Medicine and Health Sciences Commons^™

Improving Handover Process For Stroke Patients Transferring From Emergency Department To Interventional Radiology: A Quality Improvement Project, Megan Buchman

Doctoral Projects

Background: A standardized handover process is needed for stroke patients transferring from the Emergency Department to Interventional Radiology.

Local Problem: Emergency Department and Interventional Radiology had different handover processes.

Methods: A quality improvement project was conducted in a large Magnet® designated midwestern health system. Participants included emergency department and interventional radiology nurses and stroke patients. Pre/post-quality and post implementation measures were obtained.

Interventions: The interventions included utilizing a standardized handover tool between departments, calling report prior to patient transfer, and turning in handover tool following stroke case to ensure compliance. Two cycles of the Plan-Do-Study-Act Cycle were completed.

Results: No …

“Warm Handoff” To Increase Enrollment In A Maternal Infant Health Program, Samantha Worthem

Doctoral Projects

Introduction: In a Midwest Health Department’s (HD) Maternal Infant Health Program (MIHP), infant death rate has been on a steady incline at 4.8 deaths per 1,000 in 2019 (Michigan Department of Community Health, 2020). Implementation of a “warm handoff” between the local HD and Michigan Department of Health and Human Services (MDHHS) was created to increase enrollment and visits. During warm handoffs, health care providers work together within the same setting to provide evaluation and care to patients and clients (Musselman et al., 2018).

Methods: This program evaluation reviewed data retrospectively from March 31 to September 30, for 2019 and …

Enteral Nutrition Protocol For Pediatric Burn Patients: A Quality Improvement Initiative, Margaret Tepe

Doctoral Projects

Objective: This quality improvement project was conducted to determine the efficacy of an enteral feeding protocol to improve nutrition supplementation in pediatric burn patients.

Methods: Non-ICU patients with >10% total burn surface area requiring enteral nutrition supplementation were fed within 12 hours of admission or with the first sedated dressing change, whichever took place first. Pre (n = 3) and post (n = 5) implementation of the enteral feeding protocol data were obtained. Data were collected via chart audit and survey.

Results: Patients and nurses had similar characteristics; and nurses had similar nutrition practices. Total intake of calories (93.8%) and …

Evaluating The Impact Of Nurse Server Standardization On Patient Safety, Megan L. Priebe

Doctoral Projects

Aim: The aims of nurse server (supplies at bedside) standardization program evaluation were to: (1) examine supply costs; (2) identify staff efficiency; (3) evaluate patient safety; (4) identify staff satisfaction and acceptance.

Background: A healthcare facility in the Midwest implemented standardization of the nurse server. Standardization was done to improve patient safety and staff efficiency

Methods: The literature provided metrics for evaluating standardized nurse servers to determine the impact on patient safety. Specific measures used in this quality improvement project were: census data, costs analysis, supply room observations, semi-structured interviews, and data from the VOICE reporting system (system for adverse …

Improving Care Coordination For The Homeless Population Using Systematic Quality Improvement, Rutendo Nyasvisvo

Doctoral Projects

Background and Objectives: Care coordination for the homeless population is challenging due to the complexity of healthcare and the uncertain life circumstances of the homeless individual. Objectives were developed to guide care coordination for the homeless by utilization of the free clinic to create PCP referrals, appointments and tracking follow-up care to increase appointment attendance and improve health outcomes for the homeless individual.

Design: A quality improvement project.

Setting: A faith-based non-profit homeless shelter organization in the Midwestern United States.

Participants: Participants include 25 homeless guests, 5 staff members including a clinic coordinator, 3 registered nurses and 1 licensed practical …

Enhancing Medication Adherence Behaviors Among Ambulatory Pediatric Hematology & Oncology Patients: A Quality Improvement Project, Desiree Palmer

Doctoral Projects

Introduction: Researchers have found that pediatric patients with acute lymphoblastic leukemia and adolescent patients with sickle cell disease struggle to adhere to medication treatment requirements. Because of this trend, there is a clear need to address medication adherence. The purpose of this quality improvement project was to enhance medication adherence behaviors among pediatric hematology and oncology patients and their families within an ambulatory hematology and oncology clinic.

Methods: The project included a systematic literature review to identify evidence-based interventions, an organizational assessment, and a three-phase multifaceted quality improvement process. To increase patients bringing medications to appointments, 32 medication transportation bags …

Utilizing Educational Materials To Change Vaccine Compliance In Children Under 24 Months Of Age, Kelsey M. Arnold

Doctoral Projects

Background: Childhood vaccinations are critical to preventative care for the pediatric population. The goal for the clinic’s combination 10 insurance quality measure, which reflects the number of fully vaccinated children by 24 months of age, is to be greater than 68%.

Purpose: This quality improvement project sought to implement evidence-based interventions to improve childhood vaccine compliance by increasing the parent/caregiver’s knowledge about vaccines and increasing the communication with their healthcare provider.

Methods: A parent friendly vaccine schedule, information pamphlet, interactive video, and survey were given to parents/caregivers during well-child visits. A total of 117 parent/caregiver surveys were collected. Vaccine compliance …

Sickle Cell Disease: Development Of An Acute Pain Management Program In A Hematology/Oncology Practice, Elizabeth Pohl

Doctoral Projects

Background: Patients with sickle cell disease experience can experience acute episodes of severe pain that require prompt pain medication. Treating uncomplicated, acute sickle cell disease pain in the emergency department setting has been shown to be costly and lead to higher rates of hospitalization than similar care in a dedicated outpatient setting.

Objectives: The aim of this article is to outline the program development efforts undertaken to apply current literature findings and evidence-based practice guidelines to create a program development toolkit and business plan for a sickle cell disease acute pain management program in an outpatient hematology practice.

Methods: A …

A Program Evaluation To Assess Readiness For The National Committee For Quality Assurance’S Patient Centered Medical Home Model Application, Alida M. Semrinec

Doctoral Projects

The Patient Centered Medical Home Model is associated with enhanced patient experience and quality improvement outcomes. The Model has the capacity to guide primary care practices to enhance quality, provide more comprehensive, patient centered care, and increase practice revenue. An urban, nurse managed community health center that has recently implemented the nurse care manager role (a Model requirement) desires to apply for recognition. A program evaluation was conducted to assess current practice, policies, and procedures in place at a Community Health Center through the lens of the National Committee for Quality Assurance’s forty Patient Centered Medical Home Model core competencies. …

Improving Adolescent Risk Assessment And Provider Follow-Up In Primary Care, Darby R. Disselkoen

Doctoral Projects

Purpose: The purpose of this quality improvement project was to improve preventive care for adolescent patients by implementing standardized, routine screening for risk-taking behaviors and improving provider response to identified risks using the Rapid Assessment for Adolescent Preventive Services tool and resources for providers to reference during discussions about risk.

Methods: Quality improvement methodology was utilized at a midwestern pediatric primary care office to implement a practice workflow for staff to follow during annual, adolescent wellchild exams beginning at age thirteen.

Results: Analysis of project results demonstrated a significant increase in routine screening for adolescent risk behaviors compared to the …

Evaluation Of A Chewing Gum Protocol For Postoperative Spinal Patients, Lauren E. Vachon

Doctoral Projects

Aims and objectives: The purpose of this project was to evaluate if the implementation of a chewing gum protocol improved bowel motility, decreased ileus rate, length of stay, bowel and pain medication use, and hospital costs in post-surgical spinal patients in a suburban hospital.

Background: Postoperative bowel dysfunction is a major source of health problems, including abdominal pain, ileus, increased length of stay, pain medication use, and healthcare costs.

Design: Retrospective cohort study with a focus on program evaluation of the previously implemented chewing gum protocol. An audit of the electronic health record compared outcomes in patients five months before …

A Budget Impact Analysis Of A Tobacco Control Program In A Community Mental Health Clinic, Thuy-Nhi Nguyen

Doctoral Projects

Objectives: This project evaluation aimed to determine if the tobacco cessation program, American Lung Association’s Freedom From Smoking (ALAFFS), within the designated community mental health organization (CMHO) is affordable and sustainable through a budget impact analysis.

Methods: The study modeled the impacts on the costs of facilitator training, staff salaries/time, program workbooks, program supplies, bus passes, and other supplies and materials. The Medicaid reimbursement rate used for tobacco cessation group therapy was included. The budget impact analysis projected financial consequences of the presence of training costs and number of smokers with severe mental illness who attended the program.

Results: The …

Improving The Screening And Care Of Hospitalized Adults With Obstructive Sleep Apnea Through Standardized Workflow Processes, Elizabeth Henschel

Doctoral Projects

BACKGROUND: Adults can be screened for obstructive sleep apnea in acute care settings using the validated STOP-BANG questionnaire. Healthcare providers can treat patients with confirmed or suspected obstructive sleep apnea to reduce risk for complications during hospitalization or after surgery.

PURPOSE/ RELEVANCE TO HEALTHCARE QUALITY: To determine if the standardization of obstructive sleep apnea screening and patient care workflows improves process efficiency saving nursing time and healthcare expenses.

METHODS: Quality improvement project included an organizational assessment of healthcare system setting to define clinical problem; determined appropriate evidence-based interventions; and implemented strategies guided by quality improvement models.

INTERVENTION: Updated inpatient units …

Utilization Of Home Blood Pressure Monitoring In Adult Patients With Hypertension, Justin R. Crow

Doctoral Projects

Hypertension is one of the most prevalent conditions in the United States, affecting roughly 45% of adults in the country (Centers for Disease Control and Prevention [CDC], 2020). The CDC (2020) reports that only an estimated 24% of patients have controlled blood pressure, which is defined as blood pressure less than 130/80 mm Hg. In 2017, the American Heart Association (AHA) and American College of Cardiology (ACC) released a comprehensive set of guidelines that aimed to assist providers with hypertension management. The Measure Accurately, Act Rapidly, and Partner with Patients (MAP) protocol was formulated as an evidence-based strategy to improve …

Addressing Social Determinants Of Health In Community-Based Palliative Care, Mary D. Chenge

Doctoral Projects

Background and Objectives: Addressing social determinants of health (SDOH) in the medical community has recently started; however, there is yet to be a standardized format for addressing the social needs of patients. Consequently, a protocol was developed to address SDOH to increase screening rates, social work referrals, and capture depression reimbursement.

Methods: The quality improvement project was implemented using the Plan-Do-Study-Act framework at an urban Community-Based Palliative Care organization in the Midwestern United States. Participants included office staff and 140 patients (two separate sets of 70 randomly selected patients pre/post-implementation). A protocol was developed for screening 11 SDOH using an …

Creating Equal Opportunities Through Developmental Screening At A Rural Health Clinic, Allison Honderd

Doctoral Projects

Background: 17% of United States children have a developmental delay, but only 2-3% receive early intervention referrals (Rice et al., 2014; Zablotsky et al., 2019). Standardized developmental screening improves developmental delay identification and early intervention referrals (Guervara et al., 2013; Lipkin et al., 2020).

Objectives: This project aimed to implement standardized developmental screening, refer positive screenings, and generate revenue through proper billing.

Methods: A 12-week quality improvement project was implemented with the M-CHAT and Ages and Stages Questionnaire (ASQ) through four PDSA cycles at a rural health clinic for 9, 18, and 24-month well-child checks. Data were analyzed through a …

Program Evaluation Of Parent Engagement Activities In The Pediatric Cardiac Intensive Care Unit, Cheryl A. Bos

Doctoral Projects

Introduction: Leaders of a six-bed pediatric cardiac critical care unit identified the need to evaluate family engagement in patient care activities prior to implementing quality improvement initiatives. This program evaluation identified staff and family perception of barriers and facilitators to parent engagement in the Pediatric Cardiac Intensive Care Unit.

Methods: Data were collected through quantitative and qualitative methods. Surveys collected staff baseline and parent pre-/post-hospital perception of the role of family engagement in caring for the child.

Results: The Questionnaire of Factors That Influence Family Engagement survey of 58 registered nurses indicated the nurse workflow (τb = .579, p = …

Creating A Quality Improvement Toolkit To Identify & Address Gaps In The Care Of Older Adults With Hip Fracture, Amanda J. Covell

Doctoral Projects

Introduction: Traumatic hip fracture remains a major cause of disability, decline, and mortality for adults over 65. Gaps remain in the consistency of care and services hip fracture patients receive during hospitalization and post-discharge, leading to adverse outcomes, including MI, surgical site infection, poorly managed pain, and increased mortality. To help address these inconsistencies, the AAOS released updated clinical practice guidelines for management of hip fracture care in the elderly in 2014. These guidelines examine the entire hospitalization process for this population and set forth evidence-based standards to assist with improving outcomes for hip fracture patients.

Objectives: Five of the …

Video Education For Improved Education Of Newly Diagnosed Multiple Sclerosis Patients, Theresa Mccrumb

Doctoral Projects

Anxiety and depression are prevalent in multiple sclerosis (MS) patients, especially those newly diagnosed. Receiving a diagnosis of MS can be overwhelming and impact patients in multiple areas including physical issues, cognitive changes and anxiety and depression (Kantor, Bright & Burtchell, 2017). This anxiety and depression can cause patients to be less engaged in their plan of care and thereby reduce their quality of life (Rieckmann, et al., 2015). According to the Multiple Sclerosis Association of America (MSAA), four of 10 MS patients are diagnosed with depression and anxiety, with the highest incidence at diagnosis (Multiple Sclerosis Association of America, …

Evidence-Based Policy And Procedure Review System, Meredith A. Stokes

Doctoral Projects

Policies and procedures guide practice and the care of patients in every field of healthcare. Incorporating best practice evidence into clinical practice is a critical step towards providing safer patient care and improved patient outcomes. The challenge has been finding a way to incorporate best practice evidence into policies and procedures. Accordingly, an evidence-based project to answer the following clinical practice question was proposed: What is an evidence-based strategy for reviewing, updating, and disseminating policies and procedures for office staff at a cancer treatment organization? Through the use of Donabedian’s Model for Quality Improvement, student created tools, and an evidence-based …

Honoring Patient Do Not Resuscitate Wishes And Reducing Harm During Transitions Of Care: A Quality Improvement Project, Emily L. Kraus

Doctoral Projects

Objectives: The quality improvement project objectives were to honor documented Do Not Resuscitate wishes in emergency departments by examining and improving workflow during primary care to emergency department transitions. A location for advance care planning documentations was designated for advanced directives, yet not utilized.

Methods: Mixed method, pre-/post-comparison, and thematic design examined clinicians and patients in a primary care office and two emergency departments in a Midwest healthcare system. Data was collected from patient records, clinician surveys, and observation of workflow. Descriptive statistics, frequency counts and non-parametric tests were used to analyze data.

Results: Patient charts were audited (N=261 [pre=124; …

Self-Monitoring Of Blood Pressure In Community – Dwelling Senior Adults, Laura N. Love

Doctoral Projects

Unregulated hypertension is a public health concern. Hypertension is a chronic disease affecting adults across the lifespan. Although hypertension is easy to diagnose and treat, rates of blood pressure control continue to be low (AHA, 2017). Because of this, it is imperative to employ novel strategies for blood pressure control; especially in high risk populations. The purpose of this evidence-based, project was to determine whether self-monitoring of blood pressure (SMBP) improves knowledge about hypertension, while also increasing the frequency of SMBP. Another outcome of interest was a reduction in mean systolic blood pressure for the cohort. The project enrolled participants …

Improving Blood Pressure Control Among Patients Diagnosed With Hypertension In A Primary Care Setting, Eriko Apriliando

Doctoral Projects

Hypertension affects over 38% of adults or approximately 103 million Americans, costing around $131 billion annually in treatment and loss of productivity. It is also an independent risk factor for coronary events, heart failure, stroke, and end-stage renal disease contributing to 410,624 United States (U.S.) deaths in 2014. The American Heart Association (2016) has released the Measure Accurately, Act Rapidly, and Partner with Patient (MAP) protocol in order to address this issue. This project focused on implementing parts of the MAP protocol. The purpose was to improve blood pressure (BP) control of patients diagnosed with hypertension in a primary care …

Implementation Strategies To Reduce Hospital Readmission Rates In Adults With Sepsis: A Quality Improvement Project, Erin Kucharek

Doctoral Projects

Background: Sepsis is a concern in healthcare, as patients are 2 to 3 times more likely to be readmitted to the hospital than those with other illnesses. Readmitted patient with sepsis costs the healthcare system $3.5 billion dollars per year. Effective care coordination is a tool that decreases readmission rates in other illnesses and is likely applicable to those with sepsis. The purpose of this quality improvement project was to determine if primary care provider follow-up appointments, increased home care utilization, and patient education would reduce sepsis readmissions.

Methods: The Transitional Care Model guided project design and The Kotter Model …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

Increasing Annual Retinal Exams Among Patients With Type 2 Diabetes, Afokoghene H. Odhu

Doctoral Projects

The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the …

Implementation Of Early Mobility In The Pediatric Cardiac Intensive Care Unit, Kelly Lubbers

Doctoral Projects

Patients admitted to pediatric intensive care units and pediatric cardiac intensive care units often experience prolonged periods of immobility due to critical illnesses and surgical interventions. Many pediatric intensive care unit survivors develop physical and developmental disabilities that have long-lasting impacts into childhood and adulthood. Early mobility may be one aspect to mitigate the risks associated with pediatric intensive care unit admissions. Early mobility protocols have shown to be a safe and feasible intervention to encourage mobility in pediatric patients. This quality improvement project developed and implemented an infant holding tool to promote the mobilization of infant patients admitted to …

The Impact Of A Pediatric Nurse Residency Program On Newly Licensed Registered Nurses At Six Months, Amy Rohn

Doctoral Projects

Background: Newly licensed registered nurses (NLRNs) face challenges as they transition from the academic setting to professional practice. These challenges can leave NLRNs feeling dissatisfied and vulnerable in their new positions. Nurse residency programs (NRPs) are an effective way to provide support for the NLRN.

Objectives: The purpose of this project was to evaluate the impact of a newly implemented NRP on NLRNs at six months related to their perception of support, patient safety, stress, communication/leadership, and professional satisfaction.

Methods: The project setting was a large midwestern children’s hospital. The sample consisted of twenty-six NLRNs who participated in the NRP …

Creating Opportunities For Personal Empowerment: A Project Evaluation, Ann L. Cudney

Doctoral Projects

Introduction: 66% of individuals in the United States who experienced a major depressive episode in the last year saw a general practitioner or family doctor and not a psychiatrist or psychotherapist (Center for Behavioral Health Statistics and Quality, 2018). Many primary care providers treat with medication, however, a combination of medication and psychotherapy is associated with better results (Anxiety and Depression Association of America, n.d.). A Midwestern faith-based healthcare organization implemented a pilot cognitive behavioral therapy program at a family medicine residency clinic to improve mental health care.

Objectives: The purpose of this project was to evaluate if the implementation …

Developing Lactation Support In A Primary Care Pediatric Office, Charlotte Minnema

Doctoral Projects

Background: Breast milk is known to be the best nutrition for infants, and experts recommend to exclusively breastfeed through the first six months of life and provide breastmilk through at least the first year of a child’s life (American Academy of Pediatrics, 2012). The United States is currently not achieving its breastfeeding goals set out in Healthy People 2020 by the US Department of Health and Human Services (U.S. Department of Health and Human Services, 2014). The integration of Internationally Board-Certified Lactation Consultants (IBCLC) into primary care pediatrics offices has been shown to increase all breastfeeding rates (Witt, Smith, Mason, …