Digital Commons Network^™

Aidet And Commit To Sit Implementation In The Outpatient Surgical Setting, Olivia V. Meehan

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET and commit to sit to improve communication and increase the patient satisfaction of an outpatient surgery microsystem. The microsystem’s patient satisfaction is assessed, and it is currently scoring below the reach goal of 85^th percentile. The detractors from their overall score mainly stem from the patient not feeling listened to, informed, or updated on the timeline. AIDET and commit to sit are ideal tools for addressing those deficits.

Context: The microsystem being addressed is an outpatient surgery unit that specialized in general surgery for the pediatric population. The pediatric population that the …

Improving Medication Administration Safety In A Correctional Facility With An Electronic Medication Administration System, Rosalinda Salazar

Master's Projects and Capstones

Problem: According to the World Health Organization (2020), medication errors are one of the leading causes of injury and avoidable harm in health care globally.

Context: The county jail houses approximately 700 inmates/patients on a daily basis, and the potential for error when administering medications is high as medications are prepared manually using a paper medication administration record.

Interventions: The jail began using an electronic health record/barcode administration system on October 19, 2020.

Measures: Unusual occurrence reports related to medication errors were reviewed. The time frame included 6 months before electronic implementation, and 6 months after implementation.

Results: Unusual occurrence …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Growth Begins From Within: How Internal Transparency Influences Organizational Learning, Wesley J. Cheung

Master's Projects and Capstones

Ample research exists that focuses on organizational learning in the context of program efficiency and outcomes, and organizational transparency in the context of governance and compliance. The purpose of this research is to further explore the relationship between organizational learning culture and the commitment to internal transparency, specifically pertaining to the internal members across multiple levels of an organization. This paper includes a literary review of previous research, an outline for the methodology used for this research, qualitative data analysis of 10 expert interviews, a discussion of the results and findings, and the exploration of present and future implications and …

Maximizing Mobility In The Icu, Stephen Kupiec

Master's Projects and Capstones

Problem: In a large tertiary medical center in Northern California, the patients in the 20-bed ICU achieved averaged maximum mobility (AMM) scores well below the regional target. These patients had longer lengths of stay in the ICU and spent more days on ventilators, as compared to patients in other ICUs in the region. Barriers to mobilization included patient diagnosis, sedation practices, staff burnout, insufficient staffing, a knowledge deficit around the safety and benefits of mobility, lack of standard workflows, and lack of interdisciplinary collaboration.

Context: A microsystem assessment focused on metrics-that-matter to determine the focus of this quality improvement project. …

Standardized Outreach: Increasing Vaccine Uptake In The Latinx Community Through A Standardized Phone Call Process, Vanesa Vazquez

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in several minority communities since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines (Increased risk, 2020). The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake, particularly in the Latinx community. Patients at a community clinic in Oakland, California have made apparent their distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. Most of these patients are Latinx-identifying and are considered more at risk for development of COVID-19 in …

Oakland’S Community Clinic Covid-19 Vaccination Improvement Project, Jesly Esparza

Master's Projects and Capstones

Vaccination hesitancy has been an ongoing issue over the years, but is now an even more serious problem ever since the newly developed Coronavirus (COVID-19) vaccines were released for emergency use. Due to the rapid event of COVID-19, community clinics have not been able to create effective outreach methods to inform patients about the vaccines, thus the vaccination rates have been low. The goal is to increase vaccination uptake in a Latino community clinic in Oakland, California. These patients have shared their distrust in the healthcare system due to racism and their disbeliefs regarding the effectiveness of these COVID-19 vaccines. …

Code Blue: Do You Know What To Do? Increasing Nurse Confidence And Readiness Through In-Situ Mock Code Simulation, Katelyn Nusser

Master's Projects and Capstones

An underprepared nurse is the most dangerous threat to patient survival in the intense and frightening environment of a code blue situation. With basic life support certification required on merely a biannual basis, it cannot be expected that nurses maintain the skills and knowledge without routine application. This quality improvement project proposed the following PICOT question: for medical-surgical nurses, how does in-situ mock code blue training between BLS recertification periods affect nurse readiness and confidence in a code blue situation? Mock code simulations were conducted over a three-week period with an emphasis on hands-on practice as well as teamwork and …

Deai In Nonprofits: Through The Lens Of Museums And Gardens, Brittany Jones

Master's Projects and Capstones

This research works to understand and identify diversity, equity, accessibility, and inclusion (DEAI) practices within nonprofits through the examination of museums and public gardens. Museums and public gardens provide a generous example of nonprofit organizations that must dutifully serve the communities which surround them, as well as examine internal practices and structures. As the momentum of the racial justice movement increased in 2020, following horrific tragedies in the U.S., the work around DEAI is more relevant than ever. Through this research, identification of barriers and challenges which prevent organizations from doing DEAI work is examined. This research is carried out …

Improving Covid-19 Vaccination Uptake In The Latino Community Through Standardized Outreach, Bianca De La Piedra

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in the Latino community since the approval of the emergency use of the Moderna and Pfizer vaccines. Latino patients from a community health clinic in Oakland, CA have expressed their hesitancy. Only 47% of patients 65 years and older at the community health clinic received the COVID-19 vaccine. With COVID-19 disproportionately affecting this community, focusing on prevention through the uptake of a COVID-19 vaccine is necessary. A microsystem assessment concluded the need for the improvement of patient outreach via calls. This project seeks to examine if standardizing the patient outreach …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication errors and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. This indicated concerning quality gaps in the unit’s ICU patient handoff processes.

Intervention. The project intervention consisted of an introductory and two follow-up teaching sessions on handoff processes and implementing the I PUT PATIENTS FIRST …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

Improving Quality Of Care Through Discharge Planning, Maria Pasillas

Master's Projects and Capstones

Providing good education for the new mother is key to improving the quality of care for both mom and baby. Since nurses are frontline health care providers who perform the most postpartum education, it is imperative they work to improve discharge education so information provided is consistent, appropriate, and evidence based (Suplee et al., 2016).

The aim of this project is to improve the discharge planning process of a local community hospital utilizing evidence-based research (EBR) with the intent to increase patient satisfaction scores in care transitions to above 65% within 3 months.

The community hospital is a 122-bed acute …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

Patient Engagement: A Key Concept To Surgical Site Infection Reduction In Colorectal Patients, Vanessa Strieff

Master's Projects and Capstones

Abstract

Problem: Colorectal surgery is a procedure with one of the highest surgical site infection (SSI) rates; therefore, necessary efforts were implemented to reduce harm (Harris, 2018). Approximately 60% of these surgical infections are preventable (Ban et al., 2017). SSIs can have severe consequences, including extended length of stay, high morbidity and mortality rates, delayed recovery, and high healthcare costs (Harris, 2018). The financial burden of SSI is substantial.

Context: This project aimed to explore opportunities for enhancing patient engagement and awareness of SSI preventive measures. After an extensive microsystem analysis, a knowledge gap in patient education on …

Standardizing The Bedside Shift Report: Improving Communications And Promoting Patient Safety, Chona C. Alforque

Master's Projects and Capstones

PROBLEM: Nursing shift reports are integral to nursing as they allow for the transfer of critical information and responsibility of patient care from one nurse to another. Ineffective communication during shift-to-shift reports can contribute to gaps in patient care and breaches in patient safety, including medication errors, falls, and sentinel events. The greatest risk of communication breakdown is during transitions in care.

CONTEXT: St. Louise Regional Hospital, a small community hospital, consisting of an eight-bed medical-surgical intensive care unit lacked structure in how handoff should occur and had variances in shift handoffs. Observation of the shift handoff at the nurses’ …

Con Confianza: Using Community-Based Participatory Research Principles To Inform Community-Academic Partnership Practices And Build Trust In Hispanic Communities, Sharon Tafolla

Master's Projects and Capstones

Hispanic communities are at disproportionate risk for chronic diseases and researchers have cited the need for further community and culturally informed studies to improve research outcomes to either make treatments and interventions more generalizable or modify them to the needs of Hispanic communities. However, many of the same linguistic and cultural barriers to health care access and utilization also impact the ability for Hispanic groups to participate in research studies. Community Academic Partnerships (CAPs) are positioned to conduct culturally and linguistically competent research in Hispanic communities. For research in Hispanic communities to be effective, CAPs must prioritize practices that build …

A Teaching Plan And Toolkit To Improve Quiet At Night Hcahps Score In A Medical-Surgical Unit, Gabriela Carrico

Master's Projects and Capstones

• Problem: Noise may have undesirable effects on patients, most notably interfering with their sleep at night. Implementing a quiet-time schedule and other evidence-based practices can increase patients’ satisfaction.

• Context: This quality improvement teaching plan was initiated in a 25-bed unit in a large rural community hospital to increase patients’ HCAHPS satisfaction scores for quietness at night. The project involved educating staff members in a medical-surgical unit where patients require constant monitoring. The unit leadership has been concerned about patient-satisfaction scores falling below the 24th percentile.

• Interventions: To meet its goals by the end of the performance year …

The Nonprofit Gender Leadership Gap: Data-Driven Systemic And Inclusive Solutions, Katya Alcaraz-Minnick

Master's Projects and Capstones

The gender leadership gap has maintained its divide throughout world history. There have been positive advancements in gender leadership equity within the political arena and in the for-profit sector, however, it is within the nonprofit sector that the most progress has been made in collapsing the gender leadership gap. Women make up a large percentage of the nonprofit sector’s workforce, so it would seem that the nonprofit sector is poised to lead the economic world to close the gender leadership gap and achieve equity within its top managerial ranks. Research on leadership theories relating to skills, traits, and styles will …

Improving Identification Of Ssi In Snf, Jennifer Teng Yuan Yu

Master's Projects and Capstones

Educational deficit in basic wound assessment can lead to failure to recognize early signs of infection or wound deterioration. Despite many challenges towards wound care, there are potential opportunities to reduce patient injury and clinical outcomes through continuing education. The purpose of this paper is to review literature on current wound care knowledge in nurses and assess existing wound care knowledge in nurses at a skilled nursing facility. A 10-question pre-test wound assessment quiz based on the Bates-Jensen Wound Assessment Tool (BWAT) selected by the Wound Care Coordinator (WCC)/Wound Care Specialist (WCS) was given to 22 nurses: 5 Registered Nurses …

A Formal Hcahps Teaching Program Targeting Communication Improves Hcahps Scores, Bobbie Davis

Master's Projects and Capstones

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey given to patients after discharge from an inpatient unit is a validate tool used to determine the level of patient experience. Organizations across the country, including the Northern California Academic Medical Center, have implemented many initiatives aimed at improving these scores. HCAHPS scores for the hematology/oncology unit at this medical center remain low even after previous education efforts. The aim of this quality improvement project was to improve the patient experience, as evidenced by HCAHPS scores, with the implementation of an HCAHPS teaching program for nursing staff, focusing on …

Transitions Of Care: Raising Awareness And Improving Identification Of The Social Determinants Of Health, Stephanie Le

Master's Projects and Capstones

Problem: Hospital readmission rates have steadily climbed in the United States and the cost of unplanned readmissions can be detrimental. It has been identified that greater discharge preparation and quality care coordination greatly impacts the patient’s plan of care and reduces the risk of unplanned 30-day readmissions. Transition programs help reduce the psychosocial barriers that prevent patients from being able to self-manage their conditions outside the acute setting and help patients effectively navigate the through the continuum of care.

Context: Research has shown that when the social determinants of health (SDOH) barriers are identified appropriately and early-on, this can decrease …

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

Hospital Acquired Pressure Injury Prevention: A Quality Improvement Project, Sukhjit Dhillon

Master's Projects and Capstones

Abstract

Hospital Acquired Pressure Injuries (HAPI) can be costly for the hospitals and devastating for the patients. Most pressure injuries are considered preventable, but despite that a lot of Americans die from pressure injury related complications each year. Hospitals spend billions of dollars on pressure injuries which can be used for other treatments. A quality improvement project was created to address these concerns and improve patient care. There were 5 cases of HAPIs on the telemetry/stroke unit prior to the start of this project. Interventions were created to improve the outcome. After careful review of the related literature, HAPI prevention …

Transformational Relationships: Re-Framing Impact In Faith-Based Social Service Organizations, Sonja E. Schappert

Master's Projects and Capstones

Theories of change and logic models are the industry standard foundation for impact evaluation. However, half of all nonprofits do not use these models due to resource constraints or the perception that their work does not fit into a model. This is especially true in relationship-based programs, such as those in faith-based social services. This Capstone examines the influence of relationship theory on a faith-based organization’s impact. The research methodology included deductive, action-based research with a foundational literature review focused on nonprofit planning and evaluation theory and social science theory. Then a total of 6 expert interviews were conducted, 3 …

Healthy Aging In The Community Initiative, Didem Kadriye Unver

Master's Projects and Capstones

In 2016 the Sequoia Health Care partnering with Peninsula Family Services developed a non-profit and free program called 70 Strong. It is a personal resource guide for the 60 and above client base for activities and services from Redwood City to Foster City to encourage independence amongst the older population. It includes a wide array of categories, such as fitness and social activities, volunteer opportunities, transportation, enrichment, and support groups. This is not an acute healthcare provider; however, it is a primary prevention effort by Sequoia Healthcare District to increase wellness among the older population in the county. The purpose …

Multilingual Museums: A Proposal To Increase Linguistic Diversity In Contemporary Art Museums, Jennifer Cha

Master's Projects and Capstones

The U.S. population is becoming more ethnically, racially, and linguistically diverse. It is estimated that by the year 2050, the U.S. will shift to a majority-minority population, meaning that the total minority population will become the majority of the U.S. population. But while the U.S. is diversifying, the current museum visitorship demographic is not representative of or on track to measure up to these changes in the future. If museums are valuable civic spaces with several associated health, social, and educational benefits, and a large percentage of the population have low-English proficiency and cannot access the information, then there is …

Mdr Matters! Improving Primary Nurse Participation In Multidisciplinary Rounds, Alma Alcantara

Master's Projects and Capstones

Abstract

Problem: The current model of multidisciplinary rounds (MDR) in a 40-bed medical-surgical unit within a Northern California community hospital has demonstrated low participation rates from primary nursing. The primary nurse attendance in MDRs is consistently at 50% participation, below the target goal of 80%. This lack of engagement leads to ineffective communication and fragmented care coordination resulting in suboptimal quality care and cost outcomes.

Context: An intervention strategy to standardize the MDR model was implemented over three months. A literature review revealed that effective and consistent MDR practices can directly influence primary nurse participation. This change management project focus …

Health Care Improvement Initiative: Outcomes And Impact Of An Academic-Practice Partnership Between A Large Integrated Health System’S Nurse Scholars Academy And The University Of San Francisco School Of Nursing And Health Professions, Ryan Fuller

Master's Projects and Capstones

By December 2018, a large integrated health system’s Nurse Scholars Academy (NSA) will have financially-sponsored 64 registered nurses to return to school through a strategic academic-practice partnership program at the University of San Francisco (USF). Referred to as ‘Nurse Scholars,' health system employees elected to return-to-school through NSA. As a five-year initiative, NSA was at risk for not receiving additional funding beyond 2020 without a thorough outcomes analysis that articulated the outcomes to executive leadership.

This health system employs more than 23,000 registered nurses in Northern California (NCAL). The NSA is a region-wide effort to accelerate academic progression, leadership development, …

Improving Quiet-At-Night On A Telemetry Unit: Introducing A Holistic Sleep Menu Intervention, Christian Karl Antonio

Master's Projects and Capstones

Improving Quiet-at-Night on a Telemetry Unit:

Introducing a Holistic Sleep Menu Intervention

Abstract

Problem

A hospital in San Francisco, California has performed poorly on patient care service as evidenced by low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. The survey’s lowest score was from the “Quiet at Night” measure.

Context

A Sleep Menu initiative was implemented in the hospital’s telemetry unit. Microsystem assessment and Strengths-Weakness-Opportunities-Threats (SWOT) analysis identified practices that might impede intervention success. Findings showed that benefits and opportunities outweighed costs; cost-benefit analysis estimated an annual net benefit of $6,354. Other benefits included improved patient well-being, …