Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …

Lean Management Principles To The Creation Of Postpartum Hemorrhage Care Bundles, Bethan Faulkner

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH …

Innovative Approach To New Nurse Residency, Meaningful Use And Health Care Reform, Pamela V. Stanley

Doctor of Nursing Practice (DNP) Projects

The project’s aim was to examine the financial impact of replacing registered nurse (RN) travelers, RN registry and RN overtime with new graduate RNs. Newly graduated RNs are often viewed by hospital administrators as a more costly staffing resource. This project contributes knowledge regarding the potential cost savings with the utilization of a centralized float pool incorporating new graduates. In addition, it contributes a novel idea for reducing organizational costs of implementing an electronic medical record with the utilization of new graduates as super users.

A new graduate program, which incorporated the use of a formal preceptor and mentoring program, …

Improving Value Based Purchasing Through The Implementation Of The Clinical Nurse Leader Role: The Chief Nursing Officer’S Case For Change, Leanne M. Hunstock

Doctor of Nursing Practice (DNP) Projects

The healthcare industry is focused on the implementation of the Affordable Care Act, the payment reform package from Centers for Medicare and Medicaid Services and the development of Accountable Care Organizations. The decisions, behaviors, and practices of medical and clinical staff directly impact patient care, quality, and subsequently cost and reimbursement. The imperative to balance quality and patient safety with cost effectiveness requires a complex orchestration of all the elements of care within the clinical microsystem. A priority is to support and enable bedside nurses’ daily practice, priorities, and decision-making. This can be accomplished through the implementation of the Clinical …

The Design, Implementation And Evaluation Of A Technology Solution To Improve Discharge Planning Communication In A Complex Patient Population, Susan M. Manfredi

Doctor of Nursing Practice (DNP) Projects

Unnecessary delays in discharge planning can extend the length of stay (LOS) and add non-reimbursable days for socially and medically complex patients thereby increasing the financial burden to healthcare organizations. The literature supports enhanced discharge communication strategies and the use of checklists to facilitate safe and timely discharges. Following root cause analyses of significant discharge delays, one hospital identified gaps in communication as key precursors associated with discharge planning breakdown when discharging patients to skilled nursing facilities. Review of these events demonstrated the need for concurrent communication strategies between multidisciplinary care team members in planning for complex discharges.

Following a …

Transforming The Journey For Newly Licensed Registered Nurses: A Community Based Transition-To-Practice Program In Ambulatory Care Settings, Cathryn A. Halford Dnp

Doctor of Nursing Practice (DNP) Projects

Abstract

In response to the job shortage for newly licensed registered nurses (RNs), transition to practice and residency programs have been established in many areas of the country including the San Francisco Bay Area. The programs were designed as demonstration projects to assist new graduates by increasing their competence, confidence, and skills, and their employability. Evidence from new graduate programs suggests that the programs provide an important bridge that is necessary for the critical transition from classroom to clinical practice and from newly licensed RN to qualified nursing professional. The University of San Francisco (USF)

Transition-To-Practice (nurse residency) program in …

The Creation And Implementation Of Interprofessional Simulation Leadership Scenarios, Angeline C. Delucas

Doctor of Nursing Practice (DNP) Projects

Healthcare is in a historical state of change creating an era that requires superior leadership skills. Leaders face burgeoning challenges in a competitive environment ensconced in reform. Today’s dynamic healthcare environment demands that nurse and interprofessional leaders be astute in a variety of areas including: fiscal responsibility and accountability, organizational politics, interpersonal skills, human resources, communication, conflict resolution, and emotional intelligence. Some areas such as fiscal management are considered hard skills, or skills which can be taught, while others such as conflict resolution are referred to as soft skills, or skills that are learned through experience. Though soft …

Influencing Change In Healthcare Providers: Communication Strategies For A New Era In Healthcare, Ceonne Raasikh

Doctor of Nursing Practice (DNP) Projects

Effective provider communication is the key to patient engagement. However, many providers are not able to effectively communicate with patients, in part due to low health literacy. Evidence in the literature supports the use of specific strategies aimed at improving communication with patients. The purpose of this quality initiative was to influence providers to adopt new communication strategies with their patients. Pharmacists, nurses and physicians were invited to participate in a free, full-day, educational event. During the event providers were alerted to the issue of health literacy and provided communication strategies to improve patient comprehension and engagement. Following the presentation, …

Improving The Implementation Of The Acute Care Nurse Practitioner (Acnp) Role: Development Of Acnp Role Implementation Guidelines, Megan Elizabeth Liego

Doctor of Nursing Practice (DNP) Projects

With the implementation of the Patient Protection and Affordable Care Act (PPACA) and the Value Based Purchasing (VBP) initiative, hospitals and the health System have rolled out a strategic goals of focusing on meeting the VBP objectives and standardizing care within their hospitals. To help meet these goals and improve patient care, many hospitals have looked toward the implementation of the acute care nurse practitioner (ACNP) role in the hospital setting. There is a lack of guidelines, though, on how to implement the ACNP role. This has led to several barriers, which have created variation in practice and outcomes across …

Interprofessional Roles Shoulder Dystocia: Maximizing Safety In Community Hospitals, Elizabeth Yznaga

Doctor of Nursing Practice (DNP) Projects

Prompted by evidence that clinical simulations improve patient safety, team simulations are emerging in hospital settings. Accrediting organizations such as the U.S. Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists (Joint Commission, 2004, American College of Obstetricians and Gynecologists, 2002) have recommend simulation of obstetrical emergencies, including shoulder dystocia for hospital teams. National patient safety mandates for simulation training of critical events have not been available to small, rural hospitals because of lack of talent and equipment, creating a gap in resources. Other than demonstrations by manikin companies, this author has currently been …

Improving Advance Directive Completion Rates In The Primary Care Setting, Esperanza Donahue

Doctor of Nursing Practice (DNP) Projects

As technology has improved and the ability to artificially prolong life has increased dramatically, so has the need to draw attention to end-of-life care issues (Duke, Thompson, & Hastie, 2007). The Federal Patient Self-Determination Act (PSDA) of 1991 first brought attention to the importance of advance directives (ADs), (Government, 1995). Increasing the focus on advance directives for adult patients in the primary care setting could assist in increasing completion rates, prior to hospitalization.

The purpose of this project was to test a model to increase AD completion rates, to provide more complete patient centered care. Many programs and interventions have …

Sexually Transmitted Infections Among College Women Secondary To High Risk Behaviors Related To Lack Of Behavioral Health Interventions, Jennifer M. Brouillette

Doctor of Nursing Practice (DNP) Projects

OBJECTIVES: The goal of this doctorate of nursing practice (DNP) capstone project was to bridge the research gap on the problem of increased risk of sexually transmitted infections (STIs) including immunodeficiency virus (HIV), human papillomavirus (HPV), chlamydia, gonorrhea, and genital herpes among college women, ages 18-25 years, related to high risk sexual behaviors. Although a review of the literature reports that this population is provided with educational opportunities, including prior schooling, electronic resources, and primary care providers, rates of STIs among this population remain high. The purpose of this research translation project is to disseminate the current evidence of the …

The Blood Pressure Effect Of The Addition Of The Dash Diet And Exercise To The Treatment Plan Of Both Pre-Hypertensive And Hypertensive Rural Adults, Marian Michel

Doctor of Nursing Practice (DNP) Projects

Hypertension is a significant problem in the United States. This is especially true of rural populations who have diets high in saturated fat and sodium and low in fruits, vegetables and potassium. Furthermore, research has shown that a large number of rural residents do not engage in regular physical activity. These lifestyle characteristics have been associated with increased blood pressure and the risk for the development of cardiovascular disease. Conversely, adoption of the Dietary Approaches to Stop Hypertension (DASH) diet and exercise has been associated with decreases in blood pressure in pre-hypertensive/hypertensive patients. Purpose: The purpose of this project was …

Road To Health Diabetes Program, Alicia Johnson

Doctor of Nursing Practice (DNP) Projects

Diabetes is a major health problem in the United States. Individuals with diabetes are at greater risk of developing other health problems such as heart or kidney disease. African Americans are at 1.8 times greater risk of developing diabetes, and they suffer more severe consequences and complications from the disease. One major reason for poor outcomes in African Americans with diabetes is a lack of knowledge and understanding of the disease process and sequelae of diabetes. This DNP scholarly project focused on implementing a culturally sensitive diabetes education program in the hope of improving glycemic control among participants. The project …

Motivational Interview Intervention Use In Discharge Teaching Of Heart Failure Patients, Jason O'Brien

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Evidenced Based Asthma Education Intervention For Adults In A Primary Care Setting Using Self Management Guidlines, Jeanette Toro-Linnehan

Doctor of Nursing Practice (DNP) Projects

Using the standard of treatment for asthma developed by the expert panel reports from the National Heart, Lung, and Blood Institute allows a clear roadmap to patient centered control(National Heart Lung And Blood Institute, 2007). A focus on proper diagnosis and control of a patient’s asthma, using self-management tools that will allow the patient to partner with their primary care provider is crucial to successful control of this disease (Safety Net Medical Home Initiative, 2010). In order to achieve this, educational interventions on control and reduction of exacerbations was taught in a primary care practice/medical home under the direction of …

Improving Provider Adherence To Recommended Cervical Cytology Screening Guidelines, Amanda K. Worcester

Doctor of Nursing Practice (DNP) Projects

Cervical cancer is the second most common malignancy that affects women worldwide (WHO, 2011). Adherence to cervical cancer screening practice guidelines and use of high-quality screening practices by primary care providers (PCPs) can reduce associated rates of morbidity and mortality. With recent changes in practice guidelines stemming from evolving scientific evidence suggesting more frequent screening for cervical cancer leads to overtreatment, providers have not fully adopted newer, less frequent testing when indicated for otherwise healthy women. This research translation project involved the assessment of adherence to cervical cancer screening guidelines of 9 primary care providers (7 physicians and 2 nurse …

Network Of Learning For Pediatric Palliative Care: A Pilot Project, Margaret R. Nelson

Doctor of Nursing Practice (DNP) Projects

In the past ten years, pediatric palliative care has evolved. Notre Dame Pedi Pals is a new venture providing pediatric palliative care for Notre Dame Hospice. Presently in Massachusetts an infant dies daily devastating the family (Massachusetts Department of Public Health, 2013). Collaboration and coordination of care is a common concern for these families who are difficult to identify and study, so that the measure of the effects of this care is challenging. Coordination and assistance with this aspect of care is viewed positively by parents of a similar group of children suffering from major chronic, life-altering diseases (Data Resource …

Improving Compliance With Healthcare Associated Infection (Hai) Practice Guidelines To Reduce The Acquisition Of Hais, Nelia Bruce

Doctor of Nursing Practice (DNP) Projects

Healthcare Associated Infections (HAIs) have been estimated to be in the millions, directly associated with 99,000 deaths and costing nearly $28 to $33 billion in excess health care costs each year (AHRQ, 2011; Scott, 2009). The literature indicates that healthcare workers are aware and understand that their patients are susceptible to HAIs and that they themselves can affect patient outcomes. However, despite this awareness and the existence of evidence based HAI guidelines there are clear gaps between what is recommended and practiced, greatly impacting the acquisition of HAIs. The objective of this capstone project was to assess for gaps between …

Increasing Knowledge About Hpv And The Hpv Vaccine Amongst Adolescents And Adults Through A School-Based Setting: A Capstone Project, Denise Barry

Doctor of Nursing Practice (DNP) Projects

Infection with human papillomavirus (HPV), the sexually transmitted virus that causes cervical and other types of cancer, can be prevented. A safe and effective vaccine has been approved for both boys and girls. Despite this recommendation and alarming rates of HPV-associated cancers, vaccination rates among adolescents in the United States are low. A capstone project was implemented to target students and parents of students who attend Holyoke High School and William J. Dean Vocational Technical High (Dean Tech) in Holyoke, Massachusetts. The goals of the project were to improve knowledge about HPV and the HPV vaccine in students and parents, …