Medicine and Health Sciences Commons^™

Implementation Of An Evidenced-Based Concussion Management Protocol Utilizing Telemedicine In A Student Health Center, Shelly Benfield

Doctor of Nursing Practice Final Manuscripts

Background: An estimated 3.8 million concussions occur yearly in the United States and the incidence of youth concussions is on the rise. If untreated or unrecognized, more serious complications of concussions include post-concussion syndrome, second impact syndrome, and chronic traumatic encephalopathy. Clinic leadership in a southern California student health center identified systematic inefficiencies and noted a lack of standardized follow-up concussion appointment times which resulted in decreased clinic efficiency.

Purpose: The purpose of this evidenced-base project was to implement an effective concussion protocol and follow-up treatment plan that would improve clinic efficiency without negatively impacting concussion outcomes.

Evidence-based Interventions: A …

Enhancing Chronic Pain Management Motivational Interview Among Lower Back Pain Patients, Melissa L. Hines-Antico

Doctor of Nursing Practice Final Manuscripts

Purpose: Untreated chronic pain is a nationwide epidemic affect individual physically, psychologically, and financially. Low back pain is the most common subset of chronic pain. Restricted clinic time and a focus on procedural/prescriptive methods for managing pain prohibits patient education regarding self-care, and formation of a relationship with the provider.

Design: Article review yielded 20 articles that supported the use of motivational interviewing for chronic pain in lower back pain patients. They were evaluated for their strength of evidence on a scale of 1-6. One article was ranked level I as a meta-analysis, and six were ranked as level II …

Managing Childhood Atopic Dermatitis: Utilizing A Written Eczema Action Plan To Improve Caregiver Self-Efficacy, Tiffany Sena

Doctor of Nursing Practice Final Manuscripts

Approximately 13% of the pediatric population suffer from atopic dermatitis (AD) or eczema (Silverberg & Simpson, 2014). Eczema is a complex and costly managed disease. There is a need to improve caregiver knowledge and to maintain and control exacerbations as national prevalence increases in the United States. Literature supports utilization of a written Eczema Action Plan (EAP) to improve caregiver self-efficacy of eczema management. An evidence-based practice project was conducted in a primary care pediatric practice implementing a written EAP for mild to severely diagnosed patients ranging from 4 months to 17 years of age. The practice intervention included providing …

Chlamydia Screening For High Risk Populations, Kathryn Dickson, Karen Macauley

Doctor of Nursing Practice Final Manuscripts

Background: Chlamydia is the most common sexually transmitted bacterial infection worldwide. Chlamydia trachomatis is a bacterium that is commonly asymptomatic but highly curable with antibiotics if treated early. Without treatment, chlamydia can cause pelvic inflammatory disease and uterine scarring for women, which can lead to infertility or ectopic pregnancies. It can also be a precursor for cervical cancer and endometriosis in women, and potentially transferred to offspring during childbirth. Opportunistic prescreening and screening in urgent care can increase appropriate diagnosis of chlamydia that potentially would be missed or incorrectly dismissed as solely a urinary tract infection.

Purpose: To increase chlamydia …

A Pilot Project For School-Based Screening And Treatment Of Latent Tb Infection Among Freshman High School Students, Isis Cunningham

Doctor of Nursing Practice Final Manuscripts

Background: San Diego’s tuberculosis (TB) incidence is 2.5 times higher than the national rate. Five cases of active TB in the county’s public high schools during 2018 demonstrated the need for prevention interventions in this setting.

Objectives: This evidence-based project aimed to increase awareness, screening, and treatment of latent TB infection (LTBI) in the school setting.

Methods: A one-time TB educational presentation was given to high school freshman students with a pretest and posttest. A TB risk assessment and consent was sent home with the students. For at-risk students, a confidential package was sent to the parents recommending testing along …

Shingles Vaccine: Identifying High Risk Groups In The Ibd Clinic Setting, Crystal Barajas

Doctor of Nursing Practice Final Manuscripts

Title: Shingles Vaccine: Identifying high risk groups in the IBD clinic setting

Background: The Inflammatory Bowel Disease (IBD) population is an immunocompromised patient population who is at risk for Herpes Zoster (HZ) due to their medication regimen, which further compromises their immune system. It can be difficult for patients to receive appropriate preventative health maintenance measures due to patients’ fears, primary care providers’ lack of knowledge, and gastroenterologists not addressing what may be considered primary care topics. Furthermore, evidence demonstrates that IBD patients have low vaccination rates despite insurance coverage.

Purpose of Project: (a) To increase awareness of the …

Optimizing An Order Set To Streamline Health Care Delivery In The Emergency Department For Patients Requiring Hiv Post-Exposure Care, Marlisha Smith

Doctor of Nursing Practice Final Manuscripts

Background: The Centers for Disease Control and Prevention (CDC) updated guidelines to support efforts to decrease the number of Human Immunodeficiency Virus (HIV) incidences. The principle method for risk reduction utilized in the guidelines is the 28-day non-occupational post-exposure prophylaxis (nPEP) antiretroviral course administered within 72 hours of exposure. Despite this recommendation, adherence to a full 28-day course nPEP is very low nationally. Root cause analysis completed at the study site indicated that the use of an outdated order set caused unwarranted variability in care which accounted for failure in the delivery of appropriate nPEP care and low medication adherence. …

Multilingual Postpartum Depression Screening In Pediatric Community Health Clinics, Margo Cohen

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidence-based project is to screen all mothers for postpartum depression at their infant’s 1-week, 1-month, 2-month, and 4-month well-child visits and to educate pediatric providers and mothers on the importance of early detection, referral and utilization of mental health services.

Background: Every year, 400,000 infants are born in the United States to mothers with depression, most of which have not been diagnosed or treated. The prevalence of postpartum depression (PPD) among immigrant and low-income women following birth, is estimated to be as high as 22%. Despite their high rate of prevalence, recognition and treatment …

Missed Shots: Increasing Flu Vaccine Documentation Utilizing A Clinical Reminder In A Student Health Clinic, Noelle Simms

Doctor of Nursing Practice Final Manuscripts

Objectives: The primary purpose of this evidence-based practice project is to increase influenza vaccination documentation in the student health setting utilizing a standardized clinical reminder.

Participants: 1,337 undergraduate and graduate students at a private university is Southern California.

Methods: A clinical reminder template was created and added to the intake form in the electronic medical record. The medical assistants complete the template with the patient. The provider then orders the vaccine or educates the patient based on the documented refusal reason.

Results: During the 10-week implementation period there was a 46% increase from baseline in flu vaccine documentation at the …

Understanding The Impact Of A Perinatal Mood And Anxiety Disorders Phone Support Line, Diana Nguyen, Semira Semino-Asaro

Doctor of Nursing Practice Final Manuscripts

Postpartum depression affects one in every seven women and anxiety is estimated to range from 13-21% in new mothers. Risk factors include prior diagnosis of depression, family history of depression, having medical complications during childbirth including a premature baby and a lack of social, emotional support. The purpose of this evidence-based practice project was to increase the amount of data gathered by a local perinatal support organization by analyzing the callers’ demographics through phoneline surveys and use the information to expand resources and access to care for mothers with perinatal mood and anxiety disorders (PMADs). The project was guided by …

Promoting Diabetes Self-Management Education And Support In Primary Care Clinic: An Evidence-Based Project, Maricel Veluz Delacruz

Doctor of Nursing Practice Final Manuscripts

Objective: Self-care disease management is a crucial component in achieving healthy glycemic targets among type 2 diabetes mellitus (T2DM) patients to improve health outcome resulting in reduced healthcare cost. The purpose of this evidence-based practice (EBP) project is: 1) to improve hemoglobin glycated (A1C) levels to

Research Design and Methods: The EBP project took place in a private primary clinic in National City, California. A total of eight T2DM respondents with an A1C level of >7% were included to partake in the EBP project. A 30-minute Diabetes Self-Management Education and Support (DSMES) utilizing the designated seven self-care behaviors of the …

The Roles Of An Evidence-Based Weight Management Protocol In Hypertension Control, Belinda Akakpo Maxwell

Doctor of Nursing Practice Final Manuscripts

The Roles of an Evidence-Based Weight Management Protocol in Hypertension Control

Abstract

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led protocol for patients with hypertension (HTN) and weight loss needs to improve weight control, cardiovascular risk and quality of life.

Background: Evidence shows that a 1.2-kg weight loss can reduce systolic blood pressure (SBP) by 3.8mmHg. Thus, a 10kg (22lbs) weight loss is likely to yield a SBP decrease of as much as 32mmHg. Such results would positively impact quality of life and costs. The simple approach of instructing patients to eat less …

Implementing A Trigger-Based Model For Early Palliative Care Consultation On A Medical Oncology Floor, Hsiu Jan Chen

Doctor of Nursing Practice Final Manuscripts

Background: A systematic review by Wendlandt et al. (2012) showed that 84% of the providers referred their patient to palliative care (PC) at a very late stage for uncontrolled symptom management. Significant barriers included a lack of training, lack of recognized referral criteria, lack of a referral protocol. A delayed PC referral can result in prolonging patient suffering from symptom distress, avoidable laboratory work in addition to unnecessary aggressive medical treatment.

Purpose of Project: This Evidence-based Practice pilot project is aimed to facilitate an early PC consultation on an oncology medicine floor by implementing a Palliative care (PC) …

A Shared Medical Appointments For The Two-Week Well Child Visit, Sarah Anderson, Jennifer Eng-Kulawy Md, Faap, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: The World Health Organization (WHO), American Academy of Pediatrics (AAP), and the literature supports exclusive breastfeeding for newborns until six months of age and continued breastfeeding until 12 months of age. Postpartum maternal breastfeeding support has been insufficient in the pediatric clinic to support exclusive breastfeeding recommendations. Shared Medical Appointments (SMA) are an alternative approach to individual well-child appointments that provide lactation consultants sufficient time to conduct breastfeeding education during the extended appointment.

Objective: Through utilization of a shared medical appointment (SMA), a southern California military pediatric clinic will increase exclusive breastfeeding rates (EBF) of new mothers by 10% …

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …

Herpes Zostervaccine To The Homebound Elderly: Prevention, Protection, And Access To Care, Serena Arts

Doctor of Nursing Practice Final Manuscripts

Herpes Zoster Vaccine to the Homebound Elderly: Prevention, Protection, and Access to Care

Purpose: To increase the administration rate of the Herpes Zoster (Hz) vaccine Zostavax by 10% for persons 65 years and older in a home-based primary care practice, utilizing Medicare part D.

Background: Persons in the United States (US) age 40 years and older show a 99% positive serology for Varicella, which causes Hz decades later. Zostavax has been shown to decease Hz by 51% and post-herpetic neuralgia by 67%.

Brief Description: The goal of Healthy People 2020 is to increase the vaccination rates of persons 65 years …

Using Short Message (Sms) To Deliver Appointment Reminders And Reduce No-Show Rates: An Evidence-Based Practice Project, Fernando Serrano

Doctor of Nursing Practice Final Manuscripts

Background/Objectives: Missed appointments (MAs) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment terminations for therapy (DeFife, Conklin, Smith, & Poole, 2010). MAs occur for a variety of reasons including, but not limited to severity of illness, financial/geographic constraints, and forgetting the appointment (Filippidou, Lingwood, & Mirza, 2014). Appointment compliance within outpatient mental health clinics has a wide variance with some clinics reporting MAs ranging from 15% to 50% (Car, Gurol-Urganci, de Jongh, Vodopivec-Jamsek, & Atun, 2013).

With decreasing costs and a subsequent massive increase in mobile phone technology use by the general population, …

Telephone Follow Up For Obstetrical Triage, Ann Grimshaw

Doctor of Nursing Practice Final Manuscripts

TELEPHONE FOLLOW UP FOR OBSTETRICAL TRIAGE VISITS

Ann Grimshaw, RN, MSN, CNS

Clinical Nurse Specialist

Doctorate of Nursing Practice, Student

University of San Diego, School of Nursing

San Diego, CA

Purpose: To reduce a patient’s knowledge deficit related to plan of care after an unscheduled obstetric triage through follow up phone calls.

Rationale and Background: Up to 75% women during their pregnancy will present to an unscheduled visit in obstetrical triage with questions about their own health and the health of their unborn newborn. The majority of these visits will result in discharge from obstetrical triage prior to delivery of …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility Pilot Project, Joshua Aaron Carr

Doctor of Nursing Practice Final Manuscripts

Labor pain is a significant source of anxiety for most pregnant women. Parturients who are excluded from epidural analgesia (EA), the most common and most effective technique to reduce this pain, deserve access to the next best choice. Remifentanil patient controlled analgesia (RPCA), due to its fast onset, short half-life and demonstrated effect at reducing pain and boosting satisfaction is the next best option when compared to EA. Adoption of this strategy represents an opportunity to help bring this evidence based technique into a mainstream health system. This project reports on the first stage of a pilot project to bring …

Pilot Implementation Of A Comprehensive Pain Assessment In An Oncology Clinic, Lauren Botta

Doctor of Nursing Practice Final Manuscripts

Purpose/Aims: This project implemented an algorithmic approach to assess pain, functionality, and psychosocial states in newly diagnosed cancer patients. This was accomplished through utilization of a validated pain assessment tool. The tool’s purpose was to identify high-risk patients for Emergency Department (ED) visits or unanticipated hospital admissions (UHA), within a second-year fellow Hematology/Oncology clinic.

Primary aims included: (a) aggregating demographic data to determine the profile of a high-risk patient seen within this clinic, (b) determining those referred to and who followed up with symptom specialists or the ED, and (c) identifying barriers for the next iteration of the project. …

Nurse Practitioner Led Identification And Treatment Of Knee Pain Severity Based On Evidence Classification Protocols, Mayra Padilla Arechiga

Doctor of Nursing Practice Final Manuscripts

Title: Nurse Practitioner Led Identification and Treatment of Knee Pain Severity Based on Evidence Classification Protocols

Background: Knee pain has become the 10^th leading office visit in the United States. Prevalence of knee pain has increased 65% in the past 20 years accounting for approximately 4 million clinic visits every year. One out of five men and one out of four women in the United States suffers from knee pain. Treatment protocols in actuality are based on physical therapy, pharmacological treatment, or surgical management. However, research has demonstrated that knee pain and progression of knee related illnesses may …

Comprehensive Sleep Apnea Screening In Veterans With Posttraumatic Stress Disorder, Richard W. Schulz

Doctor of Nursing Practice Final Manuscripts

Objectives: Recent studies have shown a higher prevalence of sleep apnea in veterans with Posttraumatic Stress Disorder (PTSD). It is estimated that 69 to 83% of veterans have Obstructive Sleep Apnea (OSA) while 80 to 90% are undiagnosed or untreated. Untreated OSA can lead to severe chronic medical conditions as well as impairment of neurocognitive and fear extinction processing potentially decreasing responsiveness to trauma focused therapy. Despite the widespread dissemination of knowledge regarding the negative effects of OSA, many veterans are not screened. The goal of this project is to increase the rate of identifying veterans who are high-risk for …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Kori Fitzgerald Bsn, Rn, Phn, Fnp/Dnp Student

Doctor of Nursing Practice Final Manuscripts

Title: Utilization of Telehealth for Palliative Care Follow-up Visits

Background: A vital part of cancer management is the implementation and integration of palliative care, to prevent and relieve suffering and to improve quality of life for patients with serious chronic illness. However, access to palliative care services continues to be inadequate. There is a nationwide shortage of skilled palliative providers and the supply is insufficient to meet the growing demand.

Purpose of Project: Implementing telehealth visits with palliative care patients with advanced cancer at the UCSD Moores Cancer Center has the potential to maintain patient satisfaction with …

Reducing Hospital Readmission Rates Via Np- Initiated Post Discharge Telephone Calls In Dialysis Dependent End Stage Renal Disease Patients, Fabiola Carapia

Doctor of Nursing Practice Final Manuscripts

Purpose/Aim:To determine whether a nurse practitioner-initiated phone call, in addition to the standard transition-of-care (TOC) protocol, will reduce 30-day hospital re-admissions by 50% in patients with end-stage renal disease (ESRD) after an inpatient index hospitalization.

Background: $27 billion is spent annually by Medicare for hospital readmissions. Approximately $17 billion of this amount can be attributed to avoidable causes (Kauffman, 2016). Hospitals have been penalized for excessive readmission rates under the Hospital Readmissions Reduction Program beginning in 2012 (HRRP; Centers for Medicare & Medicaid Services [CMS], n.d.). Index hospitalization refers to the first time, in a series of hospitalizations, that …

Reducing Ed Re-Admissions In Post-Op Neuro Patients Utilizing A Np Telephone Follow-Up Protocol, Katherine Curran

Doctor of Nursing Practice Final Manuscripts

Reducing ED Re-admissions in Post-Op Neuro Patients utilizing a NP Telephone Follow-up Protocol

Background

Post craniotomy patients discharging from the hospital to home, commonly present to the emergency department (ED) with incisional concerns. Complaints stem from minimal post-op education, poor incision management, and lack of knowledge relational to infection. Unanswered questions prior to discharge lead to unnecessary ED visits, anxious calls after discharge, and poor patient satisfaction. ED admissions lead to fortuitous costs that can be prevented through evidenced based interventions.

Purpose/Aim

Post craniotomy patients at a large hospital system in Southern California will have decreased ED visits correlated to …

Spreading The News About Peanuts: Implementing An Infant Allergy Risk Assessment, Kelly E. Kotula

Doctor of Nursing Practice Final Manuscripts

Peanut allergies are the leading cause of death from food anaphylaxis. In 2017, the National Association of Allergy and Infectious Disease (NIAID) issued a guideline for use by primary care providers to identify infants who would benefit from early peanut consumption. Many providers have not yet implemented these guidelines in clinical practice. The purpose of this project was to implement a practice change to improve assessment of risk factors for peanut allergies utilizing the NIAID guideline in infants at their six-month well-child examination at a pediatric primary care practice. Risk factors assessed included: a history of eczema and/or egg allergy …

Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr

Doctor of Nursing Practice Final Manuscripts

Purpose: Evaluation of an evidence-based protocol that measures the effectiveness of universal depression screening at an integrated healthcare center. At risk patients are those who complete a patient health questionnaire (phq-9) and score ≥ 10 when presenting for a primary care visit. A score of ≥ 10 prompts further evaluation by the primary care provider (PCP) prior to behavioral health care management (BHCM) referral.

Background: In 2016, 16.2 million adults aged 18 or older in the U.S. experienced a major depressive episode (MDE). 65.3% of those received some form of treatment from a healthcare professional (therapy and/or medication). Early identification …