Semester

Fall

Date of Graduation

2024

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Kendra Barker

Committee Co-Chair

Rebecca Smeltzer

Committee Member

Kellon Smith

Committee Member

Lya Cartwright-Stroupe

Abstract

Background: Emergence delirium (ED) is an acute state of confusion during the recovery phase from anesthesia that may be life-threatening, especially in the veteran population. Military veteran status may be explored by the Have You Ever Served questionnaire that was developed by the American Academy of Nursing to identify veterans upon admission to the hospital and thus be able to better care for them during their stay. This campaign has been in effect at the hospital site of this project for nearly 10 years. The questionnaire identifies military history risk factors such as combat history or a diagnosis of post-traumatic stress disorder (PTSD), either or which is an additional trigger for ED. Local Problem: Those who suffer from ED postoperatively may never fully recover cognitively, leading to increased mortality rates by approximately 39%. Military veterans, specifically those with PTSD, are at a 22% increased risk of having ED compared to the public. Some common anesthesia practices utilize medications that may trigger ED. Failure to document military history prior to anesthetic intervention may result in a lack of pertinent information to attenuate the veteran’s incidence of ED. At the project site, there is not a formal process in place for anesthesia providers to recognize which patients have military veteran status and/or PTSD risk factors pre-operatively, nor is there currently a documentation pathway in the electronic medical record (EMR) to document the occurrence of ED. Methods: This project took place at West Virginia University Hospitals, Ruby Memorial on the perioperative unit as a 90-day pilot study starting on January 25, 2023, and ending May 1, 2023. The theoretical framework that was utilized is the Plan, Do, Study, Act (PDSA) model. Documentation of medication utilized under anesthesia for veteran patients and occurrence of ED was reviewed through EMR audits. The financial plan for this project consistently held a minimal budget. Interventions: This DNP Qualitative Intervention (QI) project educated perioperative staff on interventions to identify and minimize ED, and to formalize the processes for recognizing military veterans and additional military history risk factors for ED prior to their surgical procedure, making this information easily recognizable by anesthesia staff with an identifiable red bonnet, decreasing the likelihood of experiencing ED through appropriate medication utilization strategies, and initiating formal anesthesia provider documentation of ED. Education about this QI project was provided to perioperative staff by way of posters, in-person education, flyers, and email poster ‘EduBlast’ reminders. Results: While some military veterans were identified to have experienced ED, the data was not statistically significant (p=0.026). The chi-square test was utilized as all the patients were of the same population, an additional variable used to run the data was the type of anesthetic received (i.e., general, monitored sedation, spinal), however, this did not have an impact. Conclusions: Though not statistically significant, implementation of this QI to improve military veteran identification and an effort to individualize anesthetic care to decrease ED incidence remains of clinical significance. This project prioritized tailoring care for veteran patients to better their experience and decrease the prevalence of adverse events. Continual education, feedback, and adjustments will be necessary for long-term sustainability.

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newest revision 12.5.23

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