Nursing Administration Commons^™

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Defying The Gravity Of Falls On Msu, Alvin Joseph Abad

Master's Projects and Capstones

Falls are a leading cause of injury and death for adult males in the United States and have been an ongoing problem on the Medical Surgical Unit (MSU). Therefore, the aim of this project is to increase fall prevention education and communication on MSU in order to ultimately improve fall rates. Although there are currently fall prevention processes already in place, these may not be sufficient as demonstrated by recent fall metrics. Many RNs on MSU are fairly new nurses; and their enthusiasm and adaptability may be an advantage for this evidence-based project. Furthermore, the management team seems to be …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

Improving The Staff Responsiveness By Bundling Care, Practicing Proactive Authentic Hourly Visits, And Using The Four P’S, Robert Vega

Master's Projects and Capstones

Abstract

Problem

Staff responsiveness is an important Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Rating composite tool that hospitals monitor because it is consumer-driven information. The intent is that the HCAHPS composite promotes patient satisfaction, contributes to the prevention of harm, and can save millions of dollars (Danaf et al., 2017). On admission, the patient is orientated to their room, provided a nurse call light button to use, and told not to get out of bed alone and to wait for their nurse (Mitchell et al., 2014). On Three North, a gap exists in the delay it …

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 …

Frontline Focus: A Nurse Manager's Employee Engagement Toolkit, Christen Straw

Doctor of Nursing Practice (DNP) Projects

Abstract

Average hospital turnover rates in the US reached 18.2% in 2017. Turnover rates for registered nurses (RNs) were also at an all-time high of 16.8%. RN turnover can cost up to $61,100 per nurse resulting in the average hospital loss of $5.7 million per year (NSI, 2018). Employee engagement and job satisfaction levels are predictors of nursing turnover and patient outcomes and should be a top priority for nurse leaders. A disengaged workforce not only affects team morale and organizational spending, but it also impacts the quality of patient care. Multiple studies suggest that employee engagement is the number …

Catheter-Associated Urinary Tract Infection Reduction: A Quality Improvement Project, Wallace Kramm

Master's Projects and Capstones

Abstract

Problem: Hospital-acquired infections are preventable harm that occurs to patients while in the hospital. Catheter-associated urinary tract infection (CAUTI) is a preventable hospital-acquired infection that continues to plague hospitals nationwide. The Centers for Disease Control and Prevention estimates that there are more than 13,000 CAUTI related deaths in the United States annually (Scanlon, 2017). In addition to the harm caused to patients by CAUTIs, the estimated $500 million yearly cost for CAUTI treatment has created a fiscal burden on healthcare systems (Scanlon, 2017). Decreasing the rate of CAUTI by decreasing overall number of catheters is the goal of this …

Identification Of Perioperative Barriers To Enhanced Recovery After Surgery In Colorectal Surgical Populations, Leah Marshall

Master's Projects and Capstones

Enhanced recovery after surgery (ERAS) has evolved over the past 30 years through evidence-based interventions. Enhanced recovery after surgery uses a multidisciplinary and multimodal evidence-based approach to maximize patient recovery. Perianesthesia nurses are critical to its success and have an obligation to understand and participate in the process to optimize patient outcomes. Despite proving to decrease complications and duration of stay in colorectal surgery patients without following colorectal surgery, the implementation of ERAS in colorectal pathways have been met with barriers (Alawadi et al., 2015). Subramaniam & Horgan (2016) describe ERAS pathways as evidence-based interventions that eliminate dated practices based …

Conflict Management And Team Building As Competencies For Nurse Managers To Improve Retention, Jeanette Black

DNP Qualifying Manuscripts

Abstract

Aim(s): To critically review and summarize evidence related to coaching and training nurse managers in conflict management and team building skills and to determine the relationship of these skills to retention.

Background: Retention of nurse managers is a significant challenge to healthcare organizations.

Evaluation: The databases searched were CINAHL, PubMed, evidence-based journals, JANE, Cochrane, SCOPUS and Joanna Briggs. The keywords searched were conflict management, team building, nurse manager retention, retention, teamwork, healthy work environment, conflict management theory, organizational culture, coaching nurse managers, and nursing. Articles with the strongest evidence were critically appraised using the Johns Hopkins Research and …

Improving Communication To Reduce Patient Falls In A 48-Bed Medical-Surgical Unit, Christian Gella

Nursing and Health Professions Faculty Research and Publications

Abstract

Problem: Patient falls has been associated with increased morbidity, mortality and decreased quality of life. The increase in total patient falls for 2018 relative to 2017, and a spike of 10 patient falls for the month of June 2018 from a baseline of 5.3 falls per month has gained greater attention to reduce patient harm from falls while hospitalized. Prevention of falls minimizes patient exposure to the possibility of being injured. Despite efforts to curtail patient falls, improvement in communication is essential to address the safety issues surrounding improving quality of care practices, and consequentially reduce un-reimbursable hospital costs …

Improving Communication: Huddling For Change, Harnoor Chahal

Master's Theses

The purpose of this communication improvement project is to incorporate huddles between interdisciplinary departments within a microsystem in order to improve customer satisfaction by decreasing the number of grievances. Based on the increasing number of grievances due to delayed hospital discharge, which results from a lack of communication between team members, there is an increased need for communication between the microsystem. By implementing weekly huddles between the Inpatient and Outpatient nurses, not only will there be increased care-coordination, but there will also be a decreased delay in discharge from the hospital caused by missed or no communication. Evidence-based practice indicates …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Reducing Inter-Unit Patient Report Delays And Transfer Times, Natalya Marinov

Master's Projects and Capstones

Inter-unit coordination is essential in preventing a bottleneck in patient flow and its resultant stresses to staff, hindering quality patient care, and wasting time. The Medical-Surgical Unit (MSU) and Post Anesthesia Care Unit (PACU) struggle to establish efficient patient report times and transfers. Preliminary data demonstrated report delays attributed to an arduous workload and overburdened MSU nursing staff. The project’s objective focuses on reducing nurse-related report time delays by 10%, increasing understanding and teamwork, promoting proactive thinking to manage workflow efficiently, improving patient flow, and improving the inter-unit relationship between MSU and PACU. Increasing awareness and reducing transfer times are …

Development Of An Advanced Practice Provider Onboarding Structure, Amy Ziegler

Doctor of Nursing Practice (DNP) Projects

Advanced practice providers, also referred to as nurse practitioners and physician assistants, are increasingly being employed to function in a variety of healthcare settings. As organizations grow their advanced practice provider staff, they must develop a distinct advanced practice provider orientation and onboarding program. Finding the right staff is only half the battle; if you do not orient and onboard staff properly the will not stay (National Systems Contractors Associations [NSCA], 2017). Administrators, certainly directors of advanced practice providers, are pursuing unique and dynamic ways to facilitate credentialing, privileging, orientation and onboarding of these individuals. The director for advanced practice …

Advanced Access: Creating An Infrastructure For Success In Primary Care, Kimberly D. Perris

Doctor of Nursing Practice (DNP) Projects

The Humboldt Independent Practice Association (IPA) has sought to improve the health of Humboldt County through practice transformation efforts. To date, Humboldt IPA’s primary care practice, the Priority Care Center, is building a foundation toward an Advanced Access model of care with an overarching aim of effectively improving access to quality care in Humboldt County. The 10 Building Blocks of High Performing Primary Care Practices framework set the stage for the intervention and was used as a roadmap to build an infrastructure for success. Team-based care was highlighted as the project relied on having systems and processes that empower the …

An Assistant Nurse Manager Leadership Laboratory Program And Its Effect On Nursing Outcomes, Alexandra Wiggins

Doctor of Nursing Practice (DNP) Projects

Aim: This paper summarizes the project development, implementation and outcomes of an Assistant Nurse Manager leadership laboratory program and elements involved in the coursework. Through lecture, simulation, and mentoring components, noted change in leadership ability of novice/advanced beginner Assistant Nurse Managers were assessed over a six-month period and monitored the effects on quality and financial metrics, as well as the self-confidence of the Assistant Nurse Managers. Evaluation conducted included both quantitative and qualitative outcome assessment.

Background: The literature shows that quality leadership produces quality nursing outcomes (Houser, 2003). Leadership style (Wong & Cummings, 2007), communication skills (Vogus & Sutcliffe, 2011), …

Manager Leadership: Beginning At Novice, Kathy Bay

Doctor of Nursing Practice (DNP) Projects

To meet the current and anticipated nursing leadership gaps, there is a critical need for tools and programs to develop of future leaders. Unfortunately, there is a deficiency related to the preparation and readiness of novice nurse managers which impacts turnover, burnout, and the quality, safety and cost of care for patients. The aim of this Doctor of Nursing evidence-based change in practice project was to create an online training program that integrated two national nursing leadership competencies to assist the development of novice nurse managers as they transition to a formal leadership role.

A video-based module system with active …

Ethics Education To Empower Nurses To Effectively Consult The Hospital Ethics Committee, Elaine L. Ware

Doctor of Nursing Practice (DNP) Projects

Nurses interacting with patients and family members need support when the course of the patient’s care becomes uncertain or conflicted leading to ethical concerns. Educating nurses about the purpose of the Hospital Ethics Committees (HEC) may support nurses with ethical concerns, alleviate moral distress and improve job satisfaction. Utilizing the HEC for ethically challenging care situations enhances the professional practice and supports the code of ethics for nurses. HECs which are often underutilized can provide valuable resources for nurses. This DNP project sought to increase the number of nurses’ ethics consultations to the HEC after providing ethics education using a …

Building The Foundation Of A Mentoring Program For Chief Nurse Executives, Patricia Gooch

Doctor of Nursing Practice (DNP) Projects

The chief nurse executive (CNE) is the senior leader whose primary responsibility is to assure quality of care and patient experience in acute care hospitals. Uncertainty in the political arena and further changes to the Affordable Care Act (ACA) highlight the need for hospitals to maintain continuity of leadership for the executive closest to patient care – the CNE. In a large and complex health system, the role of the CNE can be an overwhelming responsibility for seasoned professionals – and especially daunting if you are new to the role of CNE or new to an organization as an experienced …

Multifarious Interventions To Reduce Falls On The Medical-Surgical Units, Wenjie Ying

Master's Projects and Capstones

The CNL project was conducted on the 56-bed adult medical-surgical units in a trauma center. There were total eight fall incidences from January to February. The SWOT analysis, stakeholder analysis, pre-educational survey, cost-effective analysis and root-cause analysis suggested in-depth training on multifaceted fall prevention. The objectives include reducing falls by 50%, increasing staff’s adherence to fall prevention protocols, boosting staff’s confidence in patient mobility, improving staff responsiveness and communication with meds in HCAHPS, and enhancing knowledge of medications’ side effects by May 14, 2018. The literature reviews indicated that the multicomponent preventative measures to prevent falls along with leadership supports …