Medicine and Health Sciences Commons^™

Assessing Provider Adherence To The 2013 Acc/Aha Hyperlipidemia Guideline, Adrienne Johnston

DNP Projects

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and accounts for more than 17.3 million deaths per year with hyperlipidemia as one of the leading risk factors. The 2013 American Heart Association/American College of Cardiology (AHA/ACC) hyperlipidemia guideline recommends healthy lifestyle habits, risk estimation of the development of cardiovascular disease using a risk calculator, and intensity dosed statin therapy. There has been controversy among providers resulting in confusion and inconsistent application of the guideline. Purpose: The purpose of this project was to examine provider adherence to the AHA/ACC hyperlipidemia guideline in a primary …

Safe Prescribing Of Combined Hormonal Contraceptives Using The U.S. Medical Eligibility Criteria For Contraceptive Use Guideline, Morgan E. Thomas

DNP Projects

Safe prescribing of combined hormonal contraceptives is important to prevent unplanned pregnancies and adverse effects including thrombotic events. Combined hormonal contraceptives can be taken safely but this relies on appropriate prescribing techniques by the healthcare provider. Prior to prescribing any type of contraception, health care providers should perform a risk assessment to anticipate and prevent patient complications. The Centers for Disease Control and Prevention created the United States Medical Eligibility Criteria (U.S. MEC) for contraceptive use guideline to help direct healthcare providers to assess patient risk factors, prescribe the safest form of contraception, and provide necessary teaching and follow-up. This …

An Evaluation Of An Innovative Weight Management Program In A Primary Care Setting, Susan Peak

DNP Projects

Background- Kentucky ranks third in the nation for childhood overweight and obesity. . Consumption of high dietary fat, excessive use of electronics, low levels of physical activity and consumption of sugar filled drinks are modifiable behaviors believed to be the biggest culprits behind these statistics.

Purpose- The purpose of this evaluation was to assess the implementation of the 5-2-1-0 plan in the management of childhood overweight or obesity within an urban primary care clinic.

Methods- After initiation of the program by the clinic focused interviews with the primary care providers were conducted to evaluate barriers and benefits to …

The Effect Of A Patient And Provider Education Program On Antibiotic Overuse In Respiratory Tract Infections In A Rural Primary Care Population, Erin Chiswell

DNP Projects

Objective: In the “walk-in” portion of the Jessamine Medical and Diagnostic Center (JMC) primary care (PC) practice in Jessamine County, Kentucky, a combination patient and provider education program was implemented to assess its effects on antibiotic prescribing in respiratory tract infections (RTIs). The goal was to conduct an evaluation of the patient and provider education program at JMC, by specifically examining changes in immediate antibiotic prescribing in RTI (i.e., prescription given during visit to start taking immediately) one-year after implementation of the education program (March 1, 2015- February 28, 2016).

Methods: Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical …

A Gap Analysis On Vaccine Administration For Average And High-Risk Adults, Whitney Pack Metcalfe

DNP Projects

Background: Nationally adult immunization rates continue to fall below the current benchmark goals. It is estimated adult vaccinations range from 20 to 60 percent, depending on the vaccine. There are different vaccine schedules for those of average-risk compared to those with high-risk conditions. Providers are being encouraged to explore their administration of vaccines as preventable, communicable diseases continue to be seen. Objectives: In a primary care clinic, a gap analysis was conducted to: 1.) Determine adult immunization rates, 2.) Compare vaccine administration rates of the Tdap, PCV13, PPSV23, and influenza vaccines between average and high-risk adults, 3.) Determine if specific …

Assessment Of An Intervention To Improve Clinical Inertia In Patients With Uncontrolled Hypertension In A Primary Care Setting, Alyssa M. Sutton

DNP Projects

Purpose: A quality improvement project was undertaken in an internal medicine clinic to evaluate provider adherence with the Eighth Joint National Committee (JNC 8) hypertension (HTN) medication management guidelines for adult patients diagnosed with HTN, evaluate characteristics associated with clinical inertia (CI) in patients with uncontrolled HTN, and evaluate the utility of a brief educational intervention to decrease CI.

Methods: The project used the plan-do-study-act method to assess JNC 8 prescribing guideline adherence by consenting providers. Medical records were randomly selected from patients with HTN seen at provider visits 10 days before (January 31-February 13, 2017) and 10 days after …

Assessing Provider And Staff Knowledge Of Health Literacy And Satisfaction With A Health Literacy Assessment Tool In A Primary Care Practice, Whitney J. Lynn

DNP Projects

PURPOSE: The purpose of this quality improvement project was to assess provider and staff knowledge about health literacy. Specifically, the knowledge of health literacy and perceived importance, current usage, and benefits of the use of a health literacy assessment tool at a primary care clinic was evaluated pre-intervention. The perceived importance of health literacy as well as satisfaction with, frequency of use, and recommendation of the chosen health literacy assessment tool for future use was evaluated post-intervention.

METHODS: This project used surveys pre- and post-intervention at an urban primary care clinic in the southeastern United States from January to March …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

Improving Screening For Alcohol Use Amongst Women In Primary Care, Sarah K. Bell

DNP Projects

Purpose: The purposes of this practice inquiry project were to examine the effect of the addition of a standardized screening tool (AUDIT-C) within the ambulatory electronic health record (AEHR) and the effect of an education session with primary care providers on documentation of alcohol screening and counseling within the AEHR. Furthermore, provider confidence with Screening, Brief Intervention, and Referral to Treatment (SBIRT) was compared before and after the educational session.

Methods: A quasi-experimental one-group pretest posttest design was utilized via chart review prior to and following the educational intervention for patients seen for an annual wellness exam. Data extracted included …

The Use Of Magnets As Patient Appointment Reminders And Hpv Vaccination Rates, Hayden Kelley

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a patient reminder alert system implemented at a public health department in rural Indiana in an attempt to increase the facility’s human papillomavirus (HPV) vaccination rates.

METHODS: This study was a secondary data analysis utilizing the Children and Hoosiers Immunization Registry Program (CHIRP) database to compare HPV vaccination rates before and after the implementation of an HPV magnet reminder program. The sample consisted of 122 adolescents; 31 patients for the pre-implementation period, July 1, 2015- June 30, 2016 and 91patients for the post-implementation period, July 1, 2016- Jan …

Adult Acute Sinusitis Antimicrobial Stewardship Program In A Primary Care Setting, Katelyn M. Hellman

DNP Projects

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS.

PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic …

A Process Improvement Project To Increase Diabetic Retinopathy Screening Rates As Evidenced By Formal Documentation, Michelle Renae Campbell

DNP Projects

Purpose: To evaluate the effects of a referral process on diabetic retinopathy screening rates among patients with Type 2 diabetes and formal documentation completion rates of these screenings within a primary care setting.

Methods: A referral process for patient referral to an ophthalmologist for annual diabetic retinopathy screening was instituted for a 4-week period within a Norton Community Medical Associates (NCMA) primary care location for Type 2 diabetes patients. Charts of 30 patients pre-intervention were compared with the charts of 30 patients seen during the intervention phase of the study to evaluate the effects of the referral intervention. Demographic data, …

Evaluation Of A Primary Care Based Diabetes Education Program, Claire Pfister

DNP Projects

The improved management of diabetes is a critical clinical and economic challenge facing our healthcare system. Educating patients with diabetes to self-manage their disease is a vital component of diabetes care. The purpose of this DNP practice improvement project was to evaluate an innovative health care delivery method of individualized diabetes self-management education (DSME) in primary care. The approach combined individual DSME with a registered dietician and routine diabetes care with the primary care provider into one patient appointment. System data was reviewed to compare referral and attendance patterns of group and individual methods. Changes in clinical indicators of A1C, …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Screening For Sleep Apnea In Patients With Hypertension Using The Stop-Bang Tool In A Primary Care Setting, Natalie R. Jennette

DNP Projects

Obstructive sleep apnea (OSA) is a common cause of high blood pressure but often undetected in patients with hypertension. Screening tools for OSA exist but are underutilized. This project aimed to identify current practices and perceptions related to screening for OSA in patients with hypertension and improve primary care provider knowledge of OSA and screening rates using the STOP-BANG screening tool. The providers acknowledged the importance of screening patients with hypertension but there was no increase in screening after education was provided. Effective screening tools exist but effective strategies to bring this evidence to practice need to be explored further.

Evaluation Of A Nurse Navigator Program On The 30-Day Readmission Rate In Heart Failure Patients, Katie A. Winiger

DNP Projects

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure …

An Evaluation Of Provider Adherence To Adult Sinusitis Quality Measures And Guideline, Caitlin A. Davidson

DNP Projects

Purpose

The purpose of this project is to evaluate adherence to Physician Quality Reporting System (PQRS) Measures #331 (delaying antibiotic treatment until at least seven days of symptoms) and #332 (prescribing amoxicillin or amoxicillin/clavulanate) on adult sinusitis treatment. Data was collected from patient encounters at the University of Kentucky College of Nursing Community Health Center (UKCONCHC) in Wilmore, Kentucky. To adhere to these quality measures would foster antibiotic stewardship. Further statistical analysis was completed to determine if gender or age bias was present in prescribing practices.

Methods

A retrospective chart audit was conducted to determine adherence to the quality measures. …