Medicine and Health Sciences Commons^™

Screening For Social Determinants Of Health Screening In The Primary Care Setting: A Quality Improvement Project, Arifa Khan

DNP Projects

Significance and Background: Social determinants play a major role in the overall health of our nation. While screening for social determinants of health (SDOH) in the primary care setting is encouraged, there is no streamlined process in place. Studies have determined that improved SDOH screenings can result in better patient outcomes and a decrease in healthcare costs. A protocol to improve SDOH screenings was needed to guide patient outcomes at a Federally Qualified Health Center (FQHC) in Connecticut.

Purpose: Deliver education to providers and healthcare staff across the health system on significance of social determinants of health and PRAPARE screening …

Introducing An Evidence-Based Copd Care Bundle To Reduce Readmission Rates: A Quality Improvement Project, Michael Distasio

DNP Projects

Background

Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating lung condition, and a leading cause of readmission following an acute exacerbation. The Centers for Medicare and Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP) determines reimbursement penalties to hospitals when patients admitted with acute exacerbation of COPD are readmitted for any reason within 30 days of discharge. A regional medical facility (MF) identified 30-day readmission rates for COPD patients as a key improvement metric. Several gaps in the standardized care of patients with COPD on a pulmonary-focused medical-surgical unit (MSU) identified by key unit stakeholders provided impetus for …

Implementing The Phq-9 Tool To As A Standard Of Practice In A Mental Health Setting: A Quality Improvement Project, Gabriella Laferriere

DNP Projects

The objective of this project was to implement the Patient Health Questionaire-9 (PHQ-9) tool as a standardized protocol for depression screening on patients being treated at an outpatient mental health facility in Central Connecticut, where there was no depression screening protocol in place. The clinical question being asked was, is there any correlation between use of the PHQ-9 tool and changes being made to a patient’s depression treatment plan?

Methods: A data collection form was completed by the psychiatric nurse practitioner on each patient who met the following criteria: Depression and/or anxiety was the patient’s primary diagnosis and patient was …

Enhancing Primary Care With Progressive Muscle Relaxation For Anxiety, Depression, And Acute Stress: A Quality Improvement Project, Andrew Dudley

DNP Projects

Introduction

Depression affects 1 in 5 individuals during their lifetime (Hidalgo et al., 2021), with 23 million Americans seeking mental health treatment annually (Parish et al., 2023). While guidelines from the AAFP and APA advocate comprehensive care approaches, medication prescriptions for anxiety and depression remain prevalent, particularly among children aged 6-18 (Lester et al., 2022). Direct observation identified a need to bridge gaps in adjunctive therapies between the primary care setting and counseling services for patients who presented with mild or mild to moderate anxiety or depression. Feedback analysis by staff in the setting identified a gap in knowledge and …

Dnp Project Proposal: Toolkit For Transition Of Young Adults With Autism Spectrum Disorder (Ya-Asd) To Primary Care, Dawn Boal

DNP Projects

Significance and Background: Young adults (YA) with autism spectrum disorder (ASD) transitioning from pediatric to adult care may have more difficulty finding a primary care clinician trained to address their unique medical and mental health needs. Transition resources need to be developed to help these patients and their caregivers while they are still being cared for by their pediatrician.

Purpose: To develop an ASD resource toolkit with resources designed to help YA-ASD and their caregivers with the transition from pediatric care to adult primary care.

Methods: The Model for Healthcare Improvement guided this evidence-based quality improvement project. An evidence …

Implementing A Skin Care Bundle On Hypoperfusion Skin: A Quality Improvement Project, Emily O'Connor

DNP Projects

Significance and Background: Pressure injury rates have increased within the critical care population. Pressure injuries are known to increase pain, infection risk, length of stay leading to decreased quality of life. Thermal imaging cameras highlight areas of hypoperfusion, allowing staff to target these areas as high likelihood to progress to a pressure injury. Foam dressings have been shown to help decrease pressure injury acquisition. Prevention methods should utilize evidence-based skin care bundles and focus on known information and target areas. Combining knowledge from thermal cameras, foam dressings, turning every two hours and accurate use of documentation scale (Braden Scale), a …

Implementing Continuous Glucose Monitoring: A Quality Improvement Project, Molly Suydam

DNP Projects

Significance and Background: Continuous glucose monitoring (CGM) devices are beneficial for assessing blood glucose measurements throughout the day by simply waving a smartphone over the sensor that’s attached to the back of a patient’s arm. Patients with T2DM who check blood glucose measurements via finger-sticks, have to undergo numerous daily finger-sticks. Over time, this action can grow very cumbersome while CGM offers real-time blood glucose measurements without having to pierce the skin repeatedly. CGM use in patients with T2DM may help to improve overall blood glucose measurements.

Purpose: To trial CGM in patients with T2DM and monitor blood glucose measurements …

Implementation Of A Risk Stratification Foot Screening Tool At A Free Outpatient Clinic: A Quality Improvement Project, Joni-Kay Johnson

DNP Projects

Background: Foot conditions and disorders are prevalent concerns for the medically underserved population, that can manifest through chronic illnesses like diabetes, peripheral vascular disease, and hypertension, especially if these conditions go undetected or unmanaged for periods of time. This population is faced with complex challenges and are at risk of illness due to inequities and disparities in access to health care services. They are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. Walking is a common mode of transportation among underserved individuals and increased risks of physical injury, poor hygiene, and inadequate …

Implementing Teach Back Heart Failure Education To Improve Self-Care And Reduce Re-Hospitalization: A Quality Improvement Project, Sweata Patel

DNP Projects

Heart failure (HF) is a major health concern. External evidence supports the use of the teach-back method for patient education to promote self-care behaviors in patients with HF which may also reduce rehospitalizations. Patients with HF at one home health agency in New England participated in the quality improvement project which consisted of delivering 20 minute weekly standardized teach-back educational sessions covering topics of HF self-care over six weeks. The existing patient education materials and two new resources, Medication Tracker and Self-Check Plan for HF management, were reviewed. Three questions from the Self-Care of Heart Failure Index were asked during …

Improving Provider Ordered Annual Breast Cancer Screening In Primary Care, Alexis Manzella

DNP Projects

Significance and Background: Breast cancer is the most common cancer in women throughout the United States. Specifically, the state of Connecticut has one of the highest rates of breast cancer in the country. Multiple evidence-based organizations have developed specific guidelines for screening in clinical practice. These guidelines specify when a woman should be screened and how frequently. A project was put in place at a FQHC in Connecticut to increase the number of breast cancer screenings ordered, based on clinical guidelines. Evidence supported the use of provider education to increase the number of mammograms ordered (Marks,2022).

Purpose: Increase the number …

Implementing A Fall Screen And Prevention Program In The Primary Care Setting: A Quality Improvement Project, Manpreet Singh

DNP Projects

Significance and Background: Falls are a major health concern in the inpatient and outpatient clinical setting. They are costly for our healthcare system and lead to a sequela of challenges for patients, families and society. These challenges include fear of falling, injury, reduced quality of life, disability and death. Within the primary care setting, a fall risk assessment is required as part of the Welcome to Medicare examination. Primary care providers are reimbursed through the Medical Annual Wellness Visit. The goal of this quality improvement project was to implement a fall risk screening and intervention too for primary care patients …

Pediatric Preoperative Fasting Guidelines Update And Education: A Quality Improvement Project, Brooklyn Mickolyzck

DNP Projects

Significance and Background:

Longer preprocedural fasting times in the pediatric population causes distress among children and their families and potentiates postoperative complications. Allowing children to consume clear liquids up to two hours prior to surgery improves satisfaction and decreases overall fasting durations. Current guidelines from the American Society of Anesthesiologists (ASA) allow preoperative consumption of clear liquids up to two hours prior to arrival time. However, preoperative nursing staff at an ambulatory surgery center in Northern, CT are educating patients parents and guardians to keep their children from having “nothing to eat or drink after midnight”.

Purpose: Develop a standardized …

Utilizing The Phq9 Survey To Improve Depressive Symptoms In Opioid Dependent Adults: A Quality Improvement Project, Taylor Fuhr

DNP Projects

Significance and Background: Opioid dependence continues to be a fighting battle in our country. While many individuals do well on maintenance therapy such as suboxone, they often are faced with comorbid challenges including depression and anxiety. Research shows that the risk for depressive symptoms in opioid dependent adults increases along with the duration of use and increase of dosage (Semenkovich et al., 2014). There is no consistency among depression screening for opioid dependent adults despite the research that suggests the two often coincide with one another. The goal of this quality improvement project was to implement routine depression screening using …

Application Of Teaching Regarding Injury Appearance In Darker Pigmented Skin Patients: A Quality Improvement Project, Tiffany Akiba

DNP Projects

Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Spirituality Education For End Of Life Clinicians: A Quality Improvement Project, Mark S. Valigorsky

DNP Projects

Significance and Background: The focus of this project was to strength the knowledge, comfort, and training of end of life(EOL) clinicians working with patients in the palliative care and hospice environments. While spirituality is considered one of the essential domains of hospice care, it is an area that is often brushed aside by staff and patients and their families. Spirituality is inadequately addressed due to knowledge deficits, time issues, and lack of self-efficacy. Addressing spiritual care is particularly important for patients with chronic and end stage illnesses. Patients and their families view spirituality as a way of coping with suffering. …

Evaluating The Impact Of A No-Show Policy: A Quality Improvement Project, Adrianne S. Harding

DNP Projects

Significance and Background: No- shows are a global problem that creates a significant challenge for the healthcare system. When a patient misses an appointment, it decreases health care staff productivity, creates a waste of resources and it negatively impacts revenue (Lance et. al, 2021). Current evidence supports interventions that incorporate voluminous data and artificial intelligence with strategies such as overbooking, appointment notification systems and financial incentives to reduce outpatient no-shows (Oikonomidi et al., 2022). This project will evaluate the impact of a no-show policy and provide insights to improve primary care attendance and inform decisions.

Purpose: To evaluate an outpatient …

Decreasing Hospital Readmission Rates Of Heart Failure Patients: An Evidence-Based Quality Improvement Project, Elizabeth Rodriguez

DNP Projects

BACKGROUND: Teach back is an evidence-based health literacy intervention that encourages patient engagement in own treatment, adherence to treatment, medications, and quality of care. Implementation of teach back method could positively impact readmissions to the hospital in patients experiencing heart failure and any other chronic diseases and it could improve patient’s outcomes.

OBJECTIVE: The objective of this project was to implement teach back method in a home care agency in the Hartford area in patients with HF to prevent readmission to the hospital.

METHODS: The IOWA model was used and PSDA as tools to support EBP project.

RESULTS: Pre and …

Preoperative Pain Management Education And Narcotic Use: A Quality Improvement Project, Sarah Scheller

DNP Projects

Introduction: Comprehensive preoperative education is an important aspect of pain management and helps empower patients prior to their surgery. Evidence supports the use of a combination of the teach-back method, videos, and pamphlets to educate patients prior to their surgery. A quality improvement project was initiated for patients having total shoulder arthroplasty surgery with an orthopedic surgeon in Connecticut.

Methods: An educational video and handout were created, and preoperative education sessions using the teach-back methods were performed. Postoperative phone calls were placed at 24 and 72 hours to assess the patient’s use of narcotic pain medication, alternative pain management medication …

Naloxone Education To Improve Distribution In Primary Care: A Quality Improvement Project, Joanna Boback

DNP Projects

Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.

Purpose: Deliver education to providers across the health system on best practices related to …

Implementation Of The Stop-Bang Screening Tool In The Primary Care Setting: A Quality Improvement Project, Thriciana Powell

DNP Projects

Significance and Background. There are approximately 25 million adults in the United States with obstructive sleep apnea (OSA). OSA is a sleeping disorder that is caused by periodic airflow blockage during sleep. It has been linked to numerous health problems and within the primary care setting OSA is not routinely screened for at visits. This leads to delayed diagnosis of a serious health issue and the potential for poor health outcomes. The STOP-BANG questionnaire (SBQ) is a simple eight-question tool that is used to screen patients for OSA. The STOP section focuses on snoring, tiredness, observed apnea, and high blood …

Reducing Urinary Catheter Usage In The Intensive Care Unit Setting And Education Related To Preventing Cautis: A Qi Project, Kristina Diurno

DNP Projects

Significance and Background: Catheter-associated urinary tract infections (CAUTIs) are common but preventable hospital-associated infections. The inappropriate and prolonged use of indwelling urinary catheters can pose a significant risk for patients and healthcare organizations. The Centers for Disease Control and Prevention identified that the most important factor related to an increased risk of CAUTI is the length of time an indwelling catheter remains in place. This DNP (Doctor of Nursing Practice) project assessed the barriers to removing indwelling catheters in the intensive care unit (ICU) while providing encouragement of prompt removal.

Purpose: Three aims were developed for this quality improvement project: …

Use Of An Alarm Bundle To Reduce Alarm Fatigue In The Icu: A Quality Improvement Project, Blerina Petitti

DNP Projects

Significance and Background: In the critical care setting, frequent false alarms can lead to sensory overload and delayed reactions to alarms (aka, alarm fatigue). Patients are at risk because overtime staff may ignore or become desensitized to all alarm sounds, even true ones.

Purpose: The purpose of this QI project is to establish alarm management protocol in a 14-bed ICU. The goals were to reduce alarm fatigue and create a safe environment for patients and clinical staff.

Methods: The Model of Improvement (IHI, 2023) with cycles of the Plan-Do-Study-Act (PDSA) was used to implement an alarm bundle checklist that …

Implementation Of A Patient Satisfaction Survey At A Free Community Clinic: A Quality Improvement Project, Nora O'Sullivan

DNP Projects

Background: The uninsured, underinsured, and underserved populations in the US are impacted by health disparities and have unique experiences with healthcare. Yet, settings which serve these populations – the “safety net”- are not adequately supported to gather patient experience data. In Connecticut, Fairfield County has a higher percentage of uninsured people than the overall state. Additionally, this population has demonstrated higher frequency of emergency department utilization than the overall population. Therefore, processes to measure the barriers to accessing quality care and patient experience and satisfaction with care are needed in safety net clinics to promote elimination of health disparities and …

Use Of A Worksite Physical Activity To Improve Subjective Daytime Sleepiness Among Night Shift Healthcare Workers: A Quality Improvement Project, Marthe Sooh Nkongo

DNP Projects

Background and Significance: Shift work including work schedules beyond the typical "nine-to-five," causes the disruption of sleep-wake behaviors (Healy et al., 2021). The circadian misalignment is a potential pathway for the development of metabolic diseases, excessive daytime sleepiness, sleep deprivation, and declines in alertness and performance among night shift workers (James et al., 2017; McHugh et al., 2020; Parry et al., 2018). Emerging evidence suggests that physical activity synchronizes the sleep-wake cycles (Healy et al., 2021).

Purpose: This quality improvement project (QI) aimed to improve night-shift nurses ‘subjective daytime sleepiness by incorporating a 4-week worksite walking activity during working hours. …

Sunscreen Is Not Just For White People: Church-Based Sunscreen Education For Black Women, Lauren Mitchell

DNP Projects

Significance and Background: African American women are an undeserved population in healthcare, particularly regarding skin cancer prevention. The lack of education and misinformation surrounding skin cancer has resulted in general mistrust of the healthcare system amongst African Americans. Proper education on sunscreen use and skin cancer screening is essential to prevent late diagnosis of skin cancer and to promote prevention efforts.

Purpose: This quality improvement project utilized evidence-based practice to provide education on the proper use of sunscreen and skin cancer screening to African American women in a faith-based setting in Southern Connecticut.

Methods: A pre-survey was conducted to assess …

Implementation Of An Activity Protocol In The Acute Care Setting: A Quality Improvement Project, Crystal M. Ryan

DNP Projects

Background: Physical activity following cardiothoracic surgery can help decrease post-operative complications, expedite functional recovery, improve overall well-being, shorten hospital length of stay (LOS), and reduce morbidity and mortality (Miwa et al., 2017). Of these patients, 58% developed complications after cardiac surgery; of these complications, 31% were pulmonary, 16% were of cardiac in nature, and 14% were neurological (Yayla, 2018).

Purpose: This quality improvement project aims to implement an evidence-based protocol for evaluating the correlation between physical activity in uncomplicated post-operative coronary artery bypass and length of stay.

Methods: The Plan-Do-Study-Act (PDSA) tool from the Institute for Healthcare Improvement (IHI) guided …

Implementation Of A Daily Central Line Maintenance Audit Form In An Outpatient Infusion Center: A Quality Improvement Project, Sarah E. Christiana

DNP Projects

Significance and Background: Best evidence supports central venous access device (CVAD) dressing changes occur every 7 days or sooner, if indicated. At a community hospital in New England, patients receive outpatient antimicrobial therapy via CVADs. It is vital that nurses adequately maintain CVAD dressings according to evidence-based protocols to reduce the risk of central line-associated bloodstream infection (CLABSI). CLABSIs, associated with increased morbidity, mortality, and health care costs, are largely preventable through proper CVAD maintenance. At the project site, a review identified that dressing changes were frequently changed beyond the 7-day parameter. Documentation and surveillance processes were identified as opportunities …

Optimizing Npo Times In Infant Outpatient Surgical Patients, Julie Colangelo Ward

DNP Projects

Background: All patients are standardly kept NPO prior to surgery to minimize aspiration risks. Increased NPO times for infants has been found to lead to patient distress, hemodynamic instability, ketoacidosis and acid-base imbalances. Optimizing NPO times for young pediatric patients helps to decrease fasting times, which minimizes the safety concerns listed above.

Objectives: The objective of this project was to implement specific education instructions to parents of infants during the pre-operative phone calls and confirm their understanding of this education through the teach-back method.

Methods: The intervention for this project added educational instructions with a teach-back question into the verbal …

Medical Device-Related Pressure Injury (Mdrpi) Prevention In The Intensive Care Unit (Icu): An Evidence Based Practice Quality Improvement Project, Sana Shah

DNP Projects

Introduction: All intensive care unit (ICU) patients utilize various medical devices for care and treatment, placing them at high-risk for medical device-related pressure injuries (MDRPIs), which can lead to life-threatening infections, wounds/scars, and consumption of additional time and products to rectify these issues. Lack of appropriate decompression measures and improper bedside handoff report was recognized in the ICU at a hospital in Connecticut (CT).

Method: A literature search using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews was conducted, restricting the search to the period between 2018-2022. The keywords searched were: “pressure injuries,” “adult patients,” “intensive care …