Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Pharyngitis--prevention & control"
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Endotracheal Tube Cuff Pressure Monitoring Utilizing ManometersProblem: Over-inflation of the endotracheal tube cuff has been linked to higher instances of post-operative sore throat in patients undergoing general endotracheal tube anesthesia. Purpose: The purpose of this quality improvement project is to implement manometer use among anesthesia providers at a community hospital in Maryland to maintain endotracheal tube cuff pressures between 20-30 cmH20 to reduce the incidence of postoperative sore throat. Methods: Education on the proper use of manometers and evidence-based practice recommendations was provided to the anesthesia providers via educational handouts. Education on evaluating post-operative sore throat was provided to the Post-Anesthesia Care Unit nurses using educational handouts. A Random Observational Tool was created to track cuff pressures and completed by the anesthesia providers. A Post-Operative Sore Throat assessment tool was used by the Post-Anesthesia Care Unit Nurses to assess and track post-operative sore throat rates. Manometers were placed in two operating rooms. The post anesthesia care unit charge nurse was notified of manometer room selection to follow up on post-operative sore throat assessments and completion of the data collection tool. Results: Out of the 60 observations obtained during a 10-week period, analysis showed that 80% of patients denied experiencing a post-operative sore throat when assessed in Post Anesthesia Care Unit. 100% of anesthesia providers used manometers to maintain cuff pressures within recommended ranges. Out of the 60 random observations, 19 cuff pressures were initially measured out of the recommended range of 20 to 30 cmH20 and were adjusted appropriately to the recommended range with a manometer by the provider. Conclusions: This site has a post-operative sore throat incidence of rate of 20% which is lower than what current literature cites (44%). At the conclusion of the project, cuff pressure monitoring improved (0% vs 66%). There was a positive trend with respect to the use of manometry and reduction in POST rates. Change champions within the anesthesia department and PACU staff were identified to maintain sustainability for the practice change.
Laryngeal Mask Airway Cuff Pressure Manometry to Reduce Postoperative Sore ThroatProblem: Anesthesia providers in the selected organization found that postoperative sore throat was a common patient complaint after the use of a laryngeal mask airway during general anesthesia and estimated its incidence to be approximately 40%. Purpose: The purpose of this evidence-based quality improvement project was to implement manometer use by anesthesia providers on patients undergoing general anesthesia with a laryngeal mask airway and evaluate its effectiveness in reducing the incidence of postoperative sore throat. Methods: Anesthesia providers were educated to manometer use as well as the impact of cuff overinflation on the incidence of postoperative sore throat. Manometers were placed in both anesthesia workrooms for ease of access. Anesthesia providers using a laryngeal mask airway for general anesthesia were encouraged to obtain a manometer to measure and limit cuff pressures to 60 cmH2O after insertion. Following cuff pressure measurements, providers documented values on the data collection tool and exchanged it with the recovery room nurse during post-anesthesia handoff. Recovery room nurses followed up with patients about the presence of postoperative sore throat prior to discharge, recorded “yes” or “no” on the data collection tool, and placed it in the anesthesia box on the main desk for collection. Results: Amongst the cuff pressures that were measured with a manometer, 100% of cuff pressures were adjusted to the recommended range of < 60 cmH2O, as evidenced by documentation on the data collection tool. Among the data collected, the average percentage of patients who denied postoperative sore throat after manometer use was 80.6%. Conclusions: When a manometer was used to measure and limit laryngeal mask airway cuff pressures to 60 cmH2O or less, a large percentage of patients denied postoperative sore throat upon hospital discharge. This suggests that the use of a manometer intraoperatively helped reduce the incidence of postoperative sore throat.
Using Manometers in Operating Rooms for Endotracheal Tube Cuff Pressure MeasurementsProblem & Purpose: Postoperative sore throat represents a common adverse event following general endotracheal anesthesia. Anesthesia providers play an integral role in preventing postoperative sore throat by minimizing airway trauma, selecting appropriate size blades and endotracheal tubes, and maintaining optimal intracuff pressures at 20-30 cm H2O using manometers. Cuff over-inflation leads to tracheal mucosa damage, while cuff under-inflation leads to micro-aspiration and tube migration. At a small Maryland community hospital, the incidence of postoperative sore throat was 38%. This quality improvement project aimed to implement the use of manometers in operating rooms for intraoperative endotracheal tube cuff pressure monitoring. Methods: The practice change involved anesthesia providers measuring and documenting endotracheal tube cuff pressures with manometers after intubation. Eligible patients included adults scheduled for elective surgery. Electronic chart audits were completed to track provider compliance and cuff pressures. Post-anesthesia care unit nurses monitored postoperative sore throat occurrence. Data collection was performed weekly and analyzed using descriptive statistics and run charts. Results: The sample included a total of 146 patients. Following implementation of manometers into operating rooms, median anesthesia provider compliance to endotracheal tube cuff pressure monitoring and optimal cuff pressures improved from 0% to 26% and 0% to 69% respectively. The average percentage of patients who denied POST symptoms in the recovery unit was 83%. Conclusions: Manometer utilization in operating rooms at this organization was feasible. Findings suggest that routine intraoperative measurements and maintenance of cuff pressures between 20-30 cm H2O reduces postoperative sore throat occurrence in adults.