Digital Commons Network^™

Improving Nurses’ Attitudes, Beliefs, And Practices In Screening For Suicide Risk In Hospitalized Patients, Karen Gibbs

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Forty-seven thousand Americans died from suicide in 2018. Providing nurses with facts about suicide, intervention methods, structured screening tools, and referral resources has been shown to change attitudes and increase screening rates. This quality improvement project provided nurses with education in order to improve rates of suicide screenings on in-patient units at a 550-bed academic medical center.

Methods: Attitudes to Suicide Prevention (ASP) surveys were administered on two medical units to determine current attitudes about suicide. An online tutorial providing information about suicide, the Columbia Suicide Severity Rating Scale (CSSRS) used by the institution, personal stories of suicide, …

Assessing Maternal Satisfaction Of Perinatal Care Provided In A Rural Ob/Gyn And Midwifery Clinic, Nadia S. Fletcher

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Women’s childbirth experience can have long-term consequences on overall health and well-being of the parents and infant. Evaluating individual’s perspectives of maternal care received allows for appropriate assessment and improvements in the quality of care provided to ensure positive, evidence-based and respectful care. This project’s aim is to develop a formalized method of evaluating patient’s satisfaction with perinatal care delivered at a rural Ob/Gyn and Midwifery clinic with the intent of improving care.

Methods: A childbirth experience questionnaire was developed using a validated tool, the Norwegian Pregnancy and Maternity Care Patients’ Experiences Questionnaire (PreMaPEQ), and direct input from providers …

Measuring The Impact Of Rise Vt: Evaluating Community-Based Obesity Prevention Initiatives With A Standardized Intensity Score, Brianna K. Johnson Bsn, Rn, Ocn, Dnpc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background. Obesity is a leading cause of morbidity and mortality in the US. Rise VT is a multilevel community-based initiative to reduce obesity. The Community Programs and Policies Intensity Score (CPPI) is a standardized metric to evaluate multisector efforts over time, which has correlated with reductions in childhood obesity.

Purpose. The purpose of this project was to quantify the impact of Rise VT using the CPPI score. A secondary aim was to assess the feasibility of using the CPPI score for ongoing program planning and evaluation statewide.

Methods. Interviews with program managers were conducted to gather data related to …

Optimizing Drug Prior Authorization Procedures For Primary Care, Lydia S. Vorsteveld

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Title and Abstract

1. 1. Title

Optimizing Drug Prior Authorization Procedures for Primary Care

1. 2. Abstract

Background:

Medication prior authorization (MPA) is a cost containment strategy utilized by health plans. The payer, or health plan requires providers to obtain prior approval for plan coverage of a drug prescription. The list of drugs requiring MPA varies among health plans and is subject to frequent change. From 2007 to 2013 Medicare Part D increased MPA requirements by 38 percent (Hoadley, Summer, Hargrave, & Cubanski, 2014).

Methods:

Pre and post interventional surveys of primary care staff were used to gather descriptions of current MPA …

Evaluation Of Clinician Prescribing Practices For Contraceptive Care: A Quality Improvement Collaboration, Julie Desrochers

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Primary care providers (PCPs) have the training and opportunity to provide contraceptive care. Unplanned pregnancy is a major public health issue for which up to 50% of the population is at overall lifetime risk. Reproductive life planning during healthcare visits can reduce rates of unintended pregnancy, prompting contraception or preconception planning. Studies suggest contraceptive counseling protocols and reproductive intent screening are effective tools. This project compares clinician behaviors with best practices. The purpose is to evaluate preventive reproductive healthcare practices in primary care, identifying opportunities to meet the contraceptive healthcare needs for people of reproductive age.

Methods: PCPs and …

An Initiative To Educate And Support Young Adults Diagnosed With Hypertension, Page Tomlinson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension

Page Tomlinson, BS, RN, DNPc

Background: Hypertension is a common diagnosis in the US with significant long-term effects. While guidelines for optimal hypertension management exist, young adults lag behind older adults in treatment and control³. The young adult is arguably more capable of lifestyle changes, primarily due to fewer physical limitations than older adults. Promotion of disease self-management is the most effective way to engage young adults in seeking control over their blood pressure^1,2. Lifestyle modification as a young adult decreases costs of care and …

Development Of Evidence Based Medical Surveillance Program Recommendations For At-Risk Employees, Jessica C. Okrant

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Nearly eight million United States healthcare workers are potentially exposed to hazardous drugs (HDs) in their workplace. This exposure puts staff at increased risk of acute myeloid leukemia, breast cancer, rectal cancer, and fetal anomalies. Despite evidence-based guidelines for handling HDs, preventative measures are inadequate surveillance.

Purpose: This project sought to evaluate current policies and procedures regarding HD exposure workplace practices at large academic medical centers in the Northeast, improve education of HD exposure, and develop a standardized medical surveillance program (MSP) at one large academic health network.

Methods: Large academic medical centers in the Northeast were contacted to …

Evaluating A Hospital-Based Volunteer Doula Program In Vermont, Kiersten A. Wulff

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Continuous labor support is a feature of high quality maternal healthcare, yet access to doulas is not universal. Hospital-based doula programs can minimize barriers to continuous labor support, and evaluation of hospital-based doula programs is needed. This project evaluated a pilot volunteer doula program at an academic medical center.

Methods: Sign-in process monitored volunteer activity. Likert scale surveys measured participant (RN and doula) perspectives. Likert scale surveys with a comment section measured patient experience. Survey results and sign-in sheets were analyzed using descriptive statistics. Patient comments were assessed for themes using NVivo software.

Results: Volunteer doulas (VD) (n=74) supported …

Development Of Hospital-Wide Policy For Pediatric Needle Procedures At An Academic Medical Center, Katherine J. Rose

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Needle procedures are traumatic experiences for pediatric patients, and have been linked to formation of phobias and lifelong decreased healthcare utilization.^1,2 Pain management during needle procedures and hospital wide standardization of needle procedures are known to increase patient satisfaction, while decreasing long-term adverse outcomes related to seeking health care.^3,4 The purpose of this project was to develop a hospital-wide standardized policy for pediatric needle procedures at an academic medical center.

Methods: Those performing pediatric needle procedures were electronically surveyed to identify full spectrum issues regarding adoption of a pediatric needle policy. Based on survey findings …

Improving Behavioral Health And Social Determinants Of Health Screening In Primary Care, Caitlin Gerity Ba, Rn, Dnpc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Detection and intervention of depression, substance use disorder, and social determinants of health (SDOH) in primary care improves quality of life, prevents complications, reduces health care costs and inequities, and leads to health promotion. This project aimed to increase behavioral health and SDOH screening rates in primary care through implementation of a screening process utilizing validated patient questionnaires.

Methods: A pre-intervention assessment was conducted with Providers A and B. A process was then developed for screening patients at annual exam visits, utilizing the Patient Health Questionnaire (PHQ)-2, the Single Alcohol and Substance Abuse Screening Questions, and a SDOH Questionnaire. …

Clinical Management Of Postpartum Hemorrhage In Community Birthing Hospitals In Vermont: A Gap Analysis To Promote Best Practice, Rachel Greene

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Despite advances in research and medical technology, the rates of postpartum hemorrhage (PPH) continue to rise. Annually, these preventable events are the cause of one-fourth of maternal deaths worldwide. In order to reduce maternal mortality and morbidity rates, the effective application of evidence-based interventions is required. The purpose of this DNP project was to conduct a gap analysis in community birthing hospitals in Vermont to examine the existing clinical management of PPH.

Methods: Registered nurses at three hospitals were surveyed to assess current policies/protocols pertaining to the management of PPH in five categories: 1) systems level readiness, 2) patient …

Essential Trauma Care Documentation: Redesigning A Community Hospital’S Trauma Flow Sheet, Murphy Neenan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Poor trauma documentation has negative consequences on continuity of care, results in errors related to treatment, and yields increased time to order completion^{2, 3}. Nursing staff at a community hospital emergency department (ED) expressed frustration when utilizing the existing trauma flow sheet. The purpose of this project was to redesign and implement an evidence-supported emergency department trauma flow sheet for efficient and comprehensive documentation of trauma encounters.

Methods: A new trauma flow sheet was developed through a focus group session and semi-structured interviews. A PDSA model for improvement was introduced to facilitate future initiatives to improve trauma …

Diversifying The Healthcare Workforce: Transition Of The Combat Medic To Baccalaureate-Prepared Nurse, Lyndsey E. Gates

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose

The creation of a combat medic to accelerated Bachelor of Science in Nursing (BSN) program may offer a way to positively contribute to the nursing workforce. Therefore, the purpose of this feasibility project was to combine the four sub-roles of expert practitioner, educator, researcher, and consultant¹, to design a new pathway for military combat medic entry into nursing.

Methods

A comparative analysis elucidated gaps in 219 different nursing skills, didactic and general education requirements, clinical hours, and transfer credits between combat medic training and the BSN curriculum at a Vermont university. Identified gaps were compared to nursing …

Improving Surveillance Of Hepatitis C Infections Among Patients Receiving Medication Treatment For Opioid Use Disorder, Jacqueline Bray

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Despite harm reduction efforts, Hepatitis C virus (HCV) infections among individuals with opioid use disorder tripled between 2010 and 2015 in the US. Shifting disease burden from chronic to acute HCV, could result in $12 billion cumulative Medicaid savings in two years. Patients receiving medication for OUD (mOUD) remain at risk for HCV, but only receive screening upon admission. This project aims to implement a HCV re-screening protocol in a mOUD program, determine protocol sustainability, and secondarily evaluate need for point of care testing.

Methods: Patients with a negative screening result upon admission were prompted to opt in/out of …

Screening For Palliative Care Services In An Assisted Living Facility, Maria Delia Crosby

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Palliative care services remain under-utilized, even as evidence suggests that early palliative care leads to positive health outcomes, reduced ED visits, and substantial cost savings. Barriers include a lack of knowledge of palliative care services in the community, and under-utilization of validated assessment tools, including a symptom checklist. Aims of this project: 1. To determine whether the integration of validated community-based palliative care screening tool in an assisted living setting will identify older adults with unmet palliative care needs. 2. To determine if tool implementation could lead to a referral for palliative care consultation.

Methods: A screening tool developed …

Improving Diagnosis Of Alzheimer's Disease And Related Dementia In Primary Care, Elisa M. Vautier

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: The number of Vermonters living with Alzheimer’s disease and related dementia (ADRD) is expected to increase by 42% to 17,000 by 2025. Missed and delayed diagnoses impact patient safety, treatment opportunities, and increase health care costs. This project assessed current practices of diagnosing ADRD in primary care, identified barriers to diagnosis, and developed and evaluated an evidence-based tool to assist in diagnosis and treatment of ADRD.

Methods: Semi-structured interviews of 6 Vermont primary care nurse practitioners were conducted. Informed by themes in these interviews, an electronic health record “Smartphrase” was developed to assist NPs in diagnosis of …

Evidence Based Treatment For Excessive Alcohol Consumption And Concurrent Hypertension, Kimberly Ann Ward

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Excessive alcohol consumption is a preventable risk factor for hypertension, heart disease, and stroke. Though alcohol-related deaths number 88,000 annually in the U.S., alcohol use has the lowest treatment rate of behavioral health disorders at 10%. Excessive alcohol consumption may compromise treatment of hypertension by primary care providers (PCP). This project aims to increase awareness of the hypertension and excessive alcohol use connection and promote screening of alcohol consumption.

Methods A protocol for improving alcohol screening and concurrent hypertension management was developed including: in-person educational presentations; patient education materials; and the use of motivational interviewing. Practice change was assessed …

Transcutaneous Bilirubinometry In A Rural Teaching Hospital: A Quality Improvement Assessment, Lydia Sachs

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Up to 84% of term neonates develop jaundice, a sign of hyperbilirubinemia that warrants bilirubin measurement. The AAP recommends systematic evaluation of hyperbilirubinemia risk for every infant. Serum bilirubin tests involve needle sticks, introducing anxiety, pain, and cost. Transcutaneous bilirubin (TcB) measures bilirubin without needle sticks, may offer reduced costs, but is less accurate, and may increase phototherapy rates. This determined the effect of TcB measurement on needle sticks, phototherapy rates, and cost of bilirubin measurement at a rural teaching hospital.

Methods: A retrospective data analysis compared rates of bilirubin screening, needle stick testing, and phototherapy treatment for a …

Telehealth Visits For Common Concerns In A Primary Care Setting: Establishing A Protocol, Erin M. Leighton

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Barriers to accessing healthcare in Vermont include: weather conditions, rurality, lack of public transportation systems, and busy schedules. Telehealth mitigates these barriers, providing a safe and effective option on par with in-person visits, while lowering overall healthcare costs and increasing patient satisfaction. This project aimed to expand telehealth visits in a nurse practitioner-run primary care practice, via designing effective protocols and educating clinicians on telehealth use, requirements, documentation, and billing in order to complete telehealth visits successfully.

Methods: Infrastructure for telehealth: a workflow protocol, patient education materials, procurement of technological resources including iPads, and necessary, HIPAA compliant, secure accounts. …

From Evidence To Practice: Promoting Continued And Exclusive Breastfeeding In Rural Eastern Uganda, Katherine Judge

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Malnutrition is responsible for about one third of deaths globally among children under age five. Over 65% of these deaths, often associated with inappropriate feeding practices, occur during the first year of life and disproportionately affect those living in resource poor countries. Breastfeeding has been established as uniquely effective in providing infants with nutrients for healthy growth and development. Ugandan demographic surveys (2016) indicate less than 43% of infants age 4-5 months are breastfed.

Methods: The objective was to equip Community Health Educators (CHEs) with evidence-based practice guidelines for promoting continued exclusive breastfeeding to postpartum women. This project was …