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Background: An estimated 750,000 to 1 million people live with an ostomy, and approximately 100,000 – 120,000 people undergo the creation of a new ostomy surgery every year. Faster recovery times have decreased ostomy patients’ post-operative hospital length of stay (LOS). As a result, patients have limited time to receive adequate ostomy education and training during hospitalization. Because the LOS is short, providing necessary patient education, training, and stoma site marking (SSM) before ostomy surgery as an outpatient can impact patients’ well-being, decreasing ostomy-related complications and reducing financial burden. Objectives: This preoperative ostomy care quality improvement (QI) pilot project aimed to evaluate the impact of providing preoperative ostomy education, care training, and stoma site marking (SSM) on patients undergoing scheduled fecal ostomy creation surgery, including length of stay (LOS), emergency department (ED) visitation, and readmission occurrences associated with ostomy issues including dehydration and acute renal insufficiency. Methods: This QI project was a single-site project at a large community hospital in Los Angeles County. The project's subjects included two groups of adult patients who had undergone scheduled colorectal surgery for new fecal ostomy creation: those who had surgery prior to initiation of the QI project (non-intervention group); and those who had surgery after initiation of the intervention for the QI project (intervention group). The QI project used a pre-and post-intervention design and was guided by the Plan-Do-Study-Act (PDSA) cycle. The intervention implementation was for four months, and the data collection was for a total of five months. Due to the small sample size, a descriptive statistical analysis was used. Results: The control group had 26 participants, and the intervention group had five participants. The average LOS in the control group was 7.2 days, and 3.8 days in the intervention group. The total 30-day post-discharge ED visits were six cases in the control group (23.1%) and none in the intervention group (0%). The total 30-day post-discharge readmission was five cases in the control group (19.2%) and none in the intervention group (0%). Conclusion: Despite the small sample size, a more than three-day reduction of average LOS, and a reduction to zero readmissions or ED visitations are clinically and financially meaningful findings. Further research with larger sample sizes to examine generalizability is recommended.

Perioperative hyperglycemia is reported in 20-40% of patients undergoing general surgery and is an independent risk factor for negative surgical outcomes. Patients with diabetes presenting to a local community hospital are at risk for negative surgical outcomes due to the lack of strategies to prevent perioperative hyperglycemia. This project aimed to implement and evaluate the usefulness of succinct diabetes education for preoperative total joint surgical patients with diabetes. The intervention was a nurse-led, face-to-face diabetes education session provided to total joint surgical patients with diabetes during a preoperative evaluation appointment, compared to usual care (no preoperative diabetes education). This project utilized a retrospective review consisting of an 8-week baseline period (usual care), followed by an 8-week active period (intervention received). Participants included all total joint surgical patients with and without diabetes during the described time periods selected by convenience. Outcome measures including glycemic control, length of stay (LOS), surgical site infections, and number of patients who received diabetes education were measured. Results were analyzed using descriptive statistics to evaluate the effectiveness and usefulness of the intervention. Participants in the active period showed a significant increase in the number of patients who received diabetes education (p0.05). Studies have shown providing diabetes education leads to improved glycemic control and reduces diabetes associated complications. This project shows the importance of identifying perioperative hyperglycemia and the clinical significance it has on surgical populations.

Endoscopy procedures are frequently conducted in the United States. This project aims to enhance patient satisfaction regarding endoscopy discharge instructions. The population studied were adults who were having either a colonoscopy or esophagogastroduodenoscopy (EGD) as an outpatient. The total number of adults were 406, ages 21 to 86 years old. There were 228 females and 178 males. Patient satisfaction data was collected pre- and postintervention. The intervention was carried out in the preoperative endoscopy area at a small community hospital located in Hamilton, Ohio. The project applied six-questions in a Likert scale survey as one of the data collection tools. There were 193 preintervention patients whose data were analyzed from September 3 to 30, 2019, who received discharge instructions in the post anesthesia care unit (PACU). A total of 213 postintervention patients from October 1 to 30, 2019, received discharge instructions in the preoperative area. The percentage of patients who stated they understood the discharge instructions preintervention was 93.7% compared to 96.4% of postintervention patients who indicated they understood the discharge instructions. The Outpatient and Ambulatory Surgery Consumer Assessment of Hospital Providers and System (OAS CAHPS) results were analyzed from October 2018 through October 2019. The lowest overall patient satisfaction results from the OAS CAHPS regarding discharge instructions preintervention was 65%, whereas postintervention increased to 97%.One of the lessons learned from this project is to have only a few dedicated nurses in the preoperative endoscopy area that are trained and well versed in teaching discharge instructions. Patients who are well educated and understand the discharge information are likely to be more satisfied and care for themselves.

The inferior alveolar nerve block (IANB) is frequently used as a mandibular injection technique for achieving local anesthesia for endodontic treatment. Successful anesthesia, however, is not always achieved with the IANB. Studies have suggested that preoperative medications may increase the ability of clinicians to achieve profound pulpal anesthesia in conjunction with local anesthesia techniques. Acetaminophen/hydrocodone combination medications have been shown to effectively manage pain in a variety of dental pain models. The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of acetaminophen/hydrocodone on the efficacy of the IANB in patients with symptomatic irreversible pulpitis. One hundred emergency patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth randomly received (in a double-blind manner) either four identical capsules of 10 mg hydrocodone and 1000 mg acetaminophen or a placebo 60 minutes before the administration of a conventional IANB. Fifteen minutes after administration of the IANB, profound lip numbness was confirmed, and endodontic access was initiated. Determination of success was, no or mild pain (less than or equal to 54 mm on a 170 mm visual analog scale) on access or instrumentation. The success rate for the IANB was 32% with the acetaminophen/hydrocodone group and 28% with the placebo group, with no significant difference (p = 0.66) between the groups. For mandibular posterior teeth, a preoperative dose of 10/1000 mg (hydrocodone/acetaminophen) did not result in a statistically significant increase of the success rate of the IAN block in patients with symptomatic irreversible pulpitis.

The inferior alveolar nerve block is the most frequently used mandibular injection technique for achieving local anesthesia for endodontic treatment. However, the inferior alveolar nerve block does not always result in successful pulpal anesthesia. Recent studies have suggested the use of preoperative ibuprofen to increase the efficacy of the IAN block. The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of preoperative ibuprofen on the efficacy of the inferior alveolar nerve block in patients with irreversible pulpitis. One hundred emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either 800 mg ibuprofen or a placebo 45 minutes before the administration of a conventional IAN block. Access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) on access or initial instrumentation. The success rate for the IAN block was 41% with ibuprofen and 35% with placebo, with no significant difference (p = 0.57) between the 2 groups. For mandibular posterior teeth, a dose of 800 mg of preoperative ibuprofen did not result in an increase in success of the IAN block in patients with irreversible pulpitis.