Medicine and Health Sciences Commons^™

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operations Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Reducing Re-Hospitalizations Of Patients With Heart Failure At A Skilled Nursing Facility, Louis D'Onofrio Jr.

The Eleanor Mann School of Nursing Student Works

The purpose of this project was to introduce the quality improvement (QI) process to reduce re-hospitalization rates in a skilled nursing facility (SNF) in Stratford, Connecticut for patients having a diagnosis of heart failure (HF). After reviewing the data from the nursing facility for re-hospitalization rates over a three-month period, it was discovered that 22% of patients at the SNF were re-hospitalized within 30 days. Of this population of patients, 22.9% had a diagnosis or complication of HF, which is associated with the highest re-hospitalization rates. This QI project focused on HF education customized towards nursing and nursing assistant staff …

Early Extubation After Cardiac Surgery: An Evidenced-Based, Nurse-Driven Protocol, Emily Brooks

DNP Final Reports

Prolonged mechanical ventilation in cardiac surgery patients has been associated with increased hospital stay, increased intensive care unit (ICU) length of stay, higher health care costs, and higher morbidity from atelectasis, intrapulmonary shunting and pneumonia. Early extubation of post-operative cardiac surgery patients has been associated with shorter ICU and overall hospital stays, reduced mortality, decreased resource use, and is safe and effective in elderly patients with no increased risk of reintubation. As such, the question arises in intubated post-operative cardiac surgery patients, how does a nurse-driven extubation protocol compared to no standardized protocol affect extubation rates within six hours post-operative? …

Extracorporeal Cardiopulmonary Resuscitation, Emily Carr

Senior Honors Theses

Extracorporeal cardiopulmonary resuscitation (ECPR) is a method of resuscitation in which venoarterial (VA) extracorporeal membrane oxygenation(ECMO) is initiated during refractory cardiac arrest. ECPR promises to enhance outcomes after cardiac arrest by minimizing neurological deficits, stabilizing the patient for early reperfusion and hypothermia, and serving as a bridge to treatment or transplant. ECPR must be initiated according to structured guidelines and protocols, which are based on the patient’s age, comorbidities, code status, neurological baseline, no flow time, and low flow time.

If a patient achieves return of spontaneous circulation on ECMO, the patient will receive post cardiac arrest care which includes …

Critical Care Nurses At Higher Risk Of Burnout, Jayden Rusher, Barbara Mcclaskey

Posters

In practice today, units with high intensity, stress, and patient needs are being burnt-out quickly due to patients’ intense needs, uncertain outcomes, and the ongoing witnessing of suffering and death. The purpose of this paper is to determine if there is a significant relationship between critical care units, and a high risk of nurses who work on those units exhibiting more characteristics of burnout. The study was done to gauge burnout, strength, and prevalence of moral distress, differentiated moral distress from day-to-day stressors, and determine fortitude and other aspects indicative of resilience. There was a cross-sectional survey model to test …

Improvement Of Chf Patients’ Fluid Restriction Education Through Self-Efficacy, Johanna Ruckey, William Fyler

Interprofessional Research and Innovations Council

Improvement of CHF patients’ fluid restriction education through self-efficacy

Johanna Ruckey RN and William Fyler BSN

Background: Dietary discretion through limited salt and fluid intake is an important aspect of heart failure (HF) management. Keeping accurate account of fluid intake has shown itself to be a difficult task, as both staff and patients often fail to do so on a fairly regular basis. Although staff are aware of a patient's fluid restrictions, there is a deficit in the patient's role in tracking their own intake. Patients often express confusion and frustration regarding their daily fluid intake, but also lack …