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Anesthesia Providers’ Perceptions of Ultrasound-Guided Arterial Line Placements: A DNP Project
(2024-12-02) Pearce, Laura
Current evidence shows the use of ultrasound guidance is advantageous for arterial line placements in reducing complications and increasing efficiency. Despite this evidence, no formal guidelines have been established regarding ultrasound-guided arterial line placements, leaving anesthesia providers to use their clinical judgment and personal preferences when placing these invasive lines. At this time, there is a lack of understanding regarding anesthesia provider preference for utilization of ultrasound technology for perioperative arterial catheterization. The purpose of this DNP quality improvement project was to develop, implement, and evaluate the perceived adequacy of an educational resource designed specifically for anesthesia providers to improve awareness and utilization of ultrasound for arterial line placement. This project took place at the main operating suite of a large medical facility in eastern North Carolina. CRNAs at this site were provided information on the basics of ultrasound use, troubleshooting tips, and the current research regarding ultrasound-guided arterial line placements. The results showed that confidence level and likelihood of using ultrasound-guidance for arterial line placements increased following the implementation period. Participants also identified a lack of equipment as a barrier to using ultrasound in their practice. Future projects should focus on increasing access to ultrasound equipment and the addition of a hands-on ultrasound workshop to further increase confidence and skill.
Assessing CRNAs’ Perceptions of the Adequacy of a Quick-Reference Guide for Evaluating Airways of Patients with Obesity: A Quality Improvement Project
(2024-12-02) Craney, Tyler
Obesity (BMI > 30 kg/m2 ) has increased to over 40%, and morbid obesity (BMI > 40 kg/m2 ) to more than 9% of the United States population. Subsequently, there are more patients with obesity presenting for surgery and anesthesia. The increased adiposity in obese patients alters anatomy and physiology and places them at higher risk for difficult perioperative airway management. There are a variety of techniques to properly assess these risks, however no single source could be found that succinctly incorporated predictive scales for properly identifying and managing potential difficult airways in patients with obesity. The purpose of this Doctor of Nursing Practice quality improvement project was to assess CRNAs’ perception of a newly developed quick reference guide as a useful tool for their practice as it pertains to airway assessment in patients with obesity. The CRNAs used the provided quick reference guide for a period of two weeks and were surveyed before and after regarding their current assessment practices and patient populations. None of the providers reported using ultrasound in their assessments, despite receiving education of its high specificity and sensitivity in predicting difficult airways in patients with obesity and some CRNAs still reported patients with obesity are more difficult to intubate, which contradicts current literature. Limitations to this project are the small sample size and unequal pre- and post-implementation survey responses. Knowledge gained from this pilot project could be used in future quality improvement and policy efforts aimed at improving anesthesia care of patients with obesity.
Implementation of a Standardized Handoff Report for Nurse Anesthetists in the Intra-Operative Setting: A Quality Improvement Project
(2024-12-02) Pierce Do
Handoffs amongst anesthesia providers are complex, rapid, and frequent. The responsibilities of a nurse anesthetist consist of providing safe and effective anesthesia before, during, and after surgery. While individual anesthesia providers often use systematic methods for giving report, anesthesia departments typically do not use common reporting tools, which may improve the quality and continuity of information, perception of patient safety, and healthcare worker satisfaction. This Doctor of Nursing Practice (DNP) project aimed to assess anesthesia providers' perceptions of adequacy of the PATIENT Mnemonic to facilitate standardized handoffs of anesthetized patients. This quality improvement project was completed at a Level I trauma center located in the southeastern region of the United States. A pre- and post-survey design was utilized to complete a single Plan, Do, Study, Act cycle to assess user perceptions of the PATIENT Mnemonic amongst a non-randomized group of CRNAs. Based on project data, a shorter version of the PATIENT Mnemonic tailored to anesthesia providers at the project site would do well. Eliminating aspects reported to be redundant or unnecessary would shorten the time it takes to give report, may make the handoff process more seamless, fluid, and similar to how most CRNAs already give report. Two limitations of this quality improvement project were the small sample size and limited time for implementation. Overall, continuing this quality improvement project would be a low cost, low risk, and high reward since it has the potential to reduce patient harm and improve patient outcomes.
Test article by Yeti McGee & Sasquatch Jones
(Criptid Quarterly, 2023) McGee, Yeti; Jones, Sasquatch; Jones, Sasquatch
