Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Joseph Burkard, DNSc, CRNA

Abstract

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative cognitive dysfunction can lead to increased lengths of stay in the hospital, discharge of patients to places other than home, and leads to unnecessary spending of the healthcare system. By identifying these patients in their pre-op visit, an “anesthesia bundle for the elderly” can be implemented intra-operatively to decrease risk for cognitive dysfunction post-operatively.

EBP Model: The “8 A’s Model’ will be used to guide this Evidence Based Practice project.

Evidence Based Interventions: Elderly patients that are over the age of 70 should be administered a Mini-Cog exam in their pre-op visit. If the Mini-Cog is failed, and key patient factors that increase the risk for post-operative cognitive dysfunction are identified, this information should be disseminated to the surgical team so the patients can be treated more appropriately intra-operatively. The evidence demonstrates that Benzodiazepines and Anticholinergic drugs specifically should be avoided in patients who are at high risk for post-operative cognitive dysfunction.

Evaluation and Results: The initial stages of this project will gather information through a chart review on current practices at a local university hospital. Charts were reviewed of elderly patients aged 70 and older that underwent anesthesia at this hospital in the past month. Per the evidence, patients with a history of alcohol abuse, depression, renal insufficiency, anemia, coronary artery disease, hypertension, and poor functional capacity should be administered a Mini-Cog exam. We will note if a Mini-Cog was done or not and note which medications the patients were on prior to undergoing anesthesia. Additionally, it will be important to know which medications were administered to patients during anesthesia, as well as how the patient did post-operatively. CAM scores conducted in the PACU will be taken from the chart. All information gathered will have no patient identifiers present.

Implications for Practice: The goal of this project is to make a practice change in this local hospital’s anesthesia department to improve cognitive outcomes for the elderly post-operatively. Best practices for our growing elderly population are critical for anesthesia administration. Continuity of care between pre-op, intra-op, and post-op is imperative and can help decrease cognitive dysfunction after anesthesia for some of our most fragile patients.

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