Patient Comfort During Cataract Surgery: A Comparison of Troche and Intravenous Sedation.

Advancements in ophthalmologic procedures warrant exploration of alternative approaches to standard intravenous (IV) anesthesia sedation. One new approach, a sublingual troche containing midazolam, ketamine, and ondansetron, allows for IV catheter-free administration of sedation. This project compared the effectiveness and equivalency of sublingual troche during monitored anesthesia sedation with traditional IV sedation for maintaining comfort in patients undergoing cataract surgery. The study was conducted at a surgery center using an after-only nonequivalent control group design. Patients (N=107) were 55 to 85 years of age; 54 patients received IV sedation, and 53 received troche sedation. Four patients receiving IV sedation reported nausea during and after the procedure (n=1, 1.9%) or pain during the procedure (n=3, 5.6%), whereas 3 patients receiving troche sedation reported dizziness after the procedure (n=1, 1.9%), and pain during the procedure (n=2, 3.8%). Although the troche group (mean=6.25, SD=3.94) spent less time in recovery than the IV group (mean=6.48, SD=2.61), the difference was not significant (t[df=105]=0.677, P>.05). In conclusion, the results showed comparable experiences for both groups with equivalency and effectiveness in providing patient comfort during cataract surgery.

Comparison of High-Sensitivity Troponin T Assay to Conventional Troponin T Assay for Rule Out of Acute Coronary Syndrome in the Emergency Department.

Approximately 5% of all emergency department (ED) visits require evaluation of chest pain and atypical symptoms for diagnosis or exclusion of myocardial infarction or acute coronary syndrome (ACS) (P. ). Health care providers rely on effective tests and assessment protocols for definitive diagnosis of ACS. Cardiac biomarkers in troponin T assays enable rapid exclusion of ACS. This project compared high-sensitivity troponin T assay to conventional troponin T assay in reducing unnecessary stress tests for ACS exclusion, length of stay in the ED, and rate of readmissions within 30 days after ACS exclusion and discharge. A retrospective review of 300 medical records for exclusion of ACS compared 150 patients receiving conventional troponin T assay and 150 patients receiving high-sensitivity troponin T assay. The mean length of stay in the preintervention group was 8.3 hr (SD = 1.60) compared with 3.9 hr (SD = 1.56) in the postintervention group (t(298) = 24.56, p < 0.001). A significant difference was found in necessary and unnecessary stress testing (X(1) =17.42, p < 0.05). The preintervention group had significantly more normal stress tests and the postintervention group had significantly more abnormal stress tests. In the preintervention group, 4 (2.7%) patients were readmitted within 30 days with ACS; no readmissions were reported for the postintervention group. Findings supported outcome improvements with the high-sensitivity troponin T assay. Using high-sensitivity troponin T assay in the diagnosis protocol can improve length of stay for patients with exclusion of ACS and reduce unnecessary stress tests during the ED stay.

Improving Neurodevelopmental Outcomes in NICU Patients.

BACKGROUND: Premature infants experience stressors such as external stimulation with sounds, light, touch, and open positioning in NICU that negatively affect outcomes. PURPOSE: The purpose of this study was to measure the effectiveness of a developmental positioning intervention on length of stay, weight gain, and tone/flexion compared with neonates without structured positioning. METHODS: Study design was quasi-experimental with nonequivalent groups. A retrospective chart review of 50 neonates with the inclusion criteria of 34 weeks of gestation or less and no anomalies provided a preintervention sample. After the education in-service on positioning, a convenience sample of 27 infants was enrolled. Infant Position Assessment Tool was used as a visual guide for positioning and scoring by the researcher for intervention fidelity. Hammersmith scoring was completed by the occupational therapist prior to discharge. FINDINGS: The postintervention group was younger and sicker than the control group (P < .05). The postintervention sample (M = 7.05 where 7 = 29 to <30 weeks of gestation) was younger than the preintervention sample (M = 7.22). The postintervention sample was smaller (M = 1302.15 g) than the preintervention sample (M = 1385.94 g). Results showed that the postintervention group had clinically significant weight gain and mean Hammersmith score (3.28) was higher showing positioning positively affected tone and flexion scores. IMPLICATIONS FOR PRACTICE: With greater structure and consistent attention to developmental positioning, outcomes are positively affected. IMPLICATIONS FOR FUTURE RESEARCH: Further research with larger sample sizes will identify stronger associations and relationships between positioning and outcome measures.

Implementation of a Standardized Evaluation Tool to Improve Preceptor Confidence.

Preceptors guide the transition of new graduate nurses into practice. Having access to evidence-based tools for evaluation of new graduate nurses promotes preceptor confidence and consistent measures of performance. The Norwegian Nurse Competence Scale was implemented across three acute care organizations for evaluation of new graduate nurse performance. After implementing a standardized process to evaluate new graduate nurses, individual summary scores ranged from 17-25 (preintervention) to 20-25 (postintervention), indicating mid to high levels of preceptor confidence.

Evaluating an Order Set for Improvement of Quality Outcomes in Diabetic Ketoacidosis.

The timely management of diabetic ketoacidosis (DKA) is essential to avoid lengthy hospitalizations and poor clinical outcomes. There is often an absence of ownership for glycemic management in hospitalized patients, most notably in those with a diagnosis other than diabetes. Evidence supports the use of evidence-based DKA protocols. The purpose of this project was to determine whether utilization of an evidence-based order set versus an individualized provider approach for the treatment and management of DKA decreases resolution time and occurrences of hypoglycemia and improves clinical outcomes. Preintervention and postintervention retrospective reviews of the electronic medical record of 150 nonpregnant adult patients diagnosed with DKA allowed retrieval of relevant outcome data. Multiple events provided an intensive orientation and development of health care professionals for a systems approach to utilization of the evidence-based order set. Implementation of the institutionally approved evidence-based order set affirmed anticipated outcomes. Results showed improvements in the (a) total length of stay, (b) arrival to intravenous fluid time, (c) intravenous insulin initiation to discontinuation (resolution) time, (d) arrival to subcutaneous insulin administration time, (e) time from initial to sequential laboratory testing, (f) use of a basal, prandial, and correction insulin approach (physiological mimic), and (g) the incidence of hypoglycemia. Outcomes substantiate the importance and need for maintaining an evidence-based and systems approach for the management of DKA.

Life Skills Interventions to Improve Social Confidence, Self-Management, and Protection against Drug Use in Rural Elementary School Aged Children.

This pilot project evaluated the effectiveness of a life skills training program for elementary-school-aged children for development of social confidence, self-management, and general social and drug resistance skills. The setting was a rural community after-school program. Children participated in 30-min weekly sessions for 8 weeks. Pre- and posttest scores were analyzed to determine effectiveness of the program. Results showed improvements in antismoking and antidrinking attitudes and use of self-management and general social skills, and social confidence in conflict situations. The life skills training intervention serves as a potential supplement to community programs for the prevention of behaviors such as bullying, smoking and drug use among elementary school aged children.