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

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

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

Increasing Providers Awareness of Waste Anesthetic Gases Exposure in the Post-Anesthetic Care Unit: An Educational Module

This quality improvement project aims to increase the providers\u27 knowledge based on the current literature, the potential dangers of WAGs exposure, and ways providers can reduce exposure levels. Background: The OR\u27s concentration, effects, and reduction strategies are well addressed. Nevertheless, studies that address the exposure of WAGs in perioperative providers in the PACU are limited. Methods: An in-depth inquiry was conducted using CINAHL, PubMed, and MEDLINE, to withdraw studies from 2014 to 2021 related to the PICOT question, of which 8 articles were appraised. Then, an invitation of CRNAs solely to partake in a pre-test survey, followed by the educational module implementation and a post-test survey. Statistical analysis was applied to assess the impact of the educational intervention. Results: There was a 60% increase in knowledge for the organization responsible for setting exposure limits to WAGs, also a 20% to 30% increase in the participant\u27s ability to distinguish between the short- and long-term effects of WAGs exposure. Seventy percent of participants identified at-risk providers to WAG exposure. Finally, all participants knew that chronic WAGs had been linked to short- and long-term effects. Discussion: There was increased knowledge regarding WAG exposure, adverse effects, and practices that reduce its exposure. Considering the limitations of the project and little research focused on mitigating WAGs exposure in the PACU, further research is needed. Limitations include the sample size of 10 participants and the virtual delivery of the educational module

Lavender Aromatherapy Compared to Midazolam For Quality Improvement Of Preoperative Anxiety In Elderly Surgical Patients: An Educational Module

Impact: Investigation into the anxiolytic effects of lavender aromatherapy across several patient populations, application types, and outcome measures establish that lavender oil relieves anxiety, reduces mental stress, provides sedation, and promotes good sleep. Background: Studies have investigated the link between age and the occurrence of undesired responses to premedication with agents of the benzodiazepine drug class. This link is explained by age-related pathophysiologic changes that occur as a function of aging. Despite numerous knowledge-based concerns, benzodiazepines prevail among the top psychotropic medications prescribed in elderly patients aged between 65 and 80 years. Objective: This quality improvement project aims to enhance anesthesia providers\u27 knowledge, beliefs, and attitude regarding the value of aromatherapy with lavender oil as an affordable, safe, and effective alternative to midazolam administration for preoperative anxiolysis in elderly surgical patients. Methods: An extensive literature search was conducted to synthesize studies relevant to the PICO question and create an evidence-based educational module for virtual presentation. An anonymous online platform was used to distribute the project’s intervention and survey components to a sample of anesthesia providers working at a South Florida level-1 trauma center and to record and statistically analyze data. Results: Collectively, the evidence-based literature presented by this project positively impacts the perioperative care of older adults, as it demonstrates lavender aromatherapy as a beneficial alternative to midazolam administration for improved management of preoperative anxiety in elderly surgical patients. Discussion: Analysis of the pre-and post-survey results reveals that this quality improvement project met the objective of expanding anesthesia providers’ knowledge and understanding of the use of lavender oil aromatherapy to optimize preoperative anxiety and care outcomes in elderly surgical patients. As a result, they will be more competent and effective in helping elderly patient populations achieve relief from anxiety before surgery and improved perioperative care outcomes. The small sample size, short project duration, and online delivery platform were limitations of this project