2017
Doctor of Nursing Practice Scholarly Projects
2017 DNP PROJECTS
Foreward
Congratulations Doctor of Nursing Practice Graduates. You have worked hard and accomplished much as you completed your degree at Franciscan Missionaries of Our Lady University. Earning a DNP is not an easy task. You have worked hard and met the rigorous standards required of the program. Your achievements are featured in this booklet. Your educational journey has provided you with the knowledge and skills you need to provide safe, evidence-based, compassionate, patient-centered care at the highest level of advanced practice nursing. You have been challenged to think innovatively to transform nursing care. You are ready to embrace your new role and make a difference in the lives of your patients and in the nursing profession. You have joined an elite group of doctorally prepared nurses who have the ability to make a difference in the community and in the world around you. I am so proud of you and all your accomplishments and I cannot wait to see all that you achieve. Amy M Hall, PhD, RN, CNE Dean, School of Nursing
From the Program Director Congratulations, Class of 2017 DNP-NA Graduates! While your degree journey at Franciscan Missionaries of Our Lady University has ended, your DNP adventures are just beginning. Each of you has the awesome responsibility and privilege to improve healthcare by delivering safe, equitable and evidencebased patient-centered care at the highest level of advanced nursing practice. As leaders and scholars you have the opportunity to transform systems of care by improving quality of care and patient outcomes in a variety of healthcare settings. We are proud to have participated in your educational journey and look forward to the differences each of you will make as a doctorally prepared nurse anesthetist. Aimee L. Badeaux, PhD, CRNA Program Director, Nurse Anesthesia Program
Outstanding Student Awards Outstanding Clinical Student Dr. Joshua Todd
Outstanding DNP Project Dr. Elizabeth Smithhart
Outstanding Didactic Student Dr. Brittany Musso
Outstanding LANA Student of the Year Dr. Christopher Buchart
2017 DNP PROJECTS
Esmolol Use for Perioperative Pain Management: An Evidence-Based Teaching Plan PURPOSE The purpose of this project is to assess the educational needs of the anesthesia providers at a major medical center in southeastern Louisiana related to evidence-based practice incorporation, specifically esmolol use for pain management. Opioids have been a mainstay treatment for pain management; however, they bring many unwarranted side effects including respiratory depression and delayed recovery to name a few. In addition, patients still experience pain within the perioperative period despite multimodal pain management techniques. The lack of pain management during the perioperative period can be attributed to a knowledge gap in evidencebased practices for pain management.
MICHELLE BAJON DNP, CRNA, APRN
METHODOLOGY The first phase of this project includes a qualitative descriptive survey design that is used to identify the educational needs and attitudes and beliefs of evidencebased practices of the anesthesia providers at a major medical center in southeastern Louisiana. In addition, the survey gathered data on the use of esmolol for perioperative pain management. Data analysis of the survey, including descriptive statistics, were incorporated into an evidence-based teaching plan designed to meet the educational needs of the anesthesia providers.
RESULTS Of the 131 anesthesia providers, there were 44 respondents. The results of the anesthesia practice survey suggest a lack of knowledge of the use of esmolol of the anesthesia providers at a major medical center in southeastern Louisiana. Anesthesia providers indicated that they were wary of experimenting with a new technique and needed more knowledge on the technique of administering esmolol for pain management purposes. The hesitation and lack of use of esmolol for pain management purposes could also be attributed to a lack of confidence and experience in practicing the technique of administering esmolol for pain management. An employee in-service was the second leading preferred method of education by the surveyed participants. IMPLICATIONS FOR PRACTICE The implications for practice from this project are an increase in understanding and importance of translating evidencebased practices and research into practice as well as the importance of incorporation of participant learning styles and perceptions into development of an educational intervention. The project provides a focused evidencebased teaching plan and tool that can be used by medical institutions to educate its anesthesia providers on the use of esmolol for pain management.
Multi-Use vs Single-Use Tape for Securing Endotracheal Tubes: Translation of Evidence into Practice PURPOSE To reduce patient exposure to costly and harmful pathogens by informing anesthesia providers of current best practice for the securement of intraoperative endotracheal tubes. METHODOLOGY Delivery of an education intervention with the aid of a power point presentation and guideline to anesthesia providers. Pre- and post-education intervention surveys assessing comprehension, translation, and retention of evidence based practice guidelines.
RESULTS All participants believed the information presented during the education intervention increased their clinical knowledge. In addition, 100% of participants were likely to adopt the single patient tape roll guideline into their clinical practice. A statistically significant increase in the number of anesthesia providers believing that tape should be thrown away after each patient occurred after the education intervention. Furthermore, a potential practice change was noted when a significant increase in the number of anesthesia providers agreed they should tear off a pre-measured length of tape prior to taping an endotracheal tube. IMPLICATIONS FOR PRACTICE An education intervention and guideline implementation tailored to anesthesia providers regarding eliminating multi-use tape rolls for securing intraoperative endotracheal tubes can alter practice habits and reduce patient exposure to harmful and costly pathogens.
CHRISTOPHER BUCHART DNP, CRNA, APRN
2017 DNP PROJECTS
Multimodal Therapy for Prevention and Treatment of Post-Operative Nausea and Vomiting PURPOSE The purpose of this research project is to provide information to anesthesiologists and nurse anesthetists at a major medical center in southeastern Louisiana regarding appropriate medication administration for prevention and treatment of post-operative nausea and vomiting (PONV) in order to increase knowledge and improve management for these patients. METHODOLOGY An educational teaching session was delivered and a guideline was proposed to anesthesia providers during multiple casual sessions at a volunteer basis. A pre-survey and post-survey were collected from each participant. A Likert scale number was assigned to each answer choice for both surveys and a paired t-test using Microsoft Excel was completed.
ARIELLE BURKHALTER DNP, CRNA, APRN
RESULTS There was no significance between the presurvey and post-survey questions with the exception of question 4; however, the question differed from the pre-survey and post-survey, which may have affected the outcome. All the survey questions reflected the practice of the provider, not the actual knowledge gained from the teaching session. IMPLICATIONS FOR PRACTICE Current literature supports the implementation of guidelines or protocols for reduction in PONV incidence. Further research could be conducted with more focus on the knowledge gained by providers based on the teaching session. In addition, a more defined study comparing the difference in incidence with or without a PONV guideline could benefit the patient care at Our Lady of the Lake Regional Medical Center. Continued efforts to improve knowledge of providers and alter patient care for improved satisfaction is an imperative part of anesthesia.
Use of Prophylactic Propofol in Reducing Emergence Agitation in Pediatrics PURPOSE To provide anesthesia providers at a major medical center in southeastern Louisiana with the current literature concerning pediatric patients undergoing general anesthesia with sevoflurane and decreasing the incidence of emergence agitation by administering a prophylactic dose of 1 mg/kg propofol prior to emergence and evaluating knowledge transfer following educational session. METHODOLOGY Delivery of an educational session to invited anesthesia providers of an anesthesiology group in southeastern Louisiana. Pre- and post-educational session surveys were used to evaluate knowledge translation.
RESULTS Microsoft Excel utilized for data analysis, and a one-tailed, paired t-test was used to compare the pre- and post-surveys. All statements except one yielded statistically significant changes following the educational session. The statements related to the objectives being clearly stated, usefulness of the information delivered, and adopting the proposed preventative measure into practice all had a mean score of 5/5, which indicates that 100 percent of the participants strongly agreed to these statements. IMPLICATIONS FOR PRACTICE The educational session delivered to the participating anesthesia providers proved to be an effective tool in delivering the current literature regarding propofol and emergence agitation.
LINDSEY DIEHL DNP, CRNA, APRN
2017 DNP PROJECTS
High-Fidelity Pediatric Simulation and Student Registered Nurse Anesthetist Anxiety PURPOSE To determine whether the exposure to simulation of pediatric intraoperative crises will significantly reduce anxiety levels in the novice SRNA, when compared to traditional teaching methods. METHODOLOGY A short review lecture of emergency pediatric dosing and drugs was given to all participants. Following the presentation, the sample was divided in half at random and Group A underwent simulation. All participants returned for a second session to undergo the simulation, and pre- and post-surveys were given to measure changes in anxiety between each individual student and the two groups. The anxiety survey used for both pre- and post-evaluation was the State-Trait Anxiety Inventory (STAI). The simulation was conducted by the author on each student.
LOGAN FONTENOT DNP, CRNA, APRN
RESULTS There was a significant difference in baseline state (situational) anxiety between the simulation and control group, as well as a significant difference between the preand post-state portion of the survey of the experimental group. IMPLICATIONS FOR PRACTICE Results support the integration and adoption of pediatric simulation into the simulation portion of the university’s DNP-NA curriculum to reduce anxiety in the SRNA. Future projects should use a variety of simulation scenarios to get the maximum amount of exposure to better support the SRNA on his/her clinical journey.
The Effectiveness of Intraoperative Ketamine on Decreasing Postoperative Pain Scores: A Teaching Project PURPOSE The purpose of this scholarly inquiry project was to educate Certified Registered Nurse Anesthetists (CRNAs) on the benefits of incorporating subanesthetic doses of Ketamine into their anesthetic practice for better pain control in the postoperative period. METHODOLOGY Implementing a teaching session using the Knowledge-to-Action cycle in which CRNAs can learn about the benefits of utilizing Ketamine in their anesthetic practice. Staff CRNAs who attended the education session were asked to complete a pretest and posttest utilizing a Likert scale. The tests were compared to determine if knowledge translation occurred.
RESULTS Approximately 75% of the CRNA’s involved in the study did not utilize Ketamine in their anesthetic practice before the teaching session occurred. After the teaching session was completed, posttest statistics revealed that 75% of the group would indeed begin to utilize Ketamine in their anesthetic practice for pain control. The result of the pretest and posttest showed the teaching session was effective in persuading approximately 50% of the participants to utilize subanesthetic dosing of Ketamine during surgery for postoperative pain control. IMPLICATIONS FOR PRACTICE The project identifies if Ketamine is utilized in current everyday practice for pain control and if a teaching session could impact current practice.
JOSH GAUTREAUX DNP, CRNA, APRN
2017 DNP PROJECTS
Emergent Airway Management in the Adult Trauma Patient with Cervical Spine Immobilization: A Teaching Project PURPOSE The goal of this DNP project is to provide Student Registered Nurse Anesthetists with knowledge related to airway management in adult trauma patients, specifically tracheal intubation methods, resulting in a more standardized approach among anesthesia providers caring for this patient population. The problem was identified in both the operating suites and emergency department while observing provider differences in airway management in the adult trauma population, specifically those patients with cervical spine immobilization. A review of the literature was completed to assess the tracheal intubation practice discrepancy and assess current recommendations. METHODOLOGY An educational session was presented to second-year SRNAs on the use of GlideScope video laryngoscopy in adult trauma patients with cervical spine immobilization requiring emergent intubation. Pretest and posttest surveys were administered to evaluate knowledge translation and overall effectiveness of the educational session.
CLINT HICKMAN DNP, CRNA, APRN
RESULTS Data obtained from the pretest and posttest surveys were analyzed using a paired t-test. All five of the statements utilized for evaluation of knowledge translation reached statistical significance. Participants rated the educational session highly and indicated that the information provided would likely result in a practice change when caring for adult trauma patients with cervical spine immobilization. IMPLICATIONS FOR PRACTICE An educational session, such as the one undertaken for this project, is an effective tool for knowledge translation. Future education efforts should focus on expansion of the knowledge to other groups of providers, including practicing CRNAs, anesthesiologists, emergency medicine physicians, and nursing staff working in areas where this patient population is frequently encountered.
Safe Transfer and Positioning of the Obese Patient During the Perioperative Period PURPOSE The goal of this project was to provide an educational session to student nurse anesthetists based on the evidence in the literature as to what equipment is best suited for the transfer, padding, and positioning of the obese patient. METHODOLOGY A teaching presentation was developed and delivered to SRNAs using evidence found in the literature. A pretest/posttest design was utilized to assess any increase in knowledge related to the transfer, padding and positioning of the obese patient. The results of the pretest and posttest were analyzed using a paired t-test with significance set at p < .05.
RESULTS The analysis of the results indicated an increase in knowledge by the teaching session. 3 of the 5 questions showed a statistically significant change between pretest and posttest. IMPLICATIONS FOR PRACTICE The project supported the need for a guideline or protocol be developed and used for anesthesia providers regarding specific care for the obese patient. The project revealed that further research is needed regarding specific pressure measurements and distribution data for the different types of padding available.
REBECCA KROBERT DNP, CRNA, APRN
2017 DNP PROJECTS
Weight-Appropriate Pharmacological Guidelines for Anesthesia Induction Medications in the Obese Population PURPOSE This scholarly project examined current research on dosing scalars of anesthetic induction medications and catered to the education of second-year student registered nurse anesthetists at a small university in southeastern Louisiana using an interactive teaching approach. The objective was to ensure student preparedness for pharmacologic administration during induction of an obese population undergoing surgical procedures. METHODOLOGY An eight question pretest was administered to students to gauge their prior knowledge. Next, an educational seminar utilizing a PowerPoint presentation and a game-based learning platform was provided to anesthesia students. Students were then administered a posttest questionnaire to assess knowledge gained during the seminar and were given a reference card to use in clinical settings.
BRANDON LAGRANGE DNP, CRNA, APRN
RESULTS Six out of eight survey questions showed statistically significantly improved answer choices compared to the pretest on the teaching subject topics of: body mass index, pharmacokinetic changes, and dosing guidelines for intravenous anesthetics, midazolam, fentanyl, and lidocaine. The statistics were found to be insignificant on the subjects regarding dosing scalars and neuromuscular blocking agents. A reference guide was distributed detailing the dosing scalars discussed for specific anesthetic agents. IMPLICATIONS FOR PRACTICE The teaching project highlighted a knowledge gap related to dosing scalars for induction medications in the obese population. This gap could extend to practicing CRNAs and a teaching project geared towards the practicing anesthetists should be considered.
Pre-Oxygenation by Non-Invasive Positive Pressure Ventilation with Positive End-Expiratory Pressure in Obese Surgical Patients PURPOSE The traditional method of pre-oxygenation prior to anesthetic induction may not provide adequate oxygenation for obese and morbidly obese patients presenting for surgery. It is proposed that the use of non-invasive positive pressure ventilation (NPPV) with positive end-expiratory pressure (PEEP) during preoxygenation with 100 percent oxygen for 3 to 5 minutes is a more effective technique to use for obese surgical patients. Few studies have been conducted on this method of preoxygenation yet existing data suggests that this technique improves oxygenation, shortens pre-oxygenation time, and prolongs the safe apnea time in obese patients. METHODOLOGY An educational session was developed and delivered to student registered nurse anesthetists entering into their first semester of clinical rotations to increase their knowledge of the advantages of using NPPV with PEEP for the pre-oxygenation of obese surgical patients. A pre/posttest was distributed to assess the studentsâ&#x20AC;&#x2122; knowledge level before and after the educational session. An educational survey was also distributed to allow the participants to provide feedback on the presenter and presentation. Results of the pre/posttest were collected and interpreted using the paired samples t test.
RESULTS The results indicate that the teaching intervention was effective at increasing the knowledge level of the students regarding the pre-oxygenation of obese surgical patients. The statistical analysis showed a statistically significant increase for each paired question. IMPLICATIONS FOR PRACTICE The results support a change in current practice by indicating awareness among SRNAs that the standard approach to preoxygenation may not be adequate for obese surgical patients. The likelihood of a change in practice could be further assessed by a teaching project delivered to CRNAs and anesthesiologists at the selected facility. A teaching project delivered to practicing anesthesia providers would likely have a larger impact and could better facilitate a change in practice.
DEIDRE LEEPER DNP, CRNA, APRN
2017 DNP PROJECTS
Medication Management for Children Diagnosed with Attention Deficit Hyperactivity Disorder PURPOSE The purpose of this project is to educate anesthesia providers on the effects of attention deficit hyperactivity disorder of commonly used preoperative medications in reducing preoperative anxiety and emergence agitation. Through a review of the literature, current evidenced-based interventions were presented to help anesthesia providers understand the interactions of ADHD and common preoperative medications. METHODOLOGY Pre- and post-educational session surveys were used to evaluate anesthesia provider knowledge.
JOSEPH MARTIN DNP, CRNA, APRN
RESULTS One of the four paired statements showed a statistically significant gain in knowledge. This statement addressed the providerâ&#x20AC;&#x2122;s knowledge regarding attention deficit hyperactive disorder, preoperative anxiety, and emergence agitation. There were two unpaired questions on the post-survey. All participants (100%) agreed the goal of the educational session were clearly defined. For the statement evaluating whether the information provided would be useful in their anesthesia practice, the participants gave a mean score of 4.9/5. IMPLICATIONS FOR PRACTICE Through advocating for the pre-medication of children in the preoperative area, anesthesia providers can help reduce preoperative anxiety and emergence agitation, thus improving the overall surgical experience. Anesthesia providers also should seek out continuing educational resources on the anesthetic needs of children with attention deficit hyperactivity disorder.
A Retrospective Study: Comparing Dexamethasone to Epinephrine as Adjuvants in Nerve Blocks for Upper Extremity Surgery PURPOSE To compare and evaluate dexamethasone and epinephrine when these medications are utilized as adjuvants in peripheral nerve blocks (PNB) performed for pain management after upper extremity surgery. METHODOLOGY A retrospective chart review was performed for data collection. The inclusion criteria included upper extremity surgeries, interscalene or supraclavicular blocks, and PNBs that had included the adjuvant epinephrine or dexamethasone. Also, only PNBs performed for post-operative pain management were included. The data point collected was time from completion of PNB until return of sensation to blocked extremity.
RESULTS Twelve blocks met criteria for inclusion. The mean duration for PNBs that included dexamethasone or epinephrine was 15.875 and 17.485 hours, respectively. An independent sample t-test showed no statistical significance between groups (p = 0.7). IMPLICATIONS FOR PRACTICE Existing literature supports the utilization of adjuvants in PNBs. This retrospective study did not confirm the superiority of either epinephrine or dexamethasone. Nonetheless, it is recommended that the provider use adjuvants while taking patient morbidities into consideration.
TYLER MURPH DNP, CRNA, APRN
2017 DNP PROJECTS
Anesthetic Practices for Bronchial Thermoplasty
BRITTANY MUSSO DNP, CRNA, APRN
PURPOSE Bronchial thermoplasty (BT) is an emerging bronchoscopic treatment for severe asthma. Different anesthetic modalities are currently used for this procedure, ranging from moderate sedation to general anesthesia with airway instrumentation. A paucity of literature exists describing the specific anesthetic techniques being used during anesthesia care delivery for BT. Therefore, not enough literature exists on this topic to inform best anesthesia practice. The aim of this project is to describe current anesthetic techniques used during BT.
RESULTS The sample consisted of 19 CRNA respondents from across the US. Results of the project indicate that general anesthesia using a total intravenous anesthesia (TIVA) technique with an endotracheal tube (ETT) is the most common anesthetic technique used by respondents during BT. Overall, the most frequently used medications during general anesthesia for BT are propofol, fentanyl, remifentanil, midazolam, and lidocaine. The most frequently reported adverse events during general anesthesia are apnea, oxygen desaturation, and hypotension.
METHODOLOGY This project utilizes a descriptive study design to generate more information about the anesthetic techniques currently being provided during BT procedures. Based on the lack of available tools in the literature measuring specific anesthetic techniques, a survey instrument was developed. A BT-experienced CRNA, at the investigatorâ&#x20AC;&#x2122;s institution, reviewed the survey for content validity and clarity, through several revisions until consensus occurred among the investigator, the project chair, and the BT-experienced CRNA.
IMPLICATIONS FOR PRACTICE This project contributes to the body of knowledge on anesthesia for BT by providing a more thorough characterization of anesthetic technique, especially as it relates to general anesthesia. Directions for future research studies include investigating patient outcomes and rates of adverse event occurrence during BT based on anesthetic technique. Although survey research is appropriate to characterize the various anesthetic techniques provide for BT, retrospective chart reviews can reveal more accurate and generalizable results than survey research. As patient satisfaction is increasingly linked to healthcare reimbursement, another implication for future research is patient satisfaction and tolerability scores for BT based on anesthetic technique.
Endotracheal Tube Cuff Pressure during Laparoscopic Surgery and Postoperative Sore Throat PURPOSE To decrease postoperative sore throat (POST) and other pharyngolaryngeal complications by maintaining an endotracheal tube cuff pressure (ETTcP) of 20-30 cm H2O with manometry. The project investigated the effect of ETTcP on the incidence of POST in adult patients undergoing laparoscopic surgery and tested whether endotracheal tube cuff manometry or pilot balloon palpation is more likely to prevent POST. METHODOLOGY Conduct a pilot study utilizing the knowledgeto-action cycle to assess the relationship between ETTcP and POST. Following extubation, pain or discomfort in the throat was graded subjectively by the patients on a numeric pain scale in post-anesthesia care unit (PACU) and 24 hours postoperative.
RESULTS Participants in the study group had a mean ETTcP of 30 Âą 0 cm H2O, which was found to be significantly lower than the mean of those in the control group (67.09 Âą 15.9 cm H2O). In addition to the study group having significantly lower ETTcPs (t = -8.779, p < .001) than the control group, it was determined that those in the study group also had significantly lower sore throat pain scores in PACU (t = -4.274, p < .001) and 24 hours post-procedure (t = -6.593, p < .001) than those in the control group. IMPLICATIONS FOR PRACTICE The current study supports that maintaining an ETTcP of 20-30 cm H2O is best done by use of manometry. Aneroid manometers should be made available to anesthesia providers for proper ETTcP monitoring in surgical patients requiring intubation.
KATHERINE MUSSO DNP, CRNA, APRN
2017 DNP PROJECTS
Effectiveness of Pediatric Anxiety Reduction with the Use of Smart Devices during Induction of Anesthesia: A Mixed Methods Observational Study PURPOSE The purpose of this observational research study is to discern a superior method of anxiety reduction among pediatric patients undergoing induction of anesthesia. At a major medical center in southeastern Louisiana, Certified Child Life Specialists (CCLS) are trained to prepare pediatric patients for surgery, allowing for a smooth transition into the operating room (OR); however, at times there may be insufficient CCLS staff throughout the day to allow participation in each patientâ&#x20AC;&#x2122;s induction of anesthesia, leaving limited non-pharmacological methods to be used during induction. This is where the gap in healthcare delivery is identified. Pediatric anxiety often occurs during induction, and while there are various pharmacological and non-pharmacological modalities to treat this, a preferable method has yet to be determined.
KRISTEN PILCHER DNP, CRNA, APRN
METHODOLOGY To guide this observational research study, a concurrent embedded mixed methods design provided the framework for this project, collecting qualitative and quantitative data simultaneously during one phase. The primary investigator assessed the preoperative anxiolytic effects of smart devices verses verbal distraction methods for pediatric patients ages three to six, once as a baseline during the preoperative period and then once again during induction of anesthesia. Utilizing the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) and collecting
participant demographic information, data analysis was performed with descriptive test statistics, a two-way ANOVA, a one-way ANOVA for change, and individual paired t-tests. RESULTS Anxiety scores decreased with the use of smart devices; however, these findings did not yield statistically significant results. While results were not statistically significant, data analysis revealed mean baseline anxiety scores among all three groups starting at greater than 30, signifying heightened anxiety prior to any intervention presented. Group 1 (CLP-SDP) and group 3 (CLA-SDP) decrease in mean anxiety scores, whereas group 4 (CLA-SDA) increases in mean anxiety scores. IMPLICATIONS FOR PRACTICE This study proposes the need for further research in preoperative anxiety reduction in pediatric patients, with goals of incorporating current technology and reducing the undesirable short and long-term effects of intensified levels of anxiety and distress. Further research is needed on larger diverse sample sizes in the field of nonpharmacological interventions to reduce the undesirable short and long-term effects of intensified levels of anxiety and distress. Incorporating technology into the preoperative arena may yield satisfactory results in anxiety reduction.
Routine Use of the STOP BANG Questionnaire during the Preoperative Evaluation of Patients Undergoing Anesthesia and Increasing Awareness of Obstructive Sleep Apnea PURPOSE The goal of this project was to utilize the STOP BANG questionnaire in a setting that was not regularly using the tool in order to identify at-risk patients and educate patients about obstructive sleep apnea (OSA) and the benefits of seeking medical advice when deemed necessary. Specifically, patients undergoing anesthesia were asked to participate. METHODOLOGY During the preoperative evaluation of patients, the STOP BANG questionnaire was used to identify at-risk patients and invite them to participate in the study. Only those determined to be at high risk and not previously diagnosed with OSA were offered to participate in the pretest, provision of an educational handout, and subsequent posttest. The educational handout addressed the possible causes of OSA, signs and symptoms, and treatment options. The comparison between the pretest and posttest assessed any knowledge gained from the educational handout. A paired t test was then utilized to compare the two patient surveys to indicate the statistical significance of the knowledge gained from the educational session.
RESULTS Five out of the five survey statements revealed a statistically significant increase in patient knowledge of OSA. IMPLICATIONS FOR PRACTICE The STOP BANG questionnaire is a brief, efficient tool to detect at-risk patients for OSA, and identifying the population at risk is the first step in avoiding adverse events and promoting health outcomes. The tool is useful in increasing patient knowledge of OSA.
CLINTON PRASNICKI DNP, CRNA, APRN
2017 DNP PROJECTS
Ensuring a Successful Healthcare Policy Implementation
PURPOSE All healthcare institutions have numerous policies and procedures to guide various aspects of the organizational functions and mission. The policies are intended to streamline processes, standardize practice, and increase efficiency in the workplace. However, these policies and procedures are only effective when properly developed and when implemented correctly. The purpose of this project is to increase the policy maker’s awareness of the policy making process as well as barriers to successful implementation.
MATT RICHARDSON DNP, CRNA, APRN
METHODOLOGY An educational session, visual aid, and checklist was provided to members of a large medical center in Southeastern Louisiana’s Nursing Policy and Procedure Committee. Following the presentation to the initial committee meeting, a survey was provided to the committee members. The SRNA then evaluated and altered the checklist and visual aid according to feedback. The SRNA was invited and attended a policy management improvement initiative session at the medical center. The PRIME checklist and visual aid were presented to the attendees and included as part of a standard operating procedure for the policy mapping process. RESULTS The committee members that completed surveys reported an increased knowledge of critical policy components (p = 0.02) and
barrier recognition following the educational session that included a PowerPoint presentation and educational handouts. The mean scores all show favorable results and comments highlight “ease of use” and “probability of checklist use”. IMPLICATIONS FOR PRACTICE The low risk of its use when compared to the potential benefits provided by the checklist’s application justifies its use in many potential scenarios. The education of policymakers of appropriate policy components and barriers to effective implementation can increase the effectiveness of a policy or procedure. The checklist can be used at any level of healthcare policy and procedure, whether at the unit level and/or systems level. With the current issues that healthcare institutions encounter regarding reimbursement that can be corrected using effective policy implementation, a tool such as this has the ability of increasing both facility revenue and the overall goal of healthcare practitioners: increase patient safety. The implementation of the checklist in a policy drafting process or revision and subsequent measurement of compliance would prove the effectiveness of the checklist. The overall study could be improved in several ways in future projects. A larger sample would increase the strength of the results and possibly decrease the margin of error.
Developing an Evidence-Based Smartphone APP with the Focus of Enhancing the Use of Low Flow Anesthesia PURPOSE To disseminate literature on low flow anesthesia through an evidence-based smartphone medical reference application (APP). The overreaching goal was to increase the knowledge of low flow anesthesia and positively change the attitude toward low flow anesthesia among anesthesia providers. Additional objectives were to investigate the ease of use of the evidence-based APP and the likelihood of anesthesia providers to download and use the APP. METHODOLOGY Design an evidence-based medical reference smartphone APP that also provides a calculator to compute the cost of inhalational agents at different fresh gas flow rates. The virtual connection occurred at the largest private medical center in Louisiana. Data collection consisted of administering a survey to a select sample group of CRNAs before and after a virtual connection and trial of the evidence-based smartphone medical reference low flow anesthesia APP.
RESULTS All nine of the paired survey statements showed a statistically significant gain from preto posttest scores. Five of these statements addressed the knowledge of low flow anesthesia while the other four statements addressed the attitude toward the use of low flow anesthesia in clinical practice and the use of a low flow anesthesia smartphone APP. For the two unpaired statements, all participants strongly â&#x20AC;&#x153;agreedâ&#x20AC;? that the APP was easy to navigate and use, and that they would download and utilize the APP. IMPLICATIONS FOR PRACTICE This project provides insight into the impact of this emerging technology, suggesting that an evidence-based smartphone APP can increase the knowledge of and positively change the attitude toward low flow anesthesia. Further research is needed to investigate the effects of clinician-based smartphone APPs on anesthesia care and providers with the focus of increasing the use of low flow anesthesia. The methods used in this DNP project might apply to future studies involving the utilization of technologies in anesthesia practice.
ELIZABETH SMITHHART DNP, CRNA, APRN
2017 DNP PROJECTS
Best Practice for Reducing Propofol Injection Pain
PURPOSE The purpose of this project was to disseminate evidence-based literature to anesthesia providers on the pharmacokinetics, recommended dosing, and effectiveness of a lidocaine-propofol admixture and mitigate propofol injection pain.
ALLISON SPENCE DNP, GRNA
METHODOLOGY A minimum of 10 CRNAs currently employed with a large anesthesia group in southeastern Louisiana were recruited to participate. This project was implemented at a major medical center in southeastern Louisiana. The anesthesia providers practice among three towers of operating room suites and in nonoperating room settings within the hospital for minor surgical procedures. An educational session was delivered to nurse anesthetists regarding the effectiveness of a lidocaine and propofol admixture to reduce propofol injection pain. A pretest, posttest and threeweek posttest survey was administered to all participants. The data was entered into Excel for data analysis. Descriptive statistics and a one-tailed, paired t-test were computed to compare the individual responses between the surveys.
RESULTS The mean response by provider to each question illustrated knowledge attainment of learner objectives and results were statistically significant (P<0.05). The findings were disseminated via a poster presentation during the Transforming Research into Practice (TRIP) educational conference on October 20, 2017 at Lod Cook Alumni Center in Baton Rouge, Louisiana. IMPLICATIONS FOR PRACTICE Research should continue to investigate the admixture formula and focus on developing a standardized tool to measure injection pain response. Additionally, educational presentations should remain a primary platform to educate anesthesia providers with evidence-based practice literature.
Anesthetic Approach for Pediatric Spine Surgery
PURPOSE The purpose of this project is to educate novice anesthesia providers on the use of TIVA as an anesthetic technique in the pediatric spine surgery population with a project aim to administer a peer led educational intervention to fellow SRNAs focused on presenting information on medications, equipment, and methods of use for TIVA administration. METHODOLOGY A peer led educational intervention to fellow student registered nurse anesthetists (SRNA) in the nurse anesthesia skills and simulation laboratory, focused on presenting information on medications, equipment, and methods of use for TIVA administration. The educational session utilized various teaching methods to appeal to diverse learning styles and included both video and printed resources.
RESULTS Twenty-two junior SRNAs participated in the educational session. A pretest survey was administered to each student prior to the presentation and a posttest survey is administered to each SRNA at the conclusion of the presentation asking the student to rate their attainment of each learner outcome. There was an improvement in the mean of each learner outcome as well as in the overall score of each pre and posttest. IMPLICATIONS FOR PRACTICE Practitioners must be aware that TIVA set up will depend on supplies and equipment available at their specific facility. These factors lead to the need for facility specific protocols, guidelines, and dosing regimens for TIVA. Future teaching projects may include hands-on demonstrations or checkoffs of TIVA setup by the participant utilizing an objective checklist designed by the researcher. Continuous periodic educational reinforcement of the benefits of TIVA, specifically in unique populations and settings such as pediatric spine surgery, should be available to anesthesia providers by healthcare organizations and anesthesia regulatory bodies.
WILL STEVENS DNP, CRNA, APRN
2017 DNP PROJECTS
Transfusion Practices in Aortic Valve Replacement: Is Less More?
PURPOSE In 2007, the Society of Thoracic Surgeons (STS) and Society of Cardiothoracic Anesthesiologists (SCA) Blood Conservation Task Force was assembled to find ways to decrease the use of blood transfusions in the care of cardiovascular surgical patients. At the time these recommendations were made, 80% of intraoperative blood transfusions were occurring in cardiac procedures. The recommendations in the STS and SCA Blood Conservation Task Force (2007) guidelines changed the transfusion trigger from a hemoglobin value of 10 g/dL to 7 g/dL. In 2011, the STS and SCA Blood Conservation Task Force published updated blood conservation guidelines reinforcing the current transfusion trigger. Since publication of the STS and SCA Blood Conservation Task Force (2007 & 2011) guidelines, research has shown that a blood conservation strategy improves patient outcomes in coronary artery bypass grafting, but minimal evidence exists supporting this strategy in aortic valve replacement surgery.
JOSHUA TODD DNP, CRNA, APRN
METHODOLOGY A retrospective analysis of de-identified data from aortic valve replacement surgery cases at a larger regional medical center evaluated the impact of current packed red blood cell (PRBC) transfusion practices on end-organ perfusion, excluding those patients with renal failure or who were on dialysis, those who had two or more vessels bypassed, unplanned aortic valve procedures, and other valve procedures.
RESULTS Incidence of acute kidney injury (AKI) proved to be more significantly impacted by PRBC transfusion as compared to transfusion at a lower hemoglobin level. Postoperative PRBC transfusion proved a stronger predictor of AKI (β = 0.451; p < 0.001) than intraoperative transfusion, which did not prove statistically significant as a predictor. IMPLICATIONS FOR PRACTICE These results suggest that: 1) it is safe to use a more conservative transfusion trigger during aortic valve replacement surgery and 2) the decision to transfuse PRBCs should be guided by clinical evidence of inadequate tissue perfusion rather than a specific hemoglobin value.
Development of TIVA Instructional Handout for Improving Outcomes in Spine Surgery PURPOSE The purpose of this project was to provide education and increase knowledge of current literature and recommendations concerning the use of total intravenous anesthesia (TIVA) in adult spine surgery among junior student registered nurse anesthetists (SRNAs) currently enrolled in the nurse anesthesia program at a small university in southeastern Louisiana in order to increase the likelihood of TIVA usage in the clinical setting.
METHODOLOGY Twenty-two SRNAs participated in this project, this number of participants allowed for the project lead to obtain adequate beginning descriptive statistics (Bonnel & Smith, 2014). The educational session took place on July 14, 2017. The project was implemented at a small university in southeastern Louisiana in the skills laboratory of the nurse anesthesia building. The project lead provided an instructional handout and an instructional video to the SRNAs in attendance detailing the following five key aspects of TIVA administration: TIVA equipment and setup, advantages and disadvantages of TIVA, appropriate candidates for TIVA, TIVA dosing, and timing of drug administration.
RESULTS The participants exhibited increased scores on the post-survey compared to the pre-survey in all five categories evaluated. IMPLICATIONS FOR PRACTICE Examine barriers to TIVA utilization among practicing CRNAs and provide education to overcome these barriers.
JOSEPH WRAY DNP, CRNA, APRN
2017 DNP PROJECTS
2017 DNP PROJECTS
For more information visit franu.edu/dnp or call (225) 768-1700.