Clinical Improvement/Innovation Poster Abstract Evaluation

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 59
POSTER TITLE:
Perioperative Nursing and Humanitarian Relief
A military perioperative nurse may unexpectedly be tasked with creating functional operating rooms
(ORs) in preparation to receive casualties with a variety of injuries, regardless of assigned location in
the world. When an earthquake ravaged the country of Haiti, the crew from Fleet Surgical Team 8 was
ordered to stand up three functional ORs onboard the amphibious platform USS Bataan (LHD-5) with
less than 48 hours notice. The team consisted of a variety of medical personnel that included one
general surgeon, one certified registered nurse anesthetist (CRNA), one perioperative nurse, and three
surgical technologists. The perioperative nurse was responsible for ensuring all equipment and
instruments were functioning and to stock all ORs with supplies necessary to treat any surgical trauma
patient. The perioperative nurse also supervised the augmentation of 25 additional surgical personnel,
including additional surgical technologists, anesthesia providers, and orthopedic, trauma, and general
surgeons. Duties of the military perioperative nurse included daily tracking of all surgical patients,
inventorying all surgical supplies, and providing daily briefings to the surgical staff and theatre officers
in charge. The surgical staff treated over 95 patients of varying ages and injuries during a four week
mission aboard the amphibious platform. The military perioperative nurse must adapt to their assigned
environment. They must understand the amenities afforded by a Conus hospital, or those offered by a
military hospital ship may not be available. The views expressed in this article are those of the author
and do not necessarily reflect the official policy or position of the Department of the Navy, Department
of Defense, or the United States Government. I am a military service member. This work was prepared
as part of my official duties. Title 17 U.S.C. 105 provides that Copyright protection under this title is not
available for any work of the United States Government. Title 17 U.S.C. defines a United States
Government work as a work prepared by a military service member or employee of the United States
Government as part of that persons official duties.
AUTHOR
LT Eric M. Hoyer, BSN, RN, CNO
FACILITY
US Navy

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 60
POSTER TITLE:
Developing a Case Cart System in a Renovated Space
At University Hospital St. Paul, a case cart system was not available due to space constraints. We
perform approximately 150 cases each week and pulling cases takes valuable time away from the
nursing staff that could best be applied to performing patient care activities. A vacated rehab area was
located as available space and is now being renovated to include supply receiving, case cart pulling,
and staging areas. This project requires the cooperation of the operating room (OR), facilities support,
sterile processing, and supply chain management staff. Workflow and process changes are necessary
to make the new system successful. The outcome will free up OR nursing staff to provide clinical
patient care rather than pulling cases and checking case carts. The project impacts inventory, resource
utilization, staffing, processes, and supply chain management. Current and future state workflows must
be identified and developed to ensure that case carts are correctly picked, staged, stored, and in the
correct location as needed for patient care. An added bonus is additional storage space for OR
equipment once supplies are relocated in the case cart area. We are using a team approach to create a
process that will provide a positive outcome for our patients, staff, and physicians.
AUTHOR
Renee D. Bailey, MS, RN, CNOR
FACILITY
University of Texas Southwestern Medical Center

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 61
POSTER TITLE:
Evidence-Based Practice for Mechanical VTE Prophylaxis
Purpose: Determine evidence-based practice for implementation of mechanical venous
thromboembolic (VTE) prevention in the perioperative period based on a systematic literature review.
Methodology: Systematic literature review of the Ovid database for all currently available years was
conducted to answer the following questions. What evidence exists for optimal application time of
intermittent pneumatic device (IPC) and compression stockings for perioperative prophylaxis? What
evidence exists for addressing the benefit of using a combination of IPC and compression stockings?
What evidence exists regarding efficacy of use of mechanical prophylaxis both perioperatively and
postoperatively? What evidence exists regarding alternative configurations of mechanical prophylaxis
for use on specialty operative tables?
Results: Optimal application time was determined to be as soon as possible prior to the surgical
procedure. In some instances, the application of device(s) may be as much as one-hour prior to
transport to surgery. There is no consensus in the literature that the combination of compression
stockings with IPC offers any additional benefit in preventing VTE. Fibrinolytic activity is increased by
use of external compression and that the effect lasts up to three days postoperatively. No alternative
configurations with significant supporting evidence were identified for use with specialty operative
tables.
Implications for Perioperative Nurses: Evidence suggests implementation of mechanical prophylaxis as
early as possible in the perioperative period decreases occurrences of VTE for the surgical patient.
Ambulatory patient prophylaxis should begin as soon as they are settled, and prior to transport to the
operative suite. Prophylaxis should be maintained for all patients throughout the perioperative period.
AUTHOR
Brenda G. Larkin, MS, RN, CNOR, TNCC, APRN-BC; Matthew E. Beier, MS, RN, CNS-BC, CNOR;
Cindy Lewis, RN; Kimberly M. Mitchell, BSN, RN, CNOR; and Kathryn H. Petrie, RN
FACILITY
Aurora West Allis Medical Center

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 62
POSTER TITLE:
The Effectiveness of Evidence-Based Surgical Gloving
Purpose: The purpose of this study is to investigate current additional surgical gloving protection aimed
at preventing micro-perforations in surgical gloves.
Methodology: 585 innermost pairs of surgical gloves were collected in an academic medical center in
San Francisco. Gloves were subjected to a watertight test to reveal otherwise undetected microperforations.
Additionally, 144 pairs of an orthopedic surgical teams triple gloving combinations that
include cloth gloves, colored indicator gloves, special orthopedics gloves, and powered and nonpowered
gloves were tested for micro-perforations.
Results: 87% of surgical team members practice the double gloving, while 13% practice single gloving.
The undetected micro-perforation rate in the innermost pairs of surgical gloves was 2% and 3%,
respectively. It approximately four times lower than the reported rate in the literature, which was ranged
from 8% to 50%. The undetected micro-perforation rate using triple gloving combinations that included
special orthopedic gloves as innermost pairs was 0%.
Perioperative Nursing Implications: Double gloving with either colored perforation indicator gloves or
special orthopedics gloves is an inexpensive practice reducing the micro perforation rate in the
innermost pair of surgical gloves. Results of this study may provide perioperative nurses a guide in their
usage of surgical gloving protection while not yet establishing a standardized additional glove protection
method. Limitation of this study was other possible contributing factors were not controlled, such as the
seniority and subsequent experience of the glove wearers. Further study is needed to evaluate the
relationship between clinically visible glove perforation and the occurrence of SSIs.
AUTHOR
Kyung Mi Kim, MS, RN
FACILITY
St. Mary's Medical Center

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 63
POSTER TITLE:
Manifestations of Hypothermia During Anesthesia Recovery
Hypothermia interferes with the biotransformation of drugs, increasing the duration of action of
sedatives, hypnotics, and anesthetics, delaying recovery of consciousness, and that tremors may
determine the increase in oxygen consumption and production of carbon dioxide. The aim of this study
was to identify the signs of hypothermia in the anesthetic recovery room. The sample consisted of 30
adult patients with body temperature at the entrance to the operating room (OR) between 36°C and
37.2°C, elective surgery and general anesthesia. The results showed a predominance of females, aged
between 28 and 38 years, with surgery for diagnostic hysteroscopy and endometrial biopsy. Regarding
axillary temperature of the patient off the OR, the majority 22 (73.3%) maintained between 35.1°C and
35.9°C, and seven (23.4%) with temperature below 35°C. Most patients 24 (80.0%) remained
hypothermic during the first 30 minutes spent in the anesthetic recovery room, with axillary temperature
between 35.1°C and 35.9°C. As to the manifestations of hypothermia, the average was 1.83 events per
patient, and hypoxemia in 22 (73.3%), requiring oxygen to maintain oxygen saturation, tremors in 20
(66.6%), pallor in eight (26.6%), and hypertension in five (16.6%). As for methods for treatment of
hypothermia, 30 (100.0%) used a sheet and blanket policy. It was concluded that the patient develops
hypothermia in the OR, staying in the anesthesia recovery room, with various manifestations, so it must
be prevented in the OR to avoid complications.
AUTHORS
Ana Lucia De Mattia, PhD, RN; and Maria Helena Barbosa, PhD, RN
FACILITY
Minas Gerais Federal University School of Nursing, Brazil

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 64
POSTER TITLE:
Lessons Learned During Implementation of a Perioperative
Information System
The National Institutes of Health, Department of Perioperative Medicine, implemented electronic
documentation for statisical perioperative information in June 2006, and implemented nursing clinical
documentation in July 2009, which interfaced with the clinical center's preexisting electronic medical
records system.
Purpose: The goal of this poster is to educate institutions regarding lessons learned from our
implementation of a perioperative information system.
Description of Events: Since Executive Order 13335 mandated electronic patient care records in 2004,
hospitals have been charged to implement an electronic medical record system, including a
perioperative information system. Paper charting is fast becoming obsolete. Advantages of an
electronic medical record include readability, consistency in charting, accessibility to care provider,
simplicity, increased speed in charting, ease of obtaining data, and increased patient protection from
human errors.
Perioperative Nursing Implications: Downtime processes and education to be used if system is not
stable or is down. Delay in accessing patient information when interfaces not working. Charting is
streamlined, easier, and saves time for perioperative nurses. Patient can receive more individualized
attention from the perioperative nurse.
Outcomes: Many lessons during this implementation project were learned. Institutional decisions are
made for reasons which are not always shared with key players in the implementation. If any clinical
staff will be involved with the implementation of the system, additional resources must be provided to
assume clinical duties. The institution needs to have a financial plan for unplanned costs. If interfacing
with an existing hospital information system, make sure information is compatible and fields match in
both systems. A change or upgrade in any system or process may require modifications. The quick fix
does not always work. A thorough change in management process needs to be in effect in order to
ensure valid testing of system changes. In conclusion, while there are many advantages for utilizing a
perioperative information system, it must be realized that such an implementation is a complex process
and the specific needs of the institution adopting such a system should be carefully considered.
AUTHORS
Maureen George, BSN, MSEd, RN, CNOR, OCN; and Nova D. Little, MS, RN, CNOR
FACILITY
National Institutes of Health

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 65
POSTER TITLE:
LVAD Technology at Northwestern Memorial Hospital
LVAD technology provides definitive treatment of heart failure. The purpose of this abstract is to
discuss the technologies used at Northwestern Memorial Hospital (NMH) for bridge to transplant
patients.
Description of Team: Departments of surgery, anesthesiology, cardiology, and nursing.
Preparation and Planning: Patients who advance to or acutely develop Stage 4 heart failure based on
ACC/AHA system are evaluated for cardiac transplant and/or long-term mechanical circulatory support.
After appropriate medical and surgical workup and patient consent, surgery is scheduled for device
implantation.
Assessment: Northwestern Memorial Hospital embraces the work of nursing theorist Virginia
Henderson. Henderson's work focused on patient-centered care and, as such, NMH nurses embody a
Patient Centered Care Model. The perioperative course for management of end-stage heart failure
patients includes well developed evidence based nursing practice.
Implementation: Prevention of major adverse events postoperatively requires a coordinated team effort
in the operating room. Extensive surgical dissection for creation of a pump pocket exposes the patient
to increased risks for bleeding, hematomas, and driveline infections. Anticipating the needs of the team
can significantly reduce the incidence of these events.
Outcomes: During the perioperative course, competent nursing results in decreased procedure time,
decreased need for transfusion, and ethical support for family and patient.
Implications for Perioperative Nursing: Aging of the population in industrialized countries will lead to
continuous increases in heart failure. Perioperative nurses will need knowledge of VAD technology to
properly care for heart failure patients requiring mechanical circulatory support.
NOTE: A product in this poster is being used for a purpose other than for which it was approved
by the Food and Drug Administration (FDA).
AUTHORS
Maggie C. Oldham, MSN, RN, CNOR; Ella S. Echavez, RN, CNOR; and Margaret M. Simons, RN
FACILITY
Northwestern Memorial Hospital

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 66
POSTER TITLE:
Chill Out
Malignant Hyperthermia (MH) is a rare occurrence, but nursing and medical staff must recognize and
initiate treatment of a MH crisis immediately. The need was identified to develop an ongoing learning
opportunity and competency evaluation of critical skills needed in a MH crisis. Knowledge of the the
recognized MH guidelines decreases the risks of MH mortality. The project goal was to provide and
offer increased MH disease knowledge, practice-based learning, treatment modalities, and critical skill
performance improvement. Utilizing a Medical Advanced Skill and Simulation Education Center, our
team of a simulation nurse, hospital education coordinator, and periopative unit educators established a
MH learning event. We staged a simulation scenario and training activity for perioperative staff and
physicans. Our MH policy was revised and our cart contents reorganized to reflect current AORN and
Malignant Hyperthermia Association of the United States (MHAUS) guidelines. We developed and
assigned computer based self learning modules for nursing staff to complete prior to the simulation lab
experience. Medical and nursing staff participated in the activity. Participants were able to demonstrate
recognition and treatment of MH, knowledge of proper Dantrolene Sodium mixing/usage, and
management of MH susceptibleclients. Teamwork, communication skills, professionalism, knowledge of
the disease process, and post procedural care were also demonstrated and discussed. MH training in
the simulation lab is now required for new staff during orientation and is available to all staff for review
as needed.
AUTHORS
Anita Faye B. Akers, RN, CNOR; Florence N. Cooper, BSN, RN, CNOR; Kimberly Douglas, BSN, RN,
CAPA; and Michelle I. Schweinfurth, MSN, RN, CCRN
FACILITY
University of Mississippi Health Care

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 67
POSTER TITLE:
Customer Service Focused Approach for the Perioperative Team
Purpose: To identify factors impacting perioperative case management between the operating room
(OR) and the sterile processing department (SPD) using a customer service survey and the FOCUS
PDCA model.
Description of Team: Perioperative team members in a Level I trauma center.
Assessment: Frustration in having incorrect case carts assembled for orthopedic cases. Lack of team
work and communication between SPD and OR service nurses. Instruments sets returned to SPD
grossly contaminated/in disarray, delaying turnover. Underlying issues included influx of staff surgeons
due to realignment of military facilities; improper selection/absence of preference cards; and updated
preference cards not communicated/delay of update in surgical scheduler system. Intervention included
OR morning rounds with SPD representative; interdisciplinary meeting to review next days cases;
service nurses meet with and update preference cards for new surgeons; and educating all staff
members on new initiative.
Outcome Improvement: Improve perioperative teamwork. Enhance communication between SPD and
the OR. Decrease incorrectly assembled case carts by 80%. Diminish grossly contaminated
instruments received by SPD. Reduce the number of missing instruments and/or sets in disorder by
SPD.
Perioperative Nursing Implications: Promoting customer service has a positive impact on the
professional working environment. Customer service among staff members increases the quality of
perioperative patient care.
AUTHORS
MAJ Denise A. Moultrie, MSN, RN, CNS-BC, CNOR; and MAJ Lance Taylor, BSN, RN, CNOR
FACILITY
Brooke Army Medical Center

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 68
POSTER TITLE:
CIGI: A One-Stop-Shop for Multi-Modality Procedures
A multi-divisional team designed and implemented a facility that would improve patient care by fostering
an ability to perform multi-modality procedures involving endoscopic, radiologic, and surgical disciplines
in one location. This three-year project culminated as the Center for Image Guided Interventions (CIGI)
at Memorial Sloan Kettering Cancer Center. This undertaking moved the endoscopy suite and surgical
day hospital operating rooms to the new radiology platform, three floors and two buildings away from
the original site. This location was critical in that it was in immediate proximity to Central Processing,
the main hospital, and existing radiology units. The new facility includes 17 rooms around a clean-core:
seven ORs; four-room Endo suite, one PET/CT, two angio-CT rooms, one room shelled out for future
modification, and two MRI rooms. The area also maintains a 48 bed pre- and post-procedure area,
including two respiratory isolation rooms and two lead-lined rooms for post PET procedures. An onsite
pharmacy is located adjacent to the interventional and pre-/post- area. All 17 technologically advanced
interventional rooms were outfitted with operating room recommendations, including higher number of
air-exchanges, central lighting, equipment booms, Live Data, and online documentation systems.
Programs that bridge this vision included procedures, such as endoscopic EUS/FNA for staging,
followed by surgical laparoscopy, isolated limb infusions, and virtual ERCP. Staffing is currently crosslearning
to accommodate the new procedure mix. The newly developed M2 Committee includes
members from all departments using the platform and is responsible for overseeing operations and
encouraging future program development.
AUTHOR
Ann Marie Mazzella, MS, RN, CGRN
FACILITY
Memorial Sloan Kettering Cancer Center

POSTER SESSION HANDOUTS
SESSION # 3385
POSTER ID: 69
POSTER TITLE:
Surgical Outreach Program (SOP)
In early 2010, Idaho's unemployment rate reached 10% and an increase in homeless population
ensued. Both situations contributed to a greater population of medically underserved. Several private,
public, local, state, and federal medical programs exist for underserved surgical patients. However,
many people are unable to obtain the surgical care needed or end up in the emergency department to
receive surgery. Unfortunately, both may lead to advanced disease processes that increase morbidity,
mortality, cost, and length of stay. On September 18, 2010, the Surgical Outreach Program (SOP)
partnered with International Surgical Missions, The Terry Reilly Health Clinics, and St. Lukes Health
System to provide outpatient surgery to patients in need.
Giving to others is hallmark to making a difference. However, many hospital staff may not have financial
or family arrangements allowing them to travel out of country for medical missions. The SOP cared for
six surgical patients locally with involvement by more than 50 employees across a spectrum of
departments. Partnership for care was achieved with five surgeons, four nurse anesthetists, an
anesthesiologist, a pathologist, a radiologist, and allied health providers. In addition, outpatient
pharmacy, food and nutrition services, patient financial services counselors, and pathology supported
the first Surgical Outreach Program.
AUTHORS
Janette Silbernagel, MBA, BSN, RN, CNOR; and Rachel Hugens, MS, RN, CNOR
FACILITY
St. Luke's Health System