Medicine and Health Sciences Commons^™

Improving Triage Accuracy In The Emergency Department, Joselyn Silverman

Master's Projects and Capstones

Problem: High rates of patients being mis-triaged was occurring at Hospital X leading to poor patient outcomes and incorrect staffing levels.

Context: This quality improvement project took place at Hospital X’s emergency department. A stakeholder analysis and a microsystem assessment along with a staff survey was created in order to determine areas of improvement and staff responsiveness.

Interventions: Eight educational seminars were conducted along with Hospital X leadership and students created supplemental materials for the staff to use on a daily basis.

Measures: Two data pulls were conducted over the course of the quality improvement project; one prior to the …

Increasing Sepsis Bundle Compliance Through Nurse Education, Parth S. Papaiya

Master's Projects and Capstones

There exists opportunities for improvement in regards to sepsis management and compliance rates in efforts to reduce sepsis-related complications and incidents in the ED. SEP-1 fallouts and requirements linked to education gaps about sepsis bundle protocols, nurses’ attitudes about implementation of the protocols, and differences in nurse/physician order sets present as deterrents for timely sepsis management and improvements in the rates of compliance/adherence. Denouncing the usage of standardized protocols/use of order sets have been identified as a process gap and a much needed opportunity for improvement. It is presumed that the failure to implement, in addition to improper documentation of …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Amanda H. Tran

Master's Projects and Capstones

Problem: According to a pre-survey collected, approximately six percent of medical-surgical nurses report expert knowledge with the “Inpatient Handoff Sepsis Bundle Checklist,” a checklist that details interventions to be taken when a patient is diagnosed with sepsis. About thirty-five percent of these nurses also report expert confidence levels in caring for sepsis patients. Therefore, there is an opportunity to provide education so that nurses may confidently and competently care for sepsis patients.

Context: A medical-surgical unit at Hospital A affiliated with a large, non-profit, integrated healthcare system located in the San Francisco Bay Area.

Intervention: Create an educational handout to …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Addressing Critical Care Nurse Burnout, Julie Suarez

Master's Projects and Capstones

Problem: Critical care nurses are at higher risk for developing burnout than nurses from other areas of clinical practice. If not addressed promptly, the problem of burnout can worsen, negatively affecting the healthcare provider, organization, and patient outcomes.

Context: Increased stress and burnout observed in the microsystem with the onset of the COVID-19 pandemic prompted consideration of ways to address the well-being of critical care nursing staff with targeted interventions that could be implemented quickly with readily available resources.

Interventions: The project aim was to reduce critical care nurse burnout scores through implementation of evidence-based strategies addressing participative management, camaraderie …

Implementing In-Situ Mini Mock Code Trainings For Medical-Surgical Nurses To Improve Nurse Readiness And Self-Confidence During A Code Blue, Allison Haley Jeong

Master's Projects and Capstones

Immediate, high-quality cardiopulmonary resuscitation (CPR) and early defibrillation are important in increasing survival rates during a cardiac arrest. At the Medical Center, which is part of an integrated healthcare system in a metropolitan area of the San Francisco Bay Area, a quality improvement project was implemented to increase readiness and self-confidence of medical-surgical nurses during a code blue situation. Nurse participants completed a pre- and post-intervention survey containing questions about their self-confidence in performing different skills relevant to a code blue, scored on a 5-point Likert scale from Strongly Disagree (1) to Strongly Agree (5). The intervention included an in-service …

Preceptor Education And Structured Onboarding Process, Charles Morato

Master's Projects and Capstones

Problem: Staff nurse retention is an ongoing problem for this intensive care unit (ICU). Through exit interviews from staff who left, inadequate onboarding and education made them feel unprepared for their job and not part of the team. The preceptors on the unit have never been trained on the roles and responsibilities of being a preceptor. The current onboarding process consists of pairing new hires with a preceptor who either happens to be willing to do it that day or someone who has been there the longest. There is no consistency or personalizing the orientation information to the new hire. …

Compounding Effects Of Reducing Nurse Burnout And How It Can Produce An Increase In Patient Safety And Satisfaction, Alexander Mua

Master's Projects and Capstones

The reduction of nurse burnout has shown to have an increase in patient satisfaction and quality of care. It also has shown a decrease in patient-related or sentinel events. Accordingly, with the reduction of nurse burnout, there has also been a reduction of compassion fatigue. This project has illuminated the benefits of acuity-based caseload at the micro-level, including the cost-effective nature of overtime pay, including HCHAPS benefit score. The method of obtaining, planning, and implementing was based on the Plan, Do, Study, Act (PDSA), which required collaboration amongst multiple disciplines, groups, departments, and executives. The process and goals concluded to …

"Rise And Shine" Early Ambulation In Surgical Patients, Bhapinder Thiara

Master's Projects and Capstones

Abstract

An assessment done in a hospital unit established low rates of early ambulation for patients in postoperative care. At the same time, early ambulation after surgery has been shown to improve clinical outcomes and patient satisfaction. Some of the factors for the low rates of early ambulation include inadequate nurse staffing, poor teamwork, and the inability to utilize technology effectively. Consequently, a project was designed to empower nursing staff, promote interprofessional collaboration, and obtain technologies for ambulation. It is expected that the project will improve rates of early ambulation and lower hospital length of stay.

Improving Nursing Communication Outcomes Through The Tell-Us Card, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes, Jeffrey Salao

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Improving Nursing Communication Outcomes Through The Tell-Us Card, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Jillian Cule, Maricarmen Reyes

Master's Projects and Capstones

Abstract

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined …

"Improving Nursing Communication Outcomes Through The Tell-Us Card", Jillian Cule, Jeffrey Salao, Nina Park, Laura Le, Brittney Pilker, Maricarmen Reyes

Master's Projects and Capstones

Nursing communication plays a pivotal role in patient-centered care. However, statistics have shown that failures in communication exist in more than 20% of all hospital settings (Sethi & Rani, 2017). Within the explored microsystem, a gap in patient communication was identified through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Reports revealed that the microsystem was performing at 69%, which is 11% below the national average for nursing communication (Centers for Medicare and Medicaid Services [CMS], 2018). After performing a microsystem assessment, there was a measurable communication opportunity between the patients and nurses. It was determined that …

Implementing A Telephone Triage System, Joanyett Mays-Scott

Master's Projects and Capstones

Implementing a Telephone Triage System

Abstract

Introducing a telephone triage system requires conscientious regard to the organizational configuration and culture, staff abilities and experience, observed need and expected outcomes, staffing issues, and the physical location in which the system will be introduced (Murdoch et al., 2015). For this microsystem A SWOT analysis and microsystem assessment were performed. This community health center’s goal was to have standardized, evidence-based triage protocols followed by the nursing staff and the contracted nursing staff. The workflow was introduced in a series of lunch and learns provided by clinical nurse managers. Once workflows were established a …

Reducing Inter-Unit Patient Report Delays And Transfer Times, Natalya Marinov

Master's Projects and Capstones

Inter-unit coordination is essential in preventing a bottleneck in patient flow and its resultant stresses to staff, hindering quality patient care, and wasting time. The Medical-Surgical Unit (MSU) and Post Anesthesia Care Unit (PACU) struggle to establish efficient patient report times and transfers. Preliminary data demonstrated report delays attributed to an arduous workload and overburdened MSU nursing staff. The project’s objective focuses on reducing nurse-related report time delays by 10%, increasing understanding and teamwork, promoting proactive thinking to manage workflow efficiently, improving patient flow, and improving the inter-unit relationship between MSU and PACU. Increasing awareness and reducing transfer times are …

Fall Prevention, Linda Fang

Master's Projects and Capstones

Fall Prevention Abstract

Background: According to the CDC, the medical cost for falls was approximately $30 billion in 2012. When a patient falls, and gets serious injury, these costs could sum up to $14,056 per patient. As a result, hospital stays per patient are observed to increase by approximately 6.3 days longer than those patients who haven’t encountered falls.

This study focused on identifying high fall risk patients, and developing a plan of care to reduce the occurrence of falls in a hospital setting. Nurses using safe fall interventions techniques have been proven to inspire fall preventions.

An assessment of …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Improving Communication And Satisfaction Through Hourly Rounds, Karen E. Sondeno

Master's Projects and Capstones

The focus of this CNL project is quality improvement using high quality hourly rounds to achieve improved patient satisfaction and communication with nurses. It was determined by reviewing survey results that patient satisfaction and nurse communication is below National levels. Data shows that rounds are not being done well on a medical unit before the improvement project. It is proven that patients receive and perceive higher quality care and communication with increased nurse presence at the bedside. The population of the medical unit has high numbers of confused/dementia, and dual-diagnosis patients. It was determined that the unit would benefit from …

Improved Satisfaction On Postpartum Unit By Implementing A Discharge Nurse Role, Nicole Ware Rn, Msn

Master's Projects and Capstones

A three-month time period was used to develop a postpartum education program change by designing a discharge nurse role on the postpartum unit at University of North Carolina Women’s Hospital. The goal of the education change is to increase patient satisfaction scores of discharged post-natal mothers on the postpartum unit by having HCAPS and Press Ganey to improve up to10% over the next 6 months.

An observational assessment revealed a fragmented and antiquated discharge process. This process was paper based and difficult to complete in light of the short stay and high volume patient population. Informal nurse feedback as well …

Just Sit For A Bit: A Moment Of Caring, Gabrielle M. Malouf

Master's Projects and Capstones

Background: Research shows that time spent sitting at the bedside promotes trust, which ultimately improves nurse satisfaction, patient satisfaction and patient outcomes. Patient satisfaction scores have been below benchmark for several months on an adult medical unit at an academic medical center.

Overview: The purpose of this project was to improve patient satisfaction in the areas of nursing courtesy, friendliness, and listening. Nurses were asked to sit down for at least 5 minutes per shift with each patient, engaging in a “moment of caring”. Nurse surveys were given and both pre and post implementation. These surveys assessed whether or not …

Improving Nurse Education On Research Informed Consent, Tina Rasooli

Master's Projects and Capstones

As the number of human participants in clinical trials continues to grow, it is increasingly imperative that research nurses are educated about valid research informed consent to improve patient outcomes. As patient advocates, nurses must be aware of the components and principles of valid informed consent in order to protect the rights, safety, and wellbeing of their patients as human subjects. The research nurse must also be aware of their available resources and who to contact if they suspect a problem or a lack of patient comprehension of the study. In order to address these needs, an evidence-based performance improvement …