Medicine and Health Sciences Commons^™

Scares: A Clinician Guide To Spinal Cord Awareness, Response, And Emergency Support Creation And Implantation Of Scares Protocol Among Hospitalist Advanced Practice Providers, Brittany Biega

DNP Scholarly Projects

While they are more common in patients with oncological disease and trauma, SCE still exist among patients without these comorbidities. Less has been established regarding care protocols in this population. The absence of standardized procedures has been linked to preventable, adverse patient outcomes, including cases of permanent damage due to delayed treatment. This project employs Lean Six Sigma methodologies and Johns Hopkins Evidence- Based Practice to devise a robust SCE protocol, aimed at standardizing care and improving patient outcomes. A multidisciplinary team including general medicine, neurology, neurosurgery, and neuroradiology developed “Spinal Emergency Management Guidelines” protocol, which was implemented within the …

Increasing Education And Staff Knowledge Of Delirium Care: An Evidence-Based Quality Improvement Project, Serena Martinath

Master's Theses and Capstones

Introduction At a small, community hospital in Massachusetts a gap analysis was conducted leading to a quality improvement project to increase staff education and knowledge regarding delirium and evidence-based best practices for delirium care. Delirium is a growing, often under recognized medical condition that occurs in hospitalized patients (Loftus & Wiesenfeld, 2017). Delirium is characterized by acute changes in congnition, level of consciousness, and attention (Loftus & Wiesenfeld, 2017). A better understanding of this condition is expected to result in improved patient care.

Methods The clinical microsystem studied in this gap analysis project was assessed by using the AHRQ Gap …

Using Education To Improve Nurse Perceptions On Rounding To Increase Patient Safety And Efficiency Of Care On A Behavioral Health Unit: A Quality Improvement Project, Shannon Alty

Master's Theses and Capstones

Abstract

Background: Hourly rounding completed by nursing staff are routinely completed on most inpatient hospital units. Evidence suggests that hourly rounding can improve patient outcomes, patient satisfaction rates, communication, minimize patient requests and improve the nurse patient relationship (Halm, 2009). Additional evidence suggests that inpatient psychiatric patients often feel disconnected from their nurse and hourly rounding is recommended to build the nurse-patient relationship (DaSilva, 2017). However, for successful implementation, nurse perceptions of rounding must be obtained.

Local Problem: Hourly rounding is a standard of practice, however, was not being consistently completed. Assessing the nurse perceptions regarding rounding, was imperative understand …

Improving Communication Between The Emergency Department And Prehospital Emergency Medical Services Through The Use Of A Secure Messaging Application: A Quality Improvement Project, Jacob G. Petlon

Master's Theses and Capstones

Background: Communication between emergency medical services (EMS) and the emergency department (ED) is a key part of treating patients being transported by ambulance. This communication is moving away from traditional radio and cell phone calls to the use of secure text-based apps. These apps can generate metrics and provide real time location information that is not available using traditional methods. Increased use of these apps can improve communication between EMS and receiving EDs.

Local Problem: Wildcat hospital introduced the EMS communication app Twiage in May of 2023. There is low utilization of the app and some EMS and ED …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Increasing Access And Adherence To Cognitive Behavioral Therapy For Insomnia (Cbti) For Adults: A Quality Improvement Project, Kristen Newell

DNP Scholarly Projects

BACKGROUND: Insomnia is a sleep disorder that is becoming more prevalent. It can significantly impact a person's quality of life and it contributes to a substantial economic financial burden. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for insomnia, but patients are rarely referred for this treatment. This quality improvement project focused on implementing motivational interviewing to increase patient utilization of CBTi. It also encouraged utilization of CBTi Coach, a free phone application that has all of the CBTi components, a rigid sleep behavioral plan and frequent follow-up appointments to improve sleep quantity and quality.

INTERVENTION: Patients that …

Implementing Change: The Use Of Minocycline-Rifampin Impregnated Central Venous Catheters In Central Line Associated Blood Stream Infection Prevention In Critically Ill Patients, Shawn B. Murray

Master's Theses and Capstones

Introduction: At a large academic healthcare facility in the northeast a Gap Analysis was conducted finding quality improvement opportunities for central line associated blood stream (CLABSI) prevention in critically ill patients. Review of literature reveals the use of minocycline-rifampin impregnated (MNRI) central venous catheters (CVCs) as being an effective intervention in CLABSI prevention.

Methods: Several assessments were conducted regarding the implications of updating the facilities practice to reflect this evidence including AHRQ Gap Analysis Tool, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Stakeholder Feedback, and Resource Allocation.

Results: Facilitators and barriers were identified in implementing this …

Utilization Of The Broset Violence Checklist For Early Identification Of Aggressive And Violent Behavior To Improve Unit Safety: A Quality Improvement Initiative, Emily Sharretts

Master's Theses and Capstones

BACKGROUND: There continues to be an increase in workplace violence nationally in the healthcare setting which jeopardizes patient and staff safety. Liu et al. (2019) found about 59% of health care workers experience workplace violence. Kafle et al. (2022) emphasizes the link between workplace violence and increased levels of nurse burnout and therefore decreased job satisfaction.

LOCAL PROBLEM: The microsystem assessment revealed that there was no risk assessment tool to identifying early aggressive or violent patient behavior.

METHODS: The Plan-Do-Study-Act (PDSA) framework was used for this quality improvement project to reduce workplace violence on this unit.

INTERVENTIONS:After completion …

Implementing Education For Maternity Nurses To Improve Nurses’ Knowledge, Attitudes, And Practices Regarding Postpartum Depression: A Quality Improvement Initiative, Haley Merrill

Master's Theses and Capstones

BACKGROUND: Postpartum depression (PPD) is the most common complication of childbirth, but often goes undiagnosed. Adequate patient education on PPD increases the patient’s knowledge and supports enhanced communication between patients and provider. Maternity nurses have continued interaction with new mothers and are in a vital position to educate patients regarding PPD. However, maternity nurses may lack confidence in delivering the appropriate education and resources for PPD to postpartum women.

LOCAL PROBLEM: Within the given microsystem, there was currently a gap that existed between PPD education for nurses and the delivery of PPD patient education.

METHODS: Utilizing the Plan-Do-Study-Act model, a …

Reducing Violence In The Workplace: A Quality Improvement Project, Molly Mcqueeney

Master's Theses and Capstones

Abstract

BACKGROUND: Violence in the United States has significant impacts on the healthcare system. On average, there are about 7.8 per 1,000 workers yearly that experience violent injuries (Grossman & Choucair, 2019). In 2016, it was estimated that approximately $429 million was added to treat and prevent injuries to healthcare workers (Grossman & Choucair, 2019). By implementing the Broset Violence Checklist (BVC) as a screening tool for early identification of risk for violence, there is a possibility for a reduction in the number of violent occurrences in the workplace.

LOCAL PROBLEM: Within the given microsystem, there is a lack of …

Reducing Blood Culture Contamination Rates Through Staff Education: A Quality Improvement Initiative, Kirsten M. Mutuberria

Honors Theses and Capstones

BACKGROUND: Blood cultures are a widely utilized tool that aids in diagnosis and treatment plans. Contaminated cultures are incredibly costly, resulting in increased length of stay, opportunistic infections, pharmacy costs, repeated laboratory tests, and decreased reimbursements. Evidence suggests higher incidence rates of blood culture contaminations (BCCs) are seen in emergency departments (ED) compared to any other unit within a hospital system. The internationally accepted threshold of 3% is not often met, although recent studies suggest a lower rate is possible, even in critical care environments. A literature review resulted in data showing that educational-based interventions focusing on adherence to facility …

Implementation Of A Standardized Medication Reconciliation Protocol In A Psychiatric Stabilization Setting, Sara Robinson

DNP Scholarly Projects

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit.

INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol.

Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the …

Reduction Of Order-To-Scan Times To Increase Patient Throughput And Improve Patient Outcomes: A Quality Improvement Project, Jason Harrington

Master's Theses and Capstones

Background: Throughput is a key metric for both the emergency department and the hospital system. Diagnostic tests, such as CT scans, can lead to a large delay in patient throughput which can negatively impact patient satisfaction and patient outcomes. Finding ways to reduce delays in CT scan acquisition can positively impact patient satisfaction and patient outcomes.

Aim: The specific aim of this quality improvement project was to decrease the amount of time it takes to complete abdominal CT scans with IV contrast once ordered from 61 minutes to below 35 minutes by July 1^st, 2022

Methods: Plan was …

Implementing A Health-Related Quality Of Life Assessment Tool In An Outpatient Hematology/Oncology Clinic: A Pilot Quality Improvement Project, Jennifer Holl

DNP Scholarly Projects

BACKGROUND: Although overall and disease-free survival remain the goals of cancer care, health-related quality of life (HRQOL) during and after treatment is increasingly acknowledged as vital to the patient’s outcomes. The purpose of this project was to identify and implement a valid, reliable HRQOL assessment tool into daily clinical practice in an outpatient hematology/oncology clinic at a 25-bed critical access hospital in rural New Hampshire.

METHODS: This project used a methodological design. Descriptive and inferential statistics, plus qualitative analysis were used to determine results. Three nurses and seven patients participated in this quality improvement project.

INTERVENTIONS: The interventions …

Implementation Of Oncology Standardized Scheduling Bundle Impacting Staff Productivity And Patient Satisfaction, Carolyn Brausch

DNP Scholarly Projects

BACKGROUND: Patients having timelyaccess to healthcare services is the entryway to quality of care and patient safety. Timely access is essential in cancer treatment and often requires complex scheduling requiring multiple, highly coordinated, time sensitive appointments. To facilitate optimal clinical care, timely appointment scheduling must be patient-centered. With the heavy scheduling workload growing at the the Cancer Network at Froedtert & the Medical College of Wisconsin and recognition of timely scheduling as a quality indicator, the need to examine the workflow and improve the process became apparent.

METHODS: The goal of the quality improvement project was to provide patients with …

Tackling Burnout: Investing In Nurse Managers To Secure The Future Of Nursing, Enhance Manager Effectiveness, And Support High Quality Patient Care, Corey French

DNP Scholarly Projects

Background: Burnout is a widespread, pervasive issue the healthcare industry. Many efforts related to burnout reduction have been focused on front line caregivers but there is continued opportunity to address burnout in leadership. The global aim of this quality improvement project was to reduce burnout among the nursing leadership team at a large, academic medical center in the greater Boston area.

Problem Description: A preliminary survey was completed to assess for the presence of burnout within the leadership team. Results revealed that more than half of the nurse leaders surveyed were experiencing burnout at least 50% of the time. This …

Enhancing Patient Safety By Promoting The Use Of The Electronic Medication Administration Record During The Preparation Of Injectable Medications: A Quality Improvement Project, Michael Ferrone

Master's Theses and Capstones

Background: Patient safety is a top priority for registered nurses (RNs) while caring for individuals in the healthcare setting. Of the various responsibilities of an inpatient RN, administering injectable medications pose significant risks to patients if done incorrectly. Given these known risks, the RNs of an inpatient medical-surgical microsystem were studied during the process of preparing these medications.

Local Problem: Through observations (N = 20), it was noticed that 13 (65%) of the preparations were done at a location referred to as the nurse server counter. This is problematic since this location does not provide the RN with access …

Documenting Body Mass Index And Lifestyle Counseling For Pediatric Patients: A Quality Improvement Project At A Federally Qualified Healthcare Facility, Taylor R. Graziano

Master's Theses and Capstones

Background: Screening and monitoring growth throughout childhood and adolescence, as well as providing the necessary education on positive lifestyle choices is vital in combating the childhood obesity epidemic. Counseling children on the importance of nutrition and physical activity also helps to prevent numerous comorbid conditions associated with obesity. The United States. Preventive Services Task Force recommends that healthcare workers screen for obesity at least annually in all patients 3-17 years of age, as well as offer lifestyle counseling regardless of Body Mass Index ranking.

Aim: The aim of this quality improvement project was to improve the current percentage of pediatric …

Enhancing Peripheral Intravenous Line Maintenance Practices Among Nurses In A Critical Care Setting: A Quality Improvement Project, Jaylene Velasquez

Honors Theses and Capstones

Abstract

Background: One of the major risks of infection lies in a patient’s intravenous (IV) access. On a cardiac intensive unit, a Levell II trauma center, preventing adverse events (i.e. infections, sepsis, etc.) is essential within this unit due to the nature of these health conditions. To ensure patient safety, nurses must abide by evidence-based practices and facility guidelines regarding intravenous line management. This quality improvement (QI) project implemented interventions to enhance nursing practices for peripheral intravenous therapy.

Methods: This project included statistical analysis and audits to measure the impact of the interventions. The variables being observed in this project …

Use Of A Simplified Protocol For The Prevention Of Postoperative Nausea And Vomiting In Adult Ambulatory Surgical Patients, Roger Horne

DNP Scholarly Projects

Postoperative nausea and vomiting (PONV) remains a common complication affecting surgical patients after receiving anesthesia. Prevention of PONV is important in an ambulatory surgical setting where patient access to rescue treatment is limited after discharge. A quality improvement (QI) project introduced a simplified PONV prevention strategy to decrease the incidence of PONV at a Veterans Health Administration ambulatory surgery center. A retrospective chart audit of all facility surgical patients receiving anesthesia care (n = 94), excluding ophthalmology patients, was conducted prior to COVID-19 restrictions to establish baseline PONV incidence. An evidence-based, simplified PONV prevention protocol was developed and implemented. …

Reducing Turnaround Time From Pathology Collection To Patient Awareness In Gastroenterology Practice, Adrianna Hyams

DNP Scholarly Projects

Background: Means of improving the turnaround time from specimen completion to the patient being notified of results are not well known or researched. The aim of this study is to decrease the turnaround time (TAT) from when the specimen is collected to the time the patient is notified from 4 weeks to 2 weeks. This quality improvement project took place in a privately owned gastroenterology office in southern Indiana.

Methods: An exhaustive literature review was completed to determine the best means of improving pathology TAT. The Plan Do Check Act (PDCA) method of quality improvement was used for this project. …

Health Risks Of Firearm Ownership: A Patient Screening And Education Intervention, Aaron Kahn

DNP Scholarly Projects

BACKGROUND

There is significant health risk associated with firearm ownership. To address this risk a primary care-based intervention was designed and implemented to screen for firearm ownership, educate patients on the risks of gun ownership, and provide patients with resources for reducing associated health risks.

METHODS

A mixed methods study design was employed. Four primary care providers (PCP) practicing in family health volunteered to participate in this intervention. Focus groups with participating PCPs were conducted prior to the intervention to solicit recommendations for intervention protocol and assess participating PCPs current understanding of the health risks of firearm ownership, and after …

Quality Improvement On The Long-Term Care Ventilator Unit: Interventions To Increase Patient Safety And Prevent Patient Harm, Billie Anderson, Joanne Samuels

DNP Scholarly Projects

BACKGROUND: Tracheostomy patients are susceptible to life-threatening emergencies when their airways are compromised. Epidemiologic data suggests that 3.2% to 30% of tracheostomy patents have a complication. The long-term care ventilator unit (LTCVU) is a 25-bed unit in a nursing home. It has noted that 40% of patients have a complication. A group of hospitals demonstrated a 90% reduction in complications through five interventions.

METHODS: The Johns Hopkins Nursing Evidence-Based Practice model was utilized to take the Global Tracheostomy Collaborative interventions and apply them to the LTCVU with the aim of reducing the number of airway complications on the unit by …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

An Inpatient Rehabilitation Interprofessional Care Pathway For Traumatic Hip Fracture: A Pilot Quality Improvement Project, Sarah Plante

DNP Scholarly Projects

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around $30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period.

Purpose: The primary aim of …

Be Seen And Heard Being Clean: A Patient-Centered Approach To Hand Hygiene At Concord Hospital, Ashley Pinkham

Master's Theses and Capstones

Background: Regular hand washing is recognized as the most effective means to combat the spread of infectious illness; however hand washing behavior amongst health care workers (HCW’s) is inconsistent. Furthermore, measurement of hand washing behavior is subject to bias.

Aim: This quality improvement project aimed to remove the Hawthorne effect and improve the behavior of HH at Concord Hospital.

Methods: A quasi-experimental, pre-posttest design was used to evaluate HH rates on a 32 bed med-surge unit at Concord Hospital. Baseline data was collected for 30 days by asking patients if they had seen or heard staff cleaning their hands. Using …

Contributing To A “Culture Of Safety” By Increasing Usage Of The Drug Library On Smart Infusion Pumps: A Quality Improvement Project, Heidi Armstrong

Master's Theses and Capstones

Background: Computerized infusion devices called smart infusion pumps or smart pumps are clinical tools capable of decreasing IV medication infusion calculation errors through the use of embedded drug libraries. These devices are now important tools contributing to a “culture of safety” defined by the Joint Commission. Reports from April 2015 indicated a 22% occurrence rate in which the devices were not correctly programmed before infusion.

AIM Statement: The global aim of this quality improvement project was to improve usage of the IV pump drug library by ensuring medication is correctly labeled before infusion. The specific aim was to increase the …

Engaging Patients To Improve Documentation Of Oral Intake On A Cardiac Telemetry Unit: A Quality Improvement Initiative, Timiny A. Mosher

Master's Theses and Capstones

Background Information
It is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR).

Aim

The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day.

Methods
The Plan-Do-Study-Act (PDSA) model was used as the framework …

Implementing A Checklist & Hourly Huddles To Increase Situational Awareness During The Second Stage Of Labor-A Perinatal Quality Improvement Project, Kelly Knowles

Master's Theses and Capstones

Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth …