Medicine and Health Sciences Commons^™

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …

Every Milliliter Matters: Quantitative Blood Loss In Postpartum, Iana Vatsenko

Master's Projects and Capstones

Postpartum hemorrhage remains a leading cause of maternal mortality in the United States. Postpartum hemorrhage occurs when mothers are bleeding excessively, have uterine atony, or the placenta has failed to come out completely. Research has shown that quantitative methods of blood loss estimation revealed a higher incidence of PPH than visual estimation. That is why using quantitative methods on time is essential for diagnosing PPH. Quantification of blood loss should be replaced by estimated blood loss since it is more accurate. The project's main focus was implementing quantification of blood loss and using the Triton Scale, a smart system to …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Jared Maxwell Talsky

Master's Projects and Capstones

In order to address shortcomings of the health care system within the United States surrounding the early recognition and response to preeclampsia (PreE) and postpartum hemorrhage (PPH) emergencies The Joint Commission (TJC) revised the accreditation requirements regarding implementing yearly maternal hypertension and hemorrhage simulation scenarios in emergency departments. A Quality improvement team of Clinical Nurse Leader (CNL) students at University of San Francisco, working alongside the emergency department and labor and delivery department nurse educators assisted a dual hospital system in the Bay Area of California to develop and implement training materials and simulations for the hospital system’s Emergency Department …

Stop The Bleed And Seize Control: The Use Of Simulation In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage: A Quality Improvement Project, Raquel Andreina Torres

Master's Projects and Capstones

A quality improvement (QI) initiative was geared to assess and prepare Emergency Department (ED) nurses and clinical staff preparedness of pre-eclampsia and postpartum hemorrhage (PPH). The Non-Profit Hospital, with two different Emergency Room locations, currently does not have a Labor and Delivery (L&D) unit at one of their campuses. Additionally, there is no current policy or procedure set in place for the treatment of preeclamptic or postpartum women in the emergency room. As a direct result of The Joint Commission (TJC) standards and a very short timeline, a group of University of San Francisco Clinical Nurse Leader (CNL) graduate students …

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Yvonne Oliva

Master's Projects and Capstones

Problem: This quality improvement project aims at Hospital X meeting the new Joint Commission (JC) provisional deadline through the implementation of simulation training and video development as a way of educating emergency department (ED) staff in recognizing and treating preeclampsia (PreE) and postpartum hemorrhage (PPH).

Context: This quality improvement project utilizes evidence-based practice, California Maternal Quality Care Collaborative (CMQCC) toolkits, and JC standards to educate ED staff on worsening cases of maternal morbidity and mortality nationwide. Research shows that early recognition and prevention of maternal hemorrhage and preeclamptic emergencies has the highest probability of decreasing maternal complications in the ED. …

Implementation Of Community Health Workers To Improve Birth Outcomes, Emiko Maruri, Trinette Radasa, Jo Loomis

DNP Qualifying Manuscripts

Those who have ever been affected by an adverse childhood experience (ACE) have a greater likelihood of having poor birth outcomes. These include low infant birth weight, preterm delivery and can even lead to pregnancy loss. Black and Latina women have been identified by the Center’s for Disease Control (CDC) as those most affected by ACEs. The direct relationship is that Black and Latinas therefore have poor birth outcomes. With the implementation of nurse trained Community Health Workers (CHWs), the impacts within the community includes decreasing health care costs, adopting healthier choices for mother and child, and providing support and …

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 …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Preventing Maternal Falls, Blair Burkhart

Master's Projects and Capstones

Patient falls are unfortunate events in healthcare that are an essential quality improvement focus during patients’ hospital stays. At Hospital X, a private institution located in the suburbs of a large city, there had been 23 maternal falls within the last three years. This increase in maternal fall rate puts this hospital’s maternity unit above the average of other hospital’s fall rates according to the National Database of Nursing Quality Indicators. This quality improvement project aimed to reduce the rate of maternal falls on postpartum units through various forms of staff education. Education included Morse Fall Scale scoring, Sara Stedy …

Reducing Postpartum Maternal Falls: A Quality Improvement Project, Sarah L. Iroz

Master's Projects and Capstones

Falls are an unfortunate, common occurrence in the healthcare system and are often not thought to be a problem in the obstetrics population. Key stakeholders in a Northern California hospital brought the issue of maternal falls to leaders of the quality improvement team on the maternity unit. In the last three years, there have been 23 falls on the maternity floor, making their fall rate above the national average. It is the purpose of this project to aid the quality improvement team in reducing postpartum maternal falls over the next three years. After conducting a unit assessment, performing a literature …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …

Decreasing Maternal Breastfeeding Dissatisfaction During The Night Shift Related To Lactation Support, Robyn Caston

Master's Projects and Capstones

Abstract

Problem

This paper will discuss the Clinical Nurse Leader (CNL) project's specific aim: to decrease maternal dissatisfaction during the night shift related to lactation support in a high-risk maternal department.

Context

Research has shown that adding lactation support improves the decision to exclusively breastfeed and increases the duration. Breastfeeding for all infants starting at birth and continuing until at least 6 months of age has been recommended by the World Health Organization, UNICEF, and the American Academy of Pediatrics. Many studies about lactation support have demonstrated the health benefits to mothers and their infants.

Interventions

A baseline survey will …

Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …

Neonatal Orogastric & Nasogastric Tube Placement: Evidence Based Improvement Prospectus, Jessica K. Nagra

Master's Projects and Capstones

Problem: Variation in gastric tube placement practice has resulted in incorrect placement depth, resulting in four gastric tube perforations in a level III neonatal ICU within the last year. Gastric perforations have increased infant length of stay, increased surgical interventions, delay in oral feeding, increased hospital cost, and potentially lower family satisfaction with care.

Context: IHI’s 5 Why’s: Finding the Root Cause identified a lack of standardization in policy and practice and lack of consistent staff education as the primary reason for misplaced gastric tubes. Additionally, a cost-benefit analysis projected the estimated cost of additional infant length of stay for …

Columbia-Suicide Severity Rating Scale (C-Ssrs) Inpatient Perinatal Clinical Pathway, Kristin M. Schoen

Master's Projects and Capstones

Problem: The potential harm to women and infants due to untreated perinatal anxiety and mood disorders is both a patient safety and a public health concern. Studies show that mental health decline during the postpartum period is associated with increased morbidity and mortality for both the mother and infant. The project aim was to utilize the initial screening of perinatal patients using the Columbia-Suicide Severity Rating Scale (C-SSRS) as the baseline screening tool. The tool will help implement a standardized workflow for patients who screen low, moderate, or high, as this workflow had yet to be developed.

Context: In July …

Enhanced Recovery After Surgery Ambulation Project, Jennifer M. Rose

Master's Projects and Capstones

Abstract

Problem: The enhanced recovery after surgery (ERAS) Ambulation Project aims to increase early ambulation of cesarean section patients in the maternal child inpatient unit. The current data has shown inconsistency with the application of the ERAS program with the maternal population. Instituting standardization of care and documentation, along with increasing patient centered care, has the potential to decrease the hospital length of stay (LOS).

Context: This quality improvement project standardizes the education provided to staff nurses and patients; allotting more time for staff to create meaningful relationships with their patients. A microsystem culture utilizing patient centered care …

Decreasing Floor Morphine Equivalents Per Day Rates In The Mother/Baby Department, Jessica Welsh

Master's Projects and Capstones

Problem: Cesarean sections (C/S) are among the most common operations in the United States and result in moderate visceral and somatic pain. Historically, C/S pain has been treated with opioid pain relievers. The U.S. Department of Health and Human Services declared the misuse of opioids an epidemic in 2017, leading healthcare providers and organizations to look inward at how opioids are prescribed and used at all levels of patient care.

Context: A microsystem assessment on a 60-bed mother/baby unit indicated one of the highest average opioid administration rates per day for postoperative C/S patients in the organization’s region for the …

Standardizing And Documenting Decision-To-Incision Intervals For Unscheduled Cesarean-Section Deliveries, Molly Bloom

Master's Projects and Capstones

The term decision-to-incision interval (DII) refers to the interval between when a laboring patient and their healthcare provider agree to an unscheduled surgical cesarean section (C/S) delivery and when the first incision is made in the operating room. The ideal length for this interval varies with the urgency of each case, and there is no international consensus regarding the timing. In an urban labor and delivery unit in a private hospital, examination of this interval revealed inconsistent documentation of the decision, as well as unclear guidelines on the DII for two of the three unscheduled C/S urgency levels. This quality …

Utilizing A Stress And Coping Model Into A Preventive Abusive Head Trauma Parent/Caregiver Educational Program, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abusive head trauma (AHT) is a serious form of child maltreatment that is the primary cause of fatal head injuries in children younger than 24 months and is the cause for over 50% of severe or fatal traumatic brain injury incidences. These injuries can be caused by impact, shaking, or the combination of shaking and impact. These multi-factorial injuries can cause intracranial and spinal damage, retinal hemorrhages, and fractures of ribs and other bones. The age and severity of injuries will be used to assess the diagnosis of AHT. When AHT occurs, it is often tied to the behavior from …

Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams

Master's Projects and Capstones

Introduction

Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.

Methods

Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.

Results

Results from …

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 …

Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish

Doctor of Nursing Practice (DNP) Projects

Continuous Glucose Monitoring and Diabetes Management During Pregnancy

Abstract

According to the Scope of Practice, Standards of Practice, and the Standards of Professional Performance for Diabetes Educators, registered nurses play an integral role in the promotion of diabetes self-management education and training in diabetes care (AADE, 2017). This paper upholds the standards set forth by the American Association of Diabetes Educators (2017) governing body, to stimulate the process of peer review, promote documentation of the outcomes of diabetes self-management education and training (DSME/T), encourage research to validate practice and improve quality DSME/T and diabetes care for pregnant women who use …

Perinatal Anxiety And Depression During The Covid 19 Pandemic, Helen Xumin Chen, Nancy Selix, Marcianna Nosek

DNP Qualifying Manuscripts

Abstract

The novel coronavirus disease 2019 (COVID-19) outbreak places perinatal women at higher risk of developing anxiety and depression. Uncertainty, fear, and confusion in medical, social, economic, occupational and political aspects of life in the US add to existing stressors that perinatal women experience. To optimize the quality of perinatal care during the pandemic, appropriate mental health interventions must be implemented to prevent and alleviate perinatal anxiety and depression and improve maternal and infant outcomes. Measures include increased screening, non-pharmacologic and/or pharmacologic interventions and the use of telehealth for care delivery.

Keywords: perinatal anxiety, perinatal depression, COVID-19, SARS CoV-2, maternal …

Nursing Partnership With Patients, Parents And Families For Safety Through Simulation, Courtnay Caufield

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: The importance of communication between nurses, patients, and their family members with respect to treating each other as partners in safety cannot be overstated. It is imperative that families and patients feel empowered to speak up and report clinical errors at any time and be able to communicate effectively to prevent harm and encourage communication.

Context: This is especially important in the acute care setting, where patients may be in contact with multiple people and processes daily. Attention to this safety partnership can be established through improvements in patient satisfaction scores, which are usually collected from patients and …

Improving Analgesia Administration For Pediatric Patients In A Rural Emergency Department, Alvin R. Walters

DNP Qualifying Manuscripts

When a child is in pain, parents often seek out treatment at an emergency department. After a detailed chart review it was determined that only 32.53% of the pediatric patients who present to a rural, northern California, ED in pain receive any documented form of analgesia during their time in the ED. A review of the literature revealed that triage nurse-initiated protocols can successfully manage to provide consistent and efficient analgesia to patients who present to an ED with pain. Therefore, a practice improvement project was undertaken to increase of the consistency and efficiency of analgesia administration for pediatric patients …

Implementation Of A Transcutaneous Bilirubinometer On A Postpartum Unit At A Magnet Community Hospital, Riley O'Connell

Master's Projects and Capstones

A common clinical concern for all newborns in the first few days of life is the risk of hyperbilirubinemia. Hyperbilirubinemia if left untreated can lead to permanent hearing loss, neurological dysfunction, and even irreversible brain damage called kernicterus. Bilirubin monitoring and early intervention can prevent these adverse events from occurring. Best practice recommends the use of transcutaneous bilirubin (TcB) monitoring on all term, low-risk newborns (>38 weeks gestation at birth) at 24-hours of life. Replacing total serum bilirubin (TSB) draws through a heel stick, with TcB assessments leads to utilization of evidence-based practice. The transcutaneous bilirubinometer is a non-invasive, …

Improving The Timing Of Antibiotic Administration In High-Risk Neonates, Jed Comuelo

Master's Projects and Capstones

Improving the Timing of Antibiotic Administration in High-Risk Neonates

Abstract

Problem: The rapid nurse turnover and improper use of the golden hour flowsheet are some of the factors that affect the timing of antibiotic administration. A review of 38 patient charts was done and only shows 20% received antibiotics within 1 hour.

Context: This microsystem is a 22-bed neonatal intensive care unit with an average of 900 admissions per year. The team is composed of doctors, nurses, respiratory therapist, and pharmacists. The budget needed for this project consists of the overtime pay needed to compensate nurses for attending additional staff …

Postpartum Hemorrhage: A Change Strategy, Alison Landis

Master's Projects and Capstones

Problem: Postpartum hemorrhage (PPH) is one of the leading causes of severe maternal morbidity and mortality. It is unpredictable and can occur with or without identified risk factors. A postpartum hemorrhage can happen rapidly, therefore it is important for the team to be trained and prepared to recognize and respond quickly to the situation, by quantifying blood loss at deliveries.

Context:The California Maternal Quality Care Collaborative (CMQCC) has created a toolkit to better prepare maternal child health teams for readiness, recognition, response, and reporting when a hemorrhage occurs. This program was rolled out on the unit in 2015 resulting …

Simulation Course Redesign, Hsuan Ho

Master's Projects and Capstones

The purpose of this project is to enhance the clinical nurse leader (CNL) nursing students’ learning experiences through simulation education, ensure that their learning outcomes meet course objectives, and increase students’ recognition of educational best practices in simulation.

This summer semester, the number of students in the obstetric course doubled and the course was changed from four scenarios held over two simulation days for four pre-licensure students each class to five simulation days with eight to ten students in attendance each class period. While the old student-to-instructor ratio was three to four to one, the new ratio is nine to …