Medicine and Health Sciences Commons^™

Improving Infection Management Of The Institutionalized Elderly, Jovel Angela Viloria Broqueza

Doctor of Nursing Practice Projects

Abstract

As the elderly population rapidly grows in the United States, the burden of managing infection in long-term care facilities (LTCF) escalates. The use of evidence-based infection identification algorithms for early recognition and treatment of pneumonia, urinary tract infections (UTI) and skin and soft tissue infections (SSTI) was evaluated at a Midwest suburban 110-bed long-term care facility. Focus group sessions were conducted at the facility with four nurse practitioners, the medical director, eight nurses and certified nursing assistants (CNAs) prior to an educational in-service which was provided to all staff at the facility. As criteria of infection were reported, nurses …

Transitioning With Grace: Improving Quality Of Life For Comfort Care Patients In The Intensive Care Unit, Melissa Ashley

Doctor of Nursing Practice Projects

The primary aim of this project was to develop and execute a standard protocol of interventions for comfort care patients on a medical intensive care unit. Staff at a 15 bed MICU at a Midwest urban teaching hospital from June 1 until August 11, 2018 were trained to execute a standardized protocol of interventions for comfort care patients. Seventeen MICU patients who transitioned to comfort care were offered a standardized set of evidence-based interventions, after staff attended educational in-services on providing high quality end of life (EOL) care. Checklists were used to determine intervention compliance. Pre-project and post-project surveys were …

Overcoming Barriers For The Implementation Of Evidence-Based Practice Through Journal Clubs, Regina Thomas

Doctor of Nursing Practice Projects

Many barriers exist at a 134-bed rural hospital in southern Illinois that hinder generation, evaluation, and implementation of evidence-based research into practice. This DNP project was completed through a phase approach utilizing a modified version of Kotter’s Model of Change, the RNcEBP Survey to self-rate individual confidence in the EBP process, and the Iowa Model of Evidence-Based Practice to facilitate implementation of journal clubs. The RNcEBP survey revealed that nurses were familiar with the concept of EBP, have positive attitudes, and are confident that EBP changes can improve patient outcomes, but lack experience in evaluating literature to support implementing evidence-based …

Implementation Of High Blood Pressure Guidelines In Clinical Practice, Jessica Walker

Doctor of Nursing Practice Projects

Abstract

This quality improvement project implemented 2017 Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. An in-service education session on the 2017 High Blood Pressure Guidelines was provided to clinical staff. In addition, the AHA/ACC pooled cohort 10-year risk calculator was installed to computer desktops or smart phones, for providers. “Seven simple tips to get an accurate blood pressure reading” (American Medical Association, 2016) was posted in exam rooms and proper measurement and documentation techniques were reviewed with clinical staff. Review of recommended non-pharmacological treatment methods with proper patient education documentation was also conducted. …

Strong Recommendation Towards Hpv Vaccination, Danielle Bogue

Doctor of Nursing Practice Projects

Risk of future HPV related cancers remains high in individuals unvaccinated against HPV, leading to too many people dying from this preventable cancer. However, primary care providers’ strong recommendation to vaccinate and family education about HPV and vaccine efficacy have a positive impact on a family’s decision to vaccinate. The setting for this project was a Midwest suburban family healthcare practice. This process was implemented by providing the guardian with a handout, a short video on HPV, a question and answer period with the provider, and ended with the provider giving a strong recommendation towards HPV vaccination. Of the 35 …

Factors Contributing To 30-Day Readmission In Postsurgical Patients: A Reevaluation Of Hospital Policies And Proposal For Change, Miriam Morgan-Skinner

Doctor of Nursing Practice Projects

Background

Readmission can cause much frustration for patients and families. The Center for Medicare and Medicaid Services (CMS) has emphasized the importance of finding ways to decrease readmissions within 30 days of discharge. In the southwest healthcare organization studied, the 30-day readmission rate for abdominal surgeries was 10%. The goal of the study was to identify the causative factors for the readmissions and make appropriate suggestive changes. This project identified the factors contributing to the 30-day readmission rate in selected abdominal surgeries between January 2016-July 2017 and developed a policy to address the predominant factor.

Method

After receiving institutional review …

Evaluation Of Cardiomems Heart Failure Device, Danielle Moe, Msn, Rn

Doctor of Nursing Practice Projects

Background: Heart failure (HF) is a chronic condition where the heart cannot pump enough blood to adequately oxygenate cells. The CardioMEMS HF device is implanted into the pulmonary artery (PA) allowing practitioners to monitor pressures remotely and prescribe interventions. Objectives: The primary purpose of this project was to determine if CardioMEMS is an effective intervention in the reduction of hospital admissions, emergency department (ED), and clinic visits for HF patients. The secondary purpose was to determine if the quality of life (QOL) and exercise tolerance was improved post-implant. Methods: The author conducted a retrospective chart review by accessing previously compiled …

Relationship Between Shift Hours Worked (12 Versus 8), Workload, And Nurses' Burnout: A Study Across Acute Care Units In A Community Hospital, Liliane Nyamuziga

Doctor of Nursing Practice Projects

Nurses are expected to provide quality care to patients, and work demands in the health care system are increasing. An increased turnover in nursing staff was observed in a southwest Michigan community hospital, and the possibility of burnout contributing to this turnout was proposed. The purpose of this scholarly project was to evaluate the significance and level of perceived burnout in nurses who work the 12-hour shift compared to those who work the eight-hour shift, to investigate the relationship between nurse-to-patient ratios and burnout, and to compare burnout levels between nurses working day versus night shifts. This project utilized a …

Adult Naloxone Administration Protocol, Samuel S. Adhikari

Doctor of Nursing Practice Projects

Abstract

A tertiary care facility in central Illinois noted an increase in inpatient opioid-related adverse events, including acute opioid withdrawal syndrome due to a higher than a necessary dose of naloxone. The patient required intubation with a prolonged intensive care unit stay. A naloxone administration protocol encouraging cautious titration of naloxone could potentially decrease, if not entirely avoid similar events. When a patient exhibits opioid overdose symptoms, airway management, hemodynamic support, and due appreciation of the elimination half-life of naloxone become vital in preventing potentially tragic outcomes. This quality improvement project was non-experimental and involved the design and introduction of …

Promoting Antibiotic Stewardship For Uti Management In Long Term Care Residents Through Standardized Clinical Practice Guidelines., Juliana M. Enoakpa

Doctor of Nursing Practice Projects

Urinary tract infections (UTIs) are the most diagnosed infections requiring antibiotics in long-term care (LTC) facilities. The rising prevalence of antimicrobial resistance (AMR) threatens treatment of infections that were once responsive to antibiotic therapy. The inappropriate use of antibiotics in this Midwestern LTC facility provided the impetus for implementing a standardized clinical practice guideline (CPG) for diagnosing UTIs among the LTC residents. A data collection tool was developed for the audit that identified the specific assessment criteria for UTI management and eligibility criteria for antibiotics. Physicians and NPs at the LTC facility were administered a questionnaire prior to implementation of …

A Retrospective Analysis Of An Opiate Education And Naloxone Distribution Program, Ashley M. Tyler

Doctor of Nursing Practice Projects

Abstract

Trends indicate that misuse of opiates has increased nationally, frequently resulting in death. Substance use treatment clinics are now distributing naloxone (Narcan) to clients and laypeople as an antidote for opiate-related overdose. Offering Opiate Education and Naloxone Distribution (OEND) programs at treatment facilities increase the naloxone education opportunities available to those most closely affected by overdose.

Methods: The evaluation of naloxone distribution at a Midwestern substance use disorder clinic involved a retrospective analysis via chart audit of data regarding the delivery and administration of naloxone. The project focused on 48 individuals in the initial treatment phase for opiate use …

Standardized Patient Handoff Tool, Matthew Marten

Doctor of Nursing Practice Projects

Patient handoffs are defined as the transmission of information and accountability between teams and individuals. These handoffs can be periods of increased risk for the patient and increased errors among anesthesia providers and PACU nurses (Segall et al., 2012). The Joint Commission recommends healthcare providers improve patient handoff as a national goal (Robins & Dai, 2015). The purpose of this nursing doctoral project was to determine if using a standardized patient handoff tool could improve communication and satisfaction between anesthesiologists, CRNAs, and PACU nurses. A review of the current literature supported the need for a standardized patient handoff tool for …

Enhanced Recovery After Orthopedic Surgery In Total Hips And Knees, Christine Rigg

Doctor of Nursing Practice Projects

The prevalence of total knee and hip replacement surgery is increasing related to a combination of factors including osteoarthritis, age, and obesity (Christelis et al., 2015). The increased demand for joint replacement, current cost, and length of stay (LOS) place an increasing burden on clinical and financial resources. Enhanced recovery after surgery (ERAS) protocols have facilitated improved outcomes, such as increased patient satisfaction, decreased LOS, and associated costs (Bernard & Foss, 2014; Husted, Holm, & Jacobsen, 2008). Development and subsequent anesthesia group education were the beginning steps toward orthopedic protocol implementation in this project. This practice project had two goals: …

Developing An Online Wellness Curriculum For Nurse Anesthesia Students, Gina Calvanese, Jamie Rynearson

Doctor of Nursing Practice Projects

Student Registered Nurse Anesthetists (SRNAs) begin graduate school as confident critical care nurses, unaware of the impact that constant, daily stress will have on their lives. Wildgust (1986) presented the earliest known research and concluded stress negatively impacted the physiologic wellbeing of SRNAs. It has been reported that students in anesthesia programs experiencing high levels of stress and burnout are more likely to make critical errors when caring for their patients (de Oliveira, 2013). The goal of this doctoral project was to promote wellness and stress management among students enrolled in Southern Illinois University Edwardsville’s Nurse Anesthesia program by proposing …

Assessment Of The Validity Of Patient-Stated Allergies: De-Labeling And Education, Tawny Thomas, Angelina Leitschuh

Doctor of Nursing Practice Projects

The initial direction of the project was to develop and implement a research-based protocol to de-label hospitalized patients with a patient-stated penicillin allergy who were not truly allergic (Phase I). The project was abruptly halted due to the lack of data to justify the need, lack of sufficient communication among stakeholders, questions regarding financial cost of implementation, and strong concerns regarding educational needs of nursing staff. After developing the initial protocol, the project team was redirected to provide evidence-based allergy assessment education to the nursing staff to foster reliable and accurate patient interviews and documentation of the results (Phase II). …

Sphenopalatine Ganglion Block For Post-Dural Puncture Headache Treatment, Wesley Gallagher

Doctor of Nursing Practice Projects

Post-dural puncture headache (PDPH) is defined as an orthostatic, fronto-occipital headache. The incidence of PDPH from neuraxial anesthesia techniques averages 1%. There are several treatments for PDPHs. The gold standard is the epidural blood patch (EBP). The EBP can be costly, requires experience, and is associated with rare, but serious complications. These factors present significant barriers to treating PDPHs. The sphenopalatine ganglion (SPG) block consists of using local anesthetics to block the parasympathetic signals, which flow through the SPG. Current theories suggest that increased parasympathetic outflow is the trigger for many forms of headaches, including PDPHs. Various literature associated with …

Effect Of Nurse-Developed Dyspnea Improvement Education On Home Health Patients, Teresa Gough, Nevin Ozyurt

Doctor of Nursing Practice Projects

In home health patients, dyspnea is one of the quality indicators on the Medicare Outcome and Assessment Information Set (OASIS). Any home health agency that is seeking Medicare certification is required to meet Medicare Conditions of Participation, including compliance with OASIS data collection and transmission of data (Centers for Medicare and Medicaid Services, 2012). At a hospital affiliated home health agency in the Midwest, between November 2015 and October 2016, 82.85% of patients admitted for services received Medicare coverage (Memorial Home Services, 2016). Due to the high Medicare population seen by this home health agency, it is important to show …

Effects Of Transitional Care Management On Hospital Readmissions, Samantha Dunkirk

Doctor of Nursing Practice Projects

Primary care providers are challenged to identify strategies to decrease hospital readmissions. Transitional care management (TCM) services can improve communication and allow primary care providers (PCP) an opportunity to meet with patients just after discharge to assess needs and prevent readmissions. A TCM protocol was evaluated at a large Midwestern clinic to determine if communication improved and readmissions decreased. The protocol consisted of notifying the PCP upon admission and discharge to the hospital, communicating with the patient or family within 48 hours of discharge, and facilitating a follow up visit with the primary care provider within 14 days of hospital …

The Effectiveness Of Implementing A Diabetic Checklist To Improve Patient Care Documentation, Evans Mutua, Edwilyn Colwell

Doctor of Nursing Practice Projects

The Effectiveness of Implementing a Diabetic Checklist to Improve Patient Care Documentation of Treatment and Outcomes.

Diabetes mellitus is a major public health problem worldwide. In 2012, about 29.1 million Americans had diabetes with about 1.4 million Americans being diagnosed with diabetes yearly (CDC, 2017). Diabetes is the 7^th leading cause of death in the United states and in Illinois, the cost is $6,490 per person with a treated population of 774, 600 (CDC, 2017). Complication due to diabetes include; diabetic retinopathy, neuropathy, end stage renal disease, amputations and death.

The American Diabetes Association, provide evidence-based guidelines for the …

Developing A Ketamine Infusion Protocol To Treat Complex Regional Pain Syndrome, Nikolas M. Kozul

Doctor of Nursing Practice Projects

Complex Regional Pain Syndrome (CRPS) has been studied under different names dating back to the American Civil War. Despite being studied for over 100 years, CRPS is still not a very well understood disease process and there is no consensus on the best way to treat it (O’Connell, Wand, McAuley, Marston, & Moseley, 2016). One treatment that has shown to be effective in reducing pain scores in patients with chronic CRPS is a multiple day infusion of ketamine (Sigtermans et al., 2009). The purpose of this doctor of nursing practice project was to develop a ketamine infusion protocol for anesthesia …

Effects Of A Multi-Tiered Approach To Impact Immunization Compliance Of Students Attending A Medium-Sized Public University, Emily Watson, Stephanie Muertz, Kate Traum

Doctor of Nursing Practice Projects

Background: College students in Illinois must comply with laws regarding proof of immunity for specific vaccines. These laws, however, do not guarantee compliance with immunizations. Unvaccinated persons living in highly-vaccinated communities, such as college campuses, are at risk for many preventable diseases. Objective: The primary aim of this project is to collaborate with Southern Illinois University Edwardsville (SIUE) Health Service to develop, implement, and evaluate the effects of multi-tiered interventions to increase immunization compliance rates of first-semester college students. Methods: A brief YouTube video was presented to freshmen students, an eye-catching educational flyer was distributed by advisors and throughout campus, …

Promoting Empowerment And Innovation: A Technology Initiative, Theresa Marcotte

Doctor of Nursing Practice Projects

Improving empowerment through a supportive organizational culture can lead to innovation in practice and promote positive outcomes. Supporting employee empowerment, through a supportive organizational culture and environment, provides opportunities to innovate and creatively meet desired outcomes. Using these concepts, an Associate Degree Nursing Program empowered faculty to address a strategic planning opportunity to improve practice. The innovation, a Technology Initiative, provides opportunities for evidence-based testing practices, leading to improved, first-time pass rates on the National Council Licensure Exam (NCLEX). Technology use in the classroom can improve dissemination of nursing knowledge and retention strategies and therefore improve program retention. The utilization …

Lung Protective Ventilation During General Anesthesia: A Staff Education Project, Carrie L. Hasenstab

Doctor of Nursing Practice Projects

Lung protective ventilation has shown to be an effective strategy of ventilation in perioperative patients. However, anesthesia providers often still employ traditional modes of ventilation. To improve the knowledge and utilization of lung protective ventilation during general anesthesia a clinical practice tool was developed. A PowerPoint educational program was utilized as the initial implementation of the lung protection tool. The practice guide and educational program was presented to anesthesia providers and PACU staff at a Southern Illinois Hospital. A pre/post survey served as the method of evaluation. The pre/post survey assessed the participant’s knowledge and utilization of lung protective ventilation …

The Effect Of Home Health Interventions On Hospital Readmission Rates In Patients With Congestive Heart Failure, Lindsay Reavis

Doctor of Nursing Practice Projects

Heart failure is a common diagnosis that affects millions of people worldwide. Unfortunately, heart failure is associated with a high risk of 30-day hospital readmission rates. Home health nurses have the potential to bridge the gap between discharge and hospital readmission by providing up-to-date patient education on a one-to-one basis. Research indicates home health nurses lack knowledge of the disease process, nurse management of the disease, and treatment. This project focused on an educational session about the pathophysiology of heart failure, fluid/weight monitoring, diet, medications, and exercise with a pre- and post-tests evaluating home health nurses understanding of heart failure. …

Patient Care Advocacy Through Electronic Communication, Jared T. Holton, Scott A. Kahre

Doctor of Nursing Practice Projects

Patient advocacy is a primary role of the Certified Registered Nurse Anesthetist (CRNA). While engaged in the legislative process, CRNAs have failed to materialize significant gains in political potency on a national scale. This project involved the development of prototype software for mobile communication devices to augment the CRNA community’s ability to advocate for patients in the healthcare policy arenas. After a demonstration of the software to key leaders of the American Association of Nurse Anesthetists (AANA), an anonymous survey was distributed to the AANA executive administrators. All six executives in attendance for the demonstration of the software completed and …

Local Anesthetic Systemic Toxicity Management: An Assessment Of Simulation-Based Staff Education, Kevin L. Kanallakan

Doctor of Nursing Practice Projects

When local anesthetics are administered at toxic doses or when certain local anesthetics are directly injected into the patient’s circulation, excessive plasma concentrations of the drug will produce a systemic cascade of events known as local anesthetic systemic toxicity (LAST). LAST is a rare, potentially life-threatening complication, which affects both the central nervous and cardiovascular systems. Anesthesia providers and perioperative healthcare professionals must remain current on best practice LAST management in order to reduce morbidity and mortality.

This quality improvement project utilized high fidelity simulation paired with LAST education to improve stakeholder knowledge and management of a LAST scenario. With …

Diabetes Education, Audra Trump

Doctor of Nursing Practice Projects

Background: Diabetes Self-Management Education (DSME) has been shown to improve diabetes management. However, a Midwest academic clinic does not offer formal diabetes education. The health department offers formal diabetes education classes twice a year. However, the classes are not flexible, long, and offered infrequently. Objective: The purpose of this project is to improve access to and standardize DSME for patients newly diagnosed with type II diabetes. Methods: The project design includes a one group pre-test/post-test convenience sample of adult patients who are newly diagnosed with type II diabetes in an academic outpatient setting. Results: At the time of diagnosis, the …

Postoperative Delirium Education, Aaron Wede

Doctor of Nursing Practice Projects

Surgical patients, aged 65 and older, comprise the largest surgical population. Increased age correlates with an increased incidence of postoperative delirium. Postoperative delirium (POD) can drastically increase healthcare costs, length of hospital stay, and overall morbidity and mortality. A clinical reference tool was created to have available for perioperative staff members at a 200-bed community hospital in the Midwest. The tool describes risk factors, prevention methods, and treatment options for POD. The initial implementation of the project was achieved with a PowerPoint presentation which was created to summarize the information found in the literature review and to instruct perioperative staff …

Sugammadex Protocol, Brenna M. Thomas

Doctor of Nursing Practice Projects

Sugammadex is a new medication used for the reversal of muscle relaxation induced by rocuronium, vecuronium, and pancuronium. Sugammadex is available for use at St. Anthony’s Memorial Hospital in Effingham, IL. However, they did not have a protocol regarding the use of this medication. A sugammadex protocol was written for the operating room (OR) staff after a thorough, evidence based literature review was completed. The OR staff included certified registered nurse anesthetists, anesthesiologists, registered nurses, and pharmacy. The protocol was implemented and evaluated with a pretest, an educational PowerPoint regarding sugammadex, and a posttest. A paired samples t test was …

Diabetic Foot Screening Tool: Utility In A Busy Primary Care Setting, Crystal A. Cusanelli

Doctor of Nursing Practice Projects

Abstract

Problem: Providers in a Midwest rural clinic identified that foot care is often overlooked due to the complexity of diabetic patients and limited time available during office visits.

Purpose: This project examined the utility of an evidence-based, diabetic foot screening tool, provider satisfaction with the tool, and provider perceptions regarding foot care in a busy primary care practice.

Methodology: Providers were instructed on using the screening tool. The tool was utilized on all diabetic patients during office visits over a two-month period. Anonymous surveys were distributed and a focus group was conducted to gather post-implementation outcomes.

Results: Two providers …