Digital Commons Network^™

Healing Wounds Through Nutrition, Deanna Garza

Master's Projects and Capstones

Abstract

The role of nutrition in wound care is often overlooked. The main reasons why wounds fail to heal are malnutrition, infection, impaired organ function due to co-existing diseases such as diabetes, hypertension, renal disease, and peripheral vascular disease to name a few. These factors have contributed to poor patient outcomes and patient satisfaction, as well as an increase in hospital length of stay. To promote wound healing, fuel from macro and micronutrients are necessary to deliver oxygen and energy for cell regeneration. However, nurses must possess knowledge and understanding of these requirements and the effects of nutrition on wound …

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be …

Creating A Culture Of Learning: Improving Patient Mobility In A Medical-Surgical Unit, Camille Cabalsa

Master's Projects and Capstones

Abstract

PROBLEM: Hospitalization, especially among older adults aged 65 or over, can result in decreased mobility and functional decline. This decreased mobility can lead to accelerated bone loss, falls, increased length of stay, and delirium. In this medical-surgical unit, a pattern reflecting lack of adequate patient mobility has persisted over one year.

CONTEXT: Northwest (NW), a 42-bed community hospital medical-surgical unit- part of an integrated regional health care delivery system, has not been maximizing the mobilization of their patients for the past year based on internal data.The improvement project described in this paper focused on creating a culture of continuous …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Improving The Staff Responsiveness By Bundling Care, Practicing Proactive Authentic Hourly Visits, And Using The Four P’S, Robert Vega

Master's Projects and Capstones

Abstract

Problem

Staff responsiveness is an important Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Rating composite tool that hospitals monitor because it is consumer-driven information. The intent is that the HCAHPS composite promotes patient satisfaction, contributes to the prevention of harm, and can save millions of dollars (Danaf et al., 2017). On admission, the patient is orientated to their room, provided a nurse call light button to use, and told not to get out of bed alone and to wait for their nurse (Mitchell et al., 2014). On Three North, a gap exists in the delay it …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes, Jeffrey Salao

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

An Innovative Discharge Intervention: A Quality Improvement Project, Yvonne Swain

Master's Projects and Capstones

Abstract

Problem: This project aims to decrease the discharge time of a patient from the hospital once the discharge order has been written. Current discharge times are averaging over 3 hours, leading to a breakdown in the patient throughput process. A patient survey was conducted to determine the reason for prolonged discharge times. The survey revealed that patients are not aware of their day of discharge, which may lead them to being discharged without transportation home. Many studies conclude that there are improvement opportunities around discharge planning and communication.

Context: This quality improvement initiative takes place in a 26-bed, medical-surgical/telemetry …

Health Care Improvement Initiative: Outcomes And Impact Of An Academic-Practice Partnership Between A Large Integrated Health System’S Nurse Scholars Academy And The University Of San Francisco School Of Nursing And Health Professions, Ryan Fuller

Master's Projects and Capstones

By December 2018, a large integrated health system’s Nurse Scholars Academy (NSA) will have financially-sponsored 64 registered nurses to return to school through a strategic academic-practice partnership program at the University of San Francisco (USF). Referred to as ‘Nurse Scholars,' health system employees elected to return-to-school through NSA. As a five-year initiative, NSA was at risk for not receiving additional funding beyond 2020 without a thorough outcomes analysis that articulated the outcomes to executive leadership.

This health system employs more than 23,000 registered nurses in Northern California (NCAL). The NSA is a region-wide effort to accelerate academic progression, leadership development, …

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In …

Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm

Master's Projects and Capstones

Abstract

Problem: Hospital-acquired infections are preventable harm that occurs to patients while in the hospital. Catheter-associated urinary tract infection (CAUTI) is a preventable hospital-acquired infection that continues to plague hospitals nationwide. The Centers for Disease Control and Prevention estimates that there are more than 13,000 CAUTI related deaths in the United States annually (Scanlon, 2017). In addition to the harm caused to patients by CAUTIs, the estimated $500 million yearly cost for CAUTI treatment has created a fiscal burden on healthcare systems (Scanlon, 2017). Decreasing the rate of CAUTI by decreasing overall number of catheters is the goal of this …

Raising Oas Cahps Scores: Using Patient Education, Katrina Pangilinan

Master's Projects and Capstones

At the Golden Gate Endoscopy Center (GGEC), the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery (OAS CAHPS) survey results on patient satisfaction have been below the 50th percentile for the last three quarters of 2018. Patient satisfaction scores are a quality measure for the patient care experience and important for the success of the organization and its providers. Based on patient comments from previous surveys, patients feel that the center does not explain the possible side effects of the anesthesia in a way they can understand. Other patient comments and concerns included confusion regarding dietary restrictions …

Post-Traumatic Stress Disorder Screening Project For Adult Males From The Middle East And Afghanistan, Ricky Norwood

Master's Projects and Capstones

Current research indicates a significant rise in PTSD signs and symptoms of adult males arriving from the Middle East and Afghanistan. In an effort to increase the awareness of Post-Traumatic Stress Disorder (PTSD) in clinical personnel and adult males from the Middle East and Afghanistan, the Sacramento Refugee Health Clinic implemented a PTSD Screening Project. This project was designed to ensure the maximum number of the adult males from the Middle East and Afghanistan would be appropriately screened for PTSD and provided additional opportunities to meet the mental and acute primary care needs of these patients in an adequate and …

Improving Knowledge And Attitude Of Primary Healthcare Givers Towards Vulnerable Populations: A Quality Improvement Project, Kimberly Shankel

Master's Projects and Capstones

Improving Knowledge and Attitude of Primary Healthcare

Givers Towards Vulnerable Populations

Kimberly Shankel

University of San Francisco

Abstract

Problem

This project aims to improve patient satisfaction for vulnerable population patients while in hospital, namely transgender and gender non-conforming people. A major roadblock for this population in seeking medical care is their fear of discrimination when accessing healthcare, resulting in a delay, or avoidance of medical care. Multiple studies agree there is a need for nursing education on cultural competence to improve care and satisfaction for vulnerable populations.

Context

The site for this quality improvement project is a small suburban hospital …

Combining Patient-Centered-Care And Technology To Reduce Falls In A Medical/Telemetry Unit, Megan Mira

Master's Projects and Capstones

Abstract

PROBLEM: From October 2017 through June 2018 there were 25 patient falls recorded on the 5^th floor medical surgical telemetry unit. Top factors contributing to this high fall rate include: poor patient-centered-care planning, and inadequate set-up for use of technology.

CONTEXT: According to the Joint Commission, 2015, each fall with injury costs $14,000. This estimate doesn’t include the potential indirect costs that account for the long-term effects of injuries such as disability, dependence on others, lost time from work, household duties, and reduced quality of life.

INTERVENTIONS: Staff education was introduced and focused on using a new mindfulness …

Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara

Master's Projects and Capstones

Abstract

Problem: The current model of multidisciplinary rounds (MDR) in a 40-bed medical-surgical unit within a Northern California community hospital has demonstrated low participation rates from primary nursing. The primary nurse attendance in MDRs is consistently at 50% participation, below the target goal of 80%. This lack of engagement leads to ineffective communication and fragmented care coordination resulting in suboptimal quality care and cost outcomes.

Context: An intervention strategy to standardize the MDR model was implemented over three months. A literature review revealed that effective and consistent MDR practices can directly influence primary nurse participation. This change management project focus …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Brittney Pilker, Jillian Cule, Laura Le, Nina Park, Jeffrey Salao, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Staff Retention Through Standardized Training Materials In Adult Primary Care Clinic, David Smith

Master's Projects and Capstones

As non-profits, community health clinics face a unique set of challenges. Primary amongst these is a shortage of financial resources. Staff turnover, including Registered Nurses (RNs) and Medical Assistants (MAs), can result in avoidable increased wage costs related to training of newly-hired RNs/MAs (clinical staff). Retention of experienced RNs/MAs can be directly correlated with job satisfaction, the obverse of which is job frustration. The intent of this RN/MA training and orientation project is to ameliorate frustration related to a lack of informational resources and clear competency expectations. Upon completion and implementation, project efficacy will be assessed via four longitudinal measures: …

Implementation Of A Pediatric Post-Operative Hand-Off Tool: A Patient Safety Project, Kaye Remo

Master's Projects and Capstones

Abstract

Problem: The clinical nurse leader (CNL) performed a microsystem assessment using the Dartmouth assessment tool to evaluate the microsystem’s readiness to provide safe care for pediatric post-operative cardiovascular patients. The microsystem is a 12-bed unit caring for critically ill pediatric patients requiring intensive monitoring and therapy. The microsystem’s interdisciplinary team is comprised of medical doctors, nurses, respiratory therapists, social workers, nutritionists, child life specialists, and pharmacists. During assessment and gap analysis, the CNL identified gaps in nursing knowledge and skills to deliver safe care for this patient population during the immediate post-operative phase of recovery. There is a …

Improving Operating Room Turnover Cleaning Communication, Alexander Lao Jr.

Master's Projects and Capstones

Operating room (OR) turnover cleaning is an important part of perioperative workflow for surgical teams, particularly to prevent cross-contamination of infectious pathogens from the surgical environment to staff and patients. Incomplete OR turnover cleaning ultimately leaves vulnerable surgical patients at risk for surgical-site infections (SSIs) and other types of hospital acquired infections (HAIs), which leads to delays in overall operations of the OR. A microsystem assessment at a large metropolitan hospital revealed an issue with incomplete OR turnover cleaning evident by the presence of dirty canisters, filters, and unclean anesthesia machines/work-areas after sterile surgical supplies had already been opened in …

Scheduling Autonomy For Nursing Staff Retention, Gina Fungcharoen, Gina Fungcharoen

Master's Projects and Capstones

It is the obligation of the Clinical Nurse Leader to place their skills up against the pulse of the microsystem they work within. This nursing leader is in a position to observe and react to flaws that affect their specific workforce. This microsystem project will provide an evidence-based perspective on how to improve monthly scheduling within the unit of 4 South, Surgical Intensive Care. The intent is to increase nurse retention as a function of improved scheduling efforts, allowing staff the ability to manage their own exchange of shifts while addressing the daily staffing needs of the unit. Despite efforts …

Improving Quiet-At-Night On A Telemetry Unit: Introducing A Holistic Sleep Menu Intervention, Christian Karl Antonio

Master's Projects and Capstones

Improving Quiet-at-Night on a Telemetry Unit:

Introducing a Holistic Sleep Menu Intervention

Abstract

Problem

A hospital in San Francisco, California has performed poorly on patient care service as evidenced by low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The survey’s lowest score was from the “Quiet at Night” measure.

Context

A Sleep Menu initiative was implemented in the hospital’s telemetry unit. Microsystem assessment and Strengths-Weakness-Opportunities-Threats (SWOT) analysis identified practices that might impede intervention success. Findings showed that benefits and opportunities outweighed costs; cost-benefit analysis estimated an annual net benefit of $6,354. Other benefits included improved patient well-being, …

Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger

Master's Projects and Capstones

Abstract

The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …

Improving Surgical Patient Outcomes Through A Cross-Training Program For The Hybrid Operating Room, Ana Chozet-Griggs

Master's Projects and Capstones

Abstract

Innovations in the treatment of abdominal aortic aneurysms have resulted in the reduction of open surgical procedures and the increased use of minimally invasive procedures known as endovascular aortic artery repairs (EVAR) and thoracic endovascular artery repairs (EVAR). These hybrid procedures integrate the technical skills and resources used in surgical procedures with the technology used for radiological interventions. (Odle, 2011). These procedures are performed in a Hybrid Operating Room (HOR) within the Catheterization Laboratory (Cath Lab) microsystem. A HOR is a surgical operating room that is equipped with interventional radiology imaging and equipment (Taylor, 2017). These high-risk procedures demand …

Early Recognition Of Severe Sepsis, Robin Haynes

Master's Projects and Capstones

Early Recognition of Severe Sepsis Presentation: A Quality Improvement Project

Abstract

Sepsis is a medical emergency. If not treated immediately a patient may quickly progress

to severe sepsis, septic shock and eventually death. The early recognition of severe sepsis

presentation project is an evidence based project for the medical-surgical floor to decrease the

amount of time from early signs of sepsis to treatment of sepsis.

In October 2017, the average hospital compliance for the severe sepsis bundle for the

fiscal year decreased from 80% down to 55%. Further review showed the decrease in

compliance was from the medical-surgical floor nursing …

In Home Support For All: A Community Outreach Project, Lily Moll

Master's Projects and Capstones

Abstract

In Home Supportive Services Public Authority (IHSSPA) is a Medi-Cal funded organization that helps the elderly and disabled living in San Francisco find care and support at home. The Public Authority component of IHSS specializes in providing support to their clients or “consumers” when attempting to hire home care workers or “providers.” However, IHSSPA services remain relatively unknown throughout many communities in San Francisco county and there is a need for increased community outreach. To address this problem, communities that are currently underserved by IHSSPA were defined by their zip code. These communities were compared with data indicating which …