Medicine and Health Sciences Commons^™

Implementation Of An Education Program To Decrease Inpatient Falls, Elizabeth M. Carpenter, Jewyl Gibson

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

BACKGROUND: Inpatient falls are affecting 1 million patients across the United States every year with 25% of fall resulting in injury. Approximately 25% of falls are preventable with accurate assessment and appropriate fall precaution interventions. According to the literature, obtaining an accurate fall risk assessment is the first step in inpatient fall prevention.

LOCAL PROBLEM: Patient falls increased on 2 cardiac stepdown units in a level III trauma center in Knoxville, Tennessee. From 2020- 2022, the combined units experienced a 48% increase in patient falls. Nursing leadership identified staff knowledge deficits and inaccurate scoring of fall assessments as primary contributors …

Optimizing A Clostridium Difficile Screen For Intensive Care Unit Admissions, Mary Katherine V. Natour, Jennifer Smith

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

Background: Clostridium difficile infection is one of the most common healthcare-associated infections. Careful screening upon hospital admission enables clinicians to mitigate the spread and sequelae of this illness through early intervention and isolation but this screening must be accurate and highly sensitive to maximize benefit.

Local problem: The site for this project, an ICU in Tennessee, currently employs a highly sensitive but nonspecific tool to detect CDI. This has resulted in low accuracy, low staff compliance, low patient morale, and unnecessarily high personal protective equipment (PPE) costs.

Methods: Levin’s evidence-based practice improvement model was chosen to guide this project from …

Prevalence Of Frailty And Pain In Hospitalised Cancer Patients: Implications For Older Adult Care, Heather Lane, Rosemary Saunders, Kate Crookes, Seng G. M. Ang, Caroline Bulsara, Max K. Bulsara, Beverley Ewens, Olivia Gallagher, Karen Gullick, Sue Haydon, Jeff Hughes, Kim-Huong Nguyen, Karla Seaman, Christopher Etherton-Beer

Research outputs 2022 to 2026

A hospital-wide point prevalence study investigated frailty and pain in patients with a cancer-related admission. Modifiable factors associated with frailty in people with cancer were determined through logistic regression. Forty-eight patients (19%) with cancer-related admissions were 2.65 times more likely to be frail and 2.12 more likely to have moderate pain. Frailty and pain were highly prevalent among cancer-related admissions, reinforcing the need for frailty screening and importance of pain assessment for patients with cancer.

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 …

Outpatient Intravenous Antibiotics, Audrey Crews

MSN Capstone Projects

This paper discusses the use of outpatient intravenous antibiotics in comparison to inpatient intravenous antibiotics. Hospital admission rates, cost of care for patients and facilities, length of stay, patient experience, and patient outcomes are compared and evaluated with treatment to determine the efficacy of use.

Risk Of Suicide In Patients With Major Depressive Disorder And Comorbid Chronic Pain Disorder: An Insight From National Inpatient Sample Data, Taranjeet Jolly, Ramu Vadukapuram, Chintan Trivedi, Zeeshan Mansuri, Mahwish Adnan, Steven P. Cohen, To-Nho Vu

School of Medicine Publications and Presentations

Background: Approximately 17.3 million adults in the United States have had a minimum of one major depressive episode. Comorbidity of depression and pain can affect individuals of any age, but is more prevalent in the elderly affecting up to 13% of people in the elderly population. Given that depression and suicidal ideation (SI) pose a considerable burden resulting in enormous suffering, there is a need to understand the factors of the relationship between chronic pain (CP), depression, and SI.

Objectives: Our primary objective in this study was to compare suicidality (SI/attempt [SA]) between patients with major depressive disorder (MDD) and …

Implementation Of The Brøset Violence Checklist For Adult Psychiatric Patients, Brandy R. Cauthen, Jude Campbell, Brittany Mcgill, Allyson Neal, Stephan Haaquist, Courtney Glissen

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

Violence has become an increasing issue in healthcare systems worldwide, especially in inpatient psychiatric units. Violence can lead to harmful effects for patients and staff members and has been shown to increase the risk of depression, anxiety, and suicide. Additionally, violence has been shown to lead to staff burnout, which in turn leads to poorer patient outcomes. This project aimed to decrease rates of violence by implementing the Brøset Violence Checklist (BVC), a screening tool that predicts imminent violence. The BVC is a six-item checklist that allows patients to be scored based on behaviors. Then, a sum score is produced, …

Impact Of Hourly Rounding On Fall Rates: A Benchmark Paper, Monica D. Smith

MSN Capstone Projects

Falls and fall-related injuries create a significant financial burden on patients and healthcare organizations, particularly in adult inpatient hospital units such as rehabilitation and medical-surgical units. Costs associated with additional hospital days, diagnostic testing, and potentially fall-related surgeries can average about $14,000 per fall (The Joint Commission, 2015). Moreover, falls can be devastating in older adults, impacting their overall quality of life. According to Abou et al., 20% of yearly individual costs associated with falls are among patients with Parkinson's disease (2020). This is a proposal to implement a pre-and post-implementation change project. This paper addresses the use of evidence-based …

Huddle And Safety, Jaelynn Hall Bsn, Rn

MSN Capstone Projects

The purposed evidence-based practice (EBP) project focuses on a nursing intervention (team huddles) to increase safety and reduce inpatient fall rates. Negative outcomes to consider from an inpatient fall are harm and injury to the patient along with increased health care cost for the patient as well as hospital facility. Accrued cost associated with an in-patient injury resulting from a fall is not reimbursed according to the Centers for Medicare and Medicaid Services. The additional cost for hospital-acquired falls is estimated to be $6,694 (95% CI: -$1,277 to $14,665) (Agency for Healthcare Research and Quality, 2017). This was only related …

A Nursing Education Intervention In An Adult Inpatient Setting For Decreasing Hypoglycemia Incidence, Meredith Lynn Camilleri

Doctoral Dissertations and Projects

Hypoglycemia can cause an array of outcomes including increased morbidity, mortality, and hospital length of stay. The literature revealed specific educational methods effective in decreasing hypoglycemia including case-based learning tutorials and unit-based lectures. Focused nursing education regarding the cause of hypoglycemia and understanding the importance of provider notification of hypoglycemia was also shown in the literature to reduce rates of hypoglycemia. The purpose of this project was to decrease inpatient hypoglycemia incidence utilizing a unit-based educational seminar as an intervention on a diabetic renal unit within a hospital. While anticipating a decreased hypoglycemia incidence after the educational seminar, an increased …

Delirium Point Prevalence Studies In Inpatient Settings: A Systematic Review, Binu Koirala, Bryan R. Hansen, Annmarie Hosie, Chakra Budhathoki, Stella Seal, Adam Beaman, Patricia M. Davidson

Nursing Papers and Journal Articles

Aims: To examine the delirium point prevalence studies conducted in different inpatient settings and to discuss the implication of the findings for delirium screening, assessment, prevention and management.

Background: Delirium—a common and distressing condition manifesting as an acute decline of attention and cognition—is frequently overlooked, misdiagnosed or treated inappropriately. This neuropsychiatric syndrome manifests as changes in attention, cognition and awareness, with resultant impact on behaviour, function and emotions. Delirium is recognised as a patient management challenge in the inpatient setting, and there is a need to understand the current point prevalence and assessment practices of delirium.

Design: A systematic review …

Infection Prevention In Patients Receiving Continuous Renal Replacement Therapy Through Proper Hemodialysis Line Care, Nicole Ingram, Susan Mckenna

VCU Health Nursing

The goal was to reduce Continuous Renal Replacement Therapy (CRRT)-related Central Line-Associated Bloodstream Infection (CLABSI) rates by introducing a just-in-time re-education toolkit for proper hemodialysis (HD) line care in adult Intensive Care Units (ICU).

CRRT requires specialized expertise delivered in the ICU setting with the support of HD nurses. Problem-solving when cartridges clot or clog requires ICU nurses to return the blood and notify HD to restart therapy. Current evidence supports the use of white Curos^TM caps and Tego^TM connectors when deaccessing lines in order to prevent CLABSIs, air emboli, and bleeding. A learning needs assessment revealed inconsistent …

Quiet Please: The Effects Of Sleep Quality And Quantity As A Result Of A Qi Project To Minimize Nighttime Sleep Interruptions, Chari Stump, Ashlie Tseng, Jennifer Brigle, Clifton Lee

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Quiet Please! The effects on sleep quality and quantity as a result of QI project to minimize nighttime interruptions

INTRODUCTION: Sleep is a significant component of health that is often overlooked in hospitalized patients. We introduced a QI project in 2016 to minimize nighttime interruptions in clinically stable patients by performing “passive vitals” which eliminated temperature and blood pressure readings at 4am and allowed patients to sleep longer overnight. Despite this intervention, the effects on sleep quality and quantity are unknown.

OBJECTIVE: The objective was to compare total sleep time, sleep interruptions, and sleep quality between patients eligible for passive …

Impact Of Motor Therapy With Dynamic Body-Weight Support On Functional Independence Measures In Traumatic Brain Injury: An Exploratory Study, Emily F. Anggelis, Elizabeth Salmon Powell, Philip M. Westgate, Amanda C. Glueck, Lumy Sawaki

Physical Medicine and Rehabilitation Faculty Publications

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments.

OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI.

METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = …

Strategies To Improve Timeliness For Cleaning Inpatient Rooms Following Patient Discharge, Lora Dixon, Mark Parker, Ruth Hanselman, Suneela Nayak, Amy Sparks

Operations Transformation

STRATEGIES TO IMPROVE THE TIME FRAME FOR CLEANING INPATIENT ROOMS BY ENVIRONMENTAL SERVICES

In an inpatient rehab hospital, it was noted that Environmental Services (EVS) was delayed in cleaning rooms between patient discharges and admissions. This resulted in the frequent use of a “stat clean” order that allows only 50% of the normal cleaning time , forcing patients to wait and impacting patient flow.

A root cause analysis demonstrated lack of communication between the rehab hospital and the contracted cleaning services. A number of counter measures were initiated with the goal that cleaning would be started within 20 minutes of …

Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

STRATEGIES TO INCREASE MORNING DISCHARGES IN AN ACADEMIC TERTIARY HOSPITAL

Delays in patient discharge result in numerous negative impacts on the health care system. Amongst those are a reduced patient flow and satisfaction, long wait times, and physician/ staff frustration.

An inpatient neurotrauma unit initiated a performance improvement project that utilized a multidisciplinary approach to identify barriers to discharge and coordinate a discharge plan focused on neurospine patients.

A root cause analysis was conducted to collect reasons that these patients were not discharged by 11:00am. As a result of the findings, 4 performance improvement plans were created. Subsequent data collection …

Consumers’ Perspectives Of The Meaning Of Safety In Acute Mental Health Inpatient Services, Natalie A. Cutler, Lorna Moxham, Moira Stephens

Faculty of Science, Medicine and Health - Papers: part A

Background and Aim: Safety is a priority in the acute mental health inpatient setting (ACQSHC 2014). Safety is commonly represented in government policy as the reduction or elimination of risk (AIHW 2018). Defining safety as the reduction or elimination of risk means this is where funding and resources are likely to be directed. This has limitations however, as it can lead to environments and processes considered by mental health services to be safe, but are not aligned with what people with lived experience of mental illness deem to be safe (Cutler, Moxham & Stephens 2015). This PhD study explored the …

Critical Choices Conversation Pilot Project, Lorena Paul

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) and advance directives (AD) inform the provision of health care that aligns with clients’ goals and wishes. Less than 30% of female cancer care clients presented AD when admitted for care to a Magnet® designated hospital located in the Southwest United States (U.S.).

Methods: A quality improvement project took place on a 25 bed in-patient cancer care unit to improve these rates. The nurses received ACP training and used a clinical support tool to facilitate discussions with clients. A Palliative Care Clinical Nurse Specialist assisted as needed.

Results: Seven nurses accomplished a self-paced learning activity …

Patient Fall Prevention, R9 West Cardiovascular, Cathy Palleschi, Suneela Nayak, Ruth Hanselman, Stephen Tyzik

MaineHealth Maine Medical Center

PATIENT FALL PREVENTION STRATEGIES IN AN ACUTE HOSPITAL

Every year in the United States, hundreds of thousands of patients fall resulting in injury. Injured patients often require prolonged hospital stays and a resultant increase in medical costs.

The purpose of this study was to identify the current state of fall prevention strategies on a hospital inpatient acute care cardiac unit. Through a root cause analysis, some deficiencies were identified and a process improvement plan was implemented.

Several positive outcomes were attained as a result of the countermeasures initiated. Patient falls per month and total waste in dollars saw a decline …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Variations Of Emotion Dysregulation In Borderline Personality Disorder: A Latent Profile Analysis Approach With Adult Psychiatric Inpatients, Katrina A. Rufino, Thomas E. Ellis, Joshua Clapp, Catherine Pearte, J. Christopher Fowler

Faculty Publications

Background

The purpose of the present study was to identify variations in emotional dysregulation patterns among adults diagnosed with borderline personality disorder (BPD), with an eye toward implications for treatment.

Methods

Latent profile analysis (LPA) was utilized to classify 156 inpatients with BPD, based on patterns of Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer, J Psychopathol Behav Assess 26: 41-54, 2004) subscale scores.

Results

Results revealed that a three class solution best fit the sample (Low Impairment, Global Dysregulation, and Emotionally Aware). Further analysis of the classes at admission revealed that the Global Dysregulation group reported significantly higher …

Comparison Of The Prevalence And Characteristics Of Inpatient Adverse Events Using Medical Records Review And Incident Reporting, William Macharia, Charles Muteshi, Sikolia Wanyonyi, Abraham Mukaindo, Ahmed Ismail, Herman Ekea, Abdallah Abdulkarim, John Tole, Anthony Ngugi

Paediatrics and Child Health, East Africa

No abstract provided.

Four Effective And Feasible Interventions For Hemi-Inattention Post Cva: Systematic Review And Collaboration For Knowledge Translation In An Inpatient Rehab Setting., Elizabeth Armbrust, Domonique Herrin, Christi Lewallen, Karin Van Duzer

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Purpose: To locate, evaluate, and summarize the evidence for effective and feasible interventions to treat hemi-inattention in inpatient rehabilitation settings and ensure knowledge translation with a collaborating clinician Timothy Rich, OTR/L and his team at Harborview Medical Center. Design: Systematic literature review, participatory active research with a collaborating clinician, and knowledge translation. Methods: Included studies that tested effectiveness of mirror therapy (MT), transcutaneous electric nerve stimulation (TENS), limb activation therapy (LAT), and visual scanning therapy (VST). 11 databases were searched to yield 31 articles included in a critically appraised topic (CAT) table. A concise protocol for each …

Patient Hand Hygiene Practices In Surgical Patients, Laura L. Ardizzone, Janice Smolowitz, Nancy Kline, Bridgette Thom, Elaine L. Larson

School of Nursing Faculty Scholarship and Creative Works

Background: Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections. Methods: A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding …

Using Computer Simulation To Study Hospital Admission And Discharge Processes, Edwin S. Kim

Masters Theses 1911 - February 2014

Hospitals around the country are struggling to provide timely access to inpatient beds. We use discrete event simulation to study the inpatient admission and discharge processes in US hospitals. Demand for inpatient beds comes from two sources: the Emergency Department (ED) and elective surgeries (NonED). Bed request and discharge rates vary from hour to hour; furthermore, weekday demand is different from weekend demand. We use empirically collected data from national and local (Massachusetts) sources on different-sized community and referral hospitals, demand rates for ED and NonED patients, patient length of stay (LOS), and bed turnover times to calibrate our discrete …

Predicting Clinically Signficant Change In An Inpatient Program For People With Severe Mental Illness, Talia Gonda, Frank P. Deane, Ganapathi A. Murugesan

Faculty of Health and Behavioural Sciences - Papers (Archive)

Objective: The first aim of this study was to assess the proportion of patients who achieved reliable and clinically significant change over the course of treatment in an inpatient psychosocial rehabilitation program. The second aim was to determine whether age, gender, length of stay, and diagnosis and co-morbid diagnosis predicted those who were classified as improved or not improved, using clinical significance criteria. Method: Three hundred and thirty-seven patients from inpatient units at Bloomfield Hospital, Orange, New South Wales, Australia were assessed at admission, 3-month reviews and discharge using the expanded Brief Psychiatric Rating Scale, the Health of the Nation …