Medicine and Health Sciences Commons^™

Optimization Of Triage Documentation In A Large Urban Emergency Department, Monica Reynoso-Prieto

Master's Projects and Capstones

Problem California ranks ninth nationwide in terms of longest emergency department wait times. The project aims to reduce patient triage times by refining the workflow of triage documentation, achieved through strategic rearrangement of triage documentation questions. Context This quality improvement project took place in the emergency department of a large urban Bay Area hospital. Intervention The intervention was implementation of changes to the triage documentation based on staff feedback from an opinion survey, such as: elimination of redundant questions, consolidation of related categories, and logical reorganization of triage topics. Measures Measures used in the project were triage times and pre …

Pain Assessment And Reassessment Documentation Improvements In Medical-Surgical Units, Alicia Espinoza

Master's Projects and Capstones

Problem Pain management is essential when providing quality care, and adequate documentation of pain assessment and reassessment with administration of opioid pain medications by nurses is necessary for patient safety and satisfaction. Context Nurses play a pivotal role in providing safe and effective administration of opioid pain medication and documentation of pain assessments. This quality improvement (QI) project aimed to increase opioid medication administration assessment and documentation compliance rate for nurses to 90% or greater in two medical-surgical units. Intervention A knowledge check survey was utilized to assess nurse understanding of required data needed to document, and timing for documentation …

Enhancing Pain Documentation In Medical Surgical Units: Integrating Supportive Tools With Pain Nursing Education, Mariana Arias

Master's Projects and Capstones

Problem: Pain management in in-patient care, particularly involving opioids, is critical due to the associated risks. Proper pain assessment is essential to ensure safe medication administration and mitigate adverse effects.

Context: This quality improvement (QI) project aimed to improve opioid assessment and documentation rate above 90% compliance in two medical-surgical units, focusing on bedside nurses who play a crucial role in patient safety and effective pain management.

Interventions: A baseline survey provided nurses' understanding on compliance criteria and assessment timing. Interventions included visual reminders, informational posters, and instructions on how to access individual compliance reports.

Measures: A post intervention survey …

Non-Clinical Perspectives On Sepsis: A Project For Enhanced Awareness, Anjali Kumari Singh

Master's Projects and Capstones

Problem: This project aimed to enhance non-clinical staff knowledge of sepsis through a targeted awareness campaign, while also seeking to uphold or enhance the organization's sepsis-related performance.

Context: Clinical Nurse Leader students conducted a microsystem assessment in five crucial non-clinical departments of an urban Bay Area hospital, each playing a vital role in the organization's efficiency at different levels.

Intervention: During Sepsis Awareness Month, a sepsis awareness campaign was implemented. This involved a concise presentation on sepsis, its consequences, and the significance of awareness in each department. Additionally, informational fliers detailing sepsis signs and symptoms were distributed.

Measures: A pre-and …

Campaigning Beyond: Sepsis Awareness Among Non-Clinical Staff, Cynthia Wong

Master's Projects and Capstones

Problem: Sepsis stands as the foremost cause of illness and death among hospitalized patients globally, yet a considerable number remain oblivious to this critical condition. Based on the pre-implementation survey among non-clinical staff members of an urban hospital, awareness of sepsis must be heightened to ensure swift recognition and response.

Context: The project conducted takes place in five distinct non-clinical departments at a large hospital organization in Northern California. Each department plays an essential role in the holistic and efficient functioning of the organization to provide quality patient care.

Interventions: A sepsis awareness campaign was implemented throughout the month of …

Early Mobility In The Intensive Care Unit, Kimberly Masse

Master's Projects and Capstones

Abstract

Problem: Within the intensive care unit (ICU) environment, the inconsistent implementation of early mobility practices poses a significant challenge, resulting in suboptimal patient outcomes. This quality improvement project addressed the critical issue of lower mobility scores and the barriers faced in promoting early mobilization due to the complex nature of the ICU, including the patient population and therapeutic interventions.

Context: Situated in a 327-bed hospital, the 20-bed ICU caters to critically ill patients with diverse diagnoses, such as stroke, heart failure, sepsis, and Covid pneumonia. The ICU staff comprises registered nurses (RNs), patient care technicians (PCTs), and other …

Increasing Sepsis-Bundle Adherence On A Medical-Surgical/Telemetry Unit: A Quality Improvement Project, Tiffany Liu

Master's Projects and Capstones

Problem: Sepsis is a life-threatening complication of infection that can lead to tissue damage, organ dysfunction, and death. Early recognition and intervention are crucial in the management of sepsis. Delays in sepsis care can lead to adverse health outcomes and even death. Sepsis bundles are guided by evidence-based practice. They serve as guidelines for effective and timely management of sepsis. Adherence to these sepsis bundles is associated with overall improved morbidity and mortality.

Context: This quality improvement project was led by Clinical Nurse Leader (CNL) students from the University of San Francisco. It was implemented at a 244-bed …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Improving Nursing Staff Knowledge For Management Of Geriatric Patients With Confusion In The Emergency Department, Kareem G. Carter

Master's Projects and Capstones

Problem: Staff knowledge of effective management of confusion in geriatric patients (>65yo) may be limited and inconsistent with the current goal of establishing a geriatric-friendly Emergency Department (ED) Model of Care. Suboptimal management of this patient population can result in prolonged ED stays, which increases the cost to the hospital and the patient (Han & Wilber, 2013).

Context: An Emergency Department at a large Bay Area urban hospital hopes to obtain Geriatric Emergency Department Accreditation (GEDA) through the American College of Emergency Physicians (ACEP).

Interventions: Create a simplified checklist for nursing staff using mnemonic devices to …

Aidet And Commit To Sit Implementation In The Outpatient Surgical Setting, Olivia V. Meehan

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET and commit to sit to improve communication and increase the patient satisfaction of an outpatient surgery microsystem. The microsystem’s patient satisfaction is assessed, and it is currently scoring below the reach goal of 85^th percentile. The detractors from their overall score mainly stem from the patient not feeling listened to, informed, or updated on the timeline. AIDET and commit to sit are ideal tools for addressing those deficits.

Context: The microsystem being addressed is an outpatient surgery unit that specialized in general surgery for the pediatric population. The pediatric population that the …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …

Standardizing The Bedside Shift Report: Improving Communications And Promoting Patient Safety, Chona C. Alforque

Master's Projects and Capstones

PROBLEM: Nursing shift reports are integral to nursing as they allow for the transfer of critical information and responsibility of patient care from one nurse to another. Ineffective communication during shift-to-shift reports can contribute to gaps in patient care and breaches in patient safety, including medication errors, falls, and sentinel events. The greatest risk of communication breakdown is during transitions in care.

CONTEXT: St. Louise Regional Hospital, a small community hospital, consisting of an eight-bed medical-surgical intensive care unit lacked structure in how handoff should occur and had variances in shift handoffs. Observation of the shift handoff at the nurses’ …

Compounding Effects Of Reducing Nurse Burnout And How It Can Produce An Increase In Patient Safety And Satisfaction, Alexander Mua

Master's Projects and Capstones

The reduction of nurse burnout has shown to have an increase in patient satisfaction and quality of care. It also has shown a decrease in patient-related or sentinel events. Accordingly, with the reduction of nurse burnout, there has also been a reduction of compassion fatigue. This project has illuminated the benefits of acuity-based caseload at the micro-level, including the cost-effective nature of overtime pay, including HCHAPS benefit score. The method of obtaining, planning, and implementing was based on the Plan, Do, Study, Act (PDSA), which required collaboration amongst multiple disciplines, groups, departments, and executives. The process and goals concluded to …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Reducing Inpatient Readmissions Through Early Follow-Up Appointment Planning: A Quality Improvement Project, Isabella Cuenco

Master's Projects and Capstones

Problem: Inpatient readmissions have a highly negative impact on healthcare systems. Not only do these hospitalizations have a detrimental effect on patient outcomes they also are accompanied by a prohibitive financial burden to the hospitals.

Context: Follow-up appointment with a primary care provider after discharge has been demonstrated as a viable strategy to reduce the risk of readmissions.

Interventions: Create a volunteer program to schedule patient appointments with a primary care provider within seven days of discharge.

Measures and Results: Compare the number of patients that were discharged with a follow-up appointment after the intervention to before the intervention, and …

Quiet At Night: A Quality Improvement Project, Maria Novales-Fiel

Master's Projects and Capstones

Abstract

Problem: Providing a quiet environment is essential in patient’s healing and recovery. Last year, the October 15 through May 17 survey period resulted at a 2 Star Rating for the hospital, which is below the top 25th percentile. This result along with the patient population, telemetry designation, and unit size prompted the selection of the inpatient telemetry unit in Northern California for the change strategy plan.

Context: The microsystem is a 24-bed adult inpatient telemetry unit in Northern California. Assessment of the unit shows that inconsistencies exist when it comes to bundling care at night. Doors are …

Implementation Of A Surgical Safety Checklist, Nicole Stathatos

Master's Projects and Capstones

Lack of standardization in the perioperative area leads to variations in practice that can cause preventable errors. In a 200-bed hospital in Northern California with eleven operating rooms preforming approximately 11,000 procedures a year, there was an increase incidence in sentinel events such as wrong site surgery (n=1), wrong patient surgery (n=1), and retained foreign body (n=5). Safety checks observed in the operating room (OR) were preformed differently among each surgical team and sometimes did not occur at all. Through the use of a Surgical Safety Checklist (SSC), efforts were aimed to standardize safety practices in the OR. The goal …

The Clinical Nurse Leader As Outcomes Manager: Optimizing Screening Mammography In An Outpatient Breast Center, Yao Luo

Master's Projects and Capstones

The Clinical Nurse Leader as Outcomes Manager: Optimizing Screening Mammography in an Outpatient Breast Center

Abstract

This clinical nurse leader (CNL) practice improvement project was conducted in an outpatient breast center that is part of a community safety-net hospital. The patient population consists of a large proportion of disadvantaged, low income, low English literacy, and high-risk women over 445 years of age. Recent observations and baseline data from the breast center and the mobile mammography van indicated that five to eight radiologic views were taken during a routine mammogram in a subset of screening patients which exceeds the standard set …

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 …

Implementation Of An Evidenced-Based Practice Curriculum To Improve Nursing Practice For Epidural Administration And Monitoring, Chatty O'Keeffe

Master's Projects and Capstones

Abstract

Epidural analgesia (EA) is one inpatient pain management option prescribed by Acute Pain Services (APS) at VA Puget Sound Health Care Services (VAPSHCS). Historically, EA nursing care at VAPSHCS has been managed by surgical units. However, in the last two years, facility restructuring and budget constraints have led to reorganization and consolidation of units. The reduction in units providing nursing EA care has resulted in an overflow of EA patients to the medical intensive care unit (MICU). A previous gap analysis of the compliance in nursing performance of EA nursing care on the surgical acute care unit demonstrated poor …

Improving Quality And Efficient Communication Between Providers And Nursing - A Psychiatric Sbar Tool (Psych), Karen Lee Richards

Master's Projects and Capstones

IMPROVING QUALITY AND EFFICIENT COMMUNICATION BETWEEN

PROVIDERS AND NURSING - A PSYCHIATRIC SBAR TOOL (PSYCH)

Karen Richards

University of San Francisco

Abstract

Effective communication is the cornerstone of providing safety and quality healthcare. However, nursing and providers often share information inequitably, as these disciplines are trained differently regarding communication. Providers are taught to be brief, accurate and focused while nurses are taught to be descriptive and holistic. These differences have led to disparity in the sharing of valuable patient information, subsequently leading to increased frustration, inefficiency, and medical errors. Multiple studies provide evidence that poor communication is a major contributor …

Evaluation Of The Nursing Handoff Process From Emergency Department To In-Patient Unit, Yana Marutyan

Master's Projects and Capstones

Handoff, or transition in care, is known to be a danger point in the patient care process for a long time. Ineffective communication during handoff is one of the most common identified cause of catastrophic or sentinel events in hospitals (The Joint Commission, 2015). Emergency department (ED) to in-patient unit handoff is particularly vulnerable to medical errors due to high workload, time constraints, different approaches to patient care, and lack of established relationships between care providers (Ong & Coiera, 2011; Hilligoss & Cohen, 2012).

The purpose of this project was to examine and review a current process of ED to …