Health and Medical Administration Commons^™

The Role Of An Advanced Practice Provider (App) And Its Relation To Physician Shortages And Rural Healthcare Survival: A State-By-State Analysis, Allen Anderson

Dissertations, Theses, and Projects

The extent that Advanced Practice Providers (APPs) are able to practice independently with a full scope of practice varies state-by-state. The purpose of this paper was to review how APPs could help in a number of different areas of healthcare. This analysis examines the state of rural healthcare and reviews physician shortage statistics and hospital closures by state. In the examination, it also evaluates which states have full scope, reduced scope, and restricted scope of practice laws and cross-references that with states that have experienced a hospital closure. Through case studies, this research finds that APPs can be an alternative …

Improving Breastfeeding In Rural Tanzania Using Bardach’S Policy Analysis Methodology, Katherine Skiff

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under five years (U5Y) compared to all other preventive interventions. The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. Shirati hospital, in rural Tanzania, does not have a breastfeeding policy. Bardach’s 8-Fold Pathway for policy analysis methodology (adapted by Collins for health policy) was used to evaluate three promising breastfeeding policies to improve compliance with this recommendation. They include …

Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan

Doctor of Nursing Practice (DNP) Projects

Problem: The subject organization (SO) is a Federally Qualified Health Center (FQHC) with an internally developed incident reporting system. The SO wanted to improve patient and employee safety using data from incident reports, but the incident reporting system did not give enough information to recognize patterns and develop countermeasures.

Context: Supervisors welcomed the opportunity to learn more about incident report follow-up and conducting root cause analysis (RCA). Members of the Safety Committee were eager for data to use to develop countermeasures to improve patient and employee safety. Decreases in employee injuries can save the SO from increases in the …

Service Operations Center Improves Hospital Flow And Reduces Ed Boarding!, Jeanne Rhynsburger, Patty Palmer, Michelle Hansen

Books, Presentations, Posters, Etc.

Swedish Edmonds 3 year journey to optimize hospital flow by opening a Service Operations Center – flow management hub.

Notable improvements included:

1. Patient visit times decreased 27 minutes per patient
2. Emergency department (ED) admit times decreased 68 minutes per patient
3. Boarding hours decreased 20%.

Changing Culture One Pdsa At A Time: The Creation Of An Innovation Unit, Jennifer Hoople, Gale Arnold, Jennifer Bletscher, Shawna Bolgen, Andy Branca, Tana Case, Matthew Dietz, Jennifer Ferenczy, Heather Haake, Janine Holbrook, Ingrid Jonely, Liga Mezaraups, Jessica Osantowski, Jessica Sehorn, Linda Severs, Dina Shepelyuk

Books, Presentations, Posters, Etc.

An inpatient unit in an acute care hospital was designated as an Innovation Unit. This unit was challenged with the creation of culture change in regards to process improvement. The team learned to use Improvement Science to facilitate rapid and innovative process improvements. These changes have enhanced the quality of healthcare provided while decreasing cost. The poster highlights some of the Improvement Science processes, forms, and roles of the team as well as some of the projects and successes.

Moving Slow To Move Fast-Nursing Handovers-Implementing Electronic To Ed Report To Improve Throughput, Dawn Gilbert, Roni Lyons, Patrick Mugrage, Linda Severs

Books, Presentations, Posters, Etc.

No abstract provided.

Scientific Proceedings Of The Texas Children’S Hospital’S 17th Session Of The Advanced Quality Improvement And Patient Safety Program, Arjun M. Dangre Bds Mph, Kelly Wallin Ms Rn Chse, Gertrude A. Leidich Mba, Rn, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required for each …

Scientific Proceedings Of The Texas Children’S Hospital’S 16th Session Of The Advanced Quality Improvement And Patient Safety Program, Arjun M. Dangre Bds, Mph, Kelly Wallin Ms, Rn, Chse, Gertrude A. Leidich Mba, Rn, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety (AQI) Program is a six month mixed didactic and experiential learning experience designed to improve patient care, lower costs, change the culture, and develop quality leaders. As a part of AQI program participants are grouped into teams and each team completes a healthcare related Quality Improvement (QI) project. Each project demonstrates use of various QI tools including process maps, fishbone diagrams, and key driver diagrams. The projects use the IHI ‘Model for Improvement’ as the primary QI methodology to achieve their aim. Three or more Plan-do-study-act (PDSA) cycles are required …

Hospital Nurse Burnout: A Continuing Problem, David P. Paul Iii, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

RNs are a critically important component of the U.S. healthcare system. RN burnout – the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. We examine the background, causes and consequences of burnout among RNs in U.S. hospitals, in order to identify solutions to this problem. Findings indicate that Burnout Syndrome in RNs can be analyzed in terms of four clusters of characteristics: individual, management, organizational, and work. The consequences of burnout include increased RN turnover rates, poor job performance, and threats to patient safety. RN burnout in hospitals …

Rules Of Engagement: Strategies Used To Enlist And Retain Underserved Mothers In A Mental Health Intervention, Maureen J. Baker Phd, Rn, Cnl, Beth Perry Black Phd, Rn, Faan, Linda S. Beeber Phd, Pmhcns-Bc, Faan

Patient Experience Journal

Patient engagement has been identified as both a goal and strategy to lower health care costs and improve health care outcomes. However, a lack of consensus and clarity exists as to how the process of patient engagement is implemented in clinical practice. Research addressing the underlying and crucial components of effective patient engagement is limited, leaving a significant gap as to how providers engage patients as active collaborators in their health and health care.

This study provides specific, detailed insight and description into the processes through which advanced practice mental health nurses engaged low-income depressed mothers in a mental health …

Mother Baby Discharge Process, Zander Abbott, Maria Tkacz, Suellen Clark, Justyna Coleman, Dave Cox, Kathy Cyr, Sharon Economides, Jen Johnson, Stacy Lamore, Mary Mcnulty, Joy Moody, Heidi Morin, Cathy Palleschi, Josh Sinkin, Stephen Tyzik, Helen Wild

Maine Medical Center

Problem/Impact Statement: MMC's 32-bed Mother Baby Unit is experiencing backed up flow due to high volume and patients not being discharged quickly enough. The current average discharge time on Mother Baby and the Newborn Nursery is 1:36pm. The Mother baby unit has 32 beds, is staffed by 8-9 nurses, and has average discharge of 91 patients a week.

Implementing Strategies To Reduce Central Line-Associated Blood Stream Infections On An Inpatient Pediatric Unit, Sherryann St. Pierre, Nicole Manchester, Jessica Howe, Melanie Lord, Mark Parker, Suneela Nayak, Ruth Hanselman, Stephen Tyzik, Amy Sparks, Barbara Bush Children's Hospital

Operational Transformation

STRATEGIES TO REDUCE CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTIONS

Every central line associated bloodstream infection (CLABSI) leads to poor outcomes, increased mortality and increased healthcare costs. A pediatric care team in an academic tertiary medical center set a goal to reduce the number of these infections on their unit.

The team’s research showed that daily bathing greatly decreases CLABSI. Their baseline metrics demonstrated an unacceptable level of those with central lines being bathed. A root cause analysis revealed that patient and family refusal was the leading cause for those who did not bathe.

A performance improvement plan was initiated that consisted …

Increasing Bedside Medication Safety In An Intensive Care Setting, Natasha Stankiewicz, Jonathan Archibald, Scu 2, Mark Parker, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

A PERFORMANCE IMPROVEMENT PROJECT FOR INCREASED BEDSIDE MEDICATION SAFETY

The convenience of having certain medications directly available at bedside has long been a priority for a medical intensive care nursing team in an academic tertiary medical center.

However, it was apparent to new staff and leadership that there was a lack of awareness and interest in securing medications within the department. This posed a risk to patients, families, visitors and colleagues.

Baseline metrics on patient safety were collected and a root cause analysis was conducted. Countermeasures included increased education of medication safety as well as a instituting a KPI which …

Improving Revenue Capture And Patient Safety In An Icu Setting, Natasha Stankiewicz, Laura Lewis, Jonathan Archibald, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Transformation

IMPROVING REVENUE CAPTURE AND PATIENT SAEFTY IN AN INTENSIVE CARE SETTING

Materials management department is responsible for restocking chargeable supplies in an intensive care unit (ICU) at an academic tertiary medical center. Staff confusion as to what items were considered chargeable often led to low supply par levels resulting in delays of critical patient care.

Using baseline metrics, a team of caregivers created several performance improvement goals to increase nursing compliance with appropriate supply charging. The results of a root cause analysis spearheaded the development of a KPI that encompassed staff education, lost charge tracking and charge supply labeling.

Post …

Strategies To Improve Timeliness For Cleaning Inpatient Rooms Following Patient Discharge, Lora Dixon, Mark Parker, Ruth Hanselman, Suneela Nayak, Amy Sparks

Operational Transformation

STRATEGIES TO IMPROVE THE TIME FRAME FOR CLEANING INPATIENT ROOMS BY ENVIRONMENTAL SERVICES

In an inpatient rehab hospital, it was noted that Environmental Services (EVS) was delayed in cleaning rooms between patient discharges and admissions. This resulted in the frequent use of a “stat clean” order that allows only 50% of the normal cleaning time , forcing patients to wait and impacting patient flow.

A root cause analysis demonstrated lack of communication between the rehab hospital and the contracted cleaning services. A number of counter measures were initiated with the goal that cleaning would be started within 20 minutes of …

Consistently Using A Transportation Department For Patient Discharge To Sustain Nursing Staffing Levels, Victoria Boutin, Joseph East, Stephen Tyzik, Joy Moody, Mark Parker, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operational Transformation

IMPROVING PATIENT FLOW BY UTILIZING A HOSPITAL TRANSPORTATION DEPARTMENT FOR DISCHARGES

Using a transportation department for transporting patients for discharge is the industry standard. At a large urban hospital, inconsistent use of this department has resulted in frontline caregivers (RNs) having to pick up this function, resulting in potentially unsafe staffing levels on the floor.

The goal of this quality improvement project was to improve the percent of discharges with the transport department from ≤10% to 70% by the end is fiscal year 2018 in an academic tertiary medical center.

Baseline metrics demonstrated the current state and a root cause …

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

Uams Summer Health Literacy Study, Merritt Osment

Health, Human Performance and Recreation Undergraduate Honors Theses

Background: Health Literacy is a barrier to self-care; patients often lack the skills to understand complicated instructions that deal with medications, wound care, follow up schedules, and preventative care. Patients who undergo hip and knee replacements are often older adults, a population that normally struggles with various aspects of health literacy. Patient education materials are a common means of communicating with these individuals. However, if the patient does not understand the materials that they are given, they are more likely to experience negative side effects after their operation. Purpose: The purpose of this study is to compare the health literacy …

Efficacy Of Smart Infusion Pumps From A Nursing Perspective, Kassi B. Zaborowski

Applied Research Projects

In today’s healthcare, intravenous (IV) therapy-related errors have become rampant and are responsible for a substantial portion of hospital injuries and deaths. In the last decade, however, since the development and implementation of “smart” IV pumps, a significant number of these IV medication errors have allegedly been reduced. The purpose of this paper is to discuss research surrounding an evaluation of the efficacy of smart IV pumps from a nursing perspective.

Hazardous Drug Administration In The Home Setting: Reducing Exposure Risks, Cynthia D. Huff Msn, Rn, Ocn, Crni, Cnl

Master's Projects and Capstones

Hazardous drug (HD) administration used to be contained in controlled-healthcare settings, however, the introduction of HDs for home administration has become a growing area of concern for home health agencies. The objectives of the Clinical Nurse Leader (CNL) project aims to improve homecare nurses' knowledge of HDs and improve competency with personal protective equipment (PPE). The microsystem provides short-term homecare services for acute and chronically-ill patients. One team leader, two home infusion coordinators, and twelve registered infusion nurses participated in learning about exposure risks and PPE use with HD administration. Kotter's 8-step change theory was used to develop behavior change …

Efficacy Of Technology-Based And In-Person Health Education For Behavior Change In College-Aged Women, Madeline Bremel

All College Thesis Program, 2016-2019

Purpose: The purpose of this study was to determine whether an in-person or technology based bone health intervention improved bone health knowledge and behaviors in college-aged women. Methods: 30 college-aged women were randomly divided into three groups: personal intervention (n = 10), technological intervention (n = 10), and control (n = 10). Both intervention groups received identical information regarding the importance of bone health and the appropriate behaviors for maintaining strong bones including weight-bearing exercise, calcium consumption, and vitamin D consumption. The technology group received the information via an online video, and the personal group via a one-on-one …

A Multi-Faceted Intervention To Improve Naloxone Co-Prescription Rates Among Primary Care Providers, Jolane S. Conklin

Evidence-Based Practice Project Reports

It is estimated that 91 Americans die every day due to opioid overdoses, with at least half of those overdoses involving an opioid prescription (CDC, 2016d). To address this issue, the U.S. Department of Health and Human Services (USDHHS) has initiated an opioid initiative, and the Centers for Disease Control and Prevention (CDC) has released a clinical guideline, both of which include a focus on increasing use of naloxone. Despite these recommendations, providers often fail to co-prescribe naloxone to patients at increased risk of opioid overdose. The purpose of this evidence-based practice (EBP) project was to evaluate the effect of …

Effects Of Incorporating Patient Acuity Into The Rn Assignment Process, Melissa L. Forton

Evidence-Based Practice Project Reports

As the largest sector of healthcare, nurses are the primary providers of patient care. By 2025, it is estimated that there will be a shortage of over 250,000 registered nurses (RNs) (American Association of Colleges of Nursing, 2011). Factors contributing to the nursing shortage include increased complexity of patients and decreased staffing that leads to decreased job satisfaction (Fox & Abrahamson, 2009). Over half of neonatal intensive care nurses reported missing at least one nursing task per shift when staffing was inadequate or patient acuity was high (TubbsCooley, Pickler, Younger, & Mark, 2015). The purpose of this evidence-based practice (EBP) …

An Exploration Of Patients’ Experience Of Nurses’ Use Of Point-Of-Care Information Technology In Acute Care, Leigh Mcnicol, Anastasia F. Hutchinson, Beverley Wood, Mari Botti, Bernice Redley

Patient Experience Journal

The rapid introduction of technology into acute healthcare settings, specifically the presence of point-of-care health information technology at patients’ bedsides, is expected to impact patients’ healthcare experience by altering nurse-patient interactions. This research was a multi-method naturalistic pilot study designed to explore patients’ perception of their interactions with nurses using bedside point-of-care health information technology in acute care. Data were collected using observation, interviews and surveys. Twenty-four participants were purposefully recruited from medical and surgical wards, to capture variability in their self-reported confidence with information technology; 29% were not confident, 38% were somewhat confident and 33% were completely confident with …

Hospital Nurse Burnout: A Continuing Problem, David P. Paul Iii, Lama Bakhamis, Harlan M. Smith Ii, Alberto Coustasse

Management Faculty Research

RNs are a critically important component of the U.S. healthcare system. RN burnout – the feeling of exhaustion from working long hours without rest – is a real concern, having been reported in many hospitals. We examine the background, causes and consequences of burnout among RNs in U.S. hospitals, in order to identify solutions to this problem. Findings indicate that Burnout Syndrome in RNs can be analyzed in terms of four clusters of characteristics: individual, management, organizational, and work. The consequences of burnout include increased RN turnover rates, poor job performance, and threats to patient safety. RN burnout in hospitals …

Incorporating Just Culture Principles Into Clinical Learning Experiences, Paula Gendreau, Dnp, Msn, Rn, Cne

Doctor of Nursing Practice Projects

Background: Although nursing student’s confidence regarding patient safety is influenced by both clinical faculty and environments in which they learn, faculty seemed to have the most influence in shaping student’s attitudes surrounding a culture of safety. Objectives: To explore and support faculty culture of safety practices that promote meaningful learning experiences for students surrounding patient safety in clinical learning environments.

Methods: An embedded mixed method design was utilized for this pilot study. Quantitative data was collected both pre- and post-semester utilizing an adapted Health Professional Education in Patient Safety Survey, and post-semester qualitative data further expanded on faculty perceptions and …

Evaluating Transfer Of Continuing Education To Practice: A Retrospective Mixed-Methods Study, Tiffany Bryant, Dnp, Msn, Rn-Bc

Doctor of Nursing Practice Projects

Background: Continuing education (CE) is an essential component of building and maintaining the competence and performance of health professionals. Evidence of its impact on practice is lacking. Organizations need evidence of CE transfer to the practice setting to demonstrate its value and inform CE practice.

Objectives: The purpose of this study was to provide evidence of CE’s impact on practice by analyzing nurses’ reports of intent to change practice, actual practice change, and examples of practice change. Research assessing the effects of CE on nursing practice across multiple courses involving different topics, levels of nursing practice and location supports generalizability. …

Evaluation Of Disparities In Healthcare Experiences Between Racial Identities And Age Cohorts, Christopher Ruckman, Dnp, Mba, Msn, Rn, Cen

Doctor of Nursing Practice Projects

Background: Healthcare consumers have their own perspectives and expectations of what should occur during an encounter of care; these unmet expectations create healthcare disparities. However, there is limited data regarding healthcare experiences among racial and aging groups.

Objectives: To compare the physical and emotional responses of healthcare experiences among racial/ethnic and aged cohorts in the United States.

Methods: Applying a descriptive-correlational design, secondary data from the 2014 Behavioral Risk Factor Surveillance System related to healthcare experiences among racial groups (White, Black, Hispanic, and Asian) and aged cohorts (18-39, 40-54, and 55- 69 years) were assessed.

Results: In the sample, there …

Missed Nursing Care Reported By Medical-Surgical Rns In A Community Hospital, Anne Schmidt, Dnp, Msn, Rn, Aprn-Bc, Cenp

Doctor of Nursing Practice Projects

Background: Missed nursing care is defined as any lapse in essential patient care. It is a previously studied, persistent phenomenon. If unrecognized, it can compromise patients’ recoveries, trigger adverse events, and increase healthcare costs.

Objectives: To examine the prevalence of missed nursing care reported by medical-surgical registered nurses (RNs) and contributing factors for its occurrence.

Methods: The project used a cross-sectional, correlational design. A convenience sample of 96 RNs, recruited from three medical-surgical units, completed the MISSCARE Survey between September and October 2017. An analysis of survey responses quantified the frequency, nature, and common contributing factors for care omissions. The …

Evaluation Of The Associations Between Unplanned Readmissions And The Lace Index And Other Variables, Cathy Stankiewicz, Dnp, Msn, Rn

Doctor of Nursing Practice Projects

Background: Unplanned readmissions, within 30 days following an inpatient hospital admission, are common and costly. Research has identified factors that predict readmissions, and predictive algorithms, such as the LACE index, have been studied and widely adopted by hospitals despite demonstrated variability in predictive ability.

Objectives: To examine the associations between unplanned readmissions and the LACE index, and other variables that reflect patient- and encounter-level factors not currently incorporated in the LACE index.

Methods: A retrospective analysis was conducted utilizing data from electronic health records of inpatients discharged from a large quaternary hospital located in the southeastern United States between January …