Medicine and Health Sciences Commons^™

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 …

An Evaluation Of A Care Conference Model And Improvement In The Transition Process For Medically Complex Pediatric Patients Between Inpatient And Outpatient Care, Tamara Van Kampen

Doctoral Projects

Medically complex and/or fragile pediatric patients are high utilizers of health care dollars. This population represents less than one percent of the general pediatric population, yet they account for more than 30% of pediatric healthcare costs. These patients tend to have longer lengths of stay in the hospital, high readmission rates, and lower healthcare satisfaction scores. They also have multiple transitions between inpatient and outpatient care which increases the opportunity for medical errors. Research has shown that care conferences attended by key stakeholders tend to reduce readmissions and healthcare utilization while improving satisfaction rates and patient outcomes. Research also shows …

Program Evaluation Of A Bundled Educational Intervention To Enhance Implementation Of Professional Exchange Report, Luanne M. Shaw

Doctoral Projects

Communication handover is a source of potential error and risk to patient safety. Electronic-based tools may reduce errors and mitigate risks to patient safety. Electronic tools have been successfully implemented using multiple methods of education and training. Electronic tools vary in functionality and integration with the electronic health record (EHR). A large West Michigan Regional Health System (RHS) implemented a new EHR containing an embedded tool for communication handover called Professional Exchange Report (PER). There was inconsistency in the practice of bedside report by nurses. The RHS planned to use a bundled approach of educational interventions to implement the new …

Lessons Learned From The Quality Improvement Process In A Community Based Hospital: The Dissection Of Implementation Failure Of Use Of The Prism Mortality Risk Tool And Standardization Of Case Management To Reduce Readmissions In High Risk Patients, Mary K. Ziomkowski

Doctoral Projects

Hospital readmission, particularly within 30 days of discharge, is a wicked problem. Effective case management is an imperative component of high quality healthcare for the successful transition of patients across acute and post-acute settings. Patients with complex care needs endure an increased risk for negative outcomes, mortality, and hospital readmission. A small body of evidence suggests that early, targeted interventions aimed at high risk patients can mitigate complications and poor transitions. Patient complexity is an important consideration when establishing a comprehensive care management plan. Risk prediction tools are valuable for ensuring that high risk patients receive appropriate resource allocation. Case …

Implementation Of A Patient-Centered Communication Model In The Emergency Department, Carrie Mull

Doctoral Projects

The objective of this scholarly project is to determine the impact of patient-centered communication education in an emergency department (ED) on the perception of workplace safety. The ED is a vulnerable setting and susceptible to workplace violence (WPV) due in part to increasing numbers of patients presenting to EDs with primary psychiatric complaints. High-quality patient-staff interactions correlate positively with better treatment outcomes. Patient-centered communication skills can be taught, and patients have similar expectations of what patient-centered communication means no matter their diagnoses. The purpose of this quality improvement project was to conduct patient-centered communication education with nurses, nursing assistants, and …

Implementation And Evaluation Of A Preceptor/Mentorship Program During Orientation In A Long Term Care Facility: A Strategy To Increase Nursing Employee Satisfaction, Maria A. Painter

Doctoral Projects

High nursing turnover in long-term care (LTC) facilities is a significant problem that results in additional expenses, lower quality of patient care, increased adverse patient events, and decreased patient and nursing satisfaction. A structured orientation and supportive preceptors are protective factors in retaining nurses as well as increasing nursing job satisfaction and improving patient outcomes. The goal of this pilot project was to implement an evidence-based preceptor program for staff registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs) in an LTC facility to develop preceptors’ skills and preceptees’ orientation satisfaction. The preceptor development project facilitated by …

Perceived Barriers To The Pre-Transplant Evaluation: A Patient Perspective, Linda K. Buck

Doctoral Dissertations

Patients who are afforded the opportunity for a kidney transplant tend to have better short and long-term outcomes, including improved physical health, quality of life, and long-term survival over those who are treated with prolonged dialysis (Landreneau, Lee, & Landreneau, 2010; Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients (OPTN/SRTR), 2014; Wolfe et al., 1999). At the end of 2012, 402,514 people were being treated with hemodialysis while 40,605 were receiving peritoneal dialysis (USRDS, 2014). At this same time, only 92,885 people were listed on the OPTN national waitlist for kidney transplantation. The aim of this project …

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.

Evaluation Of A Pilot Multidisciplinary Debriefing Program: Promoting Pediatric Provider Emotional, Social, And Spiritual Wellbeing, Allison E. Reynolds

Doctoral Projects

Regular exposure to trauma, such as the act of bearing witness to intense suffering and pain of pediatric patients and families, has a significant effect on healthcare professionals. Despite the fact that traumatic situations in pediatrics are a reality, there is little education and few interventions focused on how to prepare and support healthcare providers to care for dying children and families or for other clinically challenging situations. Pediatric residency program directors within a large, freestanding children’s hospital identified a subjective need for support for their pediatric residents in dealing with clinically challenging situations faced during residency, motivating residency program …

Development Of A Patient-Centered Medical Home Toolkit At An Integrated Primary Care Clinic, Lyndsay A. Randall

Doctoral Projects

Health care spending in the United States far exceeds that of other high-income countries (Squires & Anderson, 2015). In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on healthcare, which was almost 50 percent more than the next highest spender noted as France (Squires & Anderson, 2015). While the U.S. spends more on healthcare than other countries, multiple other health outcome measures are worse including life expectancy, heart disease, diabetes, and chronic respiratory illnesses (Squires & Anderson, 2015). Today’s healthcare system is highly fragmented, lacking the necessary coordination within the primary care setting. Better care coordination …

Improving Care Of Behavioral Health Patients In A Rural Emergency Department: A Needs Assessment, Margaret Perec

Doctoral Projects

Leadership and staff at a rural Critical Access Hospital (CAH)have identified the need for interventions to address the specific care issue of behavioral health patients presenting to the emergency department (ED). The ED has experienced a higher than expected number of visits, which has presented the department with challenges, especially in finding placements for patients who need inpatient treatment. ED management and staff have reported many patients have experienced long lengths of stay in the ED while waiting for beds.

A needs assessment attempts to identify characteristics of patients who remain in the ED for extended lengths of time, and …

Implementing Clinical Practice Guideline Recommendations To Address Prenatal Smoking: A Practice Change In A Community Health Department, Rachel L. Danks

Doctoral Projects

According to the authors of current literature, pregnant women who smoke may be more resistant to change, and may not fully understand the harmful effects of smoking. Therefore, there is agreement among researchers that the use of psychosocial interventions for smoking cessation can be effective. At the time of this project many settings, including clinics, health departments, and providers, were implementing the 5As which guide healthcare and community workers to ask, advise, and assess the smoking status of pregnant women at every health visit, and then assist and arrange smoking cessation interventions if applicable. Despite these efforts, pregnant women are …

Implementation Of The Reengineered Discharge Process And Transitional Care Management At A Rural Critical Access Hospital, Chad L. Wilfong

Doctoral Projects

Healthcare in the United States is changing from a fee-for-service to a value based healthcare delivery system. One area of national focus is reducing 30-day hospital readmissions by providing high-quality transitions-of-care. Patients leaving the hospital without proper assessment of home care needs, patient education, and coordination of care run into barriers managing health conditions, which contributes to hospital readmissions. Poor transitions-of-care contribute to deterioration of health leading to acute care utilization and hospital readmissions, which is costly for healthcare organizations, insurance payers, and individuals. In 2017, the value based healthcare structure will be decreasing reimbursement to hospitals that have 30-day …

Implementation Of An Evidence-Based Process For The Management Of Concussions In Adolescent Patients For A Primary Care Office, Ashley D. Karczewski

Doctoral Projects

The number of recreation and sports-related concussions (SRC) are estimated at 3.8 million every year in the United States. Recently, widespread media attention has been paid to concussion, and with this there has been a rise in adolescents with SRC seeking health care. Primary care providers are often the first to evaluate and provide treatment for adolescents with concussion. Despite the abundance of literature on concussions, there has been little empirical data to support management practices for this patient population. The purpose of the project was to provide an evidence-based process along with a clinical decision support tool to the …

A Crosswalk Protocol For Implementation Of The Patient-Centered Medical Home And Meaningful Use At A Midwest Nurse Managed Center, Kaitlyn Rath

Doctoral Projects

Healthcare expenditures in the United States far exceed the spending that occurs in other high-income countries (Squires & Anderson, 2015). However, the healthcare outcomes are poorer in the U.S. on multiple key health care measures including life expectancy and the prevalence of chronic illnesses and comorbid conditions (Squires & Anderson, 2015). New care models not only focus on improvement of key health outcomes, but also on healthcare providers to reduce fragmented care with care coordination. This DNP scholarly project addresses the need for financial stability within a Midwest nurse managed center. This center would benefit from utilization of a new …

Return On Investment Comparison Of Three Payment Models For Chronic Care Management Under Medicare In A Northwestern Physician Hospital Organization, Megan J. Madole

Doctoral Projects

Chronic disease is the most prevalent and costly health condition. The coordination of care provided to those with multiple chronic conditions (MCCs) is suboptimal and fragmented. This population is among the highest utilizers of healthcare, and accounts for the majority of Medicare expenditures annually. Chronic care management (CCM) programs represent evidence-based initiatives shown to improve outcomes, reduce hospital and emergency department utilization, and reduce healthcare costs. Centers for Medicare and Medicaid Services (CMS) have provided various payment models for reimbursement of CCM services. Primary care practices have stated that inadequate reimbursement and confusing payment models are barriers to CCM implementation. …

Development Of A Protocol For Implementing A Registered Nurse-Led Annual Wellness Visit In A Primary Care Setting, Jennifer R. Campbell

Doctoral Projects

This project was a quality improvement initiative utilizing a new format to deliver the Medicare Annual Wellness Visit (AWV) to Medicare recipients. The purpose of the project was the development of a protocol for implementing a registered nurse (RN)-led AWV in a primary care setting. The pilot project focused on changing the clinic’s current AWV structure from a provider-led format to a RN-led format. The pilot was geared towards improving care coordination, while enhancing preventive services and early intervention for chronic disease management. The 6-week pilot was used to help identify areas of weaknesses in the registered nurse-led AWV. During …

Preparing For The Merit-Based Incentive Payment Structure: A Value-Based Business Plan, Ali R. Saheb

Doctoral Projects

The notion of delivering value-based care while maintaining corporate vitality in health care is a multifaceted process. Shaping a business model to reflect this process requires the alignment of quality implications, reimbursement initiatives, a framework that takes into account stipulations on reimbursement for different types of clinicians, and an understanding and preparedness for emerging guidelines and nationally recognized structures for quality indicators. When organizations recognize the need for change, but are not yet prepared to implement it, a comprehensive business plan can help the organization visualize a path to success. In this project, the foundation of requirements for a value-based …

Acceptability Of The Md Anderson Symptom Inventory And Qualitative Analysis Of Barriers To Palliative Care Services For Rural And Non-Rural Populations, Daniel M. W. Johnson

Doctoral Projects

The United States health system strives to improve the care patients receive while reducing healthcare expenditures. A significant portion of the nation’s healthcare expenditure is spent on end of life care. Palliative care provides one solution to reducing healthcare expenditures while improving the patient experience. Reducing symptom intensity is one example of palliative care’s success. A midwest palliative care program was tasked to gather quality data on the service’s ability to manage patient symptoms.

The program selected the MD Anderson Symptom Inventory to improve symptom assessment and provide quality metrics for the organization. Additionally, research suggests rural populations have poorer …

A Quality Improvement Program In A Safety Net Clinic Serving Vulnerable Populations, Kaitlin J. Hendriksma

Doctoral Projects

The Patient Protection and Affordable Care Act of 2010 resulted in major changes to healthcare infrastructure in the United States, with two main areas of concentration: healthcare financing and population health management. Quality improvement programs focus on improving healthcare quality for populations with conscious efforts to decrease healthcareassociated expenditures. Quality improvement interventions can include patient-reported outcomes, clinical decision support systems, and clinical dashboards. The purpose of the Doctor of Nursing Practice project was to formally implement a quality improvement program for chronic disease management in a safety net clinic serving vulnerable populations. The Donabedian model served as the conceptual model …

A Technical Integration Of Primary Care Into A Behavioral Health Site, Lara M. Dengerink-Vantil

Doctoral Projects

People with persistent mental illness experience more chronic disease and co-morbidities than the general population, impacting their quality of life and increasing the cost of health care. In spite of the increased need for primary care services, people with mental illness encounter barriers to health care including lack of access to care, and a shortage of both primary care and psychiatric care providers. While this challenge was previously addressed by attempting to integrate behavioral health care into primary care settings, recent research indicates that a more successful model is reversed shared care, or the integration of primary care into a …

The Design Of An Evidence-Based Protocol For Primary Care Of Patients With Dementia, Kaitlin B. Demaagd

Doctoral Projects

Improvement in the effectiveness and optimization of care outcomes for patients with dementia in primary care is a national priority (American Medical Association-convened Physician Consortium for Performance Improvement [PCPI], 2014). Alzheimer’s disease affects more than 5 million Americans. Patients with dementia cost the nation $236 billion in 2016 (Alzheimer’s Association, 2016). In 2014, the PCPI developed ten evidence-based recommendations to address the gaps in outpatient dementia care called the Dementia Performance Measure Set (DPMS). An independently owned, non-system affiliated primary care practice identified the need to improve the quality of care they provide to their patients with dementia and their …

A Quality Improvement Initiative To Enhance Nursing Teamwork: An Element Of Excellence, Jenna L. Stoll

Doctoral Projects

Health care is changing at a rapid pace to meet the needs and expectations of consumers across the United States. The desire for improved quality of care while reducing costs has led to increased attention on team composition, relationships, and culture. There is growing evidence to support the importance of quality workplace relationships and teamwork (Brunetto et al., 2013). Research indicates a positive relationship between a culture of teamwork and quality performance measures in the health care setting (Meterko, Mohr, & Young, 2004).

Teamwork in the acute inpatient care nursing team deserves more attention (Kalisch, Lee, & Rochman, 2010). Evidence …