Medicine and Health Sciences Commons^™

Ultrasound Guided Piv Insertion Implementation, Blake Hotchkiss, Beth O'Donnell, Miles Merwin, Billie Jo Senecal, Ronica Smith, Eric Alan, Bryan Tavary, Chelsea Harkins, Taylor Archard, Leslie Geissinger, Lauren Remington

Operations Transformation

Observed high number of unsuccessful peripheral IV insertion attempts. This increases waste (cost and time) and decreases patient satisfaction.

Care Of The Critically Ill Nontrauma Patient: Improving Emergency Department Readiness And Patient Care Through The Implementation Of A Dedicated Resuscitation Bay, Martha H. Buck Rn, Bsn, Tcrn

Doctor of Nursing Practice Final Manuscripts

Current best practice among emergency departments worldwide includes the maintenance of a dedicated resuscitation space. This practice allows for team members and equipment to be ready at a moment’s notice to provide care to a patient in need of lifesaving interventions. This evidence-based performance improvement project seeks to implement this standard of care in a busy, urban emergency department in Southern California.

Prior to this study, patients at this facility were placed in the next available care space, without the maintenance of a dedicated resuscitation area for critically ill patients. Survey data evaluating staff levels of perceived readiness to care …

Development And Implementation Of An Evidence Based Practice Guideline Related To The Management Of Adult Angioedema, Megan Przybysz

Doctor of Nursing Practice Scholarly Projects

Angioedema (AE) is a potentially life-threatening medical condition that occurs with a higher frequency than medical providers may expect, with the emergency department (ED) serving as the usual first point of medical contact for patients. Any hesitation in recognizing AE or inconsideration of the disease process in differential diagnoses may lead to a dangerous delay of care. Due to the potential rapid progression of airway obstruction in AE, inexperienced providers should not attempt intubation, instead deferring to providers experienced in alternative airway techniques (i.e., anesthesia providers). The primary goal of this project is to develop an evidencebased practice guideline for …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Monica P. Rabago Moreno

Master's Projects and Capstones

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths as well as hospital length of stays.

Context: A microsystem assessment, in the emergency department (ED) unit, was performed in Hospital A located in the Greater San Francisco Bay area by Clinical Nurse Leader (CNL) students. This ED unit cares for a variety of critical care patients ranging from urgent to life-threatening conditions.

Intervention: An intervention was not implemented in the ED unit due to time constraints and limitations; however, CNL students provided recommendations …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Oscar J. Castillo

Master's Projects and Capstones

Problem: The Quality Improvement (QI) Project focused on improving early sepsis management and sepsis bundle adherence among Emergency Department (ED) nurses to decrease sepsis mortality rates and avoidable length of hospital stays (LOS).

Context: A group of Clinical Nurse Leaders (CNL) students evaluated sepsis protocol compliance at Hospital A's ED, which provides critical care for patients with various medical conditions. The CNL students concentrated on patients identified with sepsis for the QI Project.

Interventions: Limitations and time did not allow for the implementation of interventions. Recommendations offered to management included increasing sepsis training biannually and intravenous placement skills, offering sepsis …

Initiating A Skin-Care Bundle In The Emergency Department To Decrease Hospital-Acquired Pressure Injuries In Geriatric Patients, Suzanne Babcock, Pamela Hardesty

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Adults 65+ comprise 15.2% of the United States (U.S.) population and 17.9% of Emergency Department (ED) visits. Aging causes changes to skin, including thinning and loss of elasticity. Annually, in the U.S., 2.5 million individuals develop Pressure Injuries (PI), causing 60,000 deaths. Hospital acquired PIs in the U.S. cost $26.8 billion annually, over $10,000/patient and increase the length of stay by greater than four days.

LOCAL PROBLEM: This project occurred in a 27-bed Geriatric Accredited Emergency Department in a southeastern U.S. city where patients 65+ comprise 40% of the patient volume annually. PIs can begin developing within two hours. …

A Provider In Triage To Decrease “Left Without Being Seen”: A Benchmark Project, Taylor B. Weathers

MSN Capstone Projects

As Emergency Departments (ED) continue to fill and become crowed, the attention to care of each patient can be delayed or missed. Back flow into the ED can cause a bottleneck effect for patients coming in, which can lead to an increase in the number of patients who leave without being seen (LWBS). In order to combat the challenges of patient throughput that result in patients leaving prior to care, I am proposing the implementation of a provider in triage (PIT). By placing a provider, either physician or mid-level practitioner, in the triage area will allow patients to been seen …

Characterization Of Patients With Type 2 Diabetes Admitted For Acute Heart Failure During The Covid-19 Pandemic, Paola Delahoz, Karen Corrales, Justin P. Cagulada, Jessica Cardona, Jasmin Qyyum, Venessa Rodriguez, Catherina Chang Martinez

Nursing & Health Sciences Research Journal

Background: Cardiomyopathy (CMP) and heart failure (HF) are serious health conditions that impact millions of Americans, including people with Type 2 Diabetes (T2DM). The COVID-19 pandemic presented disruptions, yet it is unclear how it affected those living with T2DM and HF. This study aimed to describe the demographic and clinical characteristics of patients with T2DM and CMP who were hospitalized with acute heart failure (aHF) during the COVID-19 pandemic. Methods: Retrospective study of 288 adults with aHF between May 2020 to June 2021. Descriptive statistics were used to summarize the characteristics of adults hospitalized at a non-profit community hospital in …

How Nurses Perceive Their Task Load When Caring For Behavioral Mental Health Patients In The Pediatric Emergency Department, Emily Cameron, Robert Cornette

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Introduction: Pediatric behavioral mental health patients are being seen more frequently in the emergency department setting. With this ever-growing number of cases comes the need for trained staff, including registered nurses, to care for these children during a mental health crisis. With this increase comes increased stress of nurses’ workload. The purpose of this project was to identify nurses’ perceptions of their workload when completing three identified tasks: communication, procedures, and initial intakes. Methods: The National Aeronautics and Space Administration (NASA) Task Load Index tool was used to measure nurses’ perceptions of how difficult each task was to complete. …

Improving Safety In The Emergency Department: Utilizing Metal Detectors To Mitigate Weapon Possession, Jonathan Garcia

MSN Capstone Projects

Today’s high risk-healthcare environment has prioritized patient safety with great initiatives and, unfortunately, placed staff safety second. However, safety for both groups should be equal priorities. Evidence suggests that Emergency Departments (ED) often care for patients with a history of crime and mental health diagnoses, creating an environment where the threat of violence and weapons is increasingly prevalent compared to other clinical settings. (Erlyana, 2019) Risk mitigation is possible if we consider studies by Malka et al. (2015) and Laidlaw et al. (2017) that indicate the efficacy of metal detectors in accurately identifying concealed weapons. To improve clinician and patient …

Improving Initial Lactic Acid Compliance Of Suspected Septic Adults In A Rural Emergency Department, Nataleigh Jones

Doctor of Nursing Practice Projects

Background: Sepsis remains one of the leading causes of death in hospital settings. The doctor of nursing practice (DNP) project demonstrated areas that the hospital is doing satisfactorily with compliance and many areas for improvement within the organization regarding sepsis compliance. The DNP project demonstrated the effectiveness of the sepsis best practice advisory (BPA) tool in increasing sepsis bundle compliance in the emergency department (ED).

Purpose: The purpose of this DNP project is to help aid in the early recognition of sepsis and improve initial lactic acid compliance in a local emergency department. Many tools help with the early recognition …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader

Master's Projects and Capstones

Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.

Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.

Intervention: A video was created …

An Emergency Department Resource Nurse Checklist, Aaron Tucker

Doctor of Nursing Practice Scholarly Project

Introduction: Like many hospitals across the country, a Southwest Missouri hospital emergency department (ED) is frequently crowded with patients. The resource nurse role is one method EDs use to help manage surges in patient care. A resource nurse is a registered nurse whose dedicated role it to help other nurses in the unit. Unfortunately, there are no specific written expectations to guide the resource nurse. The nurse often waits to be needed and productivity and dependability are highly variable. Purpose: Implementation of a checklist could prompt the resource nurse to be more productive, will provide written expectations for the role, …

Education In The Emergency Department For Cardiac Conditions, Shelby Thomason

Nursing | Student Research Posters

In the United States 610,000 people die every year from coronary artery disease which equates to 1 in 4 deaths. Inequity in access to healthcare is a persistent issue that impact patient outcomes. Tracking adherence and patient outcomes can be challenging, especially for patients who may not have access to necessary resources or support. Nurses are often overworked and have limited time to provide in-depth education. Patients and their families often struggle to afford caregivers or other resources that can help manage these chronic cardiac conditions.

Establishing A Protocol To Address Workplace Violence And Increase The Perceptions Of Safety Among Emergency Department Nurses: A Quality Improvement Initiative, Devan M. Robidoux

Master's Theses and Capstones

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse's job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally …

Reducing Suicide Reattempts With A Telephone Follow Up Program, Bailey Breaux

MSN Capstone Projects

Suicide is one of the leading causes of death in the United States. Most people can say they know at least one person who has committed suicide or has considered suicide. The number of deaths continues to rise, and they aren’t stopping anytime soon. Many of these patients visit emergency rooms around the country seeking help for their depression and suicidal ideation. Some are brought into the emergency department following a suicide attempt and their visit only predicts another one happening in the near future. Some hospitals around the globe has tried to stop this recurrence of suicide reattempts by …

Stop The Bleed And Seize Control: Educating Emergency Department Staff On Maternal Hypertension And Hemorrhage, Mayra A. Portillo-Guerra

Master's Projects and Capstones

Problem: A Not-for-Profit Hospital accredited by the Joint Commission was fined for not having a current policy or procedure set in place for the treatment of obstetric emergencies. This quality improvement project implemented a simulation and a training video to prepare Emergency Department (ED) nurses and clinical staff for the awareness of preeclampsia and postpartum hemorrhage (PPH).

Context: This quality improvement project was implemented in two different Emergency Room locations for this Not-for-Profit Hospital. One of the campuses does not have a Labor and Delivery (L&D) unit while the other one does. The overarching goal is to increase awareness of …

Stop The Bleed And Seize Control: The Use Of Simulation In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage: A Quality Improvement Project, Raquel Andreina Torres

Master's Projects and Capstones

A quality improvement (QI) initiative was geared to assess and prepare Emergency Department (ED) nurses and clinical staff preparedness of pre-eclampsia and postpartum hemorrhage (PPH). The Non-Profit Hospital, with two different Emergency Room locations, currently does not have a Labor and Delivery (L&D) unit at one of their campuses. Additionally, there is no current policy or procedure set in place for the treatment of preeclamptic or postpartum women in the emergency room. As a direct result of The Joint Commission (TJC) standards and a very short timeline, a group of University of San Francisco Clinical Nurse Leader (CNL) graduate students …

Using Simulation To Develop Clinical Judgment In New-To-Practice Emergency Department Nurses: An Evidence-Based Benchmark Project, Moreno Divine Comiskey

MSN Capstone Projects

In the past 6 months, the Emergency Department at the George Washington University Hospital has onboarded over twice as many new-to-practice nurses as experienced emergency nurses. Studies suggest that these new-to-practice nurses often are deficient in clinical judgment, and our observations at our hospital support these findings. Researchers have found that onboarding programs that include simulation have success in improving clinical judgment, and advocate for its use. Simulation gives another angle to the onboarding program in addition to preceptorship and classroom learning, and allows participants to bridge the gap between theory and practice safely and without fear of harming a …

Implementing Sbirt In A Critical Access Emergency Department, Warren P. Mcdermott, Mary Val Palumbo Dr.

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Universal screening and brief intervention with referral to treatment (SBIRT) has become best practice for emergency departments (EDs) over the last two decades. Given the prevalence of alcohol use and the subsequent health impacts of drinking, EDs are well positioned to be on the front line of screening for risky drinking. The available literature is clear in its consensus that universal screening for alcohol use in the ED is critical to identifying people at high risk for drinking and improving health outcomes.

Aims: This project aimed to implement an SBIRT process in a critical access ED. To achieve this …

The Effects Of 465nm Blue Light On Sleepiness & Fatigue, Mark E. Childress

DNP Research Projects

Abstract

Background: Exhaustion is now accepted in nursing culture. Staff suffering from sleepiness and fatigue are more likely to commit medical errors and sentinel events. Emergency department nurses have the greatest risk of committing these errors. Currently, there is no relief provided to shift workers beyond a single 30-minute meal break within a 12-hour period. Other researched mitigation strategies have either failed or are unrealistic in this environment.

Local Problem: Emergency Department nurses at Parkridge Medical Center in Chattanooga, TN suffer from chronic sleepiness and fatigue that is exacerbated by shift duration, excessive workload, a stressful environment, and lack of …

Policies That Support Emergency Department Staff In Providing Behavioral Health Care, Lizabeth Lepp Hennig

Walden Dissertations and Doctoral Studies

A significant portion of individuals with a behavioral health (BH) condition return to emergency departments (ED) seeking care, resulting in reduced quality of care, and contributing to disproportionate healthcare costs. Care can be improved and return visits to the ED reduced where behavioral health care and follow-up care planning are provided as part of their treatment. However, policies expected to create declines in ED use for behavioral conditions are typically in short duration or are difficult to use given other funding and policy constraints. With little known about how policy is supporting the engagement of ED staff who are critical …

Implementing Daily Schedules To Prevent Episodes Of Agitation In Pediatric Patients Boarding In The Emergency Department With Behavioral Health Diagnoses., Alex W. Carbone, Kathleen Kiley Bsn, Rn, Cpen, Anne Meginniss Msn, Fnp-Bc, Kerry Nolte Phd, Fnp-C, Debra Lajoie Jd, Phd, Msn, Rn, Esq.

Honors Theses and Capstones

Abstract

Background: Pediatric psychiatric emergencies have been recognized as a national crisis in the United States (Roman et al., 2018). Emergency department (ED) visits for pediatric behavioral health (BH) conditions rose 31% from April 2020 to October 2020 (Bartek et al., 2021). This increase in ED visits for BH concerns, matched with overwhelmed inpatient psychiatric treatment centers and lacking community support programs, has resulted in an increase in BH ED boarders (Bartek et al., 2021). This population of patients who remain in the ED while awaiting placement at a psychiatric care program are at risk for prolonged boarding durations in …

Pain Assessment In The Emergency Department, Lynnette Huddle

Master of Science in Nursing Final Projects

Aim: The aim of this integrative review was to synthesize studies that explore barriers to pain management in the Emergency Department.

Background: Pain remains one of the main reasons a person seeks help from the Emergency Department. However, patient's pain levels continue to be under-assessed and under-treated in Emergency Departments.

Design: Integrative Review Data Sources: A systematic review of Medline, PubMed, CINAHL, and Google Scholar electronic databases was performed. The articles were searched using the keywords, and the inclusion/exclusion criteria. Eleven studies published between 2011 and 2021 were found.

Review Methods: Studies were appraised using the John Hopkins Nursing Evidence-Based …

Bridging Mental Healthcare, Kristin L. White

MSN Capstone Projects

Nurses have an important role in the care given to mental health patients presenting to the emergency department (ED). Without expectations or encouragement toward growth or continued education, the quality of care and the therapeutic ability for care are crippled, as evidenced by nurses' knowledge/competency deficits and negative attitudes. Through ongoing/continued education, the cultivation of a therapeutic culture toward patients that present to the ED for mental health complaints could result. Additionally, these improvements in care, in turn, could promote not only the closure of gaps that exist for quality mental healthcare but may also lead to an increase in …

Sepsis Initiative: Champion Series, Ashlie Barnes

Doctor of Nursing Practice Projects

Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays …

Emergency Department Staffing And Overcrowding, Royce Hudgins

MSN Capstone Projects

Overcrowding in the emergency room (ER) is a decades old problem that can be caused by factors both internal and external to the (ER). The ripple effects from this problem can be seen throughout the hospital.

This change project seeks to identify and find solutions to patient flow problems that occur in the emergency room (ER) in order to: decrease patient wait times, reduce ER overcrowding, reduce costs, and to increase patient satisfaction and overall outcomes.

Improving Emergency Department Throughput: Using A Pull Method Of Patient Flow, Jeffrey Collins

Student Scholarly Projects

Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies.

PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation?

Evidence: …

Improving Handover Process For Stroke Patients Transferring From Emergency Department To Interventional Radiology: A Quality Improvement Project, Megan Buchman

Doctoral Projects

Background: A standardized handover process is needed for stroke patients transferring from the Emergency Department to Interventional Radiology.

Local Problem: Emergency Department and Interventional Radiology had different handover processes.

Methods: A quality improvement project was conducted in a large Magnet® designated midwestern health system. Participants included emergency department and interventional radiology nurses and stroke patients. Pre/post-quality and post implementation measures were obtained.

Interventions: The interventions included utilizing a standardized handover tool between departments, calling report prior to patient transfer, and turning in handover tool following stroke case to ensure compliance. Two cycles of the Plan-Do-Study-Act Cycle were completed.

Results: No …

Implementation Of A Nurse Leader Rounding Program In The Emergency Department, John Swanhorst

Student Scholarly Projects

Practice Problem: The identified practice problem was the low “Likelihood to Recommend” patient experience survey scores within the ED at the identified project setting.

PICOT: The PICOT question that guided this project was “In ED patients (P), how does the implementation of Nurse Leader Rounding (I) compared to the prior state of no Nurse Leader Rounding (C) affect the “Likelihood to Recommend” top box score (O) within eight weeks (T)?”

Evidence: In a review of 13 articles, the evidence consistently showed that Nurse Leader Rounding was a proven intervention for increasing patient engagement scores.

Intervention: Nurse Leader Rounding is defined …