Medicine and Health Sciences Commons^™

Reducing Iatrogenic Opiate Withdrawal In The Picu: An Evidence-Based Practice Improvement Project, Kaitlin Kirk Ogle, Marian Malone, Will Guider

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Current recommendations to reduce pain associated with mechanical ventilation is the administration of opiate and benzodiazepine infusions for Pediatric Intensive Care Unit (PICU) patients. If these infusions are weaned too quickly, iatrogenic withdrawal syndrome (IWS) often occurs. IWS symptoms include tachycardia, hypertension, diaphoresis, fever, irritability, tremors, clonus, hyperactive reflexes, vomiting, and diarrhea. Untreated IWS can lead to life-threatening complications.
LOCAL PROBLEM: The PICU at the project site contains fourteen beds and treats critically-ill pediatric patients. There was no standardized withdrawal assessment tool in practice. The purpose of this project was to implement the Withdrawal Assessment Tool-Version 1 …

Dnp Final Report: An Evidence-Based Initiative To Reduce Risk Of Ventilator-Associated Events, Bailey Dee Burge

DNP Final Reports

Ventilator-associated events have been considered an outcome metric for quality patient care. Ventilator-associated events are associated with unnecessary medical expenses. These events are multifactorial, yet bedside nurses can help decrease this nosocomial infection through proper oral care. A PICOT question was constructed to search the evidence systematically. The systematic literature search evidence was appraised to provide recommendations for the bundle of care process regarding ventilator-associated event prevention, specifically oral care. The body of evidence was comprised of five articles reporting statically significant outcomes. The evidence-based oral care protocol was implemented for a quarter of a year in patients with mechanical …

Elearning Module For Nursing Students To Improve Delirium Identification, Prevention, And Management, Shannon Baker

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Delirium is a serious, acute alteration in cognition and consciousness, which is common amongst older hospitalized patients and has an overwhelmingly negative impact on patient outcomes. Under-recognition by healthcare providers poses a barrier and contributes to poor patient outcomes, including increased morbidity and mortality.

Purpose: To reduce the incidence of delirium amongst acutely ill patients via internet-based education for student nurses on delirium prevention, assessment, and management.

Methods: An eLearning intervention consisting of a virtual lecture with an unfolding case study for undergraduate nursing students. This project utilized the Nurses’ Delirium Knowledge Assessment (NDKA) …

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 …

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 …

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 …

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …