Medicine and Health Sciences Commons^™

A Standardized Unit Based Process For Obtaining Heart Failure Patient Weights, Lesli E. Teed

Master's Projects

Introduction: A CNL student-led process improvement process improvement project was proposed to help improve the accuracy of Heart Failure patient weights on a geriatric specialty unit. Cardiology voiced a preference for patients to be weighed using electronic standing scales rather than in-bed scales to improve accuracy. A literature review revealed that in-bed scale weights were less accurate due to inconsistencies in zeroing the bed prior to obtaining the weight, not removing excess patient care equipment and bed linens, and not ensuring that the patient was wearing a minimal amount of clothing.

Methods: Electronic standing scales were purchased, current practice state …

Implementing Purposeful Rounding As A Quality Improvement Project To Improve Patient Satisfaction In The Emergency Department, Kersten O'Brien

Master's Projects

Purpose: The purpose of this paper is to describe a quality improvement project to develop and implement a purposeful rounding protocol to improve patient satisfaction and call light rates which affect both patient and nursing staff satisfaction in the emergency department (ED). Importantly, patient satisfaction scores in the ED tend to be low but high scores are related to improved competitive advantage, reimbursement rate, patient outcomes, and nursing staff interruptions.

Methods: A literature review was conducted to determine best practices. Using the lean process and the Plan-Do-Study-Act (PDSA) model, this information was used to identify opportunities for improvement and to …

Developing An Evidence-Based Discharge Process For Patients On A Cardiac/Renal Acuity-Adaptable Inpatient Unit, Tami Gallagher

Master's Projects

Introduction: Readmissions continue to negatively impact patient outcomes and create a significant financial burden. Regardless of efforts to reduce readmission rates, the cost of readmission continues to increase.

Clinical Problem: All-cause, 30-day readmission rates on a cardiac/renal acuity-adaptable inpatient nursing unit ranged from 11% to 33% from July to December 2018 for patients diagnosed with COPD, AMI, HF, and sepsis. The readmission rate for the organization was 16.2% in September 2018 with a target goal of 14.8%.

Project Aim: To use quality improvement tools and an interdisciplinary team to implement the teach-back method during discharge education and a discharge preparedness …

A Quality Improvement Project To Enact Evidence-Based Guidelines To Improve Documentation Of Hemoglobin A1c For Inpatient Diabetes Populations, Karyn C. Kinney

Master's Projects

The purpose of this paper is to describe a quality improvement project aimed to improve the documentation of hemoglobin A1c in the discharge instructions for patients with a diagnosis of diabetes prior to a transition from the acute care setting. Clinical practice guidelines from the American Diabetes Association and patient education recommendations from The Joint Commission are the impetus for this process improvement. The Plan-Do-Study-Act (PDSA) model was utilized to identify, design, and implement the process change in collaboration with an interprofessional team. The documentation rate of hemoglobin A1c was measured on two medical-surgical inpatient hospital units both pre- and …

Improving A Discharge Process To Decrease Readmission Rates, Erni Ensing

Master's Projects

No abstract provided.

Implementing Evidence-Based Fall Reduction Interventions In An Urban Emergency Department, Nichole L. Schmidt

Master's Projects

The patient population that is falls in the emergency department (ED) tends to differ from population that falls on inpatient units. However, there is no validated fall risk assessment for the ED setting. In an ED in a western Michigan hospital a fall reference card was designed and trialed by a small group of ED nurses on twenty-five ED patients. The fall reference card was created as a quick-reference guide for the assessment of fall risk, and the implementation of evidence-based fall risk interventions. The card utilized interventions supported by literature as the most common reasons for ED falls. The …

Hospital Acquired Pressure Injury Gap Analysis, Mary Lou Hall

Master's Projects

Hospital acquired pressure injuries (HAPIs) were identified as an area for a quality improvement (QI) project in a progressive care unit (PCU) in a Midwestern Hospital. In order to reduce HAPIs and provide the best possible preventative care, a gap analysis between the current care practices on the progressive care unit and the best evidence-based practice recommendations for HAPI prevention in the areas of risk/skin assessment, surface support, nutrition and hydration, repositioning/movement, moisture management, and prophylactic dressings was conducted. The Model for Improvement (MFI) was the QI framework that guided this pressure injury gap analysis.

The goals of this gap …

Increasing Use Of A Tobacco Cessation Quitline In A Rural Prenatal Population, Rachel T. Schleenbaker

Master's Projects

This paper addresses prenatal smoking rates within in a rural northern Michigan district health department (HD) through a Master of Science in Nursing (MSN) quality improvement project. The paper provides a detailed microsystem assessment of the Maternal Infant Health Program (MIHP) at the district HD describing the clinical problem and identifying a practice gap in care of prenatal smokers. The literature review describes the three most effective prenatal smoking cessation interventions: counseling, incentives, and feedback. The literature review also addresses the effectiveness of and barriers to smoking quitlines. The clinical protocol followed the Model for Improvement framework with the completion …

Applying Process Standardization And Health Literacy Precautions To Increase Older Adult Patient Satisfaction With Medication Teaching, Casie N. Sultana

Master's Projects

The purpose of this paper is to describe a quality improvement (QI) project with the goal of creating an evidence-based, standardized process for nurses to teach older adult patients about newly prescribed medications.

Evidence Based Protocol: Improving Nutrition Monitoring In Hospitalized Adults, Philip W. Jackson

Master's Projects

Malnutrition affects a large number of adult inpatients. For these patients, the implications of the high rate of malnutrition include impaired wound healing, higher rates of infection, and an increased risk of death. These complications contribute to increased healthcare costs and longer lengths of stay. The level of monitoring and documentation of patients’ meal consumption was acknowledged to be below expectations in an acuity-adaptable neurosciences unit situated in a downtown hospital located in the Midwestern United States. The define-measure-analyze-improve-control (DMAIC) quality improvement framework guided the quality improvement team to develop a standard process for meal related activities. The rate of …

Early Progressive Mobility In The Intensive Care Unit Adult Patient Population, Kimberly Henry

Master's Projects

No abstract provided.

Evidence-Based Protocol: Decreasing Falls And Falls With Injury In A Nsdu, Jennifer J. Komm

Master's Projects

Patient falls in acute care tend to be the most common adverse events reported. The Centers for Medicare and Medicaid Services report that fall-related injuries are classified as hospital-acquired conditions and no longer reimburses for the diagnosis and treatment of injuries incurred from falls during hospitalization. Falls are decreasing at too slow a rate even with a variety of fall prevention guidelines being available. Falls are a complex problem within hospitals and the prevention of falls is challenging. Literature supports the individualization of fall prevention interventions based on the risk factors exhibited by a patient. Tailoring interventions to specific fall …

Cesarean Section Surgical Site Infection Prevention Evidence-Based Practices And Implementation Plan, Amanda K. Smith

Master's Projects

The Cesarean section (C-section) surgical site infection prevention implementation plan has been designed as a quality improvement project. The project included a microsystem assessment, identifying the problem, literature review, application of a nursing theory and conceptual model, and development of an implementation plan. The microsystem assessment involved a Labor and Delivery Unit who had initiated a new surgical site infection (SSI) prevention bundle developed by an interprofessional team utilizing evidence-based practices and other hospitals protocols. The problem defined was the elevated rates of SSIs due to gaps in the SSI bundle risking the sustainability of the bundle. A literature review …

Early Ambulation For Colorectal Enhanced Recovery Patients In A Surgical Specialties Unit, Jessica P. Pelletier

Master's Projects

Early ambulation is a key concept in surgical recovery and overall improvement of medical conditions. The initiation of Enhanced Recovery programs (ERP) for surgical procedures have used evidence-based research to bundle best practices for a quicker and more effective recovery.

The author evaluated the consistency of early ambulation on a surgical specialties unit using the ERP method. Through process improvement methods, data and practice were evaluated to show inconsistencies in documentation, data report abstraction, and understanding of complete collaborative bundle components.

Impacting Adherence To Infant Safe Sleep Practice, Danielle M. Hartig

Master's Projects

This paper provides a complete microsystem assessment of a pediatric unit. The assessment includes identification of a process problem with infant safe sleep practice in the hospital setting. The paper explores six different published articles regarding clinical practice guidelines, best practices, and evidence-based interventions. The literature review indicates agreement amongst various authors following infant safe sleep guidelines in the hospital setting. The literature review also indicates that caregiver role modeling while in the hospital setting is the most influential component that affects parents’ practices upon return to the home setting. The clinical project will include baseline needs assessments of both …

Improving The Supply Process In An Interventional Procedures Unit, Megan M. Rose

Master's Projects

In the combined cardiac catheterization and interventional radiology unit of an urban Midwestern hospital, having supplies when and where they are needed is necessary for efficiently and safely completing a wide variety of procedures. Due to the complexity of the supply chain process in this setting, baseline data collection revealed many missing supplies, overnight shipments, and expired items. In this project, the MSN student sought to determine whether a Clinical Nurse Leader driven Lean Six Sigma based approach to supply chain interventions in the interventional procedures setting would improve outcomes and lead to financial savings by decreasing waste and variation. …

Evidence-Based Protocol: Standardizing Handoffs To Improve Outcomes, Melissa L. Rykse

Master's Projects

Nurse to nurse handoffs were identified as an area for improvement in an acuity-adaptable, progressive care (AAPC) unit in a Midwestern hospital. By using the Plan, Do, Study, and Act (PDSA) quality improvement framework, the content of handoffs was standardized by the creation and use of a handoff tool, organized in a Situation, Background, Assessment, Recommendation (SBAR) manner. Outcomes of nursing satisfaction and incidental overtime were improved after the implementation of the handoff tool. This cost neutral project has a cost savings potential of $2000/year with the reduction of incidental overtime.

Evidence Based Protocol: Improving Depression Assessments In Primary Care, Katherine E. Hoffhines

Master's Projects

Depression is a destructive condition that can have a profoundly negative impact on quality of life, wellbeing, and health (Thase, Stowell, Berry, Mencia & Blum, 2014). Worldwide, depression is the leading cause of medical disability costing the health care system over $210 billion annually (World Health Organization, 2014; Greenberg, Fournier, Sisitsky, Pike & Kessler, 2015). The World Health Organization (2016) estimates depression affects 350 million people of all ages globally. One and three adults in the U.S. will experience a major depressive episode during their lifetime (Kessler, Petukhova, Sampson, Zaslavsky & Wittchen, 2012; Rubin, Ciechanowski, Egede, Lin & Lustman, 2004). …

Patient Falls: Reducing Patient Falls With Injury, Frederick Comer

Master's Projects

The occurrence of patient falls is a very important health concern facing the healthcare industry. Many patients not only experience falls, but have falls with an injury. This is a patient safety concern that can have serious effects on patient outcomes, is a leading cause of patient injuries in hospitals, and are costly adverse events (Trepanier & Hilsenbeck, 2014). It is important that healthcare professionals determine ways to prevent what has been deemed a preventable event (Bemis-Dougherty & Delaune, 2008). In 2005 The Joint Commission (TJC) included patient falls with injury as part of their National Patient Safety Goals (Bemis-Dougherty …

Postdischarge Calls In The Ed: Improving Quality And Efficiency, Megan E. Pashnik

Master's Projects

No abstract provided.

Evidence Based Protocol: Discharge Delays In The Acute Care Setting, Kylie C. Schaberg

Master's Projects

According to Batalden, Nelson, Godfrey and Lazar (2011, p, 25), the clinical microsystem is a “place where patients, families and health caregivers meet” and encompasses all interactions from the moment a patient enters the system up to and including when the patient leaves the system. In order to understand the complex and dynamic changes that occur at the microsystem level, a thorough assessment must be completed. The purpose of this chapter is to gain a greater understanding of the mechanism of the microsystem and the effects that this microsystem has on the process for discharging patients from the hospital setting …