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The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava

Evidence-Based Practice Project Reports

The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient outcomes, …

Nurses' Attitudes And Understanding Of The Suicidal Patient, Cheryl Lemmon

Doctor of Nursing Practice Scholarly Project

Motivation / Problem statement: While not all suicides are predictable, there are reasonable guidelines for identifying those individuals at risk and reducing risk for high-risk individuals. There is, however, an apparent gap in best practice as there is a continual climb in suicide statistics. The aim of this project is to survey emergency department nurses to discover their attitudes and understanding of suicide. The purpose is to better understand the phenomenon, and guide education initiatives, as nurse professionals are in a key position of prevention when working with these patients.

Methods / Procedure / Approach: A non-probability, purposive and voluntary …

A Multifaceted Approach To Antibiotic Stewardship In The Outpatient Clinical Setting For Bronchitis, Elizabeth A. Weaver

Evidence-Based Practice Project Reports

Antimicrobial resistance is a world-wide health crisis (Infectious Disease Society of America [IDSA], 2016; World Health Organization [WHO], 2017) expedited by the overuse/inappropriate use of antibiotics. In the outpatient setting it has been determined that approximately 60% of antibiotic therapies are prescribed (Centers for Disease Control and Prevention [CDC], 2016). Antibiotic stewardship is the coordinated effort to improve the use of antibiotic therapies, minimize misdiagnosis and delayed diagnosis and select appropriate antibiotic drug regimens (IDSA, 2016). The purpose of this evidence-based practice project was to evaluate the effects of an antibiotic stewardship program (presentation, survey collection, bimonthly e-mail reminders, patient …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Effect Of An Intervention To Improve Smoking Cessation Treatment In A Federally Qualified Healthcare Clinic, Shirley Camp

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Abstract

Significant progress has been made in the reduction of tobacco use in the United States, but the smoking prevalence among the socially and economically disadvantaged populations (i.e. individuals who are homeless, uninsured, LGBT, and living with HIV) is significantly higher than the general population (CDC, 2018b). As a result, these vulnerable populations carry a disproportionate burden of tobacco-related mortality and morbidity (CDC, 2018b). There is a cost-effective and evidence-based treatment for tobacco use dependence (Fiore et al, 2008), but the delivery by primary care providers to this population is inconsistent (Tyman, Bonevski, Paul, & Bryant, 2014). This study focused …

The Impact Of Evidence-Based Practice On A Culture Of Safety, Donald C. Hunt

Nursing Theses and Dissertations

Background: 210,000 to 440,000 deaths have been caused by errors in healthcare. Providers who are committed to core values that emphasize safety contribute to a “culture of safety.’ This culture is required for healthcare institutions to achieve high-reliability status demonstrating high potential for error but few adverse outcomes. There is little known about contributors to the culture of safety and the commitment of providers to its core values.

Purpose: To determine relationships among the predictors- EBP culture, individual evidence-based decision making, organizational implementation of evidence-based practice - and a culture of safety.

Design: Correlational Predictive Design.

Sample: Two-hundred seventeen nurses …

A Guide For Outcomes Evaluation And Sustainability Of A Dedicated Education Unit Within An Academic-Practice Partnership, Jennifer Pfannes

UNLV Theses, Dissertations, Professional Papers, and Capstones

The Dedicated Education Unit (DEU) has emerged as an innovative approach to providing a positive, high-quality, collaborative clinical learning environment that fosters the growth and learning of undergraduate nursing students. Additionally, the DEU model has demonstrated success in beginning to bridge the education-practice gap, tackling the faculty shortage, and easing the new graduate transition from education to practice; however, developing, evaluating and sustaining an economically successful DEU takes thoughtful,

strategic planning. The challenging nature of developing and sustaining a DEU that mutually benefits both the academic and clinical partner over time, reveals the need for more guidance to secure long-term …

Evidence-Based Practice Guide And Workflows: Improving Hospital Throughput And Reducing Emergency Department Overcrowding, Maulah Halley

UNLV Theses, Dissertations, Professional Papers, and Capstones

Hospitals in the United States are experiencing disruptions to patient throughput. These disruptions create barriers to patients who seek emergent care in the Emergency Department (ED) and who must be moved to hospital inpatient beds after the decision to admit has been made. As a result, patients requiring hospital admission via the ED may have long wait times, which, in turn, contribute to ED crowding and overcrowding. The root causes of ED overcrowding are inefficiencies within the system and the inability of hospitals to meet demand. Although bed capacity on any given unit may not be altered, ED patient’s arrival …

Evidence-Based Practice Self-Efficacy And Outcome Expectancy In The Nurse Resident, Amy L. Smith

Doctor of Nursing Practice Scholarly Projects

Evidence-based practice (EBP) implementation in healthcare has been associated with improved patient outcome, reduction of costs, and increases in nursing job satisfaction (Melnyk & Fineout-Overholt, 2015); however, a lack of implementation remains (Melynk, Fine-out Overholt, Gallaher-Ford & Kaplan, 2012). Although EBP training is effective in improving nurses’ knowledge of and attitudes toward EBP, such training does not consistently result in behavior change (Jackson, 2016; Black, Balneaves, Garossino, Puyat & Qian, 2015). The results of previous studies support the role of self-efficacy in the promotion of EBP implementation (Blackman & Giles, 2017; Ryan, 2016). The Institute of Medicine’s Initiative on the …

Stress And Coping In Hospice Care, Elyse L. Collier

DNP Projects

Accommodating current hospice care needs and anticipated industry expansion requires protection and optimization of human resources serving as frontline care providers. Coping responses employed by individuals serve as important determinants of their overall personal and occupational well-being. There is limited research focusing on the coping responses of hospice professionals, specifically, how they perceive and manage their own work stress and work-related quality of life. The purpose of this study was to examine how coping responses are related to work-related quality of life among individual professionals working together on outpatient interdisciplinary hospice care teams. A cross-sectional survey-based design was utilized to …

Sustainability In Quality Improvement And Patient Safety Initiatives, Angelo P. Giardino, Eileen R. Giardino

Journal of Nursing & Interprofessional Leadership in Quality & Safety

The question often asked of a quality improvement initiative is whether the improvement process has been sustained within the organization. Rarely is the question answered satisfactorily. The sustainability of an improvement process is important as it justifies the investment of human and financial capital. The term 'evaporation of improvements' addresses the dilemma that between 33% to 70% of all innovations are reportedly not sustained (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2015) . This evaporation of improvement captures the frustrating inability of many institutions to maintain the achieved improvement after the newness of the initial effort wears off (Buchanan, Fitzgerald, & …

Transitioning From Experienced Nurse To Resident In Blended Cohort Transition-To-Specialty Nurse Residency Programs, Rachael Frija

Doctor of Nursing Practice Scholarly Projects

Recommendations from the Institute of Medicine promote nurse residency programs for experienced nurses (EN) transitioning to new areas of specialty. A large non-profit healthcare system in the Southwest implemented three Transition-to-Specialty (TtS) residency programs using a blended cohort approach consisting of graduate nurses (GNs) and ENs. Upon review of program outcomes, ENs reported to have higher attrition rates than their GN counterparts. Given the substantial pecuniary loss related to EN turnover, understanding the ENs’ perspectives to achieve successful role transition to a new area of specialty is critical to a successful program. This qualitative descriptive study sought to describe the …

A Multi-Faceted Intervention To Improve Diagnosis And Treatment Rates Of Overweight And Obesity By Nurse Practitioners In Primary Care, Susan Disser

Evidence-Based Practice Project Reports

The United States is amid an obesity epidemic (Institute of Medicine, 2012). Indiana ranks as the tenth most overweight state. (America’s Health Rankings, 2018). Despite guidelines outlining the treatment of obesity, primary care providers seldom use these guidelines (Hayes et al., 2017). In a 2010 study, only 28.9% of obese patients received a diagnosis of obesity and less than 25% of these patients received counseling on diet, exercise, or weight loss (Bleich, Pickett-Blackely, & Cooper, 2011). The purpose of this evidence-based practice (EBP) project is to determine if a multi-faceted intervention consisting of academic detailing, reminders, audit with feedback, and …

Pathways To A Sustainable Community Health Worker Program In A Rural Native American Community, Hannah R. Duby

Doctoral Projects

Introduction: American Indian/Alaska Native (AI/AN) people have some of the greatest health disparities of any other citizen group in the U.S. (National Indian Health Board [NIHB], 2018). As liaisons between community members and health services, community health workers (CHWs) play an important role in reducing disparities in AI/AN communities (Indian Health Service [IHS], 2018). CHWs in the organization of interest are not being used to their full potential as the documentation of their care is not accessible to the primary care providers (PCPs) for care coordination and the program is threatened by issues related to sustainability.

Objectives: The purpose of …

Improving Heart Failure Care Plan Coordination Across The Health Care Continuum, Amy Veltkamp

Doctoral Projects

Heart failure costs the United States 31 billion dollars each year, with much of those costs attributed to hospital admissions. Coordinating care across the health care continuum is a critical factor in improving heart failure care and reducing readmissions. An organizational assessment was conducted using the Burke and Litwin Causal Model of Organizational Performance and Change. The quality improvement project implemented a longitudinal plan of care (LPOC) across 10 hospitals and numerous ambulatory care sites at a large Midwestern health organization. Nurse care managers (NCMs) were the focus of this project due to their high-level of involvement in care coordination. …

Interprofessional Collaboration To Improve Discharge Planning, Erica L. Spalding

Doctoral Projects

Historically, health care professionals collaborated solely with other professionals within the same discipline. However, evidence shows collaboration between all disciplines involved in patient care leads to improved patient outcomes. Interprofessional collaboration can reduce costs and improve patient care, yet is used inconsistently in health care systems. Interprofessional collaboration was not fully used on two medical-surgical units in a large health system in the Midwest, particularly during the discharge planning process. This project aimed to standardize rounds on two units as part of a larger initiative to standardize rounds across all units within the system. The clinical question to be answered …

Increasing Prevention And Recognition Of Delirium In A Non-Icu Acute Care Population, Anne Gembrowski

Doctoral Projects

Delirium is associated with increased mortality, nosocomial complications, increased length of hospital stay, and greater chance of readmission, increased hospital costs, and a need for skilled nursing aid after discharge from the hospital. In a hospital, delirium can affect up to 50 percent of older patient 65. The solution is to prevent delirium from occurring and to regularly screen for its presence. The purpose of this paper is to explore the best prevention strategies and screening tool for delirium and to successfully implement a delirium bundle on a medical surgical unit. The question this paper attempts to answer is if …

Development Of A Depression Screening Protocol For At Risk Patients Based On The Adverse Childhood Experience Questionnaire, Brittany J. Taylor

Doctoral Projects

Background: Adverse childhood experiences (ACEs) are associated with increased risk for adult depression. Utilization of the Patient Health Questionnaire Nine (PHQ-9), in combination with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSMV) criteria, aids in the diagnosis of comorbid depression and assessment of severity.

Objectives: To standardize the process of screening new adult patients at a specialty care clinic for ACEs. Then, implement a depression screening protocol based on ACE criteria to identify adult patients with comorbid depression.

Methods: Demographic, ACE score, PHQ-9 score, and protocol implementation data collected and analyzed by the Doctor of Nursing Practice (DNP) …

Improving Depression Screening And Follow-Up In Primary Care Through Implementation Of An Evidence-Based Protocol, Cheryl Fowler

Doctoral Projects

Depression is a leading cause of disability in adults and is a major contributor to burden of disease (World Health Organization [WHO], 2018). The United States Preventative Services Task Force (USPSTF) provides evidence-based recommendations to promote disease prevention. Among these, is the recommendation that all adults, regardless of risk factors, should be screened for depression in the primary care setting with adequate systems in place to allow for appropriate diagnosis and management (USPSTF, 2016). The purpose of this Doctor of Nursing Practice (DNP) student project was to develop and implement an evidence-based protocol in the primary care setting with aims …

Management Of Distress In Adult Oncology Patients, Lauren Jongsma

Doctoral Projects

Cancer related distress has the potential to negatively impact the health of the patient and their treatment outcome (Grassi, Spiegel, & Riba, 2017). As identification and treatment of distress has a positive impact on patient outcomes; the Commission on Cancer (2016) required distress screening for accreditation. Key stakeholders within a Midwest hospital system expressed a desire for the improvement in the current state of the distress screening. Thus, the scholarly paper describes the key attributes of the organizational assessment, a literature review on evidence-based distress screening tool and a quality improvement project. The Promoting Action on Research Implementation in Health …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Preoperative Anemia Management In Adult Outpatient Coronary Artery Bypass Graft Surgical Patients To Improve Treatment Of Preoperative Anemia, Katherine Mills

Doctoral Projects

The transfusion of blood products can lead to life-threatening complications after surgery. In addition, blood products are a scarce and expensive resource. Even though anemia in coronary artery bypass surgery patients is currently undertreated, research has shown that the intravenous infusion of iron products, as well as a single dose of erythropoietin-alpha prior to surgery, decreases the amount of blood products used in the perioperative setting. The goal of this pilot project was to increase the number of patients screened for anemia, and if necessary, treated prior to coronary artery bypass graft surgery.

Methods: This was a practice improvement, pilot …

Nutrition And Neurosurgery: Designing A Perioperative Pathway For Elective Spine Fusion Patients, Abigail J. Mckay

Doctoral Projects

Each additional hospital day related to a surgical complication costs an estimated $1,000 (Grusky et al., 2015). Due to the rising costs of healthcare, European professors designed Enhanced Recovery After Surgery pathways to mitigate potential adverse surgical outcomes and associated costs. A primary focus of these pathways emphasizes the importance of pre-procedure nutritional optimization. Literature increasingly supports malnutrition as an independent predictor of postoperative complications and increased length of stay (LOS) (Adogwa et al., 2014). The neurosurgical population has a wide variety of comorbidities that place them at increased risk for nutritional compromise. Thus, a perioperative nutrition pathway was implemented …

Implementation Of The Vaccines For Children Program In A Midwest, Urban Clinic Dedicated To The Underserved Population, Akmal Saydazamov

Doctoral Projects

Background: Low immunization rates weaken herd immunity and endanger children. The Safety Net Health Clinic (SNHC) study site serves an underprivileged and refugee population with significantly lower than ideal coverage. Series completion disparities persisted after control for demographic, access-to-care, poverty and language effects (Varan et al, 2016).

Objectives: SNHC implemented the Vaccines for Children (VFC) program in order to increase the vaccination rates among the underserved population.

Methods: As an efficacy study, the project focused on three major areas in the VFC implementation – cost, staff preparedness and patient need. Cost was determined by utilizing electronic medical records (EMR) and …

Using Technology-Driven Patient Communication Appointment Reminders To Improve Uniform Data System Measures In A Federally Qualified Health Center, Ana Torres

Doctoral Projects

Background: Process of meeting Uniform Data System (UDS) measures in a west Michigan Federally Qualified Health Center (FQHC) has several components with different team members sharing responsibility in the process and workflow to document preventative screenings. An evidence-based technology-enhanced patient communication intervention was developed to meet benchmarks for the FQHCs UDS reporting metrics. The purpose of this quality improvement project was to answer the clinical question: Will technology-enhanced communication appointment reminders using automated telephone communication increase rates of screening follow-up visits to improve data reported to UDS at a west Michigan FQHC organization?

Objectives: Increase percentage of screening visits after …

An Integrated Model Of Palliative Care In The Emergency Department To Improve Referrals, Jennifer L. Schlatter

Doctoral Projects

Introduction: The emergency department plays a critical role in the trajectory of in-hospital patient care. The Center to Advance Palliative Care (CAPC) along with the American College of Emergency Physicians (AECP) recommend early referral to palliative care for patients with life limiting illnesses that present to the emergency department. Research demonstrates that early palliative care consultations result in patient directed goals of care, improved symptom management, decreased length of stay, and reduced direct costs for inpatient hospitalizations.

Objectives: The goal of this project was to implement evidence-based recommendations for early palliative care referrals in an adult emergency department to improve …

Self-Efficacy In Emerging Nurse Leaders: The Effects Of A Virtual Community Of Practice On Nurse Educators In A New Practice Role, Kevin Daugherty Hook Msn, Ma, Ms, Agpcnp-Bc, Crnp

Doctor of Nursing Practice Projects

Background: Clinical nurse educators in long-term and skilled nursing facilities have an opportunity to exercise new leadership skills in bridging the gap between education and practice.

Objective: To assess the effects of a virtual Community of Practice (CoP) on the self-efficacy of clinical nurse educators who work in newly developing leadership roles in a large long-term and skilled nursing organization operating in multiple sites across the United States.

Methodology: The exploratory pilot study used a one group pre-test/posttest method. A convenience sample was used to enroll participants with newly created roles in clinical education. The Leader Efficacy Questionnaire (LEQ) was …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

An Evaluation Of A Nerve Block Protocol In Patients With Hip Fractures, Jenna Buchman

Doctoral Projects

BACKGROUND/PURPOSE: Pain management for hip fracture patients in the time before surgery is crucial. Literature highlights the success of local, single injection nerve blocks to aid in preoperative pain management. A local hospital implemented a preoperative, single injection nerve block protocol in March 2018. This quality improvement project investigated: (1) organization protocol compliance, and (2) if the preoperative single injection nerve block protocol reduces hip fracture pain, use of systemic opioid analgesics, decreases incidence of adverse opioid effects, and reduces cost of care.

SUBJECTS: Patients ages 18 and older admitted with the primary diagnosis of an operable isolated hip fracture …