Medicine and Health Sciences Commons^™

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 …

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 …

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 …

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 …

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 …