the educational intervention. Results: The majority of participants were able to identify clinical outcomes of high levels of preoperative anxiety, the most common pharmacological agent being utilized to sedate the pediatric population, and its negative side effects. Additionally, knowledge of DEX improved with all providers understanding not only its antianxiety benefits but also its analgesic properties. Discussion: Following the educational intervention, anesthesia providers’ knowledge on the benefits and use of DEX increased. Further research on improved methods of perioperative anxiety treatment is indicated. Limitations of the study included small sample size, time restrictions, and impersonal online platform. Keywords: Pediatrics, Intranasal DEX, Intranasal Midazolam, Oral Midazolam, Agitation, Sedation, Anxiet

The Utilization of Amisulpride as a Rescue Drug for Postop Patients Compared to Promethazine for the Treatment of Postoperative Nausea and Vomiting: An Educational Module

Abstract Background: Postoperative nausea and vomiting (PONV) persist as one of the most common adverse effects experienced by patients undergoing general anesthesia, as it can prolong a patient’s stay in the hospital, increase hospital costs, and lead to further complications delaying the recovery process.1,3,7 Despite prophylactic treatment with a combination of drugs, some patients still experience PONV. Despite its adverse side effects, Promethazine is still utilized as a rescue drug for PONV after failed prophylaxis. Objective: This quality improvement project aims to increase anesthesia providers’ knowledge of the current literature on Amisulpride\u27s efficacy and safety profile for treating PONV after failed prophylaxis compared to Promethazine. Methods: An in-depth analysis was conducted by using CINAHL, PubMed, Google Scholar, and the Cochrane Library database to obtain research studies discussing the use of Amisulpride and Promethazine as rescue treatments for failed PONV prophylaxis. CRNAs were invited to participate by completing an online pre-test survey, followed by viewing an online educational module, and a post-survey questionnaire to assess their acquired knowledge. Results: There was an increase in knowledge among anesthesia providers on using Amisulpride as a rescue treatment for failed prevention of PONV compared to Promethazine. Amisulpride has a safer profile and is less likely to cause any side effects, unlike Promethazine, which has the potential for multiple adverse effects. Discussion: Data collected from the surveys showed that anesthesia providers had increased their knowledge of the use, mechanism of action, and minimal potential for side effects of Amisulpride when used to treat PONV. A small sample size of 7 people and the online distribution were limitations for this project. Conclusion: Evidence-based research shows Amisulpride has a safer profile for treating PONV when prophylaxis fails compared to Promethazine. Results from this quality improvement project showed an increase in anesthesia providers’ knowledge regarding the benefits and adverse effects of both antiemetics. Introduction of Amisulpride to clinical practice can lead to improvements in patient outcomes by decreasing the occurrence of PONV and further complications. Keywords: Postoperative nausea and vomiting, prophylaxis, rescue, antiemetic, Amisulpride, Barhemsys, Promethazine, Phenerga

An Educational Module on the Utilization of Clinical Guidelines For Advancement In Preceptor Training and Improvement of the Clinical Learning Environment For Student Registered Nurse Anesthetists

Certified Registered Nurse Anesthetists (CRNAs) play an integral role in the clinical education arena. The preceptorship model has been widely accepted in many disciplines to enhance student learning, provide opportunities to demonstrate competence and critical thinking, and build confidence.The role of a preceptor involves many challenges. Nursing preceptors must balance their usual workload in addition to being educators.Studies report that preceptors find the lack of support from leadership most difficult.Consequently, the lack of support from leadership makes nursing preceptors less inclined to precepting. The clinical environment is critical to learning and correlates to the academic success of the student. Student perceptions and satisfaction are indicators of the quality of learning and related to several outcomes. Studies indicate that the clinical environment perpetuates students’ perceptions and indirectly relates to academic success, student retention, and coping mechanisms. It is the ability to believe in one’s own ability to carry out an objective. Preceptors who provide timely feedback, observe skills frequently, effectively communicate, and are willing to teach contribute to a better learning environment. This quality improvement educational module seeks to assess anesthesia providers’ knowledge on the efficacy of enhancing CRNAs’ roles as clinical preceptors. Anesthesia providers receiving the educational intervention included CRNA from the university alumni list. The sample included approximately 9 participants. The quality improvement project involved three phases: the pre-assessment testing, an online educational presentation, and a post-assessment exam. Pre-assessment and post-assessment testing will measure the effects of the intervention. Statistical analysis will be applied to assess the knowledge of the educational intervention. Keywords: student nurse anesthetists, preceptorship, mentors, nursing students, mentorship, preceptorship model

Utilization of Educational Module on The Benefits of Cerebral Oximetry to Reduce Postoperative Cognitive Dysfunction in PACU and ICU

Background: Aging adults are part of the largest group of people receiving surgical interventions and at the highest risk for developing postoperative complications and suffer from cognitive decline, including delirium and postoperative cognitive dysfunction (POCD). Currently, there is research suggesting a correlation between regional cerebral oxygen saturation and the incidence of POCD. Further investigation is needed to establish a link between intraoperative cerebral hypoperfusion and POCD and to create recommendations on its use. Objective: The focus of this systematic review was to evaluate current research on monitoring cerebral regional oxygen desaturation and the occurrence of POCD in patients over 60 years old enduring cardiac and non-cardiac surgical procedures. This project also assessed if an educational module used to educate anesthesia providers on cerebral oximetry and POCD increased cognitive evaluation frequency in the preoperative and postoperative period in patients at increased risk of developing POCD. Methodology: With the information from the literature review. A pre-test, post-test and educational module was created to assess the knowledge of anesthesia providers. Results: The pre-test and post-test did not demonstrate a significant shift in knowledge regarding cerebral oximetry use when caring for individuals at increased risk for POCD. Discussion: These studies in the systematic review contained several limiting factors, including the limited number of randomized, double-blind studies, and the follow-up period to assess patients for cognitive decline varied with each study. The educational module’s sample size served as a limitation to the acquired results. Conclusion: The educational module improved provider knowledge and attitudes in some areas; however, there was no significant change between the pretest and posttest assessment. Further assessments are required in the future to assess for provider knowledge and skills on utilizing the cerebral oximetry device as a tool to help reduce the incidence of POCD

The Utilization of Dexmedetomidine in the Elderly Population to Decrease Postoperative Delirium: A Quality Improvement Project

Importance: Postoperative delirium is highly prevalent among elderly hospitalized patients over 65 years old. It is associated with increased mortality, functional and cognitive impairment, admission into long-term care facilities, lengthier hospitalization, and higher costs. Dexmedetomidine decreases the incidence, duration, and severity of postoperative delirium. Objective: This quality improvement (QI) project aims to improve healthcare provider knowledge regarding dexmedetomidine to decrease postoperative delirium in the elderly population and determine the efficacy of an educational intervention. Setting: A 716-bed acute care hospital in Broward County, Florida, has a large elderly population requiring anesthetic services. Anesthesia providers at this facility will be educated on preventative measures to reduce the incidence of postoperative delirium. Methods: A pretest survey will be administered to assess anesthesia providers’ knowledge, attitudes, and behaviors regarding dexmedetomidine and postoperative delirium. An educational module will then be provided. Finally, a posttest survey containing the same questions as the pretest will be administered to participants. Results: Following the educational intervention, there was an increase in knowledge scores and stronger attitudes and beliefs regarding the role of anesthesia providers in reducing postoperative delirium. Furthermore, most participants reported that they were highly likely to implement this into their clinical practice. Conclusion: An educational module can enhance anesthesia provider knowledge and increase the likelihood of using dexmedetomidine to reduce postoperative deliriu

A Learning Module in Post-Traumatic Stress Disorder (PTSD) and the Use of 3,4-Methylenedioxymethamphetamine (MDMA) Assisted Psychotherapies in Patients who have PTSD and Other Alike Disorders

ABSTRACT Background: Patients who have PTSD are particularly vulnerable to inefficient treatment modalities and subsequent lifelong suffering. Multiple studies have exposed these inefficiencies in conventional therapies and established a potentiality for MDMA use during psychotherapy sessions in this patient population. Ketamine represents an anesthetic with a similar psychedelic profile to MDMA that is used in current clinical settings. Context: Mount Sinai Medical center is a 672-bed hospital in Miami Beach, Florida, where the Miami Beach Anesthesiology Associates (MBAA) group provides anesthesia services. Many procedures requiring anesthesia are carried out to a vast patient population, many of which are patients with PTSD and associative symptoms of depression. Objectives: The objective of the Evidence-Based Learning Module is to expand CRNA knowledge of PTSD and the use of 3,4-Methylenedioxymethamphetamine (MDMA) assisted psychotherapies in patients who have PTSD and other similar disorders. Methods: A pre-implementation survey assessed the providers’ initial knowledge of PTSD, including current treatment modalities and overall inefficiencies, and the pharmacology and history of MDMA. A virtual educational intervention then followed this. When completed, anesthesia providers were redirected to a post-intervention survey to establish the growth of knowledge. Results: Overall, there was an improvement in provider knowledge following the education intervention. There was no change regarding the likelihood of researching MDMA further on the CRNA’s own time. Conclusions: Currently, there exist many insufficiencies in the treatment of patients with PSTD. During the perioperative period, an area of heightened vulnerability for this population, a universal standard of care or anesthetic plan specific to patients with PTSD is lacking. The educational intervention provided was effective in improving anesthesia provider knowledge of PTSD and MDMA