Theresa Criscitelli

Hyperbaric Oxygen Therapy: Indications, Contraindications, and Use at a Tertiary Care Center

The indications for the use of hyperbaric oxygen therapy have expanded greatly in the last 200 years. This article provides a brief history of hyperbaric oxygen, reviews the indications and contraindications for its use, and presents an overview of the hyperbaric oxygen program at a tertiary care facility. We describe three common indications for hyperbaric oxygen therapy: osteomyelitis, delayed radiation injury, and graft or flap compromise. We also discuss therapeutic protocols for treatment with hyperbaric oxygen at our facility. Patients with a wide range of diagnoses have access to hyperbaric oxygen therapy 24 hours per day and seven days per week at our facility, in addition to a wellqualified team of health care providers who strive to deliver optimal patient care.

A Perioperative Approach to Increase Limb Salvage When Treating Foot Ulcers in Patients With Diabetes

Foot ulceration in patients with diabetes increases the risk of lower extremity amputation. Major amputations produce substantial adverse consequences, increase length of hospital stay, diminish quality of life, and increase mortality. In this article, we describe approaches that decrease amputations and improve the quality of life for patients with diabetes and foot ulcers. We highlight the role of the perioperative nurse, who is essential to providing optimal patient care in the perioperative period. Perioperative care of patients with diabetes involves providing optimal surveillance for a break in the skin of the foot, screening for neuropathy, following guidelines for foot ulcer infections, preparing for pathophysiology-based debridement, using adjuvant therapies, and offloading the patients affected foot. Nurses should understand the disease process and pathophysiology and how to use these approaches in the perioperative setting to assist in curtailing the morbidity and mortality associated with foot ulcers in patients with diabetes.

Applying Human-Centered Design Thinking to Enhance Safety in the OR

uman-centered design thinking traditionally has been used in industry to create products; it is now being considered a powerful tool in health care to solve care delivery problems, educate staff members, and improve the patient experience. Understanding the applications of human-centered design thinking can foster innovation by moving design from a convergent approach in which the best option is chosen from the existing alternatives toward a more divergent approach in which individuals create new alternatives. This method can produce innovations in health care and safer environments for staff members and patients.

Safe patient hand-off strategies.

uring any surgical experience, many health care providers care for each patient, which leads to multiple transfers (ie, hand offs) from one caregiver to another. The average surgical patient may transfer from an inpatient room or surgical waiting area to a holding area or preoperative suite to the OR to a postanesthesia care unit (PACU) and then return to his or her patient room or home. The surgical patient is more vulnerable to hand-off errors than any other patient in the clinical setting because of the large number of checkpoints and transitions. Good hand-off communication is vital for processing patient information accurately and in a timely manner, providing effective care for the patient, and preventing untoward outcomes. Communication breakdown is the primary cause of surgical never events. It is imperative that perioperative health care providers diligently address this high-risk process and create strategies to effectively communicate during patient hand offs.

The Future of Data‐Driven Wound Care

Care for patients with chronic wounds can be complex, and the chances of poor outcomes are high if wound care is not optimized through evidence-based protocols. Tracking and managing every variable and comorbidity in patients with wounds is difficult despite the increasing use of wound-specific electronic medical records. Harnessing the power of big data analytics to help nurses and physicians provide optimized care based on the care provided to millions of patients can result in better outcomes. Numerous applications of machine learning toward workflow improvements, inpatient monitoring, outpatient communication, and hospital operations can improve overall efficiency and efficacy of care delivery in and out of the hospital, while reducing adverse events and complications. This article provides an overview of the application of big data analytics and machine learning in health care, highlights important recent advances, and discusses how these technologies may revolutionize advanced wound care.

Preparing Novice Perioperative Nurses Using the QSEN Methodology

T primary objective of nursing education is to prepare nurses to provide effective, safe, and highquality patient care. Producing safe novice perioperative nurses requires education that includes overarching safety and quality measures. Quality and Safety Education for Nurses (QSEN) is a framework that incorporates The Joint Commission Accreditation Standards and the American Nurses Credentialing Center Magnet model.1 When QSEN methodology is incorporated into perioperative nursing curricula, new perioperative nurses will be better prepared to take on the challenges that health care presents. One such challenge is the critical need for strong succession planning in the perioperative community.

Human factors engineering: its place and potential in OR safety.

ealth care is a technologically driven profession that is rapidly evolving. Technology is thought to improve outcomes, but data show an increase in health care errors, some of which are technology related. The Institute of Medicine’s 1999 report, To Err Is Human: Building a Safer Health System, estimated that up to 98,000 people per year die because of health care mistakes. In 2013, James reported that medical errors resulting in death may exceed 400,000 deaths a yeardmuch higher than previously thought. These statistics have compelled health care workers to rethink their approaches to patient care and the effect technology has on this care, but more work is needed. One way to accomplish needed improvements is to re-evaluate