Medicine and Health Sciences Commons^™

Implementation Of Artificial Intelligence Initiated Rapid Responses To Reduce In-Hospital Cardiac Arrest, Alicia Potolsky

Doctor of Nursing Practice (DNP) Projects

Hospitals with strong and consistently activated rapid response teams (RRTs) have significantly fewer cardiac arrests. Early recognition of clinical deterioration supports the timely activation of RRTs, which increases earlier assessment and intervention. Current early warning tools are not sufficient and reliable for recognizing patient deterioration, and they are evolving, incorporating artificial intelligence (AI) to identify clinical decline much earlier. The project organization had previously implemented the medical early warning score tool into the RRT nurses’ practice to prioritize patient assessments, but this was not sustained due to its unreliability in identifying patients at risk.

Aiming to reduce the number of …

Application Of Sustainability Framework For Quality Improvement In An Integrated Health System, Cristine Lacerna

Doctor of Nursing Practice (DNP) Projects

Problem: Sustaining improvement in quality and patient safety is a critical challenge confronting healthcare today (Lennox, Maher & Reed, 2018). Failure to sustain the gains achieved with the improvement and results in harmful patient outcomes, wasted resources, and impact future improvement work (Lennox et al., 2018). Context: To address this challenge, the organization for this DNP project was a large, integrated healthcare system with 21 medical centers in Northern California with a redesigned a regional quality program to focus primarily on supporting the sustainability of patient safety initiatives that have been successfully implemented and spread. Interventions: Two frameworks from the …

A Quality Improvement Project To Facilitate A Human Trafficking Screening Protocol At A Maternal Resource Center, Jessica Mcdow

Doctor of Nursing Practice

Human trafficking is a global, criminal industry that negatively impacts the health of victims. Most U.S. victims of human trafficking are young females. Many female sex trafficking victims will seek health care services for unplanned pregnancies and sexually transmitted infections. Healthcare professionals fail to identify human trafficking victims due to lack of standardized screening. The aim of the project was to initiate a sustainable, standardized human trafficking screening protocol at a Maternal Resource Center in order to improve human trafficking identification.

This 10-week quality improvement project provided the staff and volunteers at a Maternal Resource Center with the necessary tools …

Sustainability Of An Outpatient Antibiotic Stewardship Program, Kristin Smith

Dissertations

Abstract

Problem: Antibiotic stewardship is an effort to evaluate and improve the use of antibiotics by providers and patients. Antibiotic stewardship programs (ASPs) promote the appropriate use of antibiotics. There is increasing evidence that supports the use of antibiotic stewardship programs in reducing antibiotic prescribing rates while continuing to maintain safe patient care. Research supports approaches with multiple interventions and ongoing commitment to antibiotic stewardship. However, information regarding long-term sustainability of antibiotic stewardship programs is lacking. The purpose of this quality assurance project was to assess long-term sustainability of a previously implemented ASP promoting appropriate prescribing of antibiotics for the …

Comorbidity And Quality Of Life Of Hiv-Positive Adults Living In Supportive Housing, Rose Sharp

Dissertations

Problem: Life expectancy for people living with HIV significantly increased with widespread use of antiretroviral therapy, resulting in population increases in comorbidity prevalence. The increased burden of living with both HIV and comorbidities lowers health-related quality of life (HRQoL).

Methods: Using a descriptive, correlational, cross-sectional design, a convenience sample of HIV-positive adults was selected from seven supportive housing communities. Comorbidities were assessed using a modified Self-Administered Comorbidity Questionnaire, and HRQoL using the Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health.

Results: A sample of 17 (N = 17) adults reported a mean of 4.2 (SD = …

Recognizing Delirium In The Picu: An Evidence-Based Practice Improvement Project, Abigail Begovich, Tracy L. Brewer, Jennifer G. Tourville Dnp

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

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift > 85% over four months.

Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Improving Hypoglycemia Protocol Compliance Through Nursing Education, Concepta Onyatta

Doctor of Nursing Practice Projects

Nurses hold a vital role in glucose management in order to ensure safety and quality outcome for hospitalized patients.

Background: Assessing serum and point of care glucose results and bringing abnormal results to the attention of the healthcare team can help maintain optimal management. Despite challenges to hypoglycemic protocol compliance, informed nurses can advocate effectively for their patients. Understanding insulin action and the effective use of evidence-based guidelines/protocols can help nurses promote optimal patient outcomes. Common barriers to glucose control and education of current best practices in the acute care setting were reviewed.

Purpose: To improve hypoglycemic protocol compliance …

Revisiting Cauti Prevention: A Multifaceted Approach Using Lean Six Sigma, Lisa Ann Behrend

Student Scholarly Projects

This project identified gaps in policy and processes to improve patient outcomes related to workflow in the catheter-associated urinary tract infection policy and process at a 400-bed hospital in southern California. Even with an evidence-based infection prevention bundle in place, the current process was not working, as demonstrated by high catheter-associated infection rates for the last two years.

This project answers the question: Does the use of a comprehensive evaluation of the current policy and process using the Lean Six Sigma quality improvement model influence a reduction in infection rates in patients who have an internal urinary catheter over 15 …

Developing And Piloting A Midwifery Audit Tool In Bangladesh’S Upazila Health Complexes (Uhcs), Achiya Khatun, Mahfuja Aktar Jhumu, Sarah Gregson, Joy Kemp

Journal of Asian Midwives (JAM)

Midwifery is a new profession in Bangladesh. Diploma-prepared midwives were first deployed in 2018. Recent studies suggest that newly qualified midwives in Bangladesh may not be able to fully perform their midwifery role due to a number of complex factors. This paper describes a pilot study of a midwifery audit undertaken in 2019 by the Bangladesh Midwifery Society, supported by the Royal College of Midwives. These two organisations are in a formal twinning partnership funded by UNFPA Bangladesh with support from UK-Aid, Sweden and Canada. The audit was successful in improving the quality of midwifery care and addressing health system …

Implementation Of Post Falls Huddles In Skilled Nursing Facility, Princess Lomax

Evidence-Based Practice Project Reports

The purpose of this paper is to discuss the quality improvement project, implementation of the post fall huddle in a long-term care facility. Falls are the most common problem in adults 65 years and older. Falls in this population can have devastating effects, often leading to significant changes in morbidity or death. Adults in long term care settings have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion (CDC, 2015). At the skilled facility, there has been a significant increase in hospitalizations due to injuries sustained from falls. To address this …

Implementing Quality Into Practice: Nurse Driven Protocol To Reduce Unnecessary Telemetry Use, Richard Clapp

Doctor of Nursing Practice Projects

Abstract

Background: As part of the American Board of Internal Medicine's Choosing Wisely initiative, the Society of Hospital Medicine issued the recommendation to reduce unnecessary use of continuous telemetry monitoring in the inpatient setting. Outside of its primary purpose continuous telemetry monitoring rarely positively impacts clinical decision making and overuse can lead to unnecessary and costly diagnostic work-ups, cause alarm fatigue, lead to emergency department congestion, and increase institutional financial burden.

Objective: Pilot an evidenced based nurse driven protocol for discontinuation of continuous telemetry monitoring to reduce unnecessary telemetry use among adult patients hospitalized outside of the intensive …

The Development Of A Pain Medication Management Protocol, Kirstie Mcgrath, Jane M. Brown, Shannon D. Walle

Doctor of Nursing Practice Projects

Implementation of an organization-wide pain management policy incorporates a multifaceted team approach that could lead to improved patient outcomes. The absence of a standardized opioid prescribing policy within a healthcare organization has led to individual departments adopting their own guidelines. Management of an individual patient’s pain medication is often met with reluctance from providers when a patient is transferred from another department leaving the patient with inadequate care.

Quality Improvement With The Breast Center, Hannah Seelye

The Eleanor Mann School of Nursing Undergraduate Honors Theses

I spent the summer of 2019 interning at The Breast Center under Audra Flammang. She has a degree in communications and holds the position of Quality Assurance Administrator. She primarily works to ensure Joint Commission Quality Indicators are met and proper documentation of these indicators takes place. She communicates with the staff in weekly meetings about their ideas for quality improvement projects and necessary indicators for ongoing or upcoming projects. Her job also includes preparing case briefings for the weekly Breast Conference that occurs at Washington Regional.

During my internship, I was fortunate to learn a lot about radiology and …

Reducing Pressure Injuries In The Intensive Care Setting: Nursing Knowledge And Best Practices Approach, Michelle Harvey

Doctor of Nursing Practice Projects

Background: For many health care organizations, pressure injury (PI) prevention strategies have become a priority focus to improve patient outcomes and associated costs.

Problem: A rural community hospital located in the Eastern U.S. experienced an increase in hospital acquired pressure injuries (HAPIs), predominantly in the intensive care unit (ICU). In 2018, 17.4% of HAPIs occurred in the ICU.

Approach: Implementation of a Quality Improvement project in an adult ICU, providing education and on-going learning activities to nursing staff, and applying a standardized plan of care “bundle” for prevention interventions.

Outcomes: The approach resulted in improved documentation of flotation of heels, …

Evaluation Of An Advanced Quality Improvement Program, Arjun M. Dangre Bds Mph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Texas Children’s Hospital implemented the Advanced Quality Improvement and Patient Safety Program (AQI) in 2009, designed to train clinicians and staff to develop leaders in quality improvement to improve patient care, lower costs, change culture, and lead improvement initiatives at the organization. Evaluations of the AQI programs measured the program’s effectiveness in achieving its goals and objectives. This paper describes the Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety program (AQI,) the program’s evaluation processes, and show the results of the evaluation of the AQI programs using evaluation surveys completed by QI participants over the span of 13 successful …

A Quality Improvement Project To Improve Financial Sustainability Of Home-Based Palliative Care Program, Andrea L. Giffel

Doctoral Projects

Background and Objectives: Home palliative care services are challenging to bill due to the complexity of services and competing time demands. Objectives and protocol were developed to guide coding and billing to increase Relative Value Unit generation and improve financial sustainability.

Design: A quality improvement project.

Setting: A home-based palliative care program in one health system in the Midwest.

Participants: Participants included 7 nurse practitioners.

Intervention: Coding protocol were developed, providers were educated, electronic health record audits were conducted to collect data on improvement, and feedback provided to prompt improvement.

Measurement and Analysis: Documentation of advanced care planning and billing, …

Assessing Maternal Satisfaction Of Perinatal Care Provided In A Rural Ob/Gyn And Midwifery Clinic, Nadia S. Fletcher

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Women’s childbirth experience can have long-term consequences on overall health and well-being of the parents and infant. Evaluating individual’s perspectives of maternal care received allows for appropriate assessment and improvements in the quality of care provided to ensure positive, evidence-based and respectful care. This project’s aim is to develop a formalized method of evaluating patient’s satisfaction with perinatal care delivered at a rural Ob/Gyn and Midwifery clinic with the intent of improving care.

Methods: A childbirth experience questionnaire was developed using a validated tool, the Norwegian Pregnancy and Maternity Care Patients’ Experiences Questionnaire (PreMaPEQ), and direct input from providers …

Evaluating A Hospital-Based Volunteer Doula Program In Vermont, Kiersten A. Wulff

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Continuous labor support is a feature of high quality maternal healthcare, yet access to doulas is not universal. Hospital-based doula programs can minimize barriers to continuous labor support, and evaluation of hospital-based doula programs is needed. This project evaluated a pilot volunteer doula program at an academic medical center.

Methods: Sign-in process monitored volunteer activity. Likert scale surveys measured participant (RN and doula) perspectives. Likert scale surveys with a comment section measured patient experience. Survey results and sign-in sheets were analyzed using descriptive statistics. Patient comments were assessed for themes using NVivo software.

Results: Volunteer doulas (VD) (n=74) supported …

Qi: Saving Skin, Saving Lives, Carrie Ann Kinney

Student Research Poster Presentations 2020

Quality Improvement (QI) projects are interprofessional team efforts, developed to improve health-care quality. Pressure injury prevention has been identified by the National Database of Nursing Quality Indicators (NDNQI) as a key nursing sensitive outcome. QI projects such as the Deal with Heels project, the Save Our Skin program, and the implementation of designated turn teams have significantly reduced the incidence of hospital-acquired pressure injuries (HAPIs). This has reduced the risk of patients developing severe complications, which significantly improves health outcomes.

Reducing Readmissions For Patients Hospitalized With Congestive Heart Failure, Morgan B. Morgan

Walden Dissertations and Doctoral Studies

Congestive heart failure (CHF) is the leading cause for readmission in hospitals and has a

high mortality and morbidity rate, with implications for hospitals and third-party payers.

Readmissions of patients with CHF are related to inadequate patient knowledge at

discharge, inadequate follow-up with a health care provider, and treatment regimen

nonadherence. Patients report feeling ill prepared to provide appropriate self-care during

the transition from inpatient hospital stay to the home setting. One strategy to assess the

patient's understanding following discharge education is through a process known as

teach-back. The purpose of this quality improvement initiative guided by Knowles's

theory was …

Evaluating An Incentive Program To Improve Teamwork And Productivity In The Operating Room, Christopher Bejil

Walden Dissertations and Doctoral Studies

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice …

Evaluating The Impact Of A Depression Care Management Program, Natalie Dreyfoos

Doctor of Nursing Practice Projects

Depression is a common mental health disorder that causes significant individual and societal burden. Depression care management programs use a collaborative approach to lessen these effects. Evaluating patient satisfaction and experience are essential to obtain a comprehensive view of program benefits. This program evaluation project evaluated the experiences of patients in a depression care management program provided by a healthcare system in Washington state. A mixed methods approach using opened ended question surveys, telephone interviews and PHQ-9 scores provided a deeper understanding of individual experiences. The analysis showed patients were highly satisfied with the program. Collectively, depression severity scores decreased …

Staff Education On American Diabetes Association Standards Of Medical Care For Diabetes, Christine Nsubuga

Walden Dissertations and Doctoral Studies

Diabetes is a commonly encountered chronic illness that leads to other lifelong comorbidities if left uncontrolled. Ranked as the seventh leading cause of death in the United States, diabetes affects over 29 million Americans. Although 90%-95% of all diabetes cases are preventable with proper planning and management, clinicians continue to be challenged as they strive to achieve the desired patient care goals. This Doctor of Nursing Practice (DNP) staff education project addressed the lack of standard evidence-based care for diabetic patients in the federally qualified health center look-alike practice for which this project was developed. Guided by the practice-focused questions …

Integrating Quality Improvement Concepts Into Nursing Curriculum: Perspectives Of Associate Degree Nurse Faculty, Debbie Krachtus

Graduate Research Theses & Dissertations

Since the groundbreaking report To Err is Human, there has been an increased focus on outcomes and quality improvement (QI) in healthcare. This focus has resulted in a change in nursing education. Nursing programs and nurse educators have been directed to integrate QI into nursing curriculum using innovative teaching methods. However, the voices of Associate Degree Nurse (ADN) educators are absent from the literature. This qualitative research study used a phenomenological approach to ascertain ADN educators’ perspectives about integrating QI into their curriculum. The central questions of this research were: what are ADN faculty views on the integration of QI …

Improving Assessment, Documentation, And Ordering Of Diabetic Retinopathy Screenings In A Primary Care Clinic, Lauren N. Motto

DNP Projects

Abstract

BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS).

PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or …

Simulation Impact On Medication Administration Safety: A Simulation Quality Improvement Project, Stacy Simpson

Doctor of Nursing Practice Projects

Background: Two medication simulations increasing in rigor, patient acuity, and distractions were implemented among undergraduate nursing students.

Objectives: To increase nursing student confidence, knowledge, and competence when administering medications.

Design: Two medication administration simulations were implemented and data was collected from students via a pre-simulation quiz, observation during the simulation via a Clinical Simulation Evaluation Tool, and student evaluation of the simulation with a modified version of the Simulation Evaluation Tool Likert scale.

Settings: Gaston Community College nursing simulation lab.

Participants: 53 undergraduate nursing students enrolled in NUR 101 and 42 students in NUR 102 …