Paravertebral Blocks

Training is used to build knowledge and skills after employees have made the personal decision to support the change.

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Implementing a change project is a challenging step of the Capstone Change Project. This paper focuses on steps that must be taken to implement a change, strategies to ensure the success, involved stakeholders and their roles, educational requirements, safety issues, ethical considerations, and external or internal regulations’ effects on the process. It also include the change theory, nursing theory, and evidence based practice influences on the implementation process.

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

Despite recent advances in information regarding perioperative care, postoperative pain continues to go undermanaged. Postoperative pain is the pain patients experience after a surgical procedure. According to Gan, 80% of all people who undergo surgeries experience postoperative pain, and 75% of them rate their pain at a moderate, severe, or extreme level (as cited by Cooney, 2016). Furthermore, inadequately managed pain can lead to patient dissatisfaction, decreased patient outcomes, and overall higher cost of care (Penprase, Brunetto, Dahmani, Forthoffer & Kapoor, 2015). In order to provide higher quality pain management,

Jae-Hwang Song et al. divided 336 patients undergoing foot and ankle surgery under sciatic or femoral-sciatic nerve block into treatment and control groups Based on the date of surgery. All the patients received a nerve block preoperatively. The block was established with mixture of lidocaine and ropivacaine injection. In the postanesthesia recovery room, a transdermal patch of fentanyl was applied to the chest of the patients with intravenous midazolam in the treatment group. The primary outcome measure was the difference in the number of requests for additional postoperative pain medication. The secondary outcome of interest was the degree of postoperative pain using a visual analog scale (VAS). also, complications noticed. Metoclopramide was given to nauseated patients (6).

The management of postoperative pain has received much interest nowadays. The intensity of postoperative pain depends on many factors such as type and duration of the surgery, type of anesthesia and analgesia used, and the patient’s mental and emotional status (11).

Multimodal or balanced analgesic techniques involving the use of smaller doses of opioids in combination with non-opioid analgesic drugs (eg, local anesthetics, ketamine, acetaminophen, and NSAIDs) are becoming increasingly popular approaches to preventing pain after surgery [36]. There is evidence showing the benefits of multimodal analgesic techniques, but major surveys have reported that these techniques are underused in clinical practice [37]. Multimodal analgesia is achieved by combining different analgesics that act by different mechanisms at different sites in the nervous system, reducing the incidence of side effects owing to the lower doses of the individual drugs. In our study from all the prescribed analgesics only 23 (19.2%) charts were done according to the multimodal pain management for postoperative pain where as the remaining 97 (80.8%) prescriptions were not in accordance with MAPP (Table

A prospective randomized, blinded clinical trial was performed by Schroer W.C. to evaluate the efficacy of liposomal bupivacaine for better pain control against bupivacaine HCL. Patients (n= 111) undergoing TKAs were randomized to receive liposomal bupivacaine vs bupivacaine HCL. 58 patients received 266mg (20cc) liposomal bupivacaine mixed with 75mg (30cc) 0.25% bupivacaine, and 53 patients received 150mg (60cc) 0.25% bupivacaine. A result of the study was generated by accessing visual analog pain (VAS) scores and narcotic use post-operatively. There were no VAS pain score differences between study group patients vs control group. As on POD1: 4.5/4.6 (P=0.73); POD2: 4.4/4.8 (P=0.27); and POD3: 3.5/3.7 (P=0.58). Narcotic use was similar during

Post operative the patient woke up with no pain. Troughout the surveillance time in Post Anaesthetc Care unit and Daycare Unit the patient did not require any additional opioids or other pain medication.

ICBN is pain often accompanied with sensory changes, in the distribution of the intercostobrachial nerve following breast cancer surgery with or without axillary dissection. The intercostobrachial nerves run from the chest wall through the axilla to innervate the shoulder and upper arm. With axillary node dissection, these nerves are impossible to spare. Unfortunately, the risk of damage to the intercostobrachial nerve in breast conserving surgery can be at times equivalent to that which occurs with complete mastectomy. A wide variation in the size, location and branching of the intercostobrachial nerve may explain the high risk of damage to these nerves irrespective of surgical approach. Sensory symptoms have been shown to vary depending on

Dr. Naidu prefers that her patients receive general anesthesia during their surgical procedures: With general anesthesia, Dr. Naidu knows that her patient remains completely comfortable throughout her breast lift procedure. As a Mastopexy is an outpatient procedure and anesthesia is provided, patients need to arrange for transportation to and from the surgery center on the day of their procedure.

The linear visual analogue scale (VAS) being a reliable validated score for assessing acute post-operative pain, was used in our study with 0 representing no pain to 10 - the worst possible pain.

To be a leader and achieve the goals set forth, one must have the ability to create and communicate a vision, put together a team with the requisite skills, set strategies, and empower and motivate others to achieve the desired ends (Porter-O’Grady & Malloch, 2016). In order to implement this project, nurses from both units must be convinced, committed, motivated, educated, and inspired to accept the need for the change and to work to bring about that change. Initially, nurses will be made aware of upcoming changes via email relaying general information regarding the need for improvement; e.g. increased numbers of readmissions to CVICU or increases in incident reports related to inappropriate and unsafe patient transfers. Periodic staff meetings will also be used to communicate updates on the project and request feedback. These meetings will also give the team a chance to designate emerging leaders who will be instrumental in implementing and supporting the project.