A Nurse-Led Implementation Science Specialist Program.

A well-known challenge in health care is integrating evidence into practice. Implementation science (IS) is a growing field that promotes the sustainable application of evidence-based practice (EBP) to clinical care. Health care organizations have an opportunity to support sustainable change by creating robust IS infrastructures that engage nurses in the clinical environment.

Growing Novice Nurses to Perianesthesia Care: Formation of a Post-Anesthesia Care Unit (PACU) Fellowship.

Purpose: To provide a proof of concept of a structured, replicable perianesthesia fellowship program for nurses with less than 2 years of experience and new graduate nurses.

Design: An immersive learning experience was implemented as a pilot quality improvement project using the Plan-Do-Study-Act method.

Methods: This 24-week fellowship program used blended learning approaches and the Tiered Skill Acquisition Model (TSAM) to develop foundational Post Anesthesia Care Unit (PACU) skills.

Thoracic enhanced recovery with ambulation after surgery: a 6-year experience.

Objectives: Our institution implemented a protocol known as thoracic enhanced recovery with ambulation after surgery (T-ERAS) in thoracic operations. The objective was early ambulation starting in the postoperative ambulatory care unit.

Methods: Video-assisted thoracoscopic surgery lobectomy patients are placed on a chair in the preoperative area and then walked to the operating room.

Surgical Fire Safety: An Ambulatory Surgical Center Quality Improvement Project.

Surgical team members use fire risk assessment tools to determine the risk of a surgical fire occurring and facilitate communication to reduce risk. The purposes of this quality improvement project were to improve knowledge and awareness of surgical fire risk and increase practitioners' use of a fire risk assessment tool during the surgical safety communication process. We recruited a purposive sample of participants that included all surgical team members of a metropolitan ambulatory surgical center.

Two-Year Experience Implementing a Curriculum to Improve Residents' Patient-Centered Communication Skills.

Objectives: Surgery milestones from The Accreditation Council for Graduate Medical Education have encouraged a focus on training and assessment of residents' nontechnical skills, including communication. We describe our 2-year experience implementing a simulation-based curriculum, results of annual communication performance assessments, and resident evaluations.

Design: Eight quarterly modules were conducted on various communication topics.

Talk the Talk: Implementing a Communication Curriculum for Surgical Residents.

Objectives: The Accreditation Council for Graduate Medical Education milestones provide a framework of specific interpersonal and communication skills that surgical trainees should aim to master. However, training and assessment of resident nontechnical skills remains challenging. We aimed to develop and implement a curriculum incorporating interactive learning principles such as group discussion and simulation-based scenarios to formalize instruction in patient-centered communication skills, and to identify best practices when building such a program.

Assessment of Surgery Residents' Interpersonal Communication Skills: Validation Evidence for the Communication Assessment Tool in a Simulation Environment.

Objectives: Although development of trainees' competency in interpersonal communication is essential to high-quality patient-centered surgical care, nontechnical skills present assessment challenges for residency program directors. The Communication Assessment Tool (CAT) demonstrated internal reliability and content validity for general surgery residents, though the tool has not yet been applied in simulation. The study provides validation evidence for using the CAT to assess surgical residents' interpersonal communication skills in simulation scenarios.

Interrater Reliability of Hospital Readmission Evaluations for Surgical Patients.

Value-based purchasing initiatives have helped shift attention to the accuracy of hospital readmission information at the most clinically detailed level. The purpose of this study was to determine the interrater reliability (IRR) of surgical experts in assessing surgical inpatient readmissions for categorical causes, relation to index procedure, and potential preventability. Cases were selected from the American College of Surgeons National Surgical Quality Improvement Program local database.

Top 10 patient safety issues: what more can we do?

A 2012 survey of AORN members identified the top 10 safety issues reported by perioperative nurses. These nurses are in a unique position to understand the errors and the unreported near misses that occur in the OR. For each of the top-rated safety issues that RNs identified, we discuss the evidence of risk and contributing factors and make targeted recommendations for further improvement in perioperative safety with the goal of mitigating risk and improving patient outcomes.

Effectiveness of 2% CHG cloth bathing for reducing surgical site infections.

We conducted a prospective cohort study on the effectiveness of preoperative bathing with chlorhexidine gluconate (CHG) cloths for reducing surgical site infections. We hypothesized that use of CHG cloths as an adjunct to surgical prep would significantly reduce the endogenous flora of surgical patients and therefore reduce surgical site infections. Data from a control group of patients who had undergone general, vascular, and orthopedic surgery were used for comparison.

Priority patient safety issues identified by perioperative nurses.

Much of the work done by perioperative nurses focuses on patient safety. Perioperative nurses are aware that unreported near misses occur every day, and they use that knowledge to prioritize activities to protect the patient. The purpose of this study was to identify the highest priority patient safety issues reported by perioperative RNs.

Selection of a method to rate the strength of scientific evidence for AORN recommendations.

The use of scientific evidence to support national recommendations about clinical decisions has become an expectation of multidisciplinary health care organizations. The objectives of this project were to identify the most applicable evidence-rating method for perioperative nursing practice, evaluate the reliability of this method for perioperative nursing recommendations, and identify barriers and facilitators to adoption of this method for AORN recommendations. A panel of perioperative nurse experts evaluated 46 evidence-rating systems for quality, quantity, and consistency.

Late stage (III and IV) non-small cell cancer of the lung: results of surgical resection at Inova Fairfax Hospital.

One hundred forty-two patients underwent surgery and related treatment for advanced stage (III, IV) non-small cell cancer of the lung. One hundred seventeen patients underwent up-front surgery, with a hospital mortality rate of 1.7% (2/117).