UC Irvine

Background: A significant concern contributing to morbidity and mortality among perioperative population is Surgical Site Infections (SSIs) compromising patient safety, readmissions and healthcare cost. In Same Day Services (SDS), variation in preoperative hygiene education and documentation created opportunities to improve workflow, standardize nursing practice and support reliable patient optimization prior to surgery. Purpose/Aims: The purpose of the Doctor of Nursing Practice (DNP) quality improvement (QI) was to implement a nurse-driven preoperative optimization bundle to improve workflow consistency, strengthen chlorhexidine gluconate hygiene (CHG) education and promote standardized documentation among SDS nurses. Methods: The QI project was implemented over a four-week period at a Magnet designated hospital ambulatory SDS within the perioperative department in Orange County, California. The intervention consisted of staff education, laminated patient centered educational materials, a QR linked digital toolkit, nurse champion support and an Epic SmartPhrase utilization among eligible preoperative encounters along with a pre/post survey findings related to nurse confidence, workflow clarity and feasibility. Findings: A total of 34 of 42 preoperative nurses received education on the optimization bundle, achieving 80.9% staff education reach. SmartPhrase usage increased across the implementation phase, reflecting improved documentation consistency among preoperative encounters meeting inclusion criteria. Post-implementation survey findings demonstrated an increase perceived workflow clarity and viability of using the standardize bundle in practice from 42% at baseline to 80% after implementation. Improvement was also observed in nurse confidence and consistency of CHG education practices. Conclusion: A nurse-driven preoperative optimization bundle supported more consistent preoperative education and documentation practices in SDS. The QI initiative highlighted the role of nursing leadership in translating evidence-based perioperative practices into sustainable improved workflow processes. Continued reinforcement, electronic medical record (EMR) integration and leadership guidance may further strengthen adoption and long-term sustainability.