Quality Improvement: Education and Implementation of Proper Narcotic Handling Practices by Nurse Anesthetists

Medication errors are estimated to occur once in every 150-300 surgeries (Wahr et al., 2017, p. 36). Unsafe injection practices can lead to increased morbidity and mortality, diminish the overall quality of life for patients, and contribute to substantial increases in healthcare costs. A large majority of unsafe injection practices are caused by a lack of education or mistaken beliefs regarding safe injection practices. Educational reinforcement of safe narcotic handling techniques has significant potential to increase the appropriate use of narcotic syringes among nurse anesthesia providers. The long-standing impact of this project could lead to a reduced number of ‘never events’, medication errors, and infection transmission in the perioperative setting. Our project’s purpose focuses on improving anesthesia provider compliance with the Narcotic Handling Policy in the perioperative setting by offering educational resources and reinforcement of basic aseptic techniques, as well as safe narcotic handling, labeling, and injection practices, which will help to improve overall patient outcomes. The Evidence-Based Practice Improvement (EBPI) Model serves as the guiding framework for the planning, implementation, and analysis of practice change and improvements. Lastly, through the use of an educational bundle, pre- and post-implementation surveys, and long-term follow-up, the project aim seeks to improve anesthesia providers’ compliance with the safe syringe handling practices outlined in the project site’s Narcotic Handling Policy, increase the percentage of appropriately labeled narcotic syringes, and improve overall patient outcomes (Ford, 2013; Pugliese et al., 2010; Wahr et al., 2017)

Exploratory research in alternative raw material sources and reformulation for industrial soda-lime-silica glass batch

For energy saving and CO2 emissions reduction, in addition to extending the range of suitable raw material sources for glass manufacture, compositional reformulation, and alternative raw materials have been studied in the context of industrial container and float‐type soda‐lime‐silica (SLS) glasses. Lithium, potassium, and boron were applied to modify benchmark glass compositions. Reformulation impacts on key glass properties including the viscosity‐temperature relationship, thermal expansion, liquidus temperature, forming behavior and color. Compared to the benchmark glass, representative of commercial SLS glasses, melting temperatures (taken as temperatures corresponding to log (viscosity/dPa·s) = 2) of reformulated glasses are reduced by 11°C‐55°C. Investigation of four industrial by‐products (seashell waste, eggshell waste, biomass ash, and rice husk ash), and their potential suitability as alternative glass batch raw materials, was also conducted. Seashell waste and biomass ash were successfully introduced into representative green glass formulations

Robotic Thyroidectomy for Cancer in the US: Patterns of Use and Short-Term Outcomes

BACKGROUND: We describe nationally representative patterns of utilization and short-term outcomes from robotic versus open thyroidectomy for thyroid cancer. METHODS: Descriptive statistics and multivariable analysis were used to analyze patterns of use of robotic thyroidectomy from the National Cancer Database (2010–2011). Short-term outcomes were compared between patients undergoing robotic versus open thyroidectomy, while adjusting for confounders. RESULTS: A total of 68,393 patients with thyroid cancer underwent thyroidectomy; 225 had robotic surgery and 57,729 underwent open surgery. Robotic thyroid surgery use increased by 30 % from 2010 to 2011 (p = 0.08). Robotic cases were reported from 93 centers, with 89 centers performing <10 robotic cases. Compared with the open group, the robotic group was younger (51 vs. 47 years; p < 0.01) and included more Asian patients (4 vs. 8 %; p = 0.006) and privately-insured patients (68 vs. 77 %; p = 0.01). Tumor size was similar between patients undergoing robotic versus open surgery. Total thyroidectomy was performed less frequently in the robotic group (67 vs. 84 % open; p < 0.0001). Patients were relatively more likely to undergo robotic surgery if they were female (odds ratio [OR] 1.6; p = 0.04), younger (OR 0.8/10 years; p < 0.0001), or underwent lobectomy (OR 2.4; p < 0.0001). In adjusted multivariable analysis, there were no differences in the number of lymph nodes removed or length of stay between groups; however, there was a non-significant increase in the incidence of positive margins with robotic thyroidectomy. CONCLUSIONS: Use of robotic thyroidectomy for thyroid cancer is limited to a few institutions, with short-term outcomes that are comparable to open surgery. Multi-institutional studies should be undertaken to compare thyroidectomy-specific complications and long-term outcomes