Examining PACU Nurse Knowledge and Confidence of Neuromuscular Blocking Drugs and Neuromuscular Blocking Reversal Agents.

Purpose: neuromuscular blockade (NMB) remains a significant risk for patients after anesthesia. This study examines the confidence and knowledge of the use and side effects of NMB and associated reversal agents amongst postanesthesia care unit (PACU) nurses caring for the postanesthesia surgical population. Retrospective data on the incidence and demographics of patients who underwent general anesthesia with NMB were also examined.

An interdisciplinary telemedicine innovation to enhance pediatric diabetes care in rural communities: A proposed practice initiative.

Purpose: The COVID-19 pandemic highlighted disparities in healthcare access and outcomes, particularly among individuals with chronic conditions. A positive outcome of the pandemic was an increased use of telehealth and the creation of innovative models of care. In many organizations, nurses became the leaders for these new models.

Identification of risk factors for postoperative pulmonary complications in general surgery patients in a low-middle income country.

Background: Postoperative pulmonary complications (PPCs) are an important cause of perioperative morbidity and mortality. Although risk factors for PPCs have been identified in high-income countries, less is known about PPCs and their risk factors in low- and middle-income countries, such as South Africa. This study examined the incidence of PPCs and their associated risk factors among general surgery patients in a public hospital in the province of KwaZulu-Natal, South Africa to inform future quality improvement initiatives to decrease PPCs in this clinical population.

The National Practitioner Database Malpractice Study of Severity of Alleged Malpractice Injuries Trends 2008-2018.

This research examined trends and severity of alleged injury in malpractice over a 10-year period. An understanding of the severity of patient outcomes is important to gauge improvements in care delivery. Analysis of the National Practitioner Database (NPDB) investigated malpractice payments from 2008 to 2018 by physicians, advanced nurse practitioners, and registered nurses and assessed the relationship of years of practice on the severity of alleged malpractice injury.

Being the third wheel: Toddlers use bystander learning to acquire cue-specific valence knowledge.

Observing others is an important means of gathering information by proxy regarding safety and danger, a form of learning that is available as early as infancy. In two experiments, we examined the specificity and retention of emotional eavesdropping (i.e.

Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient.

The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Prevention has put forward guidelines for prescribing opioids, it does not include guidance specifically for THR patients suffering from presurgical and postsurgical pain.

Presurgical and Postsurgical Opioid Rates in Patients Undergoing Total Shoulder Replacement Surgery.

Background: The purpose of this study was to describe the pre- and postsurgical opioid prescription rates and average morphine milligram equivalents (MME) per day in patients undergoing total shoulder replacement (TSR) procedures.

Methods: Patients undergoing TSR were identified from the electronic health records (EMR). In addition to patient demographics, opioid prescription 12-months presurgery and postsurgery were recorded.

Hearing impaired older adults in the acute care setting: An innovation solution to improve care.

Hearing loss is prevalent in the geriatric population. Healthcare systems and providers are challenged to meet communication needs in hearing impaired adults in the acute care setting. Patients with impaired-hearing pose risk to themselves and the healthcare system.

Improving Emergency Cricothyroidotomies: Simulation-Based Training for Critical Care Providers.

This article discusses skill proficiency of providers related to emergency cricothyroidotomies. Various techniques to improve procedural skills were studied. Accurate identification of the cricothyroid membrane via palpation remained consistently inadequate.

Using a Retrospective Secondary Data Analysis to Identify Risk Factors for Pulmonary Complications in Trauma Patients in Pietermaritzburg, South Africa.

Background: The trauma burden in South Africa is significant. The objective of this project was to investigate the incidence of posttrauma pulmonary complications (PPCs) and to identify patient, health risks, and hospital factors, which predispose trauma patients to develop PPCs hospital in Pietermaritzburg, South Africa.

Methods: The design was a retrospective secondary data analysis of patients who presented as a trauma admission via the health systems' Hybrid Electronic Medical Registry.

Maximizing Use of Social Media to Improve Member Engagement in a Professional Organization.

The North Carolina Association of Nurse Anesthetists recognized concerns surrounding decreased member engagement and communication. Member engagement and communication is the lifeblood of an organization and is directly related to the success of an organization's outcomes and goals. Revamping of social media is a cost-effective method to help increase membership engagement and communication.

Development and Implementation of a Perioperative Blood Glucose Monitoring Protocol for Patients Undergoing Spinal Surgery.

Purpose: Stress-induced hyperglycemia during the perioperative period is associated with adverse outcomes after spinal surgery, which increases both patient-related burden and hospital costs. This quality improvement project describes the development and implementation of a perioperative blood glucose monitoring protocol for patients undergoing spinal surgery.

Design: An evidence-based perioperative blood glucose monitoring protocol was developed by a multidisciplinary committee of specialists in endocrinology and anesthesiology with utilization of the American Diabetes Association diabetes screening criteria.

Evaluating a Quality Improvement Initiative to Increase Anesthesia Providers' Use of and Understanding of Quantitative Neuromuscular Monitors.

Improved understanding of the monitoring and dosing practices of anesthesia providers regarding neuromuscular blockade is necessary. The use of subjective methods such as peripheral nerve stimulation and clinical assessment tests can increase the risk of residual neuromuscular blockade and adverse postoperative outcomes. Quantitative monitoring of neuromuscular blockade is an alternative tool to peripheral nerve stimulation to guide neuromuscular blockade; however, it is rarely used by providers.

The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population.

Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald et al., 2018; Zietlow et al.

Evaluation of a Presurgical Pregnancy Testing Protocol at an Ambulatory Surgery Center.

Purpose: A presurgical pregnancy testing protocol is recommended to prevent the administration of surgery and anesthesia to women of childbearing years who present for surgery with an undetected pregnancy. It is important to determine the compliance, cost analysis, time required, and barriers to complete a presurgical pregnancy testing protocol.

Design: Postimplementation qualitative and quantitative evaluation of a presurgical pregnancy protocol.

Laboratory Monitoring and Transfusion Guidelines to Influence Care in Patients Undergoing Multilevel Spinal Fusion Surgery.

Purpose: The purpose of this project was to determine whether the use of the modified Northwestern high risk spine protocol in patients undergoing multilevel spinal fusion surgery would result in improved transfusion practices.

Design: Preimplementation and postimplementation design.

Methods: A laboratory monitoring and transfusion guideline protocol was implemented in patients undergoing multilevel spinal fusions.

Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery.

Purpose: The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery.

Design: The structure of this project was a preimplementation and postimplementation design.

Methods: A convenience sample of 63 patients admitted to the PACU after spinal fusion surgery, with diagnosed or high-risk OSA, was included in protocol implementation.

Multimodal Pain Management for Major Joint Replacement Surgery.

Effective pain management for orthopaedic major joint replacement is key to achieving earlier recovery, better functioning, and high rates of patient satisfaction. In an effort to decrease opioid dependency, practitioners are turning to multimodal pain management, which involves the use of multiple analgesic agents and techniques. To utilize this technique, a patient's history of and preoperative consumption of medications to treat pain impacts the success of this regimen.

Implementation of Postoperative Nausea and Vomiting Guidelines for Female Adult Patients Undergoing Anesthesia During Gynecologic and Breast Surgery in an Ambulatory Setting.

Purpose: Postoperative nausea and vomiting (PONV) is one of the most common complications after anesthesia. This evidence-based quality improvement (QI) project describes the implementation of a PONV guideline and the impact on providers' compliance with PONV risk assessment using the Apfel PONV score.

Design: A retrospective preimplementation and postimplementation QI project.

Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers.

The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissions Database. Compared with 2009, overall 30-day rates of readmissions after TKR decreased by 15% in 2014.

Using the Electronic Medical Record to Improve Preoperative Identification of Patients at Risk for Obstructive Sleep Apnea.

Purpose: Obstructive sleep apnea (OSA) is a breathing disorder found in surgical patients and associated with complications in the postoperative period. The implementation of a preoperative universal screening process using the STOP-BANG questionnaire to identify patients at high risk for OSA provides opportunities for improved management.

Design: A pre-post design was used to evaluate screening compliance rates.

Preprocedural Checklist for Magnetic Resonance Imaging Patients Undergoing General Anesthesia: A Process Improvement Plan to Enhance Reimbursement.

Thorough documentation is essential for hospital reimbursement from payors such as the Centers for Medicare & Medicaid Services. Inconsistencies and incomplete documentation can occur if workflow is not standardized especially in cases with interdisciplinary involvement. Documentation for patients undergoing magnetic resonance imaging (MRI) with anesthesia services was examined and revealed an opportunity for improvement to avoid financial losses.

Utilization of the STOP-Bang Questionnaire as a Standardized Screening Tool for Obstructive Sleep Apnea in Veteran Administration Surgical Patients.

Purpose: Obstructive sleep apnea (OSA) affects an estimated 20% of the adult surgical population. Veteran patients have many characteristics consistent with OSA, but lack of standardized screening results in decreased detection of patients at risk for OSA.

Design: Pre-post implementation design.