Medicine and Health Sciences Commons^™

Discharge Process Optimization, Erin M. O’Neal

Doctor of Nursing Practice Projects

As the demands of the nurse become increased with higher acuity and documentation requirements, the delivery of discharge instructions is often one of the most, and at times, only, formal education opportunities between the nurse and the patient. It is imperative to modify the discharge process to ensure patients have the ability to confidently care for themselves after they leave the hospital. The aim of this project was to create a nursing discharge workflow that meets the educational needs of the patients. This project was a quality improvement project designed to change the nursing workflow to provide a better discharge …

Patient Placement Matters: The Impact Of Unnecessary Lateral Movement On Patients, Jacqueline Strinden

Doctor of Nursing Practice (DNP) Projects

Patient Placement Matters: The Impact of Unnecessary Lateral Movement on Patients

Abstract

Background: National trends to decrease the number of licensed beds have created inpatient capacity constraints which have resulted in increased unnecessary lateral patient movement events, which contribute to decreased patient safety and quality of care. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Problem: At a 352 acute care hospital, 12,906 patient movement events were evaluated over a baseline period of three months resulting in an average of 1.48 unnecessary lateral patient …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Improving Medication Administration Safety In A Correctional Facility With An Electronic Medication Administration System, Rosalinda Salazar

Master's Projects and Capstones

Problem: According to the World Health Organization (2020), medication errors are one of the leading causes of injury and avoidable harm in health care globally.

Context: The county jail houses approximately 700 inmates/patients on a daily basis, and the potential for error when administering medications is high as medications are prepared manually using a paper medication administration record.

Interventions: The jail began using an electronic health record/barcode administration system on October 19, 2020.

Measures: Unusual occurrence reports related to medication errors were reviewed. The time frame included 6 months before electronic implementation, and 6 months after implementation.

Results: Unusual occurrence …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Change Project Using A Fall Prevention Action Program To Decrease Falls On A Behavioral Health Unit, Amy Shuptrine

Student Scholarly Projects

Practice Problem: Fall rates are increasing in the behavioral health units of the East Texas hospital. Due to the worldwide COVID-19 pandemic, the units are short-staffed, which further supports the urgent need for a targeted intervention to reduce fall risk.

PICOT: The PICOT question that guided this project was: “In adult behavioral health patients (P), what is the effect of the Edmonson Psychiatric Fall Risk Assessment Tool (I), compared with previous use of the Morse Fall Risk tool (C), on the fall rate (O), in 8 weeks (T)?”

Evidence: Falls are the most reported incidents in acute care hospitals and …

Improving The Early Detection And Management Of Peripheral Artery Disease In Patients With Diabetes Within The Primary Care Setting, Julyssa Amanda Rodriguez

Doctor of Nursing Practice

Background. Diabetes is a significant risk factor for peripheral artery disease. Individuals with diabetes, greater than 50 years of age, having at least one other risk factor should be screened for peripheral artery disease with an ankle brachial index. Purpose. Improve detection and management of peripheral artery disease in persons with diabetes within primary care. Evidence. Individuals with diabetes and peripheral artery disease have an increased risk of adverse cardiac and limb events, impairing the patient’s quality of life and causing long-term disability (Berger & Newman, 2020). Methods. During a 10-week period, these processes were implemented: (a) screening all patients …

The Relationship Of Hospital Ceo Gender And The Patient Experience: The Role Of The Mediating Effects Of Hospital Characteristics, Lanean M. Lang

Electronic Theses and Dissertations

In this quantitative study, I investigated CEO gender and the patient experience in acute care hospitals in Texas for 2019. As the patient-experience has been the metric for quality patient care and hospital reimbursements, hospital CEOs play an important role in promoting positive patient experience as they lead the organization in strategic goals. The study is relevant as a shortage of experienced and qualified healthcare leaders is expected as baby-boomers retire. The lack of women leaders remains a challenging issue. The purpose of the study was to assess the gender differences of the CEO on the impact of patient experience …

Leadership Rounding To Improve Patient Satisfaction In Pediatric Ambulatory Care, Tara J. Haskell

Student Scholarly Projects

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings.

PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks?

Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body …

Improving Patient Flow In The Urgent Care Setting, Stephanie Carpenter

Student Scholarly Projects

Practice Problem: Urgent care clinics provide care to patients with non-life-threatening illnesses or injuries and are found to be less expensive and more convenient than emergency departments. As urgent care clinics are growing in popularity so are the patient wait times and overall length of stay times.

PICOT: The PICOT question that guided this project was in urgent care clinic patients (P), how does utilizing the Emergency Severity Index (ESI) as a patient triage tool (I) compared to using no patient triage tool (C) affect the patient flow and patient wait times (O) within 13 weeks.

Evidence: Evidence search with …

Improving Patient Satisfaction By Utilizing A Chief Experience Officer, Kathleen G. Spangler

Graduate Theses, Dissertations, and Capstones

With the rapid changes in healthcare and rising costs, improving the patient experience has emerged as a vital healthcare priority among all nations. Many healthcare organizations have responded by creating positions such as the Chief Experience Officer (CXO). This person can play a crucial role as the system champion to lead initiatives to help hospital staff, administrators, and executive leaders focus on patient satisfaction, thus leading to improved patient outcomes/experiences. A descriptive nonexperimental survey design was used to evaluate this project, with the aim of validating the positive influence of the CXO in improving patient satisfaction and experience within the …

Leadership Engagement For Military Hospitals: A Case Study Of The Effects Of Executive Leader Engagement In Military Hospitals That Have Become High Reliability Organizations, Russell Phillips

Dissertations

Purpose: The purpose of this qualitative case study was to explore and explain the leadership strategies that military hospital executive leaders used to engage hospital staff in implementing the six principles of High Reliability Organizations (HROs).

Methodology: A qualitative case study approach was selected for this study. Interviews were conducted with three executive leaders describing their experiences with initiating and managing the change development of HRO. The participants in this study were executive leaders of military hospitals across the Puget Sound Military Health System. All participants had direct experience with the implementation of HRO. Interview transcripts were analyzed and reviewed …

Incorporating Emergency Management Training Within School-Based Health Centers, Alicia Christian

Seton Hall University Dissertations and Theses (ETDs)

Background: Emergencies are situations that present without warning but require skilled individuals to provide aid to someone needing assistance. The pediatric primary care setting rarely experiences emergency-based care, which could lead to a lack of training in this area of expertise. As pediatric primary care extends to schools, there is also a need to ensure staff and providers have an annual emergency management training program. Project Aim: The current program aimed to determine the need to incorporate emergency management training in the school-based health center (SBHC) setting. Methods: This quality improvement project method was a pre-intervention with post-intervention design. The …

A Rollout Of A Blood Pressure Remote Patient Monitoring Program To Improve High-Risk Maternal Outcomes At A Pilot Clinic For Systemwide Expansion, Laura Geron

Seton Hall University Dissertations and Theses (ETDs)

An existing virtual care platform provides an innovative means of early recognition, identification, and intervention for women with elevated blood pressures during pregnancy, known as preeclampsia. A pilot program took place at a Northeastern prenatal care clinic where patients were identified as high-risk for preeclampsia, enrolled, educated by their providers, and equipped with Bluetooth-enabled blood pressure cuffs.

Through remote patient monitoring (RPM) technology, blood pressure readings could transmit from a patient’s residence to a portal accessible by their clinic provider at any time. This doctoral-level quality improvement project focuses on the identification of patients at high-risk for preeclampsia, their enrollment …

Debriefing With Pearls & Watson’S Caritas, Heather A. Uccello

Seton Hall University Dissertations and Theses (ETDs)

Debriefing, an important aspect of students’ clinical experience, is a reflective, critical thinking analysis and communication strategy that provides rapid feedback after either a simulated or genuine clinical event. To teach this higher-level critical thinking skill throughout the learning process, nursing programs require specific methodology and faculty expertise. The National League for Nursing supports nurse educators having a theory-based strategy, formal training, and ongoing competency evaluation. Informed by Jean Watson’s Theory and the Promoting Excellence and Reflective Learning in Simulation standardized debriefing tool methodology, this project outlines a framework that nursing schools can use to potentially improve the debriefing process …

Food Addiction And Obesity, Lisa Ling

Electronic Theses and Dissertations

The obesity rate in the U.S. adult population has increased to epidemic levels despite attempts to decrease obesity through evidence-based knowledge, clinical practice guidelines, medical interventions, and individual efforts. For certain individuals, food addiction behaviors such as food cravings, loss of control, and binge eating contribute to obesity and require a different approach to care. Little work has been done on adding the possibility of food addiction to obesity screening and treatment. This study utilized a quasi-experimental quantitative pre- and postsurvey research design based on Lewin’s change theory. Nurse practitioners were surveyed regarding the provider’s perceptions, attitudes, and beliefs about …

Patient Reported Outcomes In Sickle Cell Disease Examined Within A Conceptual Model, Swapandeep Mushiana, Marsha Treadwell Phd, Sherif M. Badawy Md, Ms, Liliana Preiss Phd, Allison King Md Mph Phd, Barbara Kroner Phd, Yumie Chen Bs, Jeffrey Glassberg, Victor Gordeuk Md, Nirmish Shah Md, Angie Snyder Phd Mph, Theodore Wun Md

Doctoral Dissertations

Objective: To examine the relations between patient reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD related factors and barriers to care would independently contribute to functioning as measured using the PRO domains. Additionally, pain and other SCD related complications are expected to impact the relation between the variables. Methods: Participants completed a 48-item survey that included socio-demographics and PRO measures, such as social functioning, pain impact emotional distress, and cognitive functioning. …

The Use Of Isbared/Ishaped And Elimination Of Reviewing Patients’ Chart Before Handoff To Decrease Incremental Overtime, Sheila Bucao

Master's Projects and Capstones

Problem: Incremental overtime was found to majorly impact the financial well-being of a stroke unit. From an allocated budget of 22 hours per pay period, the unit’s incremental overtime averaged 40 hours. The stroke unit had skilled-mix competencies, further complicating handoffs. The absence of a standard reporting method means that reviewing patients’ charts takes approximately 10 to 15 minutes, extending what should be a quick, but thorough nurse knowledge exchange.

Context: The body of evidence reviewed indicated that pertinent information to patient care is not left out or missed when a standardized tool is used during handoff. Based on Lean …

Implementation Of The National Early Warning Score Tool In The Acute Care Setting, Amanda Reyes

Student Scholarly Projects

Practice Problem: The organization arbitrarily called a rapid response or code blue call based on abnormal vital signs or intuition and needed a new process to identify early recognition of patient deterioration.

PICOT: For adult inpatients in an acute care setting in a large healthcare system (P), will implementation of the National Early Warning Score (NEWS) across the organization (I) compared to data from the last fiscal year where NEWS was not used (C) decrease code blue calls (O) within 8-weeks (T)?

Evidence: Eleven high quality studies met the inclusion criteria and found that the NEWS is a validated …

Pre-Admission Patient Education For A Prostatectomy Enhanced Recovery After Surgery Pathway, Vanessa C. Cotton

Doctor of Nursing Practice

Background. In the United States, prostate cancer is the most common cancer diagnosed in men and a common treatment choice is a radical prostatectomy. The Enhanced Recovery After Surgery® Society developed evidence-based guidelines to optimize treatment and improve outcomes in prostatectomy patients, yet not all hospitals are utilizing these guidelines or employing all of the elements, including pre-admission education. Purpose and Objectives. The purpose of this quality improvement project was to develop, implement, and evaluate a pre-admission patient education component for a prostate surgery pathway based on the Enhanced Recovery After Surgery guidelines. Objectives included assessing the nurse’s intention to …

Bringing Hospital And Community Together: Interventions To Bridge The Transitional Care Gap, Jeremy Yates

Dissertations

Abstract

Problem

As healthcare spending continues to increase and overall quality lags in comparison to other developed countries, hospital readmission has been targeted to increase quality while decreasing cost. Components of the Affordable Care Act (ACA) have placed an emphasis on preventative and transitional care which has created programs aimed at reducing readmission, including the Community Health Access Programs (CHAP). One program in St. Louis, Missouri consisted of advanced practice paramedics and an occupational therapy assistant that performed discharge follow-up through in-home, in-office, and telephone visits. An in-depth program evaluation can create a foundation to build other programs in communities …

Preventing Complications Of Undiagnosed Diabetic Peripheral Neuropathy In Rural Healthcare Settings, Kendra Ward Harris

Doctor of Nursing Practice Projects

Background: Diabetic peripheral neuropathy (DPN) affects the lives of approximately 50% of all persons diagnosed with diabetes. Patients who are minorities, residents of rural communities, low income, or non-compliant with treatment, have a higher risk of developing DPN. The long-term effects interfere with the patient’s abilities to carry out activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

Patients incur debt from medical expenses, depression from the inability to perform self- care, and became withdrawn because of their distorted body image.

Purpose: The purpose of this project was to use the Michigan Neuropathy Screening Instrument (MNSI) …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

Exploring Provider Perspectives To Understand How To Best Inform Patients In South Dakota, Isabelle M. Lehman

Honors Thesis

Patients in rural areas are more likely to experience worse health outcomes than patients in urban or suburban areas. The reasons for this discrepancy are multi-faceted, including inequities in resources and access, as well as differences in the environment. Rural providers understand what education and resources patients are missing as they often interact with patients in multiple contexts. We interviewed rural providers and performed an inductive thematic content analysis of the interviews to shed some insight into what information rural patients would need to be better healthcare advocates for themselves. Three themes emerged from the interview data: health education, access, …

Increasing Pneumococcal Polysaccharide Vaccination Rates In Adults Age 65 Years And Older In A Primary Care Clinic, Ashley Sandbothe

Doctor of Nursing Practice Scholarly Project

The purpose of this study was to increase PPSV23 vaccination rates in adults over the age of 65 years in a Midwestern primary care clinic.

For this project, staff was educated regarding interventions including patient awareness, provider recommendation, staff and provider education, vaccine access, use of the immunization information systems (IIS) and appropriate use of electronic health record (EHR) reminders that have been shown to increase vaccination rates.

Prior to the intervention, data was retrieved, and it was found that between April 1^st-May 31^st 2020, there were 162 patients over the age of 65 that presented to …

Longitudinal Trauma Treatment Outcomes In An Immigrant And Refugee Sample, Shuen-En Ho

Clinical Psychology Dissertations

Refugee and immigrant populations are at an increased risk of having posttraumatic stress disorder (PTSD) and exhibit a significant amount of variance in trauma treatment outcomes that may be impacted by sociocultural factors. This study examines the impact of demographic variables on treatment outcome and trajectory of PTSD symptoms in a clinic setting with trauma-focused treatments in refugee/immigrant and general populations. Data was collected from the electronic medical record at the Harborview Center for Sexual Assault and Traumatic Stress. A total of 817 participants completed intake, 58 of which self-identified as immigrant/refugee. One-way ANOVAs were conducted to examine group differences …

Covid-19 And Palliative Care Through The Provider Perspective, Michaelyn V. Truong

University Honors Theses

The purpose of this study was to analyze the OHSU palliative care team response to the COVID-19 pandemic and the impact of modified pandemic operations on delivering care to patients. The study was conducted through interviews with members of the palliative care teams from the Oregon Health & Sciences University and the Portland Veteran Affairs Medical Center. Questions were asked to understand the changes in care due to the pandemic and their overall perception of these changes. Responses were analyzed through the qualitative analysis software NVIVO12. The findings of this study showed the challenges with telemedicine were limitations with communications …