Victoria Steelman

What is the focus of your research? What questions are you trying to answer? What problems are you attempting to solve?

My research focuses on perioperative patient safety and quality. I surveyed perioperative nurses, asking them to identify the safety issues that are highest priority for additional preventive action. I have used the information gained to focus my research on high priority issues. One question that I am seeking to answer is: How do we prevent adverse events, such as retained surgical sponges? To understand how we can prevent retained surgical sponges, I used a Healthcare Failure Mode and Effect Analysis (HFMEA) method to identify potential failures that can occur during the management of sponges in the operating room. By examining the causes of these failures, I was able to identify what corrective actions are likely to be ineffective and effective. One method of preventing retained sponges is using radiofrequency technology. It was not known if this was effective on morbidly obese patients, so I conducted a prospective, cross-over study to determine the sensitivity of this technology in morbidly obese subjects.

I am also focusing on how we can successfully infuse evidence-based practices to promote patient safety and prevent patient complications, such as hypothermia. We know what interventions are effective, but they have been inadequately infused into clinical practice, and patients are still becoming hypothermic. I used the HFMEA method to identify potential failures and their causes, and developed a comprehensive approach to prevention, which we will be testing this fall.

I am also interested in using research to promote informed policy decisions. There are quality performance measures that hospitals and ambulatory surgery centers use to measure and report quality, which is defined as compliance with these measures. I am currently studying the gap between compliance with these measures and positive patient outcomes. The knowledge gained can be used to refine the quality performance measures.

What led to your interest in this topic? 

My goal is to improve patient care. I have been a perioperative nurse for many years, investigating adverse events and following up on patient safety issues. This background has given me insight into what problems occur in perioperative patient care, and what gaps in knowledge need to be filled. By filling these gaps, we can provide the direction needed to improve patient care nationwide.

What impact (on citizens, practice environment, educational opportunities, funding, etc.) do you predict coming from this research?

The research that I am doing can be used immediately in clinical practice settings to reduce the incidence of or eliminate retained surgical sponges and perioperative hypothermia. I expect that it will be cited in national standards for perioperative practice, which will extend the visibility and influence, and encourage the use of the research findings. To infuse the evidence into practice, I do many presentations, locally, nationally, and internationally. This summer, I will be presenting about my research on the sensitivity of detection of radiofrequency sponges in morbidly obese subjects in Brisbane, Australia. This fall, I will be presenting this to the International Quality and Safety Forum in Geneva, Switzerland.  

How does the research integrate into education/practice/service?

By presenting at national conferences, I am encouraging educators to use this information. I have also written clinical manuscripts that showcase the application of my research findings.

One component of my program of research is implementation science. This is the study of infusing research findings into clinical practice. By designing multi-faceted interventions targeted at the barriers in the setting, we can facilitate a successful infusion of the evidence.

I consult very frequently about evidence-based practices for perioperative nursing. This allows me to share the latest research findings. I am also a member of the Perioperative Field Advisory Committee of the Department of Veterans’ Affairs. This allows me to assist with infusion of research into clinical practice in the VA hospitals. I am a member of the Physician Consortium for Performance Improvement convened by the American Medical Association. This group writes the quality performance measures for hospitals and ambulatory surgery centers. By working with this group, I can infuse the findings of my research and others into the measures used by the Joint Commission and the Centers for Medicare and Medicaid.