Medicine and Health Sciences Commons^™

Clinical Practice Implementation To Address Ascvd Risk: A Practice Change In Primary Care, Elizabeth Wooten

Student Scholarly Projects

Practice Problem: Heart disease stands as the leading cause of mortality in the United States. While healthcare providers strive to identify and optimize prevention strategies, particularly in high-risk patient populations, notable gaps in care persist, notably in the management of modifiable risk factors such as low-density lipoprotein cholesterol (LDL). By harnessing the power of artificial intelligence (AI) integrated software within clinical settings, we can revolutionize the landscape of this devastating chronic disease.

PICOT: The PICOT question that guided this project was: In Primary Care Advanced Practice Providers (APP) caring for high-risk and/or very high-risk patients with atherosclerotic cardiovascular disease (ASCVD) …

Early Discharge Planning To Improve Throughput, Alan Chhith

Student Scholarly Projects

Early discharge planning can improve the safety and outcomes of hospitalized patients. The aim of the multidisciplinary team early discharge rounds was to manage patient flow by removing discharge barriers to reduce the length of stay in the medical/surgical unit. The overall goal of the process improvement project was to make inpatient beds available to admit patients from the emergency department, reducing long ED boarding, and decrease the hours of diversion. The PICOT question for this project was: in the Veteran population (P) in the VA medical/surgical unit, early discharge planning with an interdisciplinary team (I) compared to regular discharge …

Improving Access To Cardiac Catheterization, Sunitha Dharman

Student Scholarly Projects

The American Heart Association lists cardiovascular disease as the underlying cause of death for 874,613 people who lost their lives in 2019 (Tsao et al., 2022). On average, someone in the United States has a myocardial infarction every 40 seconds, and someone dies of a stroke every 3 minutes and 30 seconds. Studies support coronary artery disease as a significant contributor to cardiac arrest in a non-hospital setting (Yannopoulos et al., 2019). The authors provide evidence supporting the importance of early cardiac catheterization. There is a 10-15% survival rate with a higher level of functioning compared to delayed or no …

Hypertension: Care Management Program And Medication Adherence, Courtney Montgomery

Student Scholarly Projects

Practice Problem: Medication adherence is a major concern in healthcare as it is a contributing factor to uncontrolled hypertension and resistant hypertension. Uncontrolled hypertension can lead to strokes, heart attacks, kidney failure, and even death.

PICOT: The PICOT question that guided this project was in Medicare Advantage members with hypertension located in Kansas, who were admitted to the hospital or emergency room identified by stratification (P), does care management utilization using hypertension clinical guidelines (I), compared to the stand-alone hypertension clinical practice guideline (C), improve medication adherence (O) over 10 weeks (T)?

Evidence: Hypertension is one of the leading preventable …

Implementing A Designated Follow-Up Plan To Increase Patient Adherence To Surveillance Recommendations After Endovascular Aortic Repair, Stacey Basta

Student Scholarly Projects

Practice Problem: Patients who have had endovascular aortic repair (EVAR) require lifelong monitoring and imaging surveillance due to the increased risk of developing serious complications. Despite specific EVAR follow-up and guideline recommendations, patient adherence remains poor.

PICOT: In adult patients who have undergone endovascular aortic repair (P), does the use of a designated follow-up plan(I), compared to the current routine follow-up care (C), increase annual adherence of patients to the recommended post-surgical surveillance (O) over 10 weeks (T)?

Evidence: The literature supported the need to improve lifelong surveillance for EVAR patients, noting a positive correlation between improved patient adherence and …

Improving Nurses Wound Care Knowledge Utilizing An App, Monica Amador

Student Scholarly Projects

Practice Problem: Nurses needed additional wound care support, but formal training was not in the budget at this time. Nurses needed a quick reference guide to help them assess, document, and treat wounds correctly until the hospital could provide adequate training.

PICOT: The PICOT question that guided this project is; “When treating wound care patients within a hospital setting (P), how does the implementation of a wound software app. (I) as compared to pre-existing nursing knowledge (C) increase a nurse’s self-reported ability to accurately assess and treat wounds (O) during a 10-week period? (T)”

Evidence: Based on a thorough and …

Implementation Of A Hospital-Wide Surge Plan To Reduce Emergency Department Length Of Stay, Laura Massey

Student Scholarly Projects

Practice Problem: Suboptimal patient flow throughout the hospital has resulted in an increased length of stay (LOS) for emergency department patients and the potential for adverse events.

PICOT: In admitted and discharged emergency room patients (P), how does a hospital-wide surge plan (I) compared to current throughput plan (C) affect the length of stay (O) within 8 weeks?

Evidence: The literature evidence reviewed supported the implementation of a hospital-wide surge plan approach positively impacts the emergency room length of stay and patient outcomes.

Intervention: The primary intervention for this project was the implementation of a hospital-wide surge policy. Targeted …

Pre-Transplant Evaluation Period Efficiency Through The Use Of An Electronic Scheduling Template, Christy Dawn Byrd

Student Scholarly Projects

Practice Problem: Candidacy for transplant evaluation is a complex and lengthy evaluation process. Delays in National Organ Registry have significant unfavorable impacts on patient outcomes as 22 people a day die awaiting a lifesaving treatment. Operational efficiencies can improve the pre-transplant evaluation period and significantly improve patient outcomes.

PICOT: In an outpatient transplant clinic (P), will leveraging an evidence-based scheduling template (I) compared to the current practice of first available appointment (C) reduce the evaluation period by 66% from a 3–4-week evaluation to a 1-week evaluation resulting in expedited listing on the National Organ Registry (O), when applied over …

Increasing Equitable Access To Care: Implementation Of Universal Palliative Care Screening In The Intensive Care Unit, Sarah Weaver

Student Scholarly Projects

Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations.

PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame?"

Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance …

From The First Encounter: A Communication Program For High Volume, High Acuity Patient Care Locations, Shazam Bacchus

Student Scholarly Projects

Effective communication is a true value to healthcare organizations. Far too many communication sessions are detrimental to patient health outcomes. National data and hospital records are proven information to suggest communication is a major barrier to overall patient satisfaction. Organizations struggle to increase market share and patient satisfaction with a likelihood to recommend because of poor communication by physician and nurses. The use of a strategic communication tool like AIDET plus the Promise can influence the improvement of an organization’s quality of care.

This paper examines the use of AIDET plus the Promise as a strategic communication tool. High volume, …

Establishing A Sustainable Occupational Therapy Student-Led Pro Bono Clinic At The University Of Saint Augustine In Austin, Texas, Daija Chumley

Student Capstone Papers

Under-resourced and underserved communities across the United States experience significant health disparities. These communities lack access to valuable services resulting in health inequities that impinge on their health, quality of life, and engagement in meaningful occupations. There is a need for occupational therapy to provide valuable services to the under-resourced and underserved community to address the historical inequity that impacts their overall quality of life. Universities have the potential to fulfill the gaps within these communities by establishing a pro bono clinic. The purpose of this capstone project is to establish a sustainable occupational therapy pro bono clinic at the …

Implementation Of Daily Nhppd Calculator In The Acute Care Setting, Spencer Y. Cho

Student Scholarly Projects

Practice Problem: In the United States, it is estimated that hospitalized patients experience an adverse event that require a rapid response and/or code blue event in 3% to 18% of hospitalizations.

PICOT: In the adult medical-surgical inpatient (P), does the implementation of a daily NHPPD calculator (DNC) (I) compared to an annual staffing methodology for calculating NHPPD (C) reduce rapid response calls, code blue episodes, and unplanned admission to critical care (O) over 8 weeks (T).

Evidence: Seven studies provided evidence that implementation of staffing methodology, nursing surveillance, and nurse staffing that supports meeting targeted nursing hours per patient …

Behavioral Code Team, Daniel Mcgrath

Student Scholarly Projects

Practice Problem: The organization lacked an evidence-based intervention for behavioral emergencies within the inpatient acute care setting, leading to increased mechanical restraints. A security-driven paradigm was the organization's primary tool for addressing behavioral crises and lacked a more patient-centered treatment and support paradigm.

PICOT: The PICOT question that guided this project was In the Veteran patient population admitted to acute inpatient services (P), how does having a behavioral code team respond to behavioral emergencies (I) compared to the current practice (C) affect the prevalence of mechanical restraint usage (O) within an eight week period (T).

Evidence: Seven …

Evidence-Based Best Practice For Discharge Planning: A Policy Review, Marissa Lewis

Student Scholarly Projects

Ineffective discharge planning produces poor patient healthcare outcomes, potential adverse events, and medical errors. A primary deterrent to successful discharge planning is communication, either within the interdisciplinary team or during handoff to the receiving transition of care facilities of home health, skilled nursing, or acute rehabilitation.

The purpose of the evaluation project was to determine if current policies, communication tools, and workflows of three healthcare organizations were based on evidence and make recommendations for policy revisions. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals Model (JHNEBP) was used with the Centers for Disease Control (CDC) Policy Process (POLARIS) …

Oral Care Bundle Impact On Staff Assisted Oral Care, Sabrina Oliver

Student Scholarly Projects

Practice Problem: Non-ventilator hospital acquired pneumonia (NV-HAP) is more common than ventilator acquired pneumonia. Oral care is the only modifiable risk factor for all patient populations.

PICOT: The PICOT question that guided this project was: In non-ventilated patients in a tertiary care setting (P), how does implementing an oral care bundle (I) compared to the current practice of individual tasks without a bundle (C) affect adherence to facility oral care standard of patients receiving oral care at least once a day (O) over six weeks (T)?

Evidence: Lack of an oral bundle that has been proven to decrease …

Perception Is Everything: Implementation Of A Peer Evaluation Program For Nurse Leaders In A Hospital Setting, Teruko Williams

Student Scholarly Projects

Practice Problem: A hospital in the Sacramento County area seeking the ANCC Pathway to Excellence Program^® designation determined upon performing a gap analysis that Element of Performance 2.8, a peer evaluation program, was absent, thus creating a deficiency in the fulfillment of the requirements for the designation.

PICOT: The PICOT question that guided this project was: In nurse leaders (P) how does the development of a formal peer evaluation process (I) compared to no formal process (C), influence the performance outcome score of self-efficacy (O) over 8 weeks (T)?

Evidence: The evidence demonstrated that if a …

Nurse-Driven Protocols For Abdominal Pain In The Emergency Department, Chris Schmidt

Student Scholarly Projects

Practice Problem: Emergency department (ED) crowding hinders the opportunity to deliver safe, quality care to abdominal pain patients and detrimentally affects clinical outcomes. Leadership of a rural community ED recognized a comparable issue by introducing a nurse-driven protocol (NDP) to reduce patient length of stay (LOS) and the rate of patients who leave the department prior to physician evaluation.

PICOT: The PICOT question that guided this project was: For adult patients in an emergency department, how does a nurse-driven protocol for abdominal pain compared to no protocol use affect the LOS and left without being seen (LWBS) rate over 10 …

Change Project Using A Fall Prevention Action Program To Decrease Falls On A Behavioral Health Unit, Amy Shuptrine

Student Scholarly Projects

Practice Problem: Fall rates are increasing in the behavioral health units of the East Texas hospital. Due to the worldwide COVID-19 pandemic, the units are short-staffed, which further supports the urgent need for a targeted intervention to reduce fall risk.

PICOT: The PICOT question that guided this project was: “In adult behavioral health patients (P), what is the effect of the Edmonson Psychiatric Fall Risk Assessment Tool (I), compared with previous use of the Morse Fall Risk tool (C), on the fall rate (O), in 8 weeks (T)?”

Evidence: Falls are the most reported incidents in acute care hospitals and …

Leadership Rounding To Improve Patient Satisfaction In Pediatric Ambulatory Care, Tara J. Haskell

Student Scholarly Projects

Practice Problem: Low patient satisfaction has been linked to poor treatment compliance, patients leaving the practice, staff decreased job satisfaction, and high staff turnover (Haskard Zolnierek & DiMatteo, 2009; Prakash, 2010). Magnet reporting has identified wide discrepancies in ambulatory clinics, with some clinics reporting below benchmark patient satisfaction ratings.

PICOT: In pediatric ambulatory and primary care services, how will the implementation of leader-led customer service rounding, compared to current practice, increase family and/or patient satisfaction over 4 weeks?

Evidence: Key findings are that the rounding needs to be population-specific, intentional, and swiftly followed up when problems are identified. The body …

Improving Patient Flow In The Urgent Care Setting, Stephanie Carpenter

Student Scholarly Projects

Practice Problem: Urgent care clinics provide care to patients with non-life-threatening illnesses or injuries and are found to be less expensive and more convenient than emergency departments. As urgent care clinics are growing in popularity so are the patient wait times and overall length of stay times.

PICOT: The PICOT question that guided this project was in urgent care clinic patients (P), how does utilizing the Emergency Severity Index (ESI) as a patient triage tool (I) compared to using no patient triage tool (C) affect the patient flow and patient wait times (O) within 13 weeks.

Evidence: Evidence search with …

Nurse Retention In Workplace Adversity, Deborah Lewis

Student Scholarly Projects

Practice Problem: Nurse turnover rate and lack of retention are issues that have an impact on safe patient care, patient mortality, quality outcomes, and patient experiences in the acute care units at the identified project setting. Turnover leads to excess labor utilization of overtime and increased hospital costs.

PICOT: The PICOT question that guided this project was (P) In acute care hospital nurses, how do (I) nurse retention strategies (C) compared with no nurse retention strategies (O) reduce nurses’ intention to leave and increase job satisfaction over (T) eight weeks?

Evidence: Twenty-one articles were reviewed that identified autonomy, recognition, …

Implementation Of The National Early Warning Score Tool In The Acute Care Setting, Amanda Reyes

Student Scholarly Projects

Practice Problem: The organization arbitrarily called a rapid response or code blue call based on abnormal vital signs or intuition and needed a new process to identify early recognition of patient deterioration.

PICOT: For adult inpatients in an acute care setting in a large healthcare system (P), will implementation of the National Early Warning Score (NEWS) across the organization (I) compared to data from the last fiscal year where NEWS was not used (C) decrease code blue calls (O) within 8-weeks (T)?

Evidence: Eleven high quality studies met the inclusion criteria and found that the NEWS is a validated …

A Safety Program In A Tertiary Care Center Emergency Department: An Evidence-Based Project To Increase Safety Event Reporting And Improve Frontline Staff Perceptions Of Hospital Management’S Response To Safety Events, Elizabeth Anne Mcmaster

Student Scholarly Projects

Practice Problem: The lack of a non-punitive safety culture with a healthcare organization is associated with decreased safety event reporting, reimbursement rates, and staff satisfaction.

PICOT: The PICOT question that guided this project was: In emergency department frontline staff, does hospital management involvement in a safety event program, contrasted with no safety event program, improve frontline staff’s reporting of safety events and perceptions of hospital management’s response to safety events management involvement over four weeks?

Evidence: Three overlapping themes that guided this project included: improving organizational culture, open communication, and leadership support in promoting patient safety.

Intervention: A safety event …

Improving Emergency Department Throughput: Using A Pull Method Of Patient Flow, Jeffrey Collins

Student Scholarly Projects

Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies.

PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation?

Evidence: …

Patient Satisfaction With Noise, Robert W. Kentner Ii

Student Scholarly Projects

Practice Problem: Noise on hospital units can interfere with patient rest, timely recovery, and statisfacton with care. Improvements in the reduction of hospital noise levels lead to improved patient satisfaction and improved rest. Patients were surveyed on their satisfaction with noise during the day and at night.

PICOT: In Acute Care Patients (P), does the implementation of a noise reduction program (I) compared to no noise reduction program (C), affect patient satisfaction with noise (O) over a six-week period (T)?

Evidence: Studies show that many hospitals have noise levels that exceed the World Health Organization’s recommended standards for noise …

Improve The Risk Of Central Line-Associated Bloodstream Infections With Central Line Dressing Changes Through A Team Approach, Jessica Comstock

Student Scholarly Projects

Practice Problem: Central Line Associated Bloodstream Infections (CLABSI) are a preventable hospital acquired infection which contributes to patient morbidity, mortality and rising healthcare costs.

PICOT: The PICOT question that guided this project was: In adult inpatients with central venous catheters, does the use of a two-person dressing change team, compared to a single person procedure, decrease the rate of central line associated bloodstream infections over the course of 8 weeks?

Evidence: The prevention of CLABSI is most effective when multifaceted line maintenance bundles are implemented and adherence to these bundles nears 100% (Schreiber et al. 2018).

Intervention: A two-person, …

Reducing Patient Falls By Realigning Nursing Hours Per Patient Days, Hermes Vargas

Student Scholarly Projects

Patient falls are the “second leading cause of unintentional injury death” (World Health Organization [WHO] (2018), para. 3) and increase healthcare costs by an estimated $13,806 per fall (Walsh et al., 2018). These fall-related costs translate to a potential savings of approximately $400,374 to the selected organization since the unit chosen for the practice change project experienced 29 falls in the fiscal year 2019 (C. Hernandez, personal communication, September 23, 2019).

The PICOT question that guided this project was: In a medical/surgical inpatient population in acute care (P) how does realigning the Nursing Hours per Patient Days (NHPPD) (I) compared …

Reducing Patient Falls Through Purposeful Hourly Rounding, Amanda Savage

Student Scholarly Projects

Practice Problem: Falls significantly affect patients, resulting in temporary or permanent harm, even death. In a large acute care facility, patient falls increased from 444 in 2016 to 556 falls in 2019.

PICOT: In an adult inpatient hospital setting, does purposeful hourly rounding (PHR), compared to no rounding, reduce patient falls over a period of 30 days during the same time period from the previous year?

Evidence: Of the 360 articles reviewed, 12 articles, varying from evidence levels two (1), level three (4), and level five (7), supported PHR as effective in reducing harm from falls in adult …

Preventing Falls In Long-Term Care Using Patient-Centered Fall Interventions, Angela Blakley

Student Scholarly Projects

Practice Problem: The practice problem identified within the Community Living Center included continuous falls, despite using current fall prevention strategies and provider-driven interventions. Baseline data reflected a fall rate of 4.2 in the long-term care areas despite improving the fall prevention program.

PICOT: The PICOT question that guided this project was: In older adult residents (P), what is the effect of a standing operating procedure (SOP) using patient-centered interventions (I) compared to physician-driven fall interventions (C) on decreasing falls and falls with injuries (O) within one month (T)?

Evidence: In twelve high-quality articles that fit the eligibility criteria and …

Decreasing Readmissions In Medically Complex Children, Colleen Bartlett

Student Scholarly Projects

Practice Problem: There was a report of an existing practice problem of increased 30-day readmission rates in medically complex children at an outpatient clinic within an extensive hospital system. Hospital readmissions can cause clinical, social, and financial burdens to the patients and their families and thus reflected a need for interventions to reduce readmissions.

PICOT: The PICOT question that guided this change project: In medically complex pediatric patients ages 0-17, what is the effect of a discharge intervention bundle in reducing all-cause 30-day hospital readmissions compared to current practice within an 8-week timeframe?

Evidence: The literature revealed 18 …