Medicine and Health Sciences Commons^™

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Implementation Of Comprehensive Footcare Program Within Primary Care, Moses Ademola-Ojo

Doctor of Nursing Practice

The incidence of diabetes and its complications is escalating, with over 34.2 million adults in the US having diabetes (CDC, 2020). Despite a decade-long decline in lower-extremity amputations, the incidence is growing (Nichols, 2019), with little emphasis on preventive foot evaluations within primary care. The purpose of this project was the implementation of a multi-faceted program aimed at early identification of lower extremity complications with focused patient education, improved assessment, and documentation, and referral for specialty care. The intervention process included staff training, patient education, foot examination, monofilament testing, pinprick tests, ankle reflex, and tuning fork test. Foot abnormality, loss …

Development And Implementation Of An Enhanced Recovery After Surgery Protocol For Thoracic Surgery Procedures, Nicholas Collier

Doctor of Nursing Practice Projects

A high prevalence of lung and esophageal cancers leads to significant healthcare dollars utilized for treatment and management. Surgical resection is regarded as a key component for multidisciplinary treatment and management of these cancers. By standardizing multidisciplinary patient care and utilizing evidence-based practice, Enhanced Recovery After Surgery (ERAS) protocols for thoracic surgery have offered better outcomes with fewer complications and reduced healthcare costs. The anesthesia providers at the host facility were deficient in basic knowledge related to ERAS protocols and best practice management of thoracic surgery patients. The purpose of this project was to educate anesthesia providers on ERAS principles …

Improving Progressive Care Nurses’ Confidence And Performance During In-Hospital Cardiac Arrest (Ihca): A Continuous Quality Improvement Initiative, Katelyn Barley

Doctor of Nursing Practice (DNP) Manuscripts

The literature is clear regarding the benefits of high-quality cardiopulmonary resuscitation (CPR) in relation to patient outcomes. The American Heart Association (AHA) guidelines recommend immediate initiation of chest compressions and defibrillation as soon as possible to increase the chance of survival from cardiac arrest. The development of automatic external defibrillators (AEDs) have increased the survival rates of out-of-hospital cardiac arrest, however rates of survival from in-hospital cardiac arrest (IHCA) have not improved over the past several decades despite an increase in resuscitation research.

This project was to develop a system of quality improvement related to patient outcomes from IHCA. The …

Evaluation And Implementation Of A Video Intervention To Increase Adherence In A Rural Phase Ii Cardiac Rehabilitation Program., Holly Yahyawi

Doctor of Nursing Practice Papers

Background: In the U.S., heart disease affects over 30 million adults and is the leading cause of death. Cardiac rehabilitation (CR) decreases cardiac hospital readmissions, decreases the risk of additional cardiac events, and increases life expectancy. Environment: This project was implemented at a CR program which serves rural Indiana and Kentucky counties. Purpose: This QI project uses a Plan-Study-Do-Act framework to evaluate patient adherence to a rural CR program, implement a video intervention for patients, and measure patient’s perceptions. Procedures: CR patients watched four videos describing what CR is, what to expect at CR, CR benefits, and a patient CR …

Improving Patient Safety During The Emergency Department Discharge Process With The Use Of Two Patient Identifiers., Hannah English

Doctor of Nursing Practice Papers

Nurses are not always confirming two patient identifiers while conducting a patient discharge, resulting in patient identification errors. This problem has been shown to significantly affect patient safety and satisfaction, decreasing both when errors are made. These errors also have heavy financial and legal consequences on the affected facility and on the discharging nurses, warranting a need for improvement. The purpose of this quality improvement project was to decrease patient-identification errors at discharge by increasing nurse use of two patient-identifiers through the implementation of an education program. This ten-week program involved education sessions that presented evidence-based material specifically focused on …

Sepsis Initiative: Champion Series, Ashlie Barnes

Doctor of Nursing Practice Projects

Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays …

Implementation Of A Quality Improvement (Qi) Intervention To Increase Influenza Vaccination Uptake In A Pediatric Primary Care Setting., Lisa Gaines

Doctor of Nursing Practice Papers

Background: Internal and external evidence demonstrates that there is a suboptimal uptake of influenza vaccination (flu vaccine) in all settings, despite national objectives to achieve 80%- 90% immunization rates across all populations. In 2002, the Advisory Committee on Immunization Practices (ACIP) issued a recommendation that all children 6 months of age and older be immunized annually with the influenza vaccine. Despite these recommendations, influenza vaccination is not required for school entry in the Commonwealth of Kentucky and immunization rates continue to fall below local, state, and national targets. Being considered an optional vaccine leaves the decision to vaccinate (or not) …

Innovation And Accreditation: A Quality Improvement Process, Kara Koschmann

Nursing Faculty Scholarship

Nursing program accreditation often has limited faculty engagement. This quality improvement project, implemented at a private university in the Midwestern United States, utilized innovative solutions including accreditation program champions and a learning management system to enhance faculty engagement in the accreditation process. Accreditation encompassed seven programs at three program degree levels: undergraduate, masters and doctorate. A survey measured overall engagement as well as the usefulness of accreditation program champions and the learning management system to improve engagement. Results showed increased faculty knowledge, professional development, and motivation in the accreditation process. Increased engagement not only accomplishes the work more efficiently, but …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …

The Use Of A Peanut Ball During Labor In Nulliparous Term Singleton Vertex Pregnancies To Decrease The Primary Cesarean Rate: An Evidence-Based Practice Improvement Project, Megan Elizabeth Honaker, Tracy L. Brewer, Melissa Nursing Hessock

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

BACKGROUND: Current statistics indicate cesarean section rates in nulliparous term singleton vertex (NTSV) pregnancies, a singleton first pregnancy > 37 weeks’ gestation in a vertex position, of 32.8% and rising. A peanut ball, a tool used to optimize pelvic opening and fetal head rotation, can decrease labor length and cesarean section rates. The aim of this evidence-based practice improvement project was to reduce the cesarean rate in NTSV pregnancies by 1% within three months. The project occurred in an urban 12-bed labor and delivery unit in Middle Tennessee. Participants included laboring women meeting NTSV criteria. METHOD: Plan- do- study- act cycles …

Improving Care Coordination For The Homeless Population Using Systematic Quality Improvement, Rutendo Nyasvisvo

Doctoral Projects

Background and Objectives: Care coordination for the homeless population is challenging due to the complexity of healthcare and the uncertain life circumstances of the homeless individual. Objectives were developed to guide care coordination for the homeless by utilization of the free clinic to create PCP referrals, appointments and tracking follow-up care to increase appointment attendance and improve health outcomes for the homeless individual.

Design: A quality improvement project.

Setting: A faith-based non-profit homeless shelter organization in the Midwestern United States.

Participants: Participants include 25 homeless guests, 5 staff members including a clinic coordinator, 3 registered nurses and 1 licensed practical …

Addressing Social Determinants Of Health In Community-Based Palliative Care, Mary D. Chenge

Doctoral Projects

Background and Objectives: Addressing social determinants of health (SDOH) in the medical community has recently started; however, there is yet to be a standardized format for addressing the social needs of patients. Consequently, a protocol was developed to address SDOH to increase screening rates, social work referrals, and capture depression reimbursement.

Methods: The quality improvement project was implemented using the Plan-Do-Study-Act framework at an urban Community-Based Palliative Care organization in the Midwestern United States. Participants included office staff and 140 patients (two separate sets of 70 randomly selected patients pre/post-implementation). A protocol was developed for screening 11 SDOH using an …

Improving Tobacco Cessation Screening And Readiness To Quit During Medication Assisted Treatment For Patients With Opioid Use Disorder, Monique Poisson Rn, Dnp-C, Jennifer Laurent Phd, Aprn

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

Purpose: Tobacco use disorder is commonly comorbid in patients with Opioid Use Disorder (OUD), yet not always regularly addressed during OUD treatment. The aim of this project was to assess tobacco cessation intervention at a small outpatient medication assisted treatment (MAT) program and improve workflow to standardize care, increase knowledge and encourage tobacco cessation among patients.

Methods: The Plan Do Study Act (PDSA) method of quality improvement was used. Patient medical records were reviewed to assess documentation of tobacco use status and readiness to quit in the electronic health record (EHR). A screening, brief intervention, and referral to treatment (SBIRT) …

Nurse And Family Perceptions Of Family-Centered Care In Phase I Recovery, Anjanette Allard

Doctor of Nursing Practice Projects

Background: Including family in the pediatric post-operative post-anesthesia care unit (Phase I PACU) benefits children and families. Seattle Children’s Hospital’s (SCH) Bellevue campus PACU routinely involves families in Phase I but, despite the same mission that includes family-centered care, the Seattle PACU does not consistently involve families in Phase I. The purpose of this quality improvement project was to analyze nurse and family perceptions of Phase I and to propose a practice change that promotes family-centered care in the Seattle Phase I PACU.

Methods: A survey (11 to 31 multiple choice, Likert style and open-ended response questions) was offered to …

Admission Documentation Overhaul, Jennifer Burris, Holly Kockler, Hillary Waldum

Nursing Posters

Improve the admission documentation workflow by revamping the admission Navigator and Functional Health Assessment

Improving Hepatitis B Vaccination Rates In Nephrology Patients With Chronic Kidney Disease: A Qi Initiative, Jill Swanson

Nursing Posters

• Hepatitis B vaccination is an important health maintenance preventative measure for patients with chronic kidney disease (CKD)
• Prior to initiating dialysis, hepatitis B vaccination administration is proven to be more effective than waiting until patients begin dialysis treatments.
• Efficacy and immune response of the hepatitis B vaccine is greater when kidney function is greater
• To better improve hepatitis B vaccine administration among the CKD stage 4 population, education measures and Epic modifiers will be implemented to achieve change
• Nursing knowledge and hepatitis B vaccine administration will improve after implementation of these measures

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. …

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) …

Improving The Patient Experience With Case Management Follow Up Phone Calls: A Quality Improvement Project Evaluation, Karen Jarrell

Walden Dissertations and Doctoral Studies

In January of 2020, a follow-up phone call quality improvement initiative was implemented by the case management department of an acute care facility located in the Mid-Atlantic region of the United States, to improve the patients’ healthcare experience. The intent was to improve the Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores. This quality improvement (QI) project was conducted using the Plan-Do-Check-Act Cycle along with the Kotter’s 8-step change model. The purpose of the QI project evaluation was to determine if a QI initiative using follow up phone calls had a positive effect on increasing CAHPS survey scores. The …

A Delirium Prevalence Audit And A Pre And Post Evaluation Of An Interprofessional Education Intervention To Increase Staff Knowledge About Delirium In Older Adults, Bev Ewens, Karla Seaman, Lisa Whitehead, Mandy Towell-Barnard, Michelle Young

Research outputs 2014 to 2021

Background

Delirium is more prevalent in older people and estimated to occur in up to 50% of the hospital population. Delirium comprises a spectrum of behaviours, including cognitive and attention deficits, and fluctuating levels of consciousness, often associated with an underlying physiological disturbance. Delirium has been increasingly associated with adverse outcomes. Although often preventable or can at least be mitigated, delirium may not be a standard part of assessment and thus may not be recognized in the early stages when it is most likely to be treated successfully. The aim of this study was to evaluate the level of knowledge …

Implementing Eating Disorder Screening And Early Intervention In A Primary Care Clinic, Brandon Dukovic

Doctor of Nursing Practice Projects

Eating disorders have a high mortality rate, increasing prevalence rate, and often go unrecognized and untreated. Primary care providers are uniquely positioned to intervene early in the development of these disorders yet screening for eating disorders in primary care is limited. This project looked to improve provider confidence and improve screening for eating disorders by introducing a provider education course focused on eating disorder screening, management, and resources, as well as implementing the SCOFF questionnaire into the annual health questionnaire completed by students utilizing a university health clinic. Pre-and post-intervention survey data showed an increase in provider self-reported confidence in …

Implementation Of A Fall Prevention Program For The Elderly In A Long-Term Care Facility, Maureen Orobosa Igharosa

Walden Dissertations and Doctoral Studies

One out of 4 older people fall each year. By the year 2030, it is estimated that 49 million older adults will fall and that 12 million will incur injuries as a result. A rise in the trend in falls among older adults represents a growing burden; the cost for falls billed to Medicare in the year 2015 was an aggregate of over $31 billion. The purpose of this quality improvement evaluation project was to assess the effectiveness of a fall preventative pilot program to reduce the number of falls among the residents of a rehabilitation and long-term care facility …

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Sustainability Of A Dnp Qi Project On Bmi Screening And Weight Management Documentation In Primary Care, Assal Moori Shir Mohammadi

DNP Projects

Background: Nurses with a Doctor of Nursing (DNP) degree are prepared at the highest level of expertise to provide safe and efficient health care to patients and help bridge the gap between research and evidence-based health care. Although DNP students invest significant effort, time and resources to implement quality improvement (QI) projects, the sustainability of the outcomes of these is not well studied and empirical evidence on sustainability of quality improvement interventions is very limited.

Objective: To assess the sustainability of the QI project titled: “Using Rapid Cycle Improvement to Improve Weight Management” over time and evaluate the characteristics of …

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. …