Target Audience: All perianesthesia nurses

Outcome: To enable the nurse to increase knowledge on healthy workplace strategies

Case Presentations:  Any case studies discussed during the program are fictional and do not reflect any real persons or events

Requirements for successful completion:  You must complete the module in its entirety, achieve 100% n the posttest, and complete the online evaluation by the deadline to receive contact hour credit.

Contact Hour: 1.0

Valid:  6/30/23 - 6/30/25
Activity Content Expiration Date:  06/30/25

Target Audience: All perianesthesia nurses

Outcome: To enable the nurse to increase knowledge on healthy workplace strategies

Case Presentations:  Any case studies discussed during the program are fictional and do not reflect any real persons or events

Requirements for successful completion:  You must complete the module in its entirety, achieve 100% n the posttest, and complete the online evaluation by the deadline to receive contact hour credit.

Contact Hour: 1.0

Valid:  6/30/23 - 6/30/25
Activity Content Expiration Date:  06/30/25

Target Audience: All perianesthesia nurses

Outcome: To enable the nurse to increase knowledge on healthy workplace strategies

Case Presentations:  Any case studies discussed during the program are fictional and do not reflect any real persons or events

Requirements for successful completion:  You must complete the module in its entirety, achieve 100% n the posttest, and complete the online evaluation by the deadline to receive contact hour credit.

Contact Hour: 1.0

Valid:  6/30/23 - 6/30/25
Activity Content Expiration Date:  06/30/25

Target Audience: All perianesthesia nurses

Outcome: To enable the nurse to increase knowledge on healthy workplace strategies

Case Presentations:  Any case studies discussed during the program are fictional and do not reflect any real persons or events

Requirements for successful completion:  You must complete the module in its entirety, achieve 100% n the posttest, and complete the online evaluation by the deadline to receive contact hour credit.

Contact Hour: 1.0

Valid:  6/30/23 - 6/30/25
Activity Content Expiration Date:  06/30/25

Target Audience: All perianesthesia nurses

Outcome: To enable the nurse to increase knowledge on healthy workplace strategies

Case Presentations:  Any case studies discussed during the program are fictional and do not reflect any real persons or events

Requirements for successful completion:  You must complete the module in its entirety, achieve 100% n the posttest, and complete the online evaluation by the deadline to receive contact hour credit.

Contact Hour: 1.0

Valid:  6/30/23 - 6/30/25
Activity Content Expiration Date:  06/30/25

Authors: Christopher H. Stucky, PhD, RN, CNOR, CSSM, CNAMB, NEA-BC, FAAN, J. Michael Hartmann, DNP, RN, CNOR, CSSM, CNAMB, RNFA, Young J. Yauger, PhD, RN, CRNA, Kenneth J. Romito, DNP, RN, APRN, AGCNS-BC, CNOR, CSSM, David F. Bradley, DNP, RN, APRN, AGCNS-BC, CNOR, Gaston Baza, DNP, RN, CNOR, Megan E. Lorenz, DNP, RN, APRN, ACCNS-AG, AGACNP-BC, RN-BC, Sherita L. House, PhD, RN, CCRN, Rebeccah A. Dindinger, DNP, RN, RNC-OB, IBCLC, Joshua A. Wymer, DNP, RN, CNOR, RN-BC, NEA-BC, CHCIO, CDH-E, FACHE, FAAN, Melissa J. Miller, PhD, RN, CNOR, Albert R. Knight, DNP, RN, CNS-CP, CNOR
Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

Authors: Geeta kamal, MDa, Swetha Rudravarama, Shilpa Agarwal, MDa, Anju Gupta, MD, DNB, IDRA, EDRA
Multisystem inflammatory syndrome in children (MIS-C) is an immune response inciting multiorgan dysfunction and a shock-like state which is typically seen in children 2 to 6 weeks after either a coronavirus disease-19 infection or exposure. When such a child comes for any surgery, perioperative anesthetic management demands multidisciplinary involvement and individualized case-based decision-making. Due to the novelty of the condition, there are limited data on anesthetic implications in these patients. Anesthetic management in the affected children is dynamic depending on the organ systems involved and the progression of the disease state. Though the long-term effects of the syndrome are largely unknown, we hope that awareness of the MIS-C-associated complications may help anesthesiologists involved in childcare. Herein, we put forward challenges and clinical dilemmas we faced during the anesthetic management of three children with MIS-C presenting for emergency and elective surgery.

Authors: Lisa Allison Herbinger, DNP, CRNA
The use of opioid-sparing and opioid-free strategies in children can provide adequate analgesia while decreasing the risk of adverse events and contributing to the ongoing battle against the opioid crisis. However, every child must be evaluated individually so that a safe and efficacious perioperative pain management plan can be created. A working knowledge of the risks and benefits of opioids, nonopioid adjuncts, and regional anesthesia along with the ethical considerations for balancing stewardship and beneficent care is essential to the success of these strategies. As perioperative practitioners caring for children, we have an obligation to consider opioid-sparing and opioid-free strategies to promote overall best outcomes. We can make a difference, one child at a time.

Authors: Melissa Harrington, BSN, RN, Erika Busz, MSN, RN, CPN, Amber Thor, BSN, RN, M. Katie Gardner, BSN, RN, Kristen Carlin, MPH, Elaine Walsh, PhD, RN, PMHCNS-BC, FAAN
Purpose: The purpose of this quality improvement (QI) project was to develop and implement an assessment tool to identify a patient’s specific needs due to autism spectrum disorder (ASD). The use of an individualized plan of care related to sensory and behavioral differences correlates with improved experiences in the perioperative setting for patients with ASD.
Design: Mixed methods, pre-post survey, retrospective data comparison.
Methods: Metrics planned to evaluate intervention outcomes included: (1) Comparison of pre and postsurvey data obtained from perioperative staff members following ASD education, (2) Evaluation of the number of behavior response team calls made compared to retrospective data, and (3) Survey response data from families assessing the perceived experience of perioperative stay.
Findings: Two hundred and fifty staff members responded to the learning needs survey; 164 in the preperiod and 86 in the postperiod. The perioperative process for these patients improved from the pre- to the postperiod in its ability to meet the needs of patients with autism (P < .001). Overall, respondents rated the sensory aids and the behavioral and sensory assessment tool as very useful (Median = 5, IQR = 2) and stated that they are likely to continue to use the tools in the future when caring for patients with autism (Median = 5, IQR = 1).
Conclusions: The caregivers of study patients felt they had a high level of satisfaction with their surgery or procedure experience. Health care providers also reported increased confidence working with individuals with ASD in the perioperative environment and satisfaction with the intervention program.

Authors: Ahmed Uslu, MD, Begüm N. Gökdemir, MD, Nedim Çekmen, PhD, Zeynep Ersoy, PhD
Purpose: In the perioperative period, fractional-inspired oxygen is used at values up to 80% to stay within the safe range, even for a short time. A clear value for the safe range has not been specified, and therefore, clinicians prefer a high oxygen value. This study aims to reduce unnecessary oxygen exposure in pediatrice patients and to provide the optimum fractional inspired oxygen value.
Design: The study was designed as a prospective randomized controlled study, including 139 patients aged 1 to 8 years without comorbidity.
Methods: Three groups were formed by adjusting the fractional inspired oxygen to 30%, 50%, or 80% intraoperatively. In the intraoperative period, a strict inspired oxygen protocol (hypoxemia threshold was SpO2 < 90) and oxygen reserve index, fractional expired oxygen value, and peripheral oxygen saturation were used to maintain the balance of hypoxemia and hyperoxemia.
Findings: One hundred and nine children were included. The mean oxygen reserve index was significantly lower in the 30% group than in the other groups (0.09 ± 0.05, P < .0001). The mean arterial pressure in the 30% group was significantly lower than the 80% group but within the normal range (78 ± 6 mmHg, P < .003). There was no significant difference between the groups regarding delirium and pain in the recovery unit.
Conclusions: Due to the known and unknown harmful effects of unnecessary oxygen exposure, it may be time to use optimal oxygen and to fear unnecessary oxygen, not less oxygen. As the next step, we think studies should be conducted with patient groups with lower oxygen concentrations (eg, %21 vs %24 vs %30), more patients, and arterial blood gas monitoring.