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Corneal abrasions (CA) are one of the most common anesthesia-related adverse events. There is limited evidence about the effect of virtual education on providers’ knowledge regarding CA prevention. The purpose of this project was to assess if a web-based educational module effectively improved anesthesia providers’ awareness of evidence-based preventative measures of CA. This project had a quasi-experimental, pretest-posttest design. All participants completed a questionnaire regarding the knowledge on CA prevention before and after the educational module. A student T-test was used to compare the differences in pre- and post-education knowledge scores. Among 25 participants, 12.0% were anesthesiologists and 88.0% were certified registered nurse anesthetists. There was a significant pretest-posttest difference on the total knowledge score (6.88 ± 1.59 vs. 8.29 ± 1.31, p < .001). Overall, the average number of correct answers increased from 6.88 (SD = 1.59) to 8.29 (SD = 1.31), t = 4.22, p<.001. The web-based educational module effectively enhanced anesthesia providers’ knowledge in preventing surgical induced CA. The finding may add evidence when developing guidelines and standardizing provider education in CA prevention.
Purpose: Identifying trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing bariatric procedures at a community hospital to determine impact of the dose received on perioperative glycemic control.
Background: Dexamethasone is a corticosteroid and despite its many documented benefits when administered perioperatively to surgical patients, it is often withheld in the type II diabetic population out of concern for postoperative hyperglycemia.
Methods: Retrospective chart reviews of 36 type II diabetics receiving dexamethasone undergoing bariatric procedures was completed. Inclusion criteria: type II diabetics, procedures <4 hours, patients with a HbA1C reading 6.5-8.9%, patients who are non-pregnant, patients with an ASA classification of I, II, or III, and who are not taking chronic steroids.
Results: Of the 36 perioperative glycemic trends reviewed, there was a significant increase (t = 8.72, p<0.001) between the preoperative and immediate postoperative blood glucose readings for dexamethasone doses 4-10 mg (p <0.011). This increase was not associated with age, HbA1C, or surgery length. The dose level itself did not influence actual BG level changes (t = -.87, p = .390).
Conclusion: Dexamethasone increases postoperative BG significantly in DMII patients undergoing bariatric surgery in the immediate postoperative period. However, it should be noted that there was not a significant difference between preoperative BG and the 24-hour postoperative BG level. Two patients who did not receive dexamethasone also showed an increase in BG that approached significance (p = .060). These results suggest that further study on the effects of dexamethasone dosing and perioperative glycemic control is necessary.
Key words: Hemoglobin A1C (HbA1C), dexamethasone, diabetic II, type 2, bariatric, intraoperative
The purpose of this quality improvement project was to identify trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing genitourinary procedures at a full-service community hospital and to determine impact of dosage level on postoperative glycemic response compared to preoperative blood glucose levels. Dexamethasone is a corticosteroid that has many dose-dependent benefits when administered perioperatively to surgical patients. It is often withheld in the type II diabetic population out of concern for effects on postoperative glycemic control due to the side effect of hyperglycemia.
The method of this quality improvement project consisted of a retrospective chart review of patients with type II diabetes undergoing genitourinary procedures. Data inclusion criteria included patients who: are type II diabetics, had procedures that lasted less than four hours, had a documented preoperative hemoglobin A1C reading within the last twelve months ranging from 6.5-8.9%, are non-pregnant, are not taking oral steroidal medications, and had an ASA classification of I, II, or III.
Forty-nine charts were reviewed and overall there was no significant change in blood glucose in the postoperative period (t = 0.92, p = 0.361). The dose of dexamethasone (4, 8, or 10 mg) had no effect on the change in blood glucose levels (t =-1.14, p = 0.263). Additionally, changes in blood glucose were not found to be associated with age, HbA1C, or ASA status.
Dexamethasone administration for patients undergoing genitourinary procedures had no significant impact on blood glucose levels in the postoperative period. These findings may be a result of the shorter length of surgery, in that all 49 charts in this sample consisted of different cystoscopy procedures and had an average surgery length of 66 minutes. Further study is needed to help facilitate anesthesia provider’s decision-making for dexamethasone dosing in type II diabetics.
The purpose of this quality improvement (QI) project was to identify trends in the intraoperative dosing of dexamethasone in type II diabetic patients undergoing orthopedic procedures at a community hospital to determine impact of dosage level on postoperative glycemic response compared to preoperative levels and HgbA1C levels.
Dexamethasone is a corticosteroid and despite its many documented benefits when administered perioperatively to surgical patients, it is often withheld in the type II diabetic population out of concern for effects on postoperative glycemic control. For this QI project, charts of type II diabetics receiving dexamethasone undergoing orthopedic procedures were reviewed. Data inclusion criteria were type II diabetics, procedures <4 hours, patients with a HbA1C reading 6.5-8.9%, patients who are non-pregnant, patients with an ASA classification of I, II, or III, & those not taking steroidal medications.
Dexamethasone dosage had a significant effect on the change of blood glucose levels, (t = 4.16, p < .001), with a higher dose leading to a greater increase in blood glucose (BG). There was a positive correlation between postoperative BG and both surgery length and age, meaning that the longer the surgery and the older the patient the higher the postop BG. Change in BG postoperatively had a negative correlation with HgbA1C, meaning that patients with a lower HgbA1C preoperatively had a greater increase in BG postoperatively. There was no significant increase in BG in doses of 0, 4, or 8 mg; but there was a significant increase in BG with a dexamethasone dose of 10 mg.
Results of the charts reviews found that small doses of dexamethasone did not increase postoperative BG significantly in type II diabetics. Larger doses of 10 mg had a significant increase in BG readings. Project results suggest further study and improvement interventions in dexamethasone dosing in diabetics.
Background: Patients with limited English proficiency (LEP) are facing significant communication challenges in peri-operative settings, spanning from understanding anesthesia-related information to obtaining informed consent. These language-based obstacles lead to decreased quality of care, lower patient satisfaction, and a heightened risk of adverse healthcare outcomes. The purpose of this study is to investigate if a web-based educational program can increase the anesthesia providers’ awareness of resources, policies, and procedures available for LEP patients. Methods: This quantitative, quasi-experimental project uses a pretest-posttest design sampling from a level II healthcare facility in Charlotte, NC. Results: Twenty-six individuals participated in this study. There was significant pretest-posttest difference on question 2 (language service resources) (χ2(1) = 7.24, p = .007); question 4 (language service procedure) (χ2(1) = 16.50, p < .001); question 5 (policy location) (χ2(1) = 10.00, p = .002); and question 7 (resource location) (χ2(1) = 28.40, p < .001). The average number of correct answers significantly increased from 3.77 ± 1.34 to 6.15 ± 0.46 (t = 8.58, p < .001). Conclusion: The result of this data serves as evidence that a short, simple education module can profoundly impact the anesthesia provider’s understanding of resources and policies surrounding language communication barriers. Future projects should emphasize the importance of bilingual teammates avoiding obtaining pre-operative consent without the presence of a certified interpreter.
Background: Patients with limited English proficiency (LEP) are facing significant communication challenges in peri-operative settings, spanning from understanding anesthesia-related information to obtaining informed consent. These language-based obstacles lead to decreased quality of care, lower patient satisfaction, and a heightened risk of adverse healthcare outcomes. The purpose of this study is to investigate if a web-based educational program can increase the anesthesia providers’ awareness of resources, policies, and procedures available for LEP patients. Methods: This quantitative, quasi-experimental project uses a pretest-posttest design sampling from a full-service community hospital in the Southeastern region of United States. Results: Twenty-five individuals participated in this study. There was significant pretest-posttest difference on question : question 1 (χ2(1) = 5.98, p = .015) (federal law); question 2 (language service resources) (χ2(1) = 13.30, p < .001); question 4 (language service procedure) (χ2(1) = 11.80, p < .001); question 5 (policy location) (χ2(1) = 11.70, p < .001); question 6 (resource location) (χ2(1) = 7.29, p = .007); question 7 (resource location) (χ2(1) = 24.10, p < .001). The average number of correct answers increased from 3.19 ± 1.48 to 5.80 ± 0.50 (t = 6.53, p < .001). Conclusion: The result of this data is evidence that utilization of a brief educational module can greatly impact anesthesia providers’ awareness of resources, policies, and procedures for language services for patients with language communication barriers. Future projects should aim to highlight the significance of obtaining informed consent via a certified interpreter in lieu of ad hoc interpretation.
JOANI FRANCESCHI. Enhancing the Anesthesia Providers’ Awareness of Resources, Policies, & Procedures Surrounding Patients with Language Communication Barriers.
(Under the direction of DR. LUFEI YOUNG)
Background: Patients who have limited proficiency in English (LEP) face significant communication challenges in perioperative settings. These obstacles range from difficulties in understanding anesthesia-related information to obtaining informed consent. These language-based barriers result in a decreased quality of care, lower patient satisfaction, and a heightened risk of adverse healthcare outcomes.
Purpose: The goal of this study is to determine if a web-based educational program can enhance anesthesia providers' knowledge of available resources, policies, and procedures for LEP patients.
Methods: We conducted a quasi-experimental study with a pre- /post-test design. The study was conducted in a surgical center located in the southeastern region of the United States. A digital survey was given before and after the online education intervention. The effect of web-based education was examined by comparing the differences of the pre-and post-education survey scores.
Results: In this study, 40 participants were predominantly female (65%), including 87.5% CRNAs and 12.5% anesthesiologists. A significant improvement in knowledge was observed in the post-education survey score. The average number of correct answers increased from 3.78 (SD = 1.61) to 5.89 (SD = 0.84), t = 8.69, p < .001. Demographic factors did not significantly impact question accuracy at the pretest or posttest. These findings underscore the educational program's effectiveness in enhancing anesthesia providers' knowledge across diverse professional and demographic groups.
Conclusion: The web-based educational program significantly improved anesthesia providers' knowledge of resources, policies, and procedures for LEP patients.
Keywords: Limited English Proficiency (LEP), Anesthesia Providers, Web-Based Learning
Problem Statement: Obese adults having laparoscopic surgery are at increased risk for postoperative pulmonary complications (PPCs) due to the alteration in pulmonary physiology caused by their body habitus, the use of Trendelenburg position, and the abdominal insufflation required for this surgical approach. Current literature recommends utilizing lung-protective ventilation (LPV) strategies to reduce the incidence of PPCs, but anesthesia provider implementation of LPV strategies is inconsistent. The purpose of this quality improvement project was to explore anesthesia providers’ knowledge and utilization of lung-protective positive end-expiratory pressure (PEEP) strategies in obese patients undergoing laparoscopic surgery.
Methods: The descriptive design aimed to investigate anesthesia providers’ knowledge and use of LPV PEEP strategies in obese patients (BMI > 30kg/m²) undergoing laparoscopic surgery via an anonymous, quantitative electronic survey consisting of 24 Likert-scale questions. A convenience sampling of certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs) was used. The survey was disseminated via e-mail and available by QR code. Data was stratified by role/education, age and years of experience to evaluate for trends.
Results: Fifty-two providers completed the survey. There were significant differences in likelihood to incorporate LPV PEEP strategies across groups.
Conclusions: Anesthesia provider utilization of LPV PEEP strategies remains inconsistent. Education regarding utilization of evidence-based LPV PEEP strategies in obese patients undergoing laparoscopic surgery is warranted.
Keywords: postoperative pulmonary complications, lung-protective ventilation, positive end-expiratory pressure
Problem Statement: Obese adults having laparoscopic surgery are at increased risk for postoperative pulmonary complications (PPCs) due to the alteration in pulmonary physiology caused by their body habitus, the use of Trendelenburg position, and abdominal insufflation required for this surgical approach.
Background: Current literature recommends utilizing lung protective ventilation (LPV) strategies to reduce the incidence of PPCs, but anesthesia provider implementation of LPV strategies is inconsistent. The purpose of this quality improvement project is to explore anesthesia providers’ knowledge and utilization of lung protective alveolar recruitment maneuvers (ARMs) in obese patients undergoing laparoscopic surgery.
Clinical question: “In a large urban trauma center, what are anesthesia providers’ knowledge and utilization of lung-protective alveolar recruitment maneuvers (ARMs) in obese (BMI>30kg/m2) patients aged 18 and older undergoing laparoscopic surgeries?”
Methods: The descriptive design of this project aimed to investigate anesthesia providers’ knowledge and use of LPV alveolar recruitment maneuvers in obese patients (BMI>30kg/m2) undergoing laparoscopic surgery via an anonymous, quantitative electronic survey consisting of 24 Likert scale questions. A convenience sampling of certified registered nurse anesthetists (CRNAs) and physician anesthesiologists (MDAs) was used. The survey was disseminated via email and available by QR code. Data was evaluated and stratified by role/education, age, and years of experience to evaluate for trends.
Results: Fifty-two providers completed the survey. There were significant differences in likelihood to utilize lung protective ARMs.
Conclusions: Anesthesia provider utilization of LPV strategies remains inconsistent. Education regarding implementation of evidence-based lung protective ARMs in obese patients undergoing laparoscopic surgery is warranted.
