Medicine and Health Sciences Commons^™

Implementation Of Supplemental Oral Anticoagulant Education To Promote Medication Adherence, Blake Cory

Doctor of Nursing Practice Projects

Proper adherence regarding high-risk medications such as oral anticoagulants (OAC) is essential for reducing the incidence of adverse events such as thrombosis or major bleeding when dosages are missed or inappropriately administered.

The goal of this project was to reduce these events by supplementing current educational practices at a metropolitan cardiac electrophysiology office with new medication education protocols, the development of specific medication informational handouts, and provider training. Providers and staff were provided with medication specific education for Vitamin K Antagonists (VKA) such as warfarin and Non-Vitamin K Agonists (NOACs) such as dabigatran, rivaroxaban, and apixaban for those patients initiating …

The Development Of A Pain Medication Management Protocol, Kirstie Mcgrath, Jane M. Brown, Shannon D. Walle

Doctor of Nursing Practice Projects

Implementation of an organization-wide pain management policy incorporates a multifaceted team approach that could lead to improved patient outcomes. The absence of a standardized opioid prescribing policy within a healthcare organization has led to individual departments adopting their own guidelines. Management of an individual patient’s pain medication is often met with reluctance from providers when a patient is transferred from another department leaving the patient with inadequate care.

Creating A Patient Handout For Venting Gastrostomy Catheter: A Quality Improvement Project, Sally A. Mathews

Doctor of Nursing Practice Projects

At the University of Texas MD Anderson Cancer Center (MDACC), approximately 200 patients undergo placement of a venting gastrostomy catheter annually (venting G-catheter). About 10% of these patients are later seen in the emergency room (ER) for complications related to venting G-catheters. These complications include leakage, infection, skin irritation, and dislocation that require interventions ranging from topical management to exchange of the catheter. The purpose of this project was to create an MDACC-designed patient education handout regarding the care of venting G-catheters as a means of improving patient care and reinforcing these concepts for clinical nurses, thus improving their knowledge. …

Implementation Of Peer Support And Shared Decision-Making Aids For The Transcatheter Aortic Valve Replacement Population, Kimberlee Einfeld

Doctor of Nursing Practice Projects

Background: Patients at a community hospital verbalized fear, stress and anxiety about transcatheter aortic valve replacement (TAVR). Patients with aortic stenosis eligible for TAVR may experience low self-efficacy and anxiety while considering valve replacement which may lead to poor quality of life, interfere with understanding information from medical providers, and other health complications.

Methods: All patients eligible for TAVR between June and August of 2019 were invited to participate in a pilot project using peer support and use of shared decision-making (SDM) aids. Former TAVR patients were trained to be Mended Hearts TAVR peer volunteers. Participants were connected by telephone …

Reducing Pressure Injuries In The Intensive Care Setting: Nursing Knowledge And Best Practices Approach, Michelle Harvey

Doctor of Nursing Practice Projects

Background: For many health care organizations, pressure injury (PI) prevention strategies have become a priority focus to improve patient outcomes and associated costs.

Problem: A rural community hospital located in the Eastern U.S. experienced an increase in hospital acquired pressure injuries (HAPIs), predominantly in the intensive care unit (ICU). In 2018, 17.4% of HAPIs occurred in the ICU.

Approach: Implementation of a Quality Improvement project in an adult ICU, providing education and on-going learning activities to nursing staff, and applying a standardized plan of care “bundle” for prevention interventions.

Outcomes: The approach resulted in improved documentation of flotation of heels, …

Cultivating Appropriate Prescribing In A Primary Care House Calls Practice: A Quality Improvement Project, Sarah J. Marzolf

Doctor of Nursing Practice Projects

Problem Description: Polypharmacy in the frail elderly can lead to suboptimal management of medical issues. Primary Care Providers (PCPs) often lack knowledge of best practices regarding deprescribing and lack a systematic process for assessing mediation appropriateness. A quality improvement project was developed and executed at Housecall Providers, a home-based primary care practice in Portland, Oregon to facilitate the incorporation of deprescribing into daily practice.

Interventions: Following a literature review, a curriculum was developed and utilized during an educational intervention for PCPs regarding deprescribing best practices. A system for introducing new PCPs to evidence-based deprescribing for the frail elderly. This information …

Pilot Project: Developing A Standardized Evidence-Based Education Process For Nurses To Enhance New Medication Eduction Of Hospitalized Patients With Heart Failure, Michele Ann Crotteau

Doctor of Nursing Practice Projects

Problem Description: Research has shown that health information is difficult for the average adult to understand while clear communication helps patients feel involved and increases adherence to treatment. The Joint Commission recommends Health Literacy (HL) assessment and the use of the Teach Back Method (TBM). Medication errors that occur between the RN and elderly patient are preventable when the RN communicates effectively about the patient’s medications. A paucity of research exists evaluating TBM for nurse-patient communications. This Quality Improvement (QI) Pilot Project (PP) took place over 3-months, aimed to improve new medication education to elderly patients with Heart Failure (HF). …

The Effects Of Diabetes Self-Care Management Education Paired With Behavior Change Support Program Using Mobile Technology In Improving Disease Knowledge, Self-Care Activities, And Health Outcomes In Adult Type Ii Diabetes, Ji Min Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Research has shown that Diabetes Self-care Management Education (DSME) paired with the Behavioral Changes Support Program using Mobile Technology (BCSP-MT) has improved patient outcomes by promoting self-care activities. Yet, not many primary practices provide BCSP-MT to improve diabetes care.

Objectives: The study aimed to assess the effectiveness of DSME paired with BCSP-MT in adult type 2 diabetes patients to improve diabetes knowledge, self-care practices, and diabetes control in a primary care setting.

Methods: In this quality improvement project, a 3-months, one-arm, pre-post pilot study was conducted in a clinic, the Northeastern U.S. A convenient sample of 14 people with …

Educational Session To Improve The Knowledge And Confidence Of State Agency Surveyors In Deficiency Citation Of Immediate Jeopardy Findings In Nursing Homes, Aileen Renolayan, Msn, Ma, Rn, Phn

Doctor of Nursing Practice Projects

Background: The oversight of nursing homes is a shared federal-state responsibility. Under the agreement with Centers for Medicare and Medicaid Services (CMS, 2018), state survey agencies assess nursing homes using standard surveys. Several studies indicate that the type of deficiencies issued to nursing facilities varies significantly by state, suggesting inconsistency in the survey process for issuing deficiencies. For example, variation in Immediate Jeopardy (IJ) citations among state agency surveyors has been the subject of reports from the Government Accountability Office (GAO, 2019) and the Office of the Inspector General (OIG, 2014).

Objective: To determine if a 1-hour educational session about …

Effect Of Care Transition Referral On Readmission Rates Of Geriatric Patients Discharged From The Emergency Department, Kyla Newbould Ms, Rn

Doctor of Nursing Practice Projects

Background: An increasing population of older adults and their need for healthcare resources, pressures hospitals to reduce per capita expenditures and incorporate population health initiatives to reduce readmissions. Multidisciplinary teams such as care transition clinics may reduce readmissions.

Objectives: This quality improvement project was implemented to (a) develop a risk assessment for readmission, (b) identify, assess, and refer geriatric patients to a care transition clinic, and (c) evaluate hospital readmission rates to determine the effectiveness of the model.

Methodology: English-speaking participants 65 years or older, who were treated in the ED and planned for discharge were recruited in a 50-bed …

Using Five Wishes To Improve Advance Care Planning In A Maryland Primary Care Practice, Amanda Bridges, Msn, Acnp-Bc

Doctor of Nursing Practice Projects

Background: Advance Care Planning (ACP) at this primary care practice was minimal and lacked a consistent process to document existing advance directives (AD) or educate patients about ADs.

Objectives: The purpose of this QI project was to improve ACP engagement, documentation of existing ADs and educate patients about Five Wishes.

Methodology: Adults, at each office encounter, were asked three kiosk questions: Do you have an AD, know what ADs are and want to discuss ACP? The responses were uploaded to the EHR to become an evidence backed, visual reminder. Affirmation of existing ADs were descriptively documented. ACP engagement was analyzed …

Using Multi-Faceted Validated Tools To Evaluate The Functional Outcomes And Quality Of Life In Patients Undergoing Elective Spine Surgery And Associated Referral Patterns For Post-Hospital Rehabilitation: A Quality Improvement Project, Mercy Oigbokie, Msn, Agnp-C, Aprn

Doctor of Nursing Practice Projects

Background/Significance: A lack of validated multi-facet assessment tools to assess postoperative patients’ functional ability and quality of life may result in untimely or no referrals to rehabilitation.

Objective: The objective of the DNP project was to introduce the use of validated multi-facet questionnaires in assessing patient-reported outcomes and to assess effect on the time in generating prescriptive rehabilitation therapies and the type of therapies following elective spine surgery evaluated in the outpatient neurosurgery clinics.

Methods: This was a quality improvement (QI) project comprising of 100 patients (50 pre and 50 post the intervention). After the introduction of baseline data, the …

Implementation Of A Provider In Triage Program In A Level Iii Emergency Department, Rachel Parmer Mph, Msn, Fnp- Bc

Doctor of Nursing Practice Projects

Background: This project implemented a Provider in Triage (PIT) system in a small emergency department (ED) in Washington State. The employment of a PIT to decrease patient waiting time and improve ED flow was supported by a literature review. A needs assessment was conducted, which indicated potential benefit from a PIT system, particularly because several ED metrics are worse than national average.

Aims/Objectives: This project aimed to develop, implement, and evaluate a PIT system by employing ED Advanced Practice Clinicians (APCs). The objectives consist of evaluating the impact of a PIT system on the percentage of patients who leave without …

Multidisciplinary Team Approach To Prevent Hf Readmissions In Rural Areas, Naydu Lucas, Rn, Msn, Mba

Doctor of Nursing Practice Projects

Background: Despite the national efforts to decrease 30-days hospital readmissions, readmission remains a challenge for healthcare organizations across the continuum of care. The aim of this quality improve project was to develop and implement a multidisciplinary team approach to provide education to patients hospitalized with congestive heart failure (CHF) to improve 30-day hospital readmissions.

Method: This project was conducted in a critical access hospital in Northeast Washington. Using a pre-post design, we evaluated the 30-day readmission before and after implementing the multidisciplinary education program for patients hospitalized with CHF. The education focused on disease management, discharge education, pharmacy consult and …

Combating Pediatric Obesity With A Community-Based, Family-Centered Pediatric Obesity Prevention Program, Hillary Mayers, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Overweight and obesity among children contributes to significant adverse health outcomes that reduce quality of life. Because children are influenced by the behaviors of their parents, there is a need for multicomponent family-based interventions within the community to help overcome these issues.

Objectives: This quality improvement project provided parents and children aged four to six years old with an interactive nutrition and physical activity educational program to increase their knowledge related to healthy lifestyle patterns and alter BMI status.

Methods: A 10-week pre/posttest design was implemented to evaluate outcome measures including BMI percentile, physical activity and nutritional habits, and …

The Effects Of Non-Pharmacological Interventions Consisting Of Earplugs And Eye Masks, Reducing Environmental Factors To Improve Self-Reported Sleep Quality In Icu Patients, Stephen Risch Msn, Rn, Ccrn, Ccns

Doctor of Nursing Practice Projects

Background: Intensive Care Units (ICU) are noisy environments that hinder sleep. Sleep disruption may have negative affects in ICU patients’ recovery.

Aims/Objectives The aim was to determine the feasibility, patient’s comfort level, and the effects of ear plugs, eye masks, and limiting nursing interventions on self-reported sleep quality during ICU stay.

Methods: This quality improvement project was conducted in a community hospital using a quasi-experimental design. Patients in the intervention group wore earplugs and eye masks with limited nursing interventions during nighttime hours compared to patients in the control group who received routine care. Patients subjective sleep quality was measured …

A Systems Perspective For Integrating A Community-Based, Family-Centered Nutrition And Exercise Program Into A Preexisiting Physical Extracurricular Activity, Chayna Hardy-Taylor, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Childhood obesity continues to be a problem in urban areas despite an understanding of the causes and consequences. It is essential to develop ways to reduce childhood obesity from a systems perspective, addressing the multifaceted elements that contribute to it.

Objectives: This project aimed to implement and evaluate a community-based, family-centered nutrition and exercise program to improve health outcomes and long-term complications related to childhood obesity in a New Jersey city.

Methods: A 12-week nutrition and exercise program based on materials from Let’s Go 5210 was provided for children age 8-13 enrolled in a community organization dance class. Participants …

Increasing Adult Influenza Vaccination Rates In The Primary Care Setting, Leah Prescott Msn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Provision of vaccinations is one of the most basic interventions aimed at health promotion and disease prevention in the primary care setting. Despite increased public awareness and improved access to vaccinations through minute-clinic settings, health fairs, and employer-offered vaccination clinics, adults in the United States continue to fall short of national goals. Literature demonstrates vaccination rates among adults vary widely and may be affected by a multitude of factors, however vaccination rates may be greatly improved with increased provider engagement.

Objectives: The purpose of this project was to develop, implement, and evaluate a program to improve immunization rates in …

Alcohol Screening, Brief Intervention, And Referral To Treatment Protocol In The Emergency Department, Malvis Ndips Achonduh Tamon, Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: The impact that results from inappropriate alcohol consumption poses challenges to public health. The rate of alcohol-related visits to the Emergency Department (ED) has increased, which has resulted in an increased annual cost of alcohol-related visits. ED serves as a common portal of entry into the healthcare system for many patients and offers a unique opportunity to impact drinking behaviors.

Objectives: To increase the number of alcohol screenings and brief interventions when indicated to adult patients who visit the ED and increase ED nurses' knowledge regarding alcohol misuse and indications for brief interventions.

Methods: An educational module was delivered …

The Effect Of Hypertension Education On Knowledge, Lifestyle Behaviors And Blood Pressure Management Among Parishioners In A Faith-Based Setting, Lynda N. Goodfriend, Msn, Rn

Doctor of Nursing Practice Projects

Background: Hypertension (HTN) is a major risk factor for life threatening events. Although evidence supports using faith-based settings to provide health education to better manage chronic conditions and prevent complications, HTN education is underutilized in this setting.

Aims/Objectives: This project aimed to assess the effectiveness of HTN education on knowledge, self-reported lifestyle behaviors and blood pressure (BP) management among parishioners in a suburban church.

Method: A pre-post educational intervention was used in this evidence-based project. BP screening identified 56 eligible adults and a convenience sample of 44 parishioners with HTN were enrolled. Participants received two 45-minutes educational sessions. Pre- and …

A Nurse Led Pre-Operative Patient Education Intervention And Its Effect On Anxiety Levels In General Surgical Patients, Elisabet C. Harms Ms, Rn, Cmsrn, Cnecl

Doctor of Nursing Practice Projects

Background: Substantial research has shown anxiety can negatively affect patients during the surgical period. Healthcare staff have limited time to educate.

Objectives: This study assessed the effect of pre-operative patient education on general surgical patients’ level of state anxiety. Also, compared the differences of pre and post intervention anxiety scores between patients undergoing different types of surgery and anticipating varied length of hospital stay.

Methods: A one-hour educational class, either in-person or online, provided information about surgery and recovery phase to 20 pre-operative patients. Participants’ anxiety levels before and after the class were measured using the State Anxiety Inventory questionnaire. …

Mitigating Delirium For The Elderly Post-Operatively Without Medication, Ann Lo Basso

Doctor of Nursing Practice Projects

Background: Often occurring after surgery, or hospitalization, the development of delirium in older adults, initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and high health care costs (Oh, et al., 2017).

Objective: The purpose of this quality improvement (QI) project was to adapt and implement best practices using HELP for managing older patients with postoperative delirium through the existing 1:1 observation structure and implementing cognitive care strategies. The 1:1 sitter roles and responsibilities were redesigned to include non-pharmacological, multicomponent interventions.

Methods: The QI project used a pre-test post-test intervention design comparing groups before and …

Time For Quiet Reducing Nighttime Interruptions In The Icu (Turn In-Icu): Evaluation And Implementation Of A Nonpharmacological Sleep Bundle To Improve Sleep Quality, Delirium, And Nighttime Sedation Requirements, Christina Junker, Msn, Rn, Ccrn

Doctor of Nursing Practice Projects

Background: Undisturbed, restful sleep is essential for physiological as well as psychological well-being. For critically ill patients, sleep deprivation caused by frequent nighttime interruptions is associated with poor sleep quality and negative patient outcomes.

Objectives: The purpose of this Quality Improvement (QI) project was to promote uninterrupted sleep between the hours of 10 PM and 5 AM. Outcomes for evaluation consisted of the following three components: (1) sleep quality, (2) incidence of delirium, and (3) nighttime sedation requirements. Except for sleep quality, these variables were compared before and after the intervention.

Methods: A descriptive, before and after design for data …

Implementing The Ami Readmits Risk Assessment Score Within A Referral Protocol To Increase Referrals For Follow-Up Among Patients With Type I Myocardial Infarction, Nailya Muganlinskaya, M.S.N., M.P.H., Acnp-Bc, Dnp Graduate

Doctor of Nursing Practice Projects

Background: The hospital’s post- myocardial infarction (MI) referral protocol does not address patient risk characteristics. Referrals to a post- MI clinic have been lower than expected. Evidence suggests the AMI READMITS score can predict readmissions within 30 days after discharge among patients with acute MI.

Aim: This quality improvement study evaluated a referral protocol that integrated the AMI READMIT score to increase appropriate referrals after discharge.

Methods: Patient chart data was analyzed to assess changes in referrals and timely follow-up from pre-intervention to intervention. A survey assessed providers’ satisfaction with the new referral protocol.

Results: Among 57 patients (n=29 pre-intervention; …

The Development, Implementation And Evaluation Of An Evidence-Based Biohazard Training Program Within A Pediatric Ambulatory Practice, Lakeshia L. Evans Mba, Fnp-Bc

Doctor of Nursing Practice Projects

Background: Communicable disease(s) such as Ebola or Coronavirus can cause a catastrophic health crisis within the United States healthcare system, especially among the pediatric and elderly population. Lack of knowledge, skills and confidence among health care professionals in the pediatric setting regarding these infectious organisms can affect early identification, proper isolation, early treatment, and increased risk of a possible pandemic and/or fatalities.

Aims/Objectives: The aim of this study was to develop, implement and evaluate an evidence-based biohazard training program-using the Identify, Isolate and Inform (3I) tool within a pediatric urgent care center to increase the staff’s knowledge, skills and confidence …

Implementing A Digital Imaging Platform Using Tissue Analytics In A Level 1 Trauma Center, Victoria Donaldson, Msn, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Background: More than 2.5 million people develop pressure ulcers (PUs) annually. PUs cost the U.S. $9.1-11.6 billion per year and add about $43,180 to a hospital stay. The Centers for Medicare Medicaid Services (CMS) stopped reimbursement for hospital-acquired pressure ulcers (HAPUs). Documentation of PUs must indicate if they are present on admission (POA) and include accurate stages and treatment plan of PUs. Aims/Objectives: To use Digital Imaging platform using Tissue Analytics (TA) along with the standard care protocol. The objectives of this study were to (1) Improve identification of PUs, (2) Increase accuracy of PU staging and (3) Improve documentation …

Nurse’S Perception Of Safety Culture And Patient Safety Following Implementation Of A Handoff Communication Process Between Pre-Operative And Operating Room Nurses, Tracy Willett, Msn, Mba, Rn, Nea-Bc, Cnor

Doctor of Nursing Practice Projects

Background: In a hospital environment the care of the patient is transferred multiple times during his or her stay. Current needs assessment indicates that nurses’ perception of safety culture with handoff communication and patient safety is an area of focus for the practice site.

Objectives: This study aimed to improve the Pre-operative and Operating Room nurses’ perception of safety culture measured with four valid and reliable survey questions. The second study’s aim was to improve patient safety with the handoff process, measured by the number of adverse events reported by the practice site.

Methods: Pre-implementation data was collected. Nurses worked …

Improving Patient And Provider Engagement By Utilizing Ask Me 3®, Joseph G. Smith, Msn, Arnp, Fnp Bc

Doctor of Nursing Practice Projects

Background: Patient and provider engagement in healthcare has an impact on health outcomes.

Purpose: To study the implementation of the Ask Me 3 (AM3) tool, a tool that encourages patients to ask three questions about their health to their care provider. The aim of the project is to explore the level of patient and provider engagement by patients` reports of their perception of engagement with their provider and in understanding their diagnosis.

Methods: The setting was a small urban family practice in the Pacific Northwest. Every patient that checked in for their appointment, excluding pediatric and younger than 18 years …

Utilizing A Mentorship Approach To Address The Underrepresentation Of Ethnic Minorities In Senior Nursing Leadership, Kimberly Jean-Louis, Msn, Mpa, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Many healthcare institutions have acknowledged the benefits of and the need for a workforce that reflects the diverse patient populations they serve. However, few healthcare organizations have made progress in increasing the diversity of their leadership teams. The American Hospital Association’s Institute for Diversity in Healthcare Management (2016) found that while minorities represent 32% of hospital patient populations across the nation, they only account for 11% of executive leadership. The objective of this DNP project was to implement a 4-month mentorship program that empowered minority nurse leaders who desire career advancement to executive leadership roles and provide them with realistic …

Does Use Of A Mobile App And Telephone Support Promote Improved Self-Care Of Heart Failure?, April Christine Chew

Doctor of Nursing Practice Projects

Background

Heart failure is a complex disease and a growing global epidemic. Symptoms and multiple comorbidities contribute to the overwhelming burden of heart failure, and support people make an important contribution to self-care. Effective self-care maintenance behaviors along with confidence and support can help people living with heart failure to effectively self-manage the disease.

Purpose

This project aimed to determine if use of a mobile app with telephone support calls was an effective intervention to promote improved self-care of heart failure and caregiver contribution to self-care of heart failure compared to the standard of care where the intervention was not …