Adoption Of Evidence-Based Practices In Stroke Transitions Of Care, Sabena Passarello, Rn, Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Stroke is a leading cause of mortality in the U.S. Individuals who suffer from stroke or transient ischemic attack are at risk for further cerebrovascular events. Prevention requires thorough diagnostic evaluation and care coordination, particularly from inpatient to outpatient settings. Transition of Care programs are effective methods for developing long-term treatment, establishing follow-up, and preventing further complications.

Aims/Objectives: The project purpose was to integrate evidence-based recommendations into a Transitions of Care program for patients with ischemic stroke or transient ischemic attack. The aims were to evaluate whether implementation of Stroke Transitions of Care improved outpatient follow-up and stroke readmission …

A Multi-Faceted Quality Improvement Project Amid A Global Pandemic: Improving Guideline-Consistent Cervical Cancer Screening Rates And Provider Knowledge Of Abnormal Cervical Cancer Screening Results During Reactivation Of A Metro Family Practice Clinic, Taylor Villwock, Agpcnp-Bc

Doctor of Nursing Practice Projects

Background: Despite the evidence-based value of cervical cancer screening, recent updates to guidelines, and general availability of the Papanicolaou (Pap) test, guideline-adherent screening rates remain low. The COVID-19 pandemic further impedes progress as preventive healthcare is delayed and patients are reluctant to enter healthcare facilities.

Objectives: The purpose of this project was to evaluate if provider education and patient reminder letters comprising written education and risk-mitigation efforts improved cervical cancer screening rates and increased providers’ knowledge of appropriate follow-up during reopening of a metro family practice clinic amid the COVID-19 pandemic.

Methods: A multi-faceted quality improvement project included a 3-month …

Increasing Mental Health Competency In School Nurses, Jennifer M. Walsh Msn, Cpnp, Cne

Doctor of Nursing Practice Projects

Background: Mental health concerns in the pediatric population have increased over recent years, even more so due to the COVID-19 pandemic. Time from onset of symptoms to treatment is over eight years, leaving less than 25% receiving care. Virginia ranks 47th for pediatric mental health care. School nurses spend a significant amount of workload on MH issues but often report being untrained to deal with these issues. Aims: Implement a quality improvement pilot program for school nurses designed to increase competency of identification, management, and referrals for students with mental health concerns. Outcomes measured domains of knowledge, attitude, and competency …

Prep Education Intervention, Kristina Jung Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: The nation’s HIV infection rate is alarming, yet only a small percentage of eligible individuals are prescribed pre-exposure prophylaxis (PrEP). This sluggish PrEP uptake may be related to lack of knowledge among non-HIV specialist providers. Thus, interventions toexpand providers’ use of PrEP as an HIV prevention strategy are needed.

Objectives: The project aim was to develop an intervention to improve retail nurse practitioners’ (NP) knowledge for PrEP clinical practice, comfort screening for “at-risk HIV” patients, confidence prescribing PrEP, and likeliness to prescribe PrEP in the next six months.

Methodology: An online PrEP tutorial was implemented for retail clinic NPs. …

Improving Nurse Manager Job Satisfaction: An Urban Academic Quality Improvement Project, Patricia A. Winston, Ms, Rn, Nea-Bc, Fache

Doctor of Nursing Practice Projects

Background: It is important that the nurse managers are able to contribute to organizational vision, mission, and goals by influencing others, sharing the vision, and implementing it (Boyce, 2018). They are pivotal to the successful accomplishments of the hospital mission. The issue of recruiting, developing and retaining nurse managers is one that challenges many health care institutions, hospitals, hospitals, and health systems. The literature regarding this concern was reviewed and the paucity of useful science in this regard led to question of how to improve the job satisfaction and job retention of nurse managers at urban academic medical centers.

Objective: …

Quality Improvement Initiative: Implementing A Nurse Peer Mentorship Program, Vepuka E. Kauari

Doctor of Nursing Practice Projects

Introduction: Formal mentoring programs are valuable experiences for the mentor and the mentee. They provide nurses with the ability to develop professional networks while refining their competency. Nurses should be properly mentored in focusing skills in addition to addressing their emotional needs. The purpose of this quality improvement project was to promote and evaluate the effectiveness of an existing mentoring program on intent to stay, perceived competency, and job satisfaction.

Methods: Institutional Review Board approval was obtained. A convenience sample of new nurses with less than 2 years’ experience in an academic medical center was recruited to assess their intent …

The Evaluation Of The Brøset Violence Checklist (Bvc) And Interventions To Reduce Patient Violence Incidents Occurring In The Emergency Department, Grace D. Yoon, Dnp, Rn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Patient violence in healthcare is an issue across many departments, but many staff members in the emergency department (ED) are directly affected by violent incidents.

Objectives: Three primary purposes determined the success of this Quality Improvement (QI) project: 1) to evaluate the effectiveness of utilizing the Brøset Violence Checklist (BVC) and implementing appropriate interventions to reduce the number of physical assault occurrences against healthcare providers in the ED; 2) to assess if there was an increase in reporting patient violence incidents; and 3) to assess for any improvements in perceived safety in the ED among the nurses.

Methods: Adult …

Implementation Of Capnography Monitoring To Improve Outcomes Among Intensive Care Unit Patients On Patient-Controlled Analgesia Or Opioids, Leslie Smith, Msn, Bmtcn, Aocns, Aprn-Cns

Doctor of Nursing Practice Projects

Background: Patient-controlled analgesia (PCA) administration of opioids is associated with risk for respiratory depression. Capnography is a non-invasive way to identify early respiratory depression and prevent adverse patient events.

Purpose: This project evaluated the effectiveness of capnography versus standard monitoring in reducing adverse events among patients admitted to an intensive care unit (ICU) who were prescribed PCA opioids and evaluated patients at high-risk for respiratory depression according to age, gender, diagnosis, co-morbidities, and type of opioid prescribed.

Methods: This project used a pre- and post-intervention design to compare differences in the number of adverse events among 20 adult patients …

A Quality Improvement Initiative To Engage Older Adults In The Discharge Process Using The Ideal Discharge Protocol, Ava D. Williams, Msn, Crnp Fnp-Bc

Doctor of Nursing Practice Projects

Background: Readmissions are costly and adversely affect patient outcomes. Readmissions significantly impact older adults’ ability to manage post-discharge. Older adults are more likely to have challenges with understanding newly prescribed medications after discharge and therefore are less compliant with medications. Older adults are also less likely to follow-up with their primary care physician after discharge. Engaging patients and families in a collaborative discharge process is a key foundational element needed to improve patient outcomes and reduce avoidable readmission rates.

Purpose: This quality improvement initiative engaged patients and families in an evidence-based discharge protocol to reduce avoidable readmission over three months. …

Design And Implementation Of A Nursing Peer Review Program In A Two-Hospital Setting, Joan L. Goss Ms, Rn, Acns-Bc

Doctor of Nursing Practice Projects

Background and Purpose: The Institute of Medicine’s (IOM) landmark publication To Err Is Human: Building a Safer Healthcare System measured the impact of medical error on the American public in both unnecessary human suffering and unsustainable financial cost to the US healthcare system. Nursing literature suggests that peer review of safety events can help mitigate the impact of medical errors by increasing nurse accountability for practice and empowerment for leading change.

Methods: Fourteen volunteers were selected from over 900 direct care nurses to participate in a four-month Nursing Peer Review Program (NPRP) pilot. Structure, process, and outcome measures of implementation, …

Effectiveness Of Community-Based Hemorrhage Control Education, Kristin Conti Dnp, Aprn, Fnp-C, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Rural residents are 14% more likely to die from an injury than their urban counterparts due to untimely and ineffective prehospital treatment, inequitable access to the most comprehensive trauma centers, and a lack of injury prevention programs. Although bystanders with bleeding control (BCon) knowledge and skills are vital to injury survival, only 0.5% of Idahoans have completed STOP THE BLEED®.

Purpose: Implement an evidence-based BCon course on how to identify and control life-threatening bleeding with pressure, packing, and tourniquets to increase willingness, confidence, and BCon knowledge, while decreasing concerns.

Methods: A pre-post same subject design was used. Participants were …

Heart Failure Management In A Skilled Nursing Facility, Leigh T. Simpkins

Doctor of Nursing Practice Projects

Background: Reducing heart failure hospital readmissions remains a priority for health systems and is a marker of quality for the Center for Medicare and Medicaid Services (CMS). Heart Failure is the most common cause of U.S. hospital admissions and an effective management program in the nursing home setting is crucial for quality and outcomes.

Purpose: The purpose of this project was to implement and evaluate a Nurse Practitioner/Physician supported heart failure management program in a skilled nursing facility that is able to be incorporated into facility staff workflow, enhances nursing staff knowledge of heart failure, improves identification of patients with …

Aiming For Accuracy In Primary Care Penicillin Allergy Identification, Elizabeth A. Thomason

Doctor of Nursing Practice Projects

Throughout scientific literature, there is overwhelming evidence penicillin-allergic diagnoses are often inaccurate and inappropriate. As this diagnosis can often have unwanted effects for both patients and the healthcare team, it is essential to aim for accuracy when considering penicillin allergies. The purpose of this project was to implement a more focused penicillin allergy screening tool aimed at accurate allergy identification. Evaluation methods included pre and post-intervention electronic medical record reviews. The project also evaluated the impact on total post-tool implementation visit time. Providers and staff received verbal instructions on how to use the tool and the project inclusion criteria. The …

Improving Medication Reconciliation Quality During Long-Term Acute Care Transitions Of Care, Teresa Clark

Doctor of Nursing Practice Projects

Literature reveals accurate medication reconciliation results in increased patient satisfaction, improved patient outcomes, higher patient safety, shorter length of stay, and cost-effectiveness. With every transition of care a patient experiences, their risk for medication discrepancies increases—the project aims to enhance the medication reconciliation process in one long-term acute care hospital in Arkansas. The project aims to evaluate the current process, educate staff, implement a medication reconciliation toolkit, and assess accuracy. Baseline information resulted from reviewing twenty medication reconciliations. Seventeen of the 20 (85%) records had some type of medication discrepancy: (13) lack of verification, (6) dosing errors, (5) missing stop …

Utilization Of A Statin Therapy Initiation Clinical Decision Aid In A Rural Health Clinic: Analysis And Implementation, Debra Schulte

Doctor of Nursing Practice Projects

Low-density lipoprotein (LDL) elevation is a primary risk factor for atherosclerotic cardiovascular problems such as heart disease and stroke. Heart disease is the leading cause of death in the United States and stroke is the fifth leading. Earlier LDL reduction improves morbidity and mortality. Literature indicates fewer women start statin medications compared to men. The purpose of this quality improvement project was to implement a policy change that integrated evidence-based clinical practice guidelines translated into a clinical decision tool. Our aim is to determine whether it would improve statin initiation for the local female population between the ages of 25 …

Improving The Utilization Of Cnas In Pressure Ulcer Prevention, Jaclyn N. Bitterman

Doctor of Nursing Practice Projects

An estimated 2.5 million Americans are affected by pressure ulcers annually with the largest majority impacted the geriatric population. In order to achieve prevention of facility acquired pressure ulcers, the nursing team must properly identify patients at risk to prevent the injury associated with pressure. CNAs play a key role in this effort. The purpose of this project was used to develop, implement, and evaluate a training program for CNA students to improve knowledge and promote engaged attitudes in the prevention of pressure ulcers. Results of the project showed improvement after the training, but overall was not statistically significant. Overall …

Discharge Planning Considerations For Congestive Heart Failure: A Dnp Project, Jainarine Ramlochan

Doctor of Nursing Practice Projects

Abstract

Clinicians are challenged to prevent readmission of patients with congestive heart failure (CHF). The purpose of this project was to: 1) prepare students to better understand the discharge process for patients with CHF; and 2) obtain the opinion of nurses that were involved in the discharge process in the presence of COVID-19 Pandemic. The Delta Care Program (DCP) was used to guide the project and may be a useful tool for discharge planning. An intervention on use of the DCP was delivered to students (N = 83). Findings indicated that student nurses felt confident in the application of …

Understanding Cyanide Toxicity In Victims Of Smoke Inhalation, Jessica L. Wyman

Doctor of Nursing Practice Projects

Every day in the United States forty-two people are killed or injured as a direct result of fire. Building construction materials and furnishings have evolved from natural textiles to synthetic plastic-based goods that release excessive lethal toxic gases when heated. Rapid release of gas results in critical levels of hydrogen cyanide and carbon monoxide leading to fatal toxic exposures. Nursing knowledge and confidence can improve victim survivability by improving rapid recognition and assessment of these complex patients. The purpose of this DNP project was to increase emergency department nursing knowledge, confidence and ability in assessing and appropriately triaging smoke inhalation …

Case Management Of Primary Care Patients, Bernadette Webster

Doctor of Nursing Practice Projects

Case management (CM) offered in primary care is a collaboration, guided by the registered nurse, working to coordinate all aspects of care for the patient and the family. The purpose of this quality improvement/assurance project was to provide nurses in primary care with the education and methods of CM to assist in more effectively managing care for a patient after testing positive for COVID-19. An intervention was delivered to registered nurses (RN) in the primary care setting designed to improve knowledge and skill with case management for patients with high care needs or recently diagnosed with COVID-19. A templated note …

Guideline Utilization To Promote De-Escalation Of Benzodiazepine Use In Adults With Generalized Anxiety Disorder, Magdalena A. Malloy

Doctor of Nursing Practice Projects

Benzodiazepines are commonly used as the first line treatment for adults diagnosed with Generalized Anxiety Disorder (GAD) despite clinical guidelines that recommend otherwise. This can lead to misuse, abuse, addiction, and dependence. To de-escalate use of benzodiazepines as first-line treatment, this DNP Project seeks to reinforce use of evidence-based practice via a reminder card. The guideline compliance program was assessed by chart review to determine impact on GAD-7 scores and benzodiazepine prescriptions. Total of 69 patients’ charts were audited by six prescribers, over the period of eight weeks, to determine if outcomes were met. When analyzed pre and post intervention …

Intervention Of Mindfulness With Students To Identify Mental Health Problems And Enhance Coping Strategies, Aileen M. Jones

Doctor of Nursing Practice Projects

When mental health care is delayed, a young person may have more difficulty in academia and social situations. Therefore, it is important to reach young people to provide them with the skills to deal with stressors and mental health issues. The purpose of this project is to use mindfulness techniques to increase mental health literacy (MHL) and strengthen coping skills which can possibly assist students in building resilience to cope with stressors. By utilizing available mental health resources and learning coping skills, there can be a drastic change in the trajectory of a young persons’ life who struggles with stressors …

Improving Psychological Trauma Awareness For Culturally Responsive Care: A Dnp Project, Jose M. Cruz

Doctor of Nursing Practice Projects

Racism and racial discrimination occur in a variety of forms (Kendi, 2017). Both can contribute to poor mental health outcomes in the United States (Alvarez, Liang, & Neville, 2016; Comas-Diaz, Hall, & Neville, 2019; Levy, 2019; Malott & Schaefle, 2015; Williams, Lawrence, Davis, & Vu, 2019). These social conditions have been identified as chronic stressors that can illicit trauma symptoms, result in post-traumatic stress disorder (PTSD), and contribute to increased suicidality (French et al., 2020). Providers should understand the ramifications of the psychological trauma that can occur and endeavor to deliver evidence-based solutions. This doctoral project was designed to develop, …

A Protocol For Improving Early Recognition And Treatment Of Bipolar Disorder, Zelluyah Gaitho

Doctor of Nursing Practice Projects

In bipolar disorder, patients present to a clinician during depressive episodes often leading to a misdiagnosis. In turn, this could lead to inappropriate treatment. This failure to diagnose could be attributed to lack of use of validated screening tools and deviation from clinical guidelines. The purpose of this quality improvement project was to develop a protocol that will help improve early recognition and treatment of bipolar disorder by using the Mood Disorder Questionnaire. A training program was developed to increase knowledge on the proper use of the Mood Disorder Questionnaire (MDQ) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). …

Improving Medication Adherence In Depressed Patients Via Mobile Applications, Melanie Ocampo

Doctor of Nursing Practice Projects

About 7% of US adults had experienced depression. Depression is characterized by the presence of feelings of sadness, emptiness, or irritability, accompanied by bodily and cognitive changes lasting at least two weeks that significantly affect the individual’s capacity to function. For successful treatment patients must adhere to taking the medication on its scheduled times. Evidence suggests apps reminding patients to take their medication is still a novel idea. The purpose of this project is to determine the impact of Medisafe™ app on medication adherence and overall compliance when used for six weeks.

Human Trafficking: Empowering Healthcare Providers And Community Partners As Advocates For Victims, Marielle A. Combs

Doctor of Nursing Practice Projects

Human trafficking (HT) is a public health crisis and the need for education is dire. Healthcare providers lack confidence in victim recognition and aid provision all while encountering victims in their practice. The project leader aimed to empower healthcare providers in recognizing signs of HT and making appropriate referrals. Ten community volunteers, including registered nurses, who assist with a mobile medical unit and spiritual 12-step program, participated in a Human Trafficking 101 training. The application of holistic nursing core principles and Human Caring Science was integrated as vital in victim identification. A pretest posttest design was utilized to administer the …

Implementing A Hospital-Acquired Pressure Ulcer Intervention In The Icu, Audrey Gross

Doctor of Nursing Practice Projects

Background: Hospitals had been confronting greater incentives to prevent Hospital-Acquired Pressure Ulcers (HAPUs). HAPU rates had increased in the Intensive Care Unit (ICU) at an academic hospital over the past six months, especially regarding device related HAPUs.

Objectives: The primary purpose of this project’s implementation was to decrease the number of HAPUs in the ICU by 50% within a three-month timeframe. Secondary objectives were to achieve scores of 100% in terms of compliance with the Registered Nurse (RN) education module, post-test scores, and documentation.

Methods: This was a Quality Improvement (QI) project involving adult patients in the ICU of an …

Improving Emergency Department Quality Of Care, Carmen Smith

Doctor of Nursing Practice Projects

Emergency department (ED) crowding can cause an extended length of stay (LOS) and high rates of patients who leave without being seen (LWBS). This quality improvement ED project sought to reduce LOS and LWBS by implementing a triage (PIT) team. The design included an outcomes evaluation with available data and a staff pre and posttest. Length of stay and LWBS rates were compared before and after implementation. Results indicated a reduction in the average LOS and LWBS rates for the 30 days of project implementation compared to the 30 days before the project initiation. The overall goal of the PIT …

Developing An End-Of-Life Discussion Protocol In Primary Care Clinics, James L. Hawley

Doctor of Nursing Practice Projects

End-of-life (EOL) issues are far too often addressed reactively in Emergency Departments when patients can no longer express their wishes. This scenario can result in unwanted futile care, increased healthcare costs, and emotional hardships for family and healthcare workers. The purpose of this quality improvement project was to implement a protocol that would shift advanced directive conversations proactively back into primary health care settings. This action would allow patients to make and document informed decisions with their Primary Care Providers (PCPs). A pilot study conducted in November 2020 at a rural clinic provided feedback from PCPs on perceived barriers to …

Student Registered Nurse Anesthetist Perspective On The Impact Of A Clinical Mentoring Program, Sheila M. Mccarley

Doctor of Nursing Practice Projects

There is a competitive push for recruiting and retaining the Student Registered Nurse Anesthetist (SRNA) graduate. Retention efforts begin with their first clinical experience. Mentoring in the clinical setting is a critical factor in influencing the student nurse anesthetist's retention to practice. The purpose of this project was to assess whether mentoring in the local setting noted similar findings. The method involved a survey of student nurse anesthetists queried about perspectives on a clinical-based mentorship program. Certified Registered Nurse Anesthetist (CRNA) faculty members vetted the survey instrument before implementation. The project focused on students presently enrolled in their first-year clinical …

Local Impact Of Implementing Multimodal Anesthesia For Total Joint Arthroplasty, Mary Christine Gilliland

Doctor of Nursing Practice Projects

The opioid epidemic is at a critical point in the United States. This quality improvement project aims to determine which anesthesia strategies lessen the use of opioids in the surgical setting to reduce this raging epidemic. The process included total knee replacement record reviews. Reviews used general linear models to compare two multimodal anesthetic plans, including pre-medications in addition to an adductor canal and subarachnoid nerve block. The researcher reviewed the records for these patients comparing those receiving only an adductor canal and those receiving a subarachnoid nerve block. The record reviews identified postoperative pain level documentation and hospital inpatient …