Medicine and Health Sciences Commons^™

Decreasing Influenza Vaccination Disparity Rates By Utilization Of Hotspot Deployments Of A Mobile Health Vehicle, Geneveve Deasis Tejada

Student Scholarly Projects

Practice Problem: Influenza vaccination for Black/African American patients is historically lower than White patients across all healthcare organizations (Quinn, 2018). In the organization’s 2022 performance, only 13.98% of Black/African American patients ages 19 and older were vaccinated compared to 27.81% of White/Caucasian patients.

PICOT: The PICOT question that guided this project was for Black/African American patients ages 19 and older receiving care from primary care clinics in Southeast San Diego (P), what is the impact of adding access to influenza vaccinations through hotspot-driven MHV deployments (I) compared to usual vaccination delivery in the medical office building (MOB) (C) on influenza …

Policy Review And Recommendation: Full Practice Authority For Psychiatric Mental Health Nurse Practitioners In Georgia, Shantelle Coe

Student Scholarly Projects

Citizens of the state of Georgia, particularly those in rural or underserved communities, experience a lack of mental health resources. Extensive research evidence underscores the urgent need for enhanced access to mental health services, especially in rural areas where individuals face significant barriers such as limited provider availability and long travel distances. Through a thorough review of existing policy related to scope of practice, this scholarly work advocates for policy changes related to the practice authority of Psychiatric Mental Health Nurse Practitioners (PMHNPs). Advancement of legislative priorities to promote full practice authority for PMHNPs in the state of Georgia empowers …

Evidence Based Practice Change To Incorporate A Standardized Process Checklist For Fecal Microbiota Therapy (Fmt) To Increase Staff Adherence, Alicia Gomez

Student Scholarly Projects

Practice Problem: Staff adherence to new procedures is crucial for ensuring patient safety, maintaining quality care, reducing risks and liabilities, and fostering a positive organizational culture that supports continuous improvement. Having a procedure done safely for patients infected with C.diff provides an overall benefit to the healthcare system.

PICOT: In an endoscopy lab staffed with nurses and surgical technicians (P), does the implementation of a new standardized process of administering FDA approved Fecal Microbiota Transplant Therapy (I) compared to the current process (C), increase staff adherence to the process (O) over 12 weeks(T)?

Evidence: Leadership, supervision, and organizational culture are …

Diabetic Coaching Program To Improve African American Patients Glycemic Control, Shonda Moore

Student Scholarly Projects

Practice Problem: The purpose of the practice problem was to find out if, among African Americans with type II diabetes who are over 18, adopting a diabetic coaching program that emphasizes diet management can result in better glycemic control over 10 weeks than for those who do not receive coaching.

PICOT: In African Americans with type II diabetes over 18 years of age (P), does a diabetic coaching program on diet management (I), compared to no coaching program (C), improve glycemic control (O) over 10 weeks (T)?

Evidence: The evidence used to guide this project came from databases, including PubMed, …

Preoperative Warming To Improve Patient Outcomes: Implementation Of A Warming Protocol, Tiara Switzer-Houston

Student Scholarly Projects

Practice Problem: Inadvertent perioperative hypothermia (IPH) is noted to be the most common surgical complication. IPH is associated with a variety of complications which are known to impact the well-being of the patient, family, and healthcare system.

PICOT: The PICOT question that guided this scholarly project was scheduled for total hip and knee arthroplasty surgical procedures under general or neuraxial anesthesia greater than 60 minutes (P), how effective is the implementation of an evidence-based pre-surgical warming protocol including forced-air warming (FAW) (I) compared to current practices (C) in improving normothermia readings within 15 minutes of arriving to the PACU, …

Implementation Of The Dynamic Appraisal Of Situational Aggression (Dasa) Tool On Inpatient Mental Health Unit, Maira Rodriguez

Student Scholarly Projects

Practice Problem: Inpatient mental health units are vulnerable to aggression and violence, which may lead to physical injuries. It is essential to implement proactive measures to prevent violence before it escalates.

PICOT: In an adult inpatient mental health unit (P), does the use of the Dynamic Appraisal of Situational Aggression (DASA) (I), compared to no screening for aggression (C) decrease restraints and seclusion, provide early detection and awareness of aggressive behaviors (O) within ten weeks.

Evidence: The DASA assessment tool has been tested in various settings, such as forensic and general adult mental health units. It has also been found …

The Impact Of Telecritical Care On Length Of Stay In A Critical Care Setting, Mallory Oberts

Student Scholarly Projects

Practice Problem: At a major metropolitan VA hospital, there was a lack of adherence by the nursing staff to the TeleCritical Care program for adult patients in the critical care setting.

PICOT: The PICOT question guiding this project was: In adult patients admitted to critical care (P), does the implementation of TeleCritical Care (I) compared to standard critical care without telemedicine (C) decrease length of stay (O) within 8 weeks (T)?

Evidence: The literature review identified improved quality of care delivery, decreased length of stay, and reduced mortality rates as key benefits of implementing TeleCritical Care in …

Actions To Improve In-Patient Communication On Medication Teaching, Tracy Wei

Student Scholarly Projects

Practice Problem: Medication education is a national and global patient safety challenge. Healthcare organizations often lack consistent and effective medication teaching policies. Studies have found that the teach-back method is an effective interactive communication practice of medication teaching to achieve optimal patient outcomes.

PICOT: In direct care nursing staff (P), How does an evidence-based medication teaching bundle (I) compared to the current medication teaching practice(C) affect staff adherence to the dissemination of medication teaching to hospitalized patients (O) in 12 weeks (T)?

Evidence: A review and appraisal of 12 research studies demonstrated that the teach-back method was …

The Positive Impact Of Reducing Polypharmacy On The Quality Of Life For Older Adults With Serious Illness, Stephanie Orlando

Student Scholarly Projects

Practice Problem

The rising prevalence of chronic health conditions, the aging of the population, and advances in healthcare technology have contributed to the rampant over-prescribing of medications and the prescribing of potentially inappropriate medicines (PIMS) in community-dwelling older adults. Additionally, reluctance by the medical community to deprescribe and resistance among patients and their caregivers due to misperceptions about withdrawing treatment has further perpetuated the problem.

PICOT

The PICOT question for this project was, in community-dwelling older adults over age 60 receiving palliative care, does the implementation of an interprofessional deprescribing intervention compared to standard care by a home-based medical care …

Policy Review And Recommendation: Full Practice Authority For Nurse Practitioners In The Southwestern United States, Sara J. Rowe

Student Scholarly Projects

This policy analysis investigates the benefits of full practice authority (FPA) for Nurse Practitioners (NPs) in the Southwestern United States, using Arizona as an FPA model and California and Tennessee as comparison states. The PICO question that directed the project is: for NPs practicing as advanced practice nurse practitioners within the Southwestern United States region (P), does a comprehensive policy recommendation for FPA for NP-led clinics in the secondary education space (I) compared to existing variable approaches within the region (C) improve access to care and direct or indirect patient outcomes as endorsed by the literature (O)? A comprehensive literature …

Policy Review And Recommendation For Secondary Education Np-Led Clinics In The Southeastern United States, Shiney Alex Jacob

Student Scholarly Projects

Secondary-level education involves adolescent children aged 11-12 years to 18-19 with unique healthcare needs. Their healthcare is of significant importance as they are transitioning to adulthood, and a majority of them lack access to primary healthcare needs. Advanced Practice Registered Nurses/Nurse Practitioners (APRNs/NPs) provide high-quality, cost-effective, and evidence-based care to people across the lifespan, and there is minimal utilization of their services in meeting the primary care needs of adolescents at the secondary school level. The purpose of the policy project was to determine if current policies and practices related to school health services in three southeastern states of the …

Palliative Care Referral Protocol: Best Practice Toolkit For Improving Early Referral Rate For Adult Cancer Patients, Linda Dinh Nguyen

Student Scholarly Projects

Despite the benefits of palliative care being well-documented in studies and early palliative care services being strongly recommended by reputable organizations, such as the American Society of Clinical Oncology, many patients did not receive or received late referrals (Pigni et al., 2022). This mainly occurs because oncologists commonly base their referrals on perceived needs and clinical judgment (Smith et al., 2017). Thus, this program development project aimed to create a toolkit to improve early identification and referral to palliative care for adult patients who would benefit from palliative care services. The PICO question that guides this program is: In ambulatory …

Advance Care Planning: Best Practice Toolkit For Improving Access To Advance Care Planning Using Telehealth Visits, Jae Jackson

Student Scholarly Projects

Advance care planning (ACP) predominately occurs during a life-threatening crisis or during an inpatient admission. The primary care provider (PCP) is generally not the healthcare provider addressing ACP at the time of a crisis or during an inpatient admission. Being proactive in limiting ACP decisions with unfamiliar providers, uncomfortable environments, and increasing access to ACP discussions with PCPs are supportive reasons to utilize an ACP telehealth toolkit in primary care. Patients risk having ACP discussions with random providers, environments that don’t provide comfort when having such personal discussions, or not having the peaceful death they deserve without having an ACP …

Block Charting For Hemodynamic Unstable Patients, Tasha Walker

Student Scholarly Projects

Practice Problem: The intensive care unit poses many challenges for nurses. Nurses are placed in a position to decide on dosing and administration, which could conflict with their scope of practice, and documentation needs to coincide with orders. The accuracy of nursing documentation plays a vital role in measuring the outcomes, and failure to document accurately could result in noncompliance with scope of practice or a medication error.

PICOT: For intensive care nurses (P), how does block charting of vasoactive medications (I) compared to current documentation practices (C) affect the accuracy of nurses' documentation (O) within 4 weeks?

Evidence: Nursing …

Promoting Patient Mobility To Decrease Hospital Length Of Stay, Saira Kinuthia

Student Scholarly Projects

Practice Problem: Promoting patient mobility may reduce hospital-acquired complications and length of stay (LOS). Evidence-based studies have established that there is a correlation between immobility and an increased length of stay in the hospital. How can nurse-driven mobility interventions effectively increase patient mobility and reduce the risk of complications and length of hospital stay?

PICOT: The PICOT question that guided this project was: For veteran patients in the Progressive Care unit (PCU) of a medical center (P), will using the Johns Hopkins Highest Level of Mobility tool (JH-HLM) (I) compared to not using a mobility tool (C) decrease hospital length …

Full Practice Authority: Policy Review And Recommendation For Regional Nurse Practitioner Practice In The Southeastern Region Of The United States, Tambra Ratledge

Student Scholarly Projects

This policy analysis examines the limited practice authority for advanced practice registered nurses (APRN) in the Southeastern United States, focusing on Tennessee while drawing comparisons to Georgia and Alabama. The PICO question that guided this policy analysis is: For advanced practice registered nurses within the southeast region of the United States (P), how does the development of a comprehensive policy recommendation for full practice authority (I), compared to existing reduced or restricted practice authority in the southeast region of the United States (C) affect access to care as endorsed by literature (O)? The literature suggests that despite being equipped with …

Reducing The No Show Rates For Mental Health Appointments Among Young Adults, Johnnie Carrico

Student Scholarly Projects

Practice Problem: Missed patient appointments have become an increasingly significant issue for healthcare organizations, private practices, and clinics. No show appointments can negatively impact the operational functions of these organizations including lost revenue. The clinical practice site’s pre-intervention no-show rate for young adult mental health appointments was 21%. The high percentage of missed mental health visits has resulted in both lost revenue for the clinic and disruptions in patient care.

PICOT: The PICOT question that guided this project was: In young adults 18-25 years with mental health appointments (P) how does patient preferred appointment reminders (I) compared to …

Improving Access To Care For Specialty Pediatric Orthopedic Patients: Maximizing Telehealth To Achieve Outcomes, Tammy Keesey

Student Scholarly Projects

Practice Problem: The lack of resources such as transportation, insurance, and finances can negatively impact a patient’s access to much-needed specialty care. Providing education, assessing telehealth literacy, and creating a specific process for identifying appropriate telehealth visits can improve pediatric specialty access to care.

PICOT: The PICOT question for this project was: In pediatric orthopedic clinic patients (P), what is the impact of the active introduction of telehealth as a clinic visit option (I) versus the current standard passive process of scheduling telehealth visits (C) on the rates of access to care (O) after nine total weeks of …

Impact Of A Provider Flagging System On Increasing Ezetimibe Utilization In High-Cardiac Risk Adults, Janessa Creado

Student Scholarly Projects

Practice Problem: Cardiovascular disease continues to be the leading cause of mortality globally. Often, healthcare providers fail to follow evidence-based guidelines in their practice.

PICOT: In high cardiac-risk, adult patients with low-density lipoprotein cholesterol (LDL-C) levels greater than 70 milligram/deciliter (mg/dl) despite being on a maximum tolerated dose of statin (P), what was the effect of a provider flagging system to initiate ezetimibe (I) compared to standard care (C) on increasing the utilization of ezetimibe according to the 2018 American Heart Association (AHA) guidelines (O) within 8 weeks (T)?

Evidence: An extensive evidence literature review …

Point Of Care Testing: Best Practice Toolkit For Improving Access To Point Of Care Testing In Mobile Medicine, Michaela Gist

Student Scholarly Projects

Practice Problem: Healthcare for persons experiencing homelessness (PEH) is a complex issue. Chronic and communicable diseases are disproportionately represented within this population. Healthcare spending is 2.5 times more costly in comparison to those who have not experienced homelessness. Although mobile health clinics aim to reduce the concerns with access to care, they do not eliminate barriers if the appropriate tests are not immediately available.

PICO: In the homeless population treated in mobile medicine (P), what is the effect of point of care testing (I) on turnaround time (O) compared with outside laboratory testing (C)?

Evidence: Critical analysis of the literature …

Improving Blood Pressure In Adults 65 Years And Older Via Weekly Telehealth Coaching, Janet Bathini

Student Scholarly Projects

Practice Problem: Hypertension is a significant modifiable risk factor for CVD and is on the rise with advancing age. The management at the VA hospital's GEC clinic acknowledged the importance of managing HTN in veterans to lower their CVD risk and were open to implementing EBP to enhance HTN management.

PICOT: The PICOT question that guided this project was: In the primary care setting, in older adults > 65 years with BP > 140/90 (P), does weekly telehealth coaching (I) compared to no telehealth coaching (C), decrease their BP (O) over a 6-week period (T)?

Evidence: The evidence that guided this project …

Early Discharge Planning To Improve Throughput, Alan Chhith

Student Scholarly Projects

Early discharge planning can improve the safety and outcomes of hospitalized patients. The aim of the multidisciplinary team early discharge rounds was to manage patient flow by removing discharge barriers to reduce the length of stay in the medical/surgical unit. The overall goal of the process improvement project was to make inpatient beds available to admit patients from the emergency department, reducing long ED boarding, and decrease the hours of diversion. The PICOT question for this project was: in the Veteran population (P) in the VA medical/surgical unit, early discharge planning with an interdisciplinary team (I) compared to regular discharge …

Pharmacogenomic Precision Medicine: Best Practice Toolkit For Improving Patient Screening For Adult Metastatic Cancer Patients, Rena L. Stewart

Student Scholarly Projects

Precision medicine utilizes pharmacogenomic testing as a therapeutic approach. Genomic testing can assess the impact of an individual's genome on their reaction to specific medications. The main objective is to find variants that may affect an individual's response to a given medication. The implementation of pharmacogenomics in oncology facilitates informed decision-making by clinicians in drug selection and dosage determination.

Nurse Leader Rounding To Provide Fall Prevention Strategies, Kerri Philipbar

Student Scholarly Projects

Practice Problem: Falls while patients are hospitalized are all too common. It was identified that the 300-bed facility in Southeast Georgia had a clinical practice gap with inpatient falls. Inpatient falls cause unnecessary pain and suffering to the patient and families. In addition to the negative effects to the patients, it creates a hardship to the organization. Increased length of stay and additional testing and treatments are charged to the hospital because of a fall.

PICOT: The PICOT question for this project is as follows: In adult patients in an acute care setting (P), does nurse leader rounding to …

Evidence-Based Intervention For Decreasing Chronic Kidney Progression In Patients With Type Ii Diabetes Mellitus, Lynn M. Johnson

Student Scholarly Projects

Practice Problem: The overall management of Type II Diabetes Mellitus (DM II) and the complications that accompany along with comorbidities are debilitating and financially exhausting. The American Diabetes Association dietary recommends a consistent low-carbohydrate diet to maintain optimal blood glucose levels to prevent complications and progression of other comorbidities. Uncontrolled diabetes mellitus leads to the development of chronic kidney disease (CKD) which can lead to the progression to End Stage Renal Disease.

PICOT: In patients in the outpatient setting aged 18 years and older(P), how does the ADA dietary guidelines for patients with type II DM(I) compared with patients self-reported …

Improving Access To Cardiac Catheterization, Sunitha Dharman

Student Scholarly Projects

The American Heart Association lists cardiovascular disease as the underlying cause of death for 874,613 people who lost their lives in 2019 (Tsao et al., 2022). On average, someone in the United States has a myocardial infarction every 40 seconds, and someone dies of a stroke every 3 minutes and 30 seconds. Studies support coronary artery disease as a significant contributor to cardiac arrest in a non-hospital setting (Yannopoulos et al., 2019). The authors provide evidence supporting the importance of early cardiac catheterization. There is a 10-15% survival rate with a higher level of functioning compared to delayed or no …

Patient Navigational Tool Increase Resource Use In A Latino Population, Kimberly Burrus

Student Scholarly Projects

Practice Problem: The practice problem is a patient navigation tool in a mobile health clinic for the Latino population to help improve utilization of resources within Daviess County, Indiana, and improve overall health literacy and health of those populations?

PICOT: The PICOT question that guided this project was: In a mobile health clinic serving Latino populations (P), does a navigation tool (I) compared to current practices (C) improve utilization of services (O) within a 12-week timeframe (T)?

Evidence: The evidence that guided this project showed patients with limited English proficiency, immigrant families have a disparity of health literacy, and an …

Primary Care Intervention: Medication Reconciliation Reduces Rehospitalizations, Dianna Twombly

Student Scholarly Projects

Practice Problem: Patients are put at risk for adverse medications events when diligent care is not taken by healthcare staff. Medication discrepancies and oversights from medical personal can lead to severe illness or even death of a patient.

PICOT: The PICOT question for this project is: For patients 65 years and older (P) does a review of a hard copy of discharge instructions (I)compared to current practice during a visit, (C) impact the number of hospital readmission (O)in eight weeks (T)?

Evidence: Medication reconciliation at each point of care, patient education on medication management, and involving patients in their own …

The Effects Of An Influenza Vaccine Education Bundle On Environmental Management Services Workers, Michelle Keister

Student Scholarly Projects

Practice Problem: Environmental Management Service Workers have low vaccination rates. They work around a vulnerable patient population.

PICOT: For Environmental Management Services (EMS) workers (P), does the use of an Influenza Vaccine Education Bundle (I) compared to the current practice (C) impact EMS worker influenza vaccine compliance (O) within a 10-week period (T)?

Evidence: Using an educational vaccine bundle that increases access to the vaccine, provides education regarding the vaccine, and comes from a trusted source will increase flu vaccination rates among Environmental Management Services workers.

Intervention: Implement a vaccine education bundle.

Outcome: After implementation in 2023, vaccination rates …

Improving Cervical Cancer Screening Rates In The Primary Care Setting, Esmeralda Young

Student Scholarly Projects

Practice Problem: Cervical cancer screening with Pap is the recommended standard practice for women aged 21 to 65. The project aimed to increase low cervical cancer screening rates at a primary care clinic.

PICOT: The PICOT question that guided this project was: (P) In women 21 to 65 years old in the primary care setting (I), does proactive pre-scheduling of cervical cancer screenings (C) compared to current standard practice (O) affect cervical cancer screening rates (T) over eight weeks?

Evidence: The evidence strongly supported improving cervical cancer screening among the targeted population. Studies showed that Pap smear screening reduced the …