Medicine and Health Sciences Commons^™

Reducing Rehospitalizations From One Skilled Nursing Facility: A Quality Improvement Project, Victoria Ann Phillips

Doctoral Dissertations and Scholarly Projects

The purpose of this quality improvement project initiated by a core project team in a large medical center was to investigate possible causes for increased hospital readmissions from one specific skilled nursing facility. The conceptual framework utilized was the Define, Measure, Analyze, Improve, Control (DMAIC) model from the Lean Six Sigma methodology. Data collection from chart audits, a staff survey, a system probe, and a process mapping project assisted to narrow the focus of the plan to improve communication among facilities by standardizing documentation and coordination of care as patients transitioned from the skilled nursing facility to the medical center’s …

Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay, Morgan Whitmore

Master's Projects and Capstones

A quality improvement project “Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay” is aimed at reducing length of stay (LOS) for patients undergoing elective ostomy surgery from the current twelve days (Kirkland-Kyhn, 2017), to less than five days. Methods included use of a Pre-Ostomy Survey, which was distributed and completed by the nursing staff. Pre-survey analysis identified the need for three ostomy educational tools which were developed using a set of evidenced based patient care “milestones” and included: a Colostomy and Ileostomy Nursing Resource Binder, Patient Milestone Checklist, and the R.N. Postoperative Process For Ostomy Patients. The evidenced …

Organizational Learning In A College Of Nursing: A Learning History, Bret Lyman, Lisa A. Cowan, Hannah C. Hoyt

Faculty Publications

Background: College of nursing leaders can foster organizational learning as a means of achieving their desired organizational outcomes. Organizational learning has not previously been studied in colleges of nursing, leaving college administrators and faculty little guidance as they strive to improve outcomes in their own colleges.

Objectives: The purpose of this study was to discover new insights related to organizational learning in a college of nursing.

Design: The learning history method was used to document and describe organizational learning in a college of nursing.

Setting: This study was conducted with a college of nursing situated in a private, religious-based university …

Turning A Blind Eye: How Lack Of Communication With Er Nurses Nearly Cost A Patient Permanent Vision Loss, Kenneth Royal, April Kedrowicz

Patient Experience Journal

This narrative presents a case in which a patient was treated for conjunctivitis, but a breakdown in several layers of communication (between the hospital and the patient, and between hospital personnel) resulted in multiple medical errors that nearly costs the patient permanent vision loss. This real-life case underscores how simple communication errors may lead to life-altering consequences. Recommendations for improving communication to ensure similar errors do not happen to others are provided.

Implementation Of An Evidenced-Based Practice Curriculum To Improve Nursing Practice For Epidural Administration And Monitoring, Chatty O'Keeffe

Master's Projects and Capstones

Abstract

Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor …

Cesarean Section Surgical Site Infection Prevention Evidence-Based Practices And Implementation Plan, Amanda K. Smith

Master's Projects

The Cesarean section (C-section) surgical site infection prevention implementation plan has been designed as a quality improvement project. The project included a microsystem assessment, identifying the problem, literature review, application of a nursing theory and conceptual model, and development of an implementation plan. The microsystem assessment involved a Labor and Delivery Unit who had initiated a new surgical site infection (SSI) prevention bundle developed by an interprofessional team utilizing evidence-based practices and other hospitals protocols. The problem defined was the elevated rates of SSIs due to gaps in the SSI bundle risking the sustainability of the bundle. A literature review …

A Quality Improvement Program In A Safety Net Clinic Serving Vulnerable Populations, Kaitlin J. Hendriksma

Doctoral Projects

The Patient Protection and Affordable Care Act of 2010 resulted in major changes to healthcare infrastructure in the United States, with two main areas of concentration: healthcare financing and population health management. Quality improvement programs focus on improving healthcare quality for populations with conscious efforts to decrease healthcareassociated expenditures. Quality improvement interventions can include patient-reported outcomes, clinical decision support systems, and clinical dashboards. The purpose of the Doctor of Nursing Practice project was to formally implement a quality improvement program for chronic disease management in a safety net clinic serving vulnerable populations. The Donabedian model served as the conceptual model …

The Design Of An Evidence-Based Protocol For Primary Care Of Patients With Dementia, Kaitlin B. Demaagd

Doctoral Projects

Improvement in the effectiveness and optimization of care outcomes for patients with dementia in primary care is a national priority (American Medical Association-convened Physician Consortium for Performance Improvement [PCPI], 2014). Alzheimer’s disease affects more than 5 million Americans. Patients with dementia cost the nation $236 billion in 2016 (Alzheimer’s Association, 2016). In 2014, the PCPI developed ten evidence-based recommendations to address the gaps in outpatient dementia care called the Dementia Performance Measure Set (DPMS). An independently owned, non-system affiliated primary care practice identified the need to improve the quality of care they provide to their patients with dementia and their …

Effect Of Provider Education On Pulmonary Rehabilitation Referrals And Discussions With Patients, Shannon Barry

Doctor of Nursing Practice (DNP) Projects

Background: Chronic obstructive pulmonary disease (COPD) is a chronic and debilitating disease from which 9% of the population suffers (CDC, 2013). Pulmonary rehabilitation (PR) is a well-documented evidence-based intervention for patients with chronic respiratory diseases, leading to better health outcomes for patients; however, PR is grossly underutilized in primary care (Rochester et al., 2015). Providers face many barriers which cause this gap between the evidence and clinical practice, such as a lack of understanding of the rehabilitation program and insurance coverage (Rochester et al., 2015).

Purpose: The aim of this Doctor of Nursing Practice (DNP) project was to launch a …

An Assessment Of Heart Failure Screening Tools For An Outpatient Arrhythmia Devices Clinic, Lucy Joanne Paul

Walden Dissertations and Doctoral Studies

People living with heart failure (PLHF) should be screened for symptoms at every

healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

Implementing & Evaluating A Nurse-Led Educational Intervention For Bone Marrow Transplant Patients In The Acute Care Setting, Tia T. Wheatley

DNP Projects

Objective: The Bone Marrow Transplant (BMT) Basics Class is a nurse-led educational program dedicated to preparing patients and their caregivers of the treatment outline and self-care behaviors associated with receiving a BMT. The purpose of this project is to evaluate the effectiveness of this intervention in order to support the needs of the BMT patient and promote patient-centered care.

Study Design: Retrospective review to evaluate a quality improvement project.

Participants & Methods: As of July 2016, the BMT Basics Class became a standard of care at an NCI-designated academic cancer center in the southeastern United States. Between July 20, 2016 …

Development Of A Quality Improvement Initiative To Screen For Postpartum Depression, Renee Traube

Walden Dissertations and Doctoral Studies

Postpartum depression (PPD) is a mood disorder affecting approximately 20% of women within 6 months of delivery. Untreated PPD diminishes a woman's functioning and may result in short and long-term consequences for her infant. Screening with evidence-based tools can identify prenatal and postpartum women at risk for PPD, ensure early treatment, and limit adverse maternal and infant effects. Using Rosswurm and Larrabee's evidence-based practice model, a multidisciplinary team of 7 key stakeholders, including directors and a nurse from the departments of OB/GYN, Pediatrics, and Primary Care, a psychiatrist specializing in women's health, and a member of nursing leadership, formed to …

Organizational Improvement Readiness Assessment (Oira) Tool Evaluation, Leslie Hough Falk

Doctor of Nursing Practice Projects

Background: Research shows that despite an increase in the number of organizational improvement initiatives there is a lack of consistent, sustained outcomes. Organizations struggle with how to reliably and accurately measure their readiness to drive and sustain outcomes. A search of the literature failed to identify a comprehensive, evidence-based tool that has been developed or evaluated to assess organizational improvement readiness. The objective of this project was to evaluate a newly developed Organizational Improvement Readiness Assessment (OIRA) Tool.

Project Design: Guided by two theoretical models, Delphi-Based Systems Architecting Framework (DB-SAF) and the Rogers Diffusion of Innovation Model, a 3-round, modified …