Medicine and Health Sciences Commons^™

Preventing Surgical Site Infections By Utilizing Chg Wipes For Preoperative Skin Preparation, Jini K. Paek

Master's Projects and Capstones

Abstract

The Clinical Nurse Leader project took place at a 106-bed community hospital in Washington. The microsystem has five operating rooms where they provide outpatient, and inpatient surgical procedures. The goal of this project is to reduce and sustain a near zero number of surgical site infections by implementing the use of a no rinse 2% CHG cloth in the surgical patient. The specific aim of the project is to reduce the rate of SSIs by 80% by December 31^st, 2015. Due to a lack of a standardized care, specifically designed for the prevention of SSIs, the microsystem …

Influence Of Child Injury Risk Perceptions On Adult Supervision Behavior, Ha Huynh

Master's Projects and Capstones

Parenting practices play an important role in child safety and injury prevention, and inadequate supervision poses a significant threat to child health. Intervention programs targeting injury beliefs have been shown to positively reduce risky play in children though these efforts vary with age and context. There is a need to further evaluate the influence of social context, environmental characteristics, and parenting practices on supervision behavior. Research has classified supervision characteristics based on dimensions of attention (level of interaction with the child and visual/auditory attentiveness), proximity (physical touch and distance to a child), and continuity (frequency/timing of supervision). Prior studies suggest …

Reinventing The Medical Request Process In A Correctional Healthcare Setting, Leah Murphy

Master's Projects and Capstones

This project was developed as part of a Clinical Nurse Leader course of study with the goal of gathering and evaluating microsystem data, and the creation and implementation of a process improvement project. The project was conducted in a correctional setting which houses male and female detainees with a wide variety of medical needs. The project addressed long wait times for detainees who have submitted a request for services from the medical department. The goal of this project was to reduce wait times for medical requests, and provide service for a greater number of patients. This project is needed because …

Limiting Exposure To Isoflurane In A Veterinary Occupational Setting, Richard A. Votava

Master's Projects and Capstones

This paper characterizes the veterinary occupational health hazards of waste anesthesia gas. A needs assessment was conducted to develop educational materials on hazard and control. Rcommendations were made to HESIS on need for educational products.

Envisioning A Trauma-Sensitive Public Health Department: Implications For Practice, Policy, And Research, Victoria Lopez

Master's Projects and Capstones

Historically, the concept of trauma and long-term sequelae has rested primarily in the fields of psychology and psychiatry. However, recent attention and research around the health implications of trauma have unmasked this concept as a pervasive public health issue. This has catalyzed a movement to create a paradigm shift that transforms a formerly myopic understanding of trauma towards one that acknowledges the complexity and wide reaching impact trauma. At the core of this paradigm shift is an understanding of the interconnectedness between trauma and socio-ecological constructs at the individual, family, community, and organizational level. Public health departments are well positioned …

The Role Of Public Libraries In Addressing Food Insecurity: A Model For Community Feeding, Monica De La Cruz

Master's Projects and Capstones

Food insecurity is a serious problem in the United States. Not having enough food to eat can negatively impact children more severely than adults. Children who are food insecure are more likely to suffer from a range of physical, mental, and developmental delays in growth. There is prior evidence that the effects of food insecurity in children can be ameliorated through national feeding programs, like the National School Lunch Program (NSLP), which provides daily lunch at school for eligible low-income children. Though these types of programs are considered successful in addressing food insecurity within the community, the lack of these …

The Human And Environmental Health Impacts Of Food Quality Among Emergency Food Providers, Alexina Cather

Master's Projects and Capstones

Abstract

Human health and environmental health are inextricably entwined, and the ways in which we grow, process, package, transport, market, and consume food are critical factors for both human and environmental health. The current industrial food system in the United States has numerous adverse effects on environmental and human health, which significantly impact the millions of food insecure Americans who receive their nutritional needs from emergency food providers (American Public Health Association, 2007). The widespread food insecurity in the United States and the increasing prevalence of obesity among adults and children have drawn attention to the role that emergency food …

Health Hub Program Evaluation, Natalie Macias

Master's Projects and Capstones

This paper examines and evaluates the work of LIFT-Levántate a non-profit organization in San Rafael, California on their school-based nutritional education “health hub,” through health promotion interventions with adolescents. The James B. Davidson Middle School health hub educates students on topics related to nutrition and physical activity with the goal of providing access and increasing consumption of fruits and vegetables while lowering students’ intake of high-fat and sugary processed foods. Through research and observations of the students and families in this community, the data seems to indicate apparent disparities which vary by ethnicity, socioeconomic status and access. Underserved populations, including …

Improving Patient Satisfaction Through Reducing Nurse Overtime And Redesigning Nurse Staffing And Scheduling, Abby Romme

Master's Projects and Capstones

Increasing cardiac device patient demands within a large Midwest healthcare institution resulted in significant increases in staff shift requirements and corresponding patient complaints. The quality improvement project aimed to decrease patient complaints by executing a standard baseline daily full time equivalent (FTE) staffing strategy for future schedules, increasing nursing FTE, and maintaining institutional staffing standards. Standard calculated daily nursing requirements targeted 17.0 FTE. Implementation occurred over a three month period including schedule reprocessing, a pending incremental nursing FTE request, and a restructuring of unit based scheduling and paid time off guidelines. The completed schedule accurately captured staffing requirements for 100% …

Decreasing Delayed Patient Transfers Prior To Shift Change, Connie M. Vazquez

Master's Projects and Capstones

This project focuses on the CNL competency leadership theme of Clinical Outcomes

Manager. “Clinical Outcomes Manager uses data to change practice and improve outcomes”

(AACN, 2013). With the assistance of my preceptor, lean team members, department managers,

and administration, this project will aim to reduce delayed patient transfers times between the

emergency department and inpatient units by 50%. This project goal will be achieved by writing

and setting in place a new guideline for 45 minute black-out transfer times. The anticipated goal

date for this project is set for mid-August, 2015.

Implementation Of A Debrief “Takeaway” Board, Carly A. Skeath

Master's Projects and Capstones

Abstract

My original focus of my project was to implement Team STEPPS, to help improve the communication and teamwork within our entire perinatal service department. However, as I started I ran into barriers with time and with other projects put out by our management that needed to take president. It is then that I decided to narrow my focus on one aspect of Team STEPPS which we are already implementing, and that is debriefs. As a member of the Perinatal Patient Safety Program (PPSP), I was able to learn about all the takeaway’s we received from debriefs that had occurred, …

Home Health: The Process Of Assigning An Appropriately Trained Skilled Nurse To Provide Safe Patient Care, Susanne Polos, Msn, Rn, Cnl

Master's Projects and Capstones

The objective of this CNL project was to improve the process of placing an appropriately trained nurse in the client's home to provide safe, quality care. This project is relevant to nursing because of nursing accountability, patient safety, and lack of education of home health nurses. The population included home health patients in the Bay Area of San Francisco of all ages. The project had its base at a home health agency office in Emeryville, California with no actual hands-on patient contact. A CNL was added to the team to ensure appropriate training of the skilled nurse has been completed …

Quantify Blood Loss To Prevent Escalation Of Blood Loss, Manprit Virk

Master's Projects and Capstones

Abstract

The CNL project’s aim is to implement quantifying blood loss (QBL) after each delivery to prevent the escalation of postpartum hemorrhage (PPH), and decrease maternal mortality and morbidity related to PPH in Maternal Child Health (MCH). This project is initiated in a Northern California acute-care facility’s MCH department, which consists of: childbearing women pregnant at gestation age of more than thirty-four weeks, and women post delivery. According to CMQCC (2014), 1-3% of pregnancies are affected by postpartum hemorrhage, and the acute-care facility has a current postpartum hemorrhage rate of 2.7%. There is lack of standardized method of measuring blood …

Addressing The Problem Of Alarm Fatigue: Enhancing Patient Safety Through Cardiac Alarm Customization, Kimberly A. Kinghorn

Master's Projects and Capstones

The global aim of this project was to improve patient safety on the Surgical Unit at an acute care facility in Southern California through enhanced cardiac alarm customization. Alarms are intended to enhance patient safety. However, unnecessary and non-actionable alarms contribute to alarm desensitization and fatigue, lessening response time to critical alerts. Alarm fatigue has become a growing patient safety concern and is included as one of the Joint Commission’s 2015 National Patient Safety Goals. Assessment data on the Surgical Unit revealed lack of alarm customization and inappropriate default settings. The framework for the project focuses on the CNL curriculum …

Improving Patient Safety By Calculating The Qt Correction In Critical Care Patients, Diane F. Newcombe

Master's Projects and Capstones

Prolonged QTc is recognized as a precursor to Torsades de Points and other lethal ventricular arrhythmias. 52% or patients in critical care units have prolonged QTc and 69% or critical care patients have risks of developing QTc. Many commonly administered medications in the critical care unit are known to prolong QTc yet a microsystem assessment and a gap analysis revealed only 3% of the patients in the surgical ICU had the QTc calculation performed and assessed by the critical care nurse.

The global aim is to improve patient safety by incorporating calculating of the QT correction (QTc) into the regularly …

Monitoring Non Compliant Diabetic A1c Levels, Laura J. Tracy

Master's Projects and Capstones

The AIM of this CNL project is to identify and connect with, those diabetic patients within the out-patient clinic that are not in compliance with their A1C laboratory values. Contacting these patients to schedule follow up and re-engagement in their health care plan, may improve their overall health care outcomes and decrease their risk of more frequent or prolonged hospitalization and increased use of medications. There are over 25.6 million adult diabetic people living in the United States as of 2010. The total cost of direct and indirect medical care is 174 billion dollars as of 2007. With over 3.9 …

Hypertension Management Through Patient Education, Shaleena Kumar

Master's Projects and Capstones

Hypertension serves as a common diagnosis among Americans, and its management to prevent further cardiovascular complications remains as an organizational goal. To prevent complications, the goal of a Primary Care Provider’s patient panel maintaining a blood pressure less than 140/90 has been established on the organization’s national office. In the Primary Care Clinic, an interdisciplinary team consisting of a Registered Nurse, Clinical Psychologist, and Cardiologist implemented a group education class aimed at a Hypertensive Veteran cohort. The purpose of this project is to improve self-management behaviors in the Veteran population, and to help increase the hypertension performance metric by 2% …

Reducing Wait Time Of Chemotherapy And Biotherapy Administration To Inpatients By Increasing The Numbers Of Chemotherapy Providers, Jessica Y. Liang

Master's Projects and Capstones

The purpose of my CNL project is to decrease the chemotherapy administration wait-time for adult oncology patients by increasing the numbers of certified providers. Unfortunately as an oncology unit, about 44% of the providers are not active chemotherapy providers. As a CNL, we must constantly evaluate our microsystems to improve our clinical practice and standards for the benefits of our patients, organization, and our clinical growth. Four barriers for not taking the online course were identified through surveys (course difficulty, low census of oncology patients, lack of knowledge or uncomfortable giving chemotherapy, and the cost of the course if failed). …

Improving Nurse-Patient Communication About New Medicines, Srimala Thinsan

Master's Projects and Capstones

Improving Nurse-patient Communication about New Medicines

Abstract

The project aimed at improving nursing communication with patients and families about medication in order to increase patient satisfaction in terms of safety, quality of care, and patient-centeredness in an acute care setting. The selected patient cohort was at a 42-bed medical-surgical unit in a trauma center in Oakland, California. The gap of nurse-patent communication about medicines was identified based on the HCAHPs scores that had been found to be lower than average (44.1% in March 2015; 40.9% in April 2015). The visibility board was provided to show the staff the HCAHPS scores, …

Reduction Of Psychiatric Patient Boarding In The Ed, Eriam S. Nnamaliri

Master's Projects and Capstones

REDUCTION OF PSYCHIATRIC PATIENT BOARDING IN THE EMERGENCY ROOM

ABSTRACT

Objective: Psychiatric patient boarding is a public health concern and a threat to patient safety. The prevalence of psychiatric emergencies in the United States continues to increase due to the strain on mental health services. There is a dire need to address psychiatric patient boarding before it gets even worse. The purpose of this project is to identify the causes and identify measures to decrease emergency department length of stay (LOS) for psychiatric patients in the ED. This project is to help facilitate the development of a more precise nursing …

Improving Hand Off Communication To Enhance Patient Outcomes And Staff Satisfaction, Karin Weinstock

Master's Projects and Capstones

Abstract

The specific aim statement is: Improving hand off communication to enhance patient outcomes and staff satisfaction 50% by August 6. Staff had 100% participation. Reduction in unnecessary appointments occurred and a structured standardized hand off form with situation, background, assessment, and recommendation (SBAR) was implemented at the start date. The clinic has 2 exam rooms, 1 lab, a reception area, and two small offices. The majority of the clients are Hispanic females ages 15-25. The non-profit clinic provides free medical services to the community. Evaluation methods yielded quantitative and qualitative results through chart audits and direct observations.

In-services, one-to-one …

Improving Patient Safety By Decreasing Restraint Use, Francesca R. Pearl

Master's Projects and Capstones

Restraints are among the top 15 most frequently reported sentinel events (Cosper et al., 2013). An improvement project was undertaken to reduce restraint use on a medical/surgical acute care unit within a 200 bed not-for-profit teaching hospital. The project aimed to reduce physical restraint use prevalence by 10%. After conducting a literature review and a microsystem assessment, Multidisciplinary Rounding (MDR) was identified as an evidence-based intervention to address physical restraint use. A reduction in restraint prevalence was noted from 2.4% to 1.6%. This equates to a 33% reduction in restraint prevalence. Other interventions implemented during the same time frame may …

Performing A Correct Surgical Time Out, Natalia E. Mariscal

Master's Projects and Capstones

The ending data reflected what we expected in that we would see a significant incline but

not quite the 100% compliance rate we are looking for. Our highest compliance rate has reached

90% and we have contributed the margin error to new staff that requires the proper teaching and

education. In conclusion I feel that the majority of staff was aware that they were not in

compliance with the time out but would proceed anyways due to the rush of the case or surgeon

or simply that they had become laxed in practice. Once the data was brought to staff …

Process Change At An All-Volunteer Run Clinic With Pcmh Level 1 Recognition, Erin Flynn

Master's Projects and Capstones

This project directly involves the Clinical Nurse Leader (CNL) essential Informatics and Healthcare Technologies, and the CNL role function will be to act as a Team Manager. (AACN, 2013). The global aim of this process improvement is to improve the clinic workflow to increase patient and provider satisfaction in a Patient-Centered Medical Home (PCMH). The need for this project was discovered during the process of applying for PCMH recognition (of which the clinic has now earned level 1), and successful implementation of this project will meet PCMH guidelines. While applying for PCMH recognition, a clinic workflow document had to be …

Patient Engagement In Transitional Care, Sheeree Dela Pena

Master's Projects and Capstones

The Clinical Nurse Leader Master’s project was conducted about a public health program called the Transitional Care Program that was working in partnership with a county hospital system, Santa Clara Valley Medical Center. The specific aim was to reduce hospital re-admissions of high-risk patients by supporting patient motivation and engagement in the Transitional Care Program by May 2015. Over a four-month period, data was collected through ten client visits, interviews with two public health nurses, information available about the program, and current research conducted on transitional care, hospital discharges, and patient engagement. Various aspects of the program were assessed, such …

Prospectus Summary Brief: Nicu Communication Improvement, Joy E. Lawley

Master's Projects and Capstones

Joy Lawley RNC, NICU Communication Improvement: A prospectus summary brief. Effective communication in the neonatal intensive care unit (NICU) not only reduces errors and adverse patient outcomes but also create an environment that promotes staff satisfaction. The purpose of this prospectus is that of improving the process of communication between the perinatal departments. The specific aim was to improve communication to the NICU through standardize communication tools (SBAR) from patient delivery to discharge starting April 1, 2015. With 100% participation of all staff members within a three month period and a 95% staff satisfaction related to improved communication from staff …

Perinatal Patient Management, Natalie Whitten

Master's Projects and Capstones

The medical center has lacked the bed capacity and nursing staff to accommodate the needs of maternity patients. Patients are redirected to other network and non-network medical centers due to lack of bed availability, inadequate nurse staffing, and poorly managed patient movement. This project aims to improve patient management in the perinatal departments, including the discharge process. We will have 100% staff participation to facilitate bed management. The patient management project was conducted in a 200-bed hospital serving the residents of an urban area. The perinatal areas of labor & delivery (L&D), antepartum, and postpartum (OB) are highly productive units …

Pre-Exposure Prophylaxis (Prep) Education Improvement Project, Reginald M. Hilarie

Master's Projects and Capstones

In 2012, the US Food and Drug Administration approved the pill Truvada for use as pre-exposure prophylaxis or PrEP. Its purpose is to help prevent HIV infection by taking one pill every day. This project aims to improve PrEP patient education provided by the multi-disciplinary team and to decrease new HIV infection and sexually transmitted infections (STIs) to zero. The focus of the study is patients on PrEP at the Infectious Disease and HIV Clinic in San Francisco Veterans Administration Medical Center. The Clinical Nurse Leader, in collaboration with the multidisciplinary team, incorporated Pender’s Health Promotion Model Theory in developing …

Emergency Response Improvement Project, Ewan Stephen Macdonald

Master's Projects and Capstones

The objective of this CNL internship project is to improve team response to emergencies through staff education and protocol development with 100% participation within six months. This need was determined after an intense analysis following a near code on a pediatric patient. After an investigation, two problems were chosen as a focus for improvement: limited educational opportunities, and poor coordination and delegation during codes. Lewins’s theory of change was used as the theoretical framework, which involves the concept of unfreezing, movement, and refreezing. The method utilized was to offer education and training sessions twice per month in the form of …

Improving Dental Care To The Elderly In A Nursing Home, Cara M. Licavoli

Master's Projects and Capstones

The project is about the collaboration between Peninsula Health Care District (PHCD) and Apple Tree Dental (ATD) in a team approach to address the current issues of improving dental care of frail and elderly patients in nursing home facilities. The specific aim is to improve dental care of clients at the San Mateo County nursing home facility by 100% by May, 2015. The methods use in this project was the adaptation and implementation of existing dental/oral health assessment tools, that is nurse driven for patient assessment upon admission to the nursing facility. The process includes staff education regarding the adapted …