How do we improve massive transfusion protocol adherence among anesthesia providers?

Background: Previous studies have called for the implementation of provider reeducation efforts to improve massive transfusion protocol adherence.

Objective: This quality improvement project implemented an educational module designed to increase anesthesia provider adherence to the hospital's massive transfusion protocol during the intraoperative massive transfusion of trauma patients. It also aimed to increase survival rates for trauma patients in the operating room for whom a massive transfusion protocol had been activated.

Improving Postoperative Handoff Communication in the Neuroscience Intensive Care Unit: A Quality Improvement Project.

Purpose: This quality improvement project aimed to improve postoperative handoff communication between anesthesia providers and neuroscience intensive care unit nurses by developing and implementing a standardized postoperative handoff checklist for the neurosurgical patient population.

Design: A quality improvement project. Pre-post interventional design.

A Comparative Study of Time to Initiate Chest Compressions and Chest Compression Fraction in the Supine and Prone Positions Using Simulation.

Repositioning a patient from the prone to supine position can delay the initiation of cardiopulmonary resuscitation (CPR). Investigators used high-fidelity simulation to assess the time to initiate chest compressions and the time during which compressions did not occur for supine and prone CPR. Sixty participants completed a knowledge assessment before and after attending an education session and completing two simulations (ie, supine, prone).

Implementation of a Perioperative Lung Protective Ventilation Protocol for Robotic-Assisted Surgeries.

This project sought to educate providers on the benefits of lung protective ventilation (LPV), implement a LPV protocol in robotic surgery, and evaluate adherence to the protocol in the adult (≥ 18 years) robotic-assisted surgery population. This project used a pre/post quality improvement design with a retrospective chart review and periodic knowledge, attitude, and practice surveys over the course of 6 months. This project retrospectively reviewed electronic medical records to assess adherence to the LPV protocol.

Clean hands are caring hands: Improving anesthesia provider hand hygiene and double-glove compliance during induction of general anesthesia.

Background: Hand hygiene and double-gloving practices during induction of general anesthesia can decrease transmission of bacteria to patients and subsequent health care-associated infections; however, compliance to these practices is low.

Methods: A pre- and postimplementation quality improvement design was used with Plan-Do-Study-Act cycles. Several implementation strategies were used to improve hand hygiene and double-glove compliance among anesthesia providers, including printed educational materials, video, in-person, and virtual meetings, visual reminders, audit, and feedback, and improved access to hand sanitizer dispensers in the anesthesia workstation.

The Development and Validation of an Objective Assessment Tool for Performing Ultrasound-Guided Transversus Abdominis Plane Blocks.

The transversus abdominis plane (TAP) block is a regional anesthesia technique used as part of a multimodal pain management plan in patients undergoing abdominal surgery. There are numerous approaches and techniques described in the literature, resulting in a lack of consistency in block performance. This potentially reduces efficacy while increasing risk to the patient.

A Mixed-Methods Exploration of Competencies and Professional Development Needs Among Chief Certified Registered Nurse Anesthetists.

This project sought to explore the experiences, self-perceived preparation, professional development needs, and preferred learning methods of certified registered nurse anesthetists (CRNAs) in a management role. A sample of 10 current chief CRNAs responded to a demographics survey and participated in one-on-one interviews using a 14-question, semi-structured interview framework modified from a previous study. Interview responses were deidentified and qualitatively analyzed for common themes by two content experts and one qualitative analysis expert.

Sustainability of an Operating Room to Pediatric Postanesthesia Care Unit Handoff Tool.

Purpose: The purpose of this quality improvement (QI) project was to reintroduce and assess the feasibility of a standardized, electronic health record (EHR) handoff tool and to evaluate the sustainability of a structured, team-based approach in a pediatric postanesthesia care unit (PACU).

Design: This QI project used an observational pre-post design using two separate convenience samples of handoffs and perianesthesia providers.

Methods: A standardized EHR handoff tool was reintroduced for operating room to pediatric PACU handoff communication.

Improving Certified Registered Nurse Anesthetists' Adherence to a Standardized Intraoperative Lung Protective Ventilation Protocol.

Purpose: The use of lung protective ventilation (LPV) during general anesthesia is an effective strategy among certified registered nurse anesthetists (CRNAs) to reduce and prevent the incidence of postoperative pulmonary complications. The purpose of this project was to implement a LPV protocol, assess CRNA provider adherence, and investigate differences in ventilation parameters and postoperative oxygen requirements.

Design: This quality improvement project was conducted using a pre- and postimplementation design.

Improving Waste Segregation in the Operating Room to Decrease Overhead Cost.

Background And Objectives: Operating rooms (ORs) disproportionally contribute 20% to 33% of hospital waste nationwide and therefore have a major impact on hospital waste management. Seventy percent of general OR waste is incorrectly eliminated as clinical waste, which compounds unnecessary financial burden and produces negative environmental impact. The primary purpose of this quality improvement (QI) project was to evaluate the effectiveness of waste segregation education for OR anesthesia staff on improving waste segregation compliance in the OR.

Design and Validation of a Simulation Scenario and Assessment Tool: A Pilot Project.

In 2016, the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) launched a Continued Professional Certification (CPC) Program to promote lifelong learning and to facilitate ongoing professional competency checks for practicing certified registered nurse anesthesiologists (CRNA). The use of simulation-based assessment is currently being studied by the NBCRNA for potential use in the CPC Program. The aim of the pilot project was to create and validate simulation scenarios and assessment tools for potential incorporation into the CPC Program.

Improved Technical Skill and Procedure Time With Central Venous Catheter Simulation.

Simulation manikins provide anesthetists a training modality to practice ultrasound-guided central venous catheter (CVC) insertion safely without the risk of patient harm. The goals of this quality improvement (QI) project were to increase technical skills and reduce procedure time among anesthesia providers during CVC placement by implementing an ultrasoundguided, simulated CVC insertion workshop. A primary benefit of simulation-based education is the provision of a safe learning environment-one in which learners and providers may practice and increase skillsets.

Three-Dimensionally Printed Simulated Tracheas to Improve Cricothyrotomy Skills Among Anesthesia Providers.

Cricothyrotomy proficiency is imperative for anesthesia providers; however, opportunities to perform this skill are infrequent making skill maintenance essential. Increased accessibility of three-dimensional (3D) printing allows for production of low-cost simulation models. The models used for simulation-based teaching and deliberate practice facilitate skill development and refinement.

Preoperative Preparation and Guidelines for Cannabis-Using Patients Undergoing Elective Surgery.

Purpose: Appropriate preoperative screening techniques are needed to safely provide anesthesia to increasing numbers of cannabis using surgical patients.

Design: This was a quasi-experimental quality improvement project.

Methods: Preoperative identification of cannabis users by registered nurses (RNs) and certified registered nurse anesthetists (CRNAs) was compared to baseline identification rates.

Education for Registered Nurses Completing Preoperative Anesthesia Interviews: A Quality Improvement Project.

Purpose: This quality improvement project implemented job-related education for registered nurses (RNs) completing preoperative anesthesia interviews (PAIs) to increase their knowledge and confidence, improve completeness of documented preoperative interviews, and decrease day of surgery (DOS) cancellations.

Design: Pre/post implementation design and retrospective chart review.

Methods: An educational module on PAIs was created and RNs working in the pre-admission testing (PAT) clinic were asked to complete the module.

How do we improve blood product administration audit rates.

Background: Failure to comply with institutional and national standards for blood product administration poses patient safety risks. Monitoring adherence to blood product administration policy is important for maintaining patient safety and ensuring regulatory agency compliance.

Study Design And Methods: This post-implementation quality improvement project evaluated an electronic paging system that was developed to facilitate perioperative blood product administration audits.

Mobile Cricothyrotomy Simulation Cart Improves Anesthesia Providers' Confidence, Technical Skills, and Procedure Time.

Cricothyrotomy is an invasive airway used in "cannot intubate, cannot ventilate" events and can be taught using simulation. A mobile cricothyrotomy simulation for 66 anesthesia providers included an initial cricothyrotomy attempt (pretest), education, practice and feedback, and a second cricothyrotomy attempt (posttest). Provider confidence, skills, and procedure time were measured.

Standardized Perioperative Note to Improve Perioperative Management of Patients With Cardiac Implantable Electronic Devices.

Purpose: Over 3 million people have a cardiac implantable electronic device (CIED) in the United States. Without an organization-wide, standardized approach to the perioperative management of patients with CIEDs, communication errors and subsequent periods of unintentional deactivation and management can leave patients vulnerable to untreated, life-threatening arrhythmias. The purpose of this quality improvement project was to refine the standardized approach for perioperative management of patients with CIEDs at a large academic medical center.

Creation and Implementation of a Preoperative Malignant Hyperthermia Screening Tool.

Background: Malignant hyperthermia (MH) is a potentially lethal pharmacogenetic disorder triggered by certain anesthetic agents. There is currently no standardized preoperative screening tool utilized to identify MH-susceptible individuals.

Local Problem: This quality improvement (QI) project aimed to enhance preoperative screening for MH susceptibility (MHS) by implementing an evidence-based screening tool for surgical patients at 2 sites.

Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol.

The clinical application of intraoperative mechanical ventilation is highly variable and often determined by providers' attitudes and preferences, rather than evidence. Ventilation strategies using high tidal volumes (V) with little to no positive end-expiratory pressure (PEEP) are associated with lung injury, increasing the risk of postoperative pulmonary complications. Literature demonstrates that applying lung protective ventilation (LPV) strategies intraoperatively, including low V, individualized PEEP, and alveolar recruitment maneuvers, can reduce the risk of postoperative pulmonary complications.