Medicine and Health Sciences Commons^™

Cancer Survivorship: Promoting A Lifetime Of Health, Janelle Coleman-Smith

Master's Projects and Capstones

Abstract

Introduction Cancer survivors can face post-cancer treatment effects that need addressing throughout their care trajectory. Education provided to stakeholders and patients will be beneficial in preventing fragmented care, increasing patient satisfaction, and expanding ongoing supportive clinical survivorship care. Methods An adapted Dr. Joanne Lester survivorship needs survey was given to n=7 post-cancer treatment patients within a northern California cancer patient advisory committee. The survey results were analyzed to identify common underserved chronic long-term survivorship needs. Based on the data, an evidence-based educational component was included within a booklet to enhance future survivorship care. Additional surveys were sent to stakeholders …

Coping With Labor Education For Nurses, Donna Vo

Master's Projects and Capstones

The “Coping With Labor Education for Nurses” education plan is substantiated by data from the California Maternal Quality Care Collaborative (CMQCC) vaginal birth initiative toolkit and other research. Evidence-based data from multiple sources indicates that improving how labor support is offered at the bedside for the laboring patient can potentially decrease cesarean rates, reduce expenses, and increase savings. The objectives of this plan are to improve patient advocacy and the level of labor support interventions labor and delivery nurses will provide for patients to improve patient satisfaction score above 80%, decrease or maintain cesarean rates below 24.9%, and improve patient …

Aim High, Win Big: Optimizing The Or Nurse's Skills To Improve Surgical Outcomes, Ammie Rose Agbuya-Gates

Master's Projects and Capstones

Abstract

Operating room nurses are constantly challenged with new surgical procedures and technology that affect the delivery of safe patient care. A deficiency in skill sets was identified among 50% of OR nurses in this microsystem. A structured scrub training program will improve the performance of novice and advanced beginner nurses to prevent the occurrence of adverse events. This program includes 320 hours of exposure to scrub the top ten procedures of two specialty services after the nurse learns how to circulate. The ability to circulate and scrub is an indication of high performance. It is expected that the OR …

Improving Nurse Proficiency: Breastfeeding And The Opioid-Dependent Mother And Infant Diagnosed With Neonatal Abstinence Syndrome (Nas), Lauren Mountanos

Master's Projects and Capstones

Management of the opioid-dependent mother-infant dyad is complex. Evidence suggests breastfeeding may decrease the severity of NAS symptoms, delay its onset, and decrease the need for pharmacologic treatment (Macmullen et al., 2014). Therefore, education of nursing staff on the benefits of breastfeeding for opioid-dependent dyads will enable them to safely recommend breastfeeding for long-term health (Pritham, 2013). The Clinical Nurse Leader (CNL) project, “Improving Nurse Proficiency: Breastfeeding and the Opioid-Dependent Mother and Infant Diagnosed with Neonatal Abstinence Syndrome (NAS)” aims to globally increase the number of infants diagnosed with NAS discharged on breast milk by 10% by June 30, 2018. …

Reducing Turnover Time To Improve Efficiency In The Operating Room, Myrna Jafari

Master's Projects and Capstones

Abstract

The purpose of this project is to improve efficiency by reducing turnover time in the operating room (OR) that can consequently enhance patients’ and physicians’ satisfaction, promote teamwork, and decrease the cost of operating room delays. The increasing trend of turnover time (TOT) requires attention for microsystem improvement in the OR of Santa Rosa Memorial Hospital. The intervention to improve efficiency is to educate the OR team members on roles and responsibilities to establish a standard workflow which can promote accountability and teamwork during the turnover process. Havelock’s theory of change is used as a framework for the action …

Saving The Brain Matter(S): Improving Stroke Outcomes Utilizing A Direct To Ct Workflow, Robert Schambach

Master's Projects and Capstones

Saving the Brain Matter(s): Improving Stroke Outcomes Utilizing a Direct to CT Workflow was a project implemented to improve outcomes for acute ischemic stroke patients arriving at a rural emergency department. The project focused on a revision of the emergency department workflow for acute ischemic stroke patients with an aim of lowering the door to needle time to under sixty minutes. An interdisciplinary team used lean methodology and the PDCA cycle to examine and revise the workflow. The workflow was revised to eliminate testing no longer required under the national clinical practice guidelines for the treatment of ischemic stroke. Within …

To Asq Or Not To Asq: A Suicide Risk Screening Improvement Project, Gina Mumper

Master's Projects and Capstones

Abstract

Suicide is the second leading cause of death in children between the ages of 10-19 years. Most people who die by suicide have visited a healthcare provider within the prior year. Inpatient healthcare providers, particularly clinical nurse leaders (CNLs), are in a strategic position to assess adolescents for suicide risk regardless of their admitting diagnosis. “To ASQ or Not to ASQ” is an evidence-based project aimed at improving compliance with the Ask Suicide Screening Questions (ASQ) in an eight-bed medical-surgical adult and pediatric overflow intensive care unit (MSICU) in a large tertiary 629-bed academic medical center. Methods included convenience …

Ready, Set, Action: Potential Breakthrough Therapy For Treatment-Resistant Depression, Alvin Garlejo

Master's Projects and Capstones

Major depressive disorder is a psychiatric illness that is associated with a variety of debilitating symptoms such as persistent sadness, lack of interest and motivation, lassitude, pessimistic thoughts, and in severe cases, suicidal ideation and behavior. Current psychological and pharmacological treatments have been demonstrated efficacious; however, an ever-growing number of individuals frequently report minimal to no improvement with these treatments; and in some cases, a worsening of symptoms. This inadequacy to treatment is commonly known as treatment-resistant depression. At Kadima Neuropsychiatry Institute, Dr. Feifel treats individuals with treatment-resistant depression with advanced treatments such as TMS and ketamine. During my fieldwork …

Improving Early Sepsis Identification On Inpatient Units, Corrina Lau

Master's Projects and Capstones

Background: On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. Now that care for sepsis patients is a core measure, it is important that all healthcare providers are knowledgeable in how to treat and identify sepsis.

Purpose: The Purpose is to be a “values-driven integrated healthcare delivery system in collaboration with those who share our values.” Patients observed were ages 18-years-old and older from five inpatient units. The professionals in this hospital consisted of a multidisciplinary approach that included, but not limited to, a team …

Fall Prevention In The Ed, Ninojoseph Lacap

Master's Projects and Capstones

This project focuses on the prevention of patient falls in the emergency department (ED). Kaiser Santa Clara Hospital is an academic medical facility in the heart of Silicon Valley. The facility has a 46 bed ED with an average daily census of 220, specializing in stroke, pediatrics, heart, and left-ventricular assist device (LVAD) patients. For the calendar year of 2016 there were thirty-reported patient falls in the ED. The global aim is to reduce the patient fall rate by 35% for the 2017 calendar year. The project’s objective is to continue the road to patient safety and to have less …

Reducing Delays In Follow-Up Care Through Process Optimization, Liam Malpass

Master's Projects and Capstones

Primary care follow-up after an emergency department (ED) visit is an important component of comprehensive healthcare, contributing to both improved patient outcomes and reduced readmissions to emergency care. In alignment with the Clinical Nurse Leader (CNL) roles of risk anticipator and lateral integrator of care, this project aimed to support improvement in care continuity for patients at a large primary care clinic in London. At this clinic, a team of physicians, nurses, and support staff care for a diverse population of adult and pediatric patients who account for nearly 3,000 ED visits annually. Assessment of the clinical review process used …

Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay, Morgan Whitmore

Master's Projects and Capstones

A quality improvement project “Developing Ostomy Educational Tools To Decrease Hospital Length Of Stay” is aimed at reducing length of stay (LOS) for patients undergoing elective ostomy surgery from the current twelve days (Kirkland-Kyhn, 2017), to less than five days. Methods included use of a Pre-Ostomy Survey, which was distributed and completed by the nursing staff. Pre-survey analysis identified the need for three ostomy educational tools which were developed using a set of evidenced based patient care “milestones” and included: a Colostomy and Ileostomy Nursing Resource Binder, Patient Milestone Checklist, and the R.N. Postoperative Process For Ostomy Patients. The evidenced …

Lessons Learned From Cuba: Using Healthcare Systems And Stillbirth Rate Example, Ravi Patel

Master's Projects and Capstones

Cuba and the U.S. have different health care systems but similar health outcomes. In 2015 U.S. and Cuba had the same stillbirth rate. Cuba is a prevention-based system that is free for all, while the U.S. is a treatment-based system that uses a fee for service system. Cuba has ratified international laws that hold it accountable for improving health outcomes especially for women and children. The U.S. can learn from Cuba when it comes to improving health outcomes. The U.S. can improve their health outcomes by including more preventative based interventions and ratifying international law that will hold the U.S. …

Discharge By 11:00 Am And The Effects On Throughput, Gena Bravo

Master's Projects and Capstones

This Clinical Nurse Leader project aims to improve the discharge process to increase the percentage of patients discharged before 11:00 AM on the Progressive Care Unit (PCU). One evidence-based approach to help alleviate capacity constraints in the hospital is to create an effective and timely discharge process. The goal of this project is to educate the front line staff, care coordinators, and providers to a standardized discharge process. The PCU is a cardiac telemetry unit with 30 private rooms. The patients on the PCU are post-cardiac surgery with some overflow medical patients throughout the unit. Kotter’s theoretical framework was chosen …

Clostridium Difficile: An Investigation On A Medical Surgical Unit, Neftali Cabezudo

Master's Projects and Capstones

The objectives for this CNL Internship Project were to: (1) identify the strongest contributors to the rising trend of Clostridium difficile cases on this medical-surgical unit, (2) review all Clostridium difficile cases for correlational factors that are of significant relevance, (3) examine current unit practices and adherence to established policies, and (4) provide recommendations for enhancing existing prevention strategies. The population examined included male adults between 56-83 years old being treated for other medical conditions. The methods used to address this clinical issue included a joint venture between nursing and housekeeping staff to ensure proper terminal cleaning and a renewed …

Interdisciplinary Team Approach In Fall Prevention: Physician Perspective Focus, Anna Gryn

Master's Projects and Capstones

An in-hospital fall is a devastating event for patients and care providers resulting in injuries, physiological and psychological patient declines, and sometimes deaths. Furthermore, fall related costs greatly increase hospitals’ expenses and cause massive distress to caregivers and health providers. Many patient-specific, organizational, and seemingly erratic factors contribute to the occurrence of in-hospital falls. Despite this, hospitals must undertake consistent evidence-based measures to prevent fall occurrences as much as possible.

The traditional nursing approach to falls prevention is not sufficient to control fall rates because the issue is too complex and must be approached from multiple perspectives rather than just …

No More Baby Steps: Preventing Unintended Pregnancies Of Los Angles Minorities And Adolescents, Rachel Bass

Master's Projects and Capstones

Previous studies have identified pregnancy intention to correlate with both maternal and fetal health. Though unintended pregnancy rates are dropping in America, they remain high among minority and young women. Contraceptive usage, a leading protective factor for unintended pregnancies, has been found to vary greatly by age and ethnicity. These two projects aimed to decrease unintended pregnancy rates through increasing patient knowledge of contraceptive options and correct usage. The first project focused on creating a comprehensive, oral contraceptive pill instructional handout for research participants of the birth control pill study. This handout was created through the analysis of compliance errors …

Health Starts In The Home: An Assessment Of Efforts To Improve Occupant Health Through Healthy Building Materials In San Francisco’S Affordable Housing, Staci Hoell

Master's Projects and Capstones

Americans spend 90% of their lives indoors, and much of this time is spent at home, surrounded by building materials that typically have added chemicals like flame retardants, highly fluorinated compounds, and antimicrobials. Recent research has linked these chemicals to adverse health outcomes such as asthma, endocrine disruption, cancer, neurodevelopmental issues, and reproductive problems (Bayer et al., n.d.; Green Science Policy Institute). Furthermore, these chronic health conditions disproportionately affect low-income populations. Fortunately, substantial efforts in research, practice, and policy are working to reduce the use of these potentially harmful chemicals in building materials, particularly in San Francisco’s affordable housing sector. …

The Clinical Nurse Leader: Improving Early Sepsis Identification On Inpatient Units, Denise G. Lopez

Master's Projects and Capstones

CNL students were invited to a large metropolitan hospital in an effort to create a quality improvement project related to sepsis in order to decrease cost, the length of stay, and improve patient outcomes. CNL students shadowed nurses in order to better un derstand the nursing culture and assess the microsystem. Chart audits were reviewed to determine whether nurses at the assigned units were completing sepsis screenings on time and used the appropriate vital signs and labs. Nurses’ questionnaires were provi ded to assess sepsis knowledge and their understanding of sepsis. Results showed a lack in compliance in completing sepsis …

Improving Early Sepsis Identification On Inpatient Units, Monica Schurle

Master's Projects and Capstones

Sepsis is a serious complication, which is initiated by the body’s extreme response to an infection. If sepsis is not identified and treated promptly, it can rapidly lead to tissue damage, organ failure and death. In order to reduce the number of patients who decline to sepsis in hospital, an efficient sepsis protocol needs to be implemented. Nursing practices, knowledge, and early recognition of systemic inflammatory response syndrome (SIRS) were assessed and measured in order to implement effective interventions. A root cause analysis was conducted to identify any discrepancies with compliance performing the sepsis screening in a timely manner, identify …

Improving Early Sepsis Identification On Inpatient Units, Leslie Virtudazo

Master's Projects and Capstones

Sepsis is a life-threatening condition that arises from a complication of severe infection characterized by a systemic inflammatory response (SIRS). As a time critical illness requiring early identification and treatment, delayed recognition of sepsis can lead to organ failure and death. Effective sepsis protocols need to be established and implemented to reduce the number of patients declining to sepsis in the hospital setting. For this project, nursing practice and knowledge of SIRS and sepsis protocol were assessed to obtain a baseline measure of the nurses’ knowledge.

A root cause analysis was used to identify existing barriers to performing timely sepsis …

Reducing Intraventricuar Hemorrhage, Nakia Green

Master's Projects and Capstones

Abstract

Global Aim:

Between September 2017 and September 2018 we aim to reduce the rate of grade III and grade IV intraventricular hemorrhage (IVH) in infants less than or equal to 32 weeks gestation, or less than or equal to 1500 grams from 11% to 5%.

Project Aim:

Develop a best practice bundle for the Prevention of Intraventricular Hemorrhage with implementation of best practice of midline head positioning for infants less than or equal to 32 weeks gestation or less than or equal to 1500 grams by October 2017.

Setting:

Level III, 64 bed Neonatal Intensive Care Unit

Quality …

Surgical Site Infection Reduction Through Nasal Decolonization Prior To Surgery, Melissa S. Schmidt

Master's Projects and Capstones

Surgical site infections (SSIs) are the most common and expensive healthcare-acquired infection. The objective of this nurse-driven process improvement project was to implement a cost-effective and practical decolonization protocol to improve outcomes for high-risk veteran populations undergoing surgery at a large veteran’s hospital in the Pacific Northwest. Prior to the implementation, a decolonization protocol was used for cardiac and orthopedic preoperative patients. The process involved screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization via nasal swab preoperatively and treating positive patients with mupirocin ointment to nares BID and chlorhexidine showers for five days prior to surgery. Adherence to the protocol was …

Lost In Translation, Daniel Pena

Master's Projects and Capstones

At the conclusion of a patient’s hospitalization the Registered Nurse (RN) will review all discharge instructions in the patients room in their preferred language. Plan time for the discharge and facilitate a calm quiet environment, such as the patient’s room with the door closed, if possible. Get the discharge instructions printed out in their preferred language and a set for yourself in English would be best so you are able to review the instructions line by line with them. When the patients medical team, such as but not limited to, medical doctors, pharmacists, physical therapists, and social work have completed …

Homecare Portacath Protocol In Ivig Administration, Cindy Watson

Master's Projects and Capstones

Homecare Portacath Protocol in IVIg Administration

The objective for this CNL internship project was to close a practice gap that was discovered while evaluating my microsystem for system improvements. My microsystem is a medium sized Home Health Agency with a specialty of in home infusion therapy. While evaluating protocols for immunoglobulin (Ig) infusion I found that there was no protocol for the administration of Ig by portacath. After consulting with the Director of Nursing (DON) and my colleagues on the Infusion Team, it was agreed that a current evidence based protocol was needed to close the practice gap. The methods …

Improving Oral Care Practices And Aspiration Risk Assessment To Mitigate Risk Of Hospital Acquired Pneumnia, Jeniffer Baker

Master's Projects and Capstones

Abstract

The aim of Improving Oral Care Practices and Aspiration Risk Assessment to Mitigate Risk of Hospital Acquired Pneumonia is to decrease rates of hospital acquired pneumonia (HAP) on a 16 bed Transitional Care Unit (TCU) with a mixed skill staff. The theme of the project is risk reduction with improved patient outcomes and cost reduction as reasons for implementation. Fourteen cases of HAP were reported in the last 5 quarters which accounts for 48% of all in-patient acquired infections. Through policy development, standardization of oral care technique, and improved risk factor assessment, the project goal is to decrease rates …

A Multi-Prong Fall Awareness Program To Reduce The Occurrence Of Falls In A Skilled Nursing Unit, Cheri Labrador

Master's Projects and Capstones

Abstract

A multi-prong falls awareness program to reduce the occurrence of falls in a skilled nursing unit

Keywords: Fall awareness program, skilled nursing unit, fall rate

The project goal was to reduce the patient fall rate by 20% by implementing a fall awareness program for clinical staff. The program had two prongs and began with a pre-survey to determine current fall prevention knowledge. The staff was encouraged to participate in the training by providing risk factors that contribute to falls and simple strategies to prevent falls based on their knowledge of the patients (Boushon et al, 2012). A post-survey was …

Fall Prevention, Linda Fang

Master's Projects and Capstones

Fall Prevention Abstract

Background: According to the CDC, the medical cost for falls was approximately $30 billion in 2012. When a patient falls, and gets serious injury, these costs could sum up to $14,056 per patient. As a result, hospital stays per patient are observed to increase by approximately 6.3 days longer than those patients who haven’t encountered falls.

This study focused on identifying high fall risk patients, and developing a plan of care to reduce the occurrence of falls in a hospital setting. Nurses using safe fall interventions techniques have been proven to inspire fall preventions.

An assessment of …

Mentor-Based Orientation Program, Sheryl Pinugu Bano

Master's Projects and Capstones

The intention of this quality improvement project is to improve the process of staff development in a 16-bed, acute rehabilitation unit by implementing a mentor-based orientation program. Rehabilitation nursing is a specialty that requires knowledge of the rehab philosophy and milieu. The lack of a rehab-specific educational component of the orientation process causes the new nurses anxiety and dissatisfaction which negatively impacts nurse retention. The project aims to improve the confidence and competence of new nurses, decrease nurse turnover rate, and increase nurse retention by providing a rehab-specific, orientation class. The MiRehab booklet and a PowerPoint presentation were …

Implementation Of A Fruit And Vegetable Voucher Program In San Francisco, Alexandra Kambur

Master's Projects and Capstones

Chronic disease has emerged as the predominant public health challenge of the 21st century. Chronic diseases like cardiovascular disease, cancer, type 2 diabetes and obesity have maintained their top positions as the leading causes of poor health, disability, death, and high health-care expenditures for over a decade. Health and hunger go hand-in-hand. Today over 15 million households in the United States struggle with food insecurity, meaning they do not have sufficient access to food that meets their dietary needs for an active and healthy life. The issue of food insecurity in cities like San Francisco, California is exacerbated by the …