Medicine and Health Sciences Commons^™

Anemia Management For Patients Receiving Peritoneal Dialysis, Kenisha Marajah

Doctor of Nursing Practice

The purpose of this quality improvement project was to develop an anemia management evidence-based intervention for patients receiving peritoneal dialysis (PD) and to educate staff on implementation of the anemia management protocol in a PD clinic in a southwestern county in Texas. Anemia is a common complication of chronic kidney disease (CKD) resulting from the inability of the kidneys to produce erythropoietin needed for red blood cell production. Erythropoiesis-stimulating agents such as Aranesp or Epogen may be administered to dialysis patients to stimulate erythropoiesis in the presence of kidney disease. Iron storage and iron availability remains imperative in effectively stimulating …

Establishing A Coumadin Clinic In A Rural Family Medicine Practice, Kathleen E. Zeledon

Doctor of Nursing Practice

Background. Coumadin is the most commonly prescribed oral anticoagulant worldwide and is safe and effective in the prevention and treatment of stroke and venous thromboembolism (Stoudenmire, DeRemer, & Elewa, 2014). Coumadin is dangerous when poorly managed due to high risk for bleeding and mortality. It is best managed using evidenced-based models of care such as point-of-care (POC) International Normalized Ratio (INR) testing (Garcia et al., 2008; Harrison, Shaw, & Harrison, 2015; Rossiter, Soor, Telner, Aliarzadeh, & Lake, 2013). Purpose. Establish a Coumadin Clinic in a rural family medicine practice with POC INR testing to improve anticoagulant management. Methods …

Diabetes Education And Management, Dina Balzano

Doctor of Nursing Practice

Purpose: Implementation of a diabetic self-management and education program based on the 2017 national standards of care.

Background: Empowering patients with the knowledge to manage their diabetes in conjunction with health care provider’s recommendations is essential. The American Association of Diabetes (2012) and American Association of Diabetic Educators (2017) have deemed the use of diabetic self-management education and support as the highest level of evidence based practice to prevent and effectively manage the long-term complications of diabetes (Burke, Sherr & Lipman, 2014).

Methods: The project was implemented at a family practice clinic in south San Antonio. A diabetic self-management and …

Assessing The Effectiveness Of A Quality Improvement Intervention To Decrease Missed Opportunities For Human Papillomavirus Vaccination At A Nurse Managed Health Center, Maria Medina-Calvo

Doctor of Nursing Practice

Purpose: To decrease the number of missed opportunities for human papillomavirus vaccine eligible patients seeking healthcare in a Nurse Managed Health Center. Background & Significance: Human papillomavirus genital infection has inflicted nearly 79 million Americans. Annually, about 14 million newly infected individuals are identified, with noted predominance in teens and young adults, and of this number approximately 19,200 females and 11,600 males receive a cancer diagnosis as a result of the human papillomavirus infection. The incidence of infections can be reduced with a human papillomavirus vaccine, but only about 63% of females and even fewer males initiate the human papillomavirus …

Building Shared Values In The Community: Culture Of Health, Donnelle D. Storrs

Doctor of Nursing Practice

The zip codes where patients live are stronger determinants of health outcomes than the frequency of visits with a primary care provider. Providers have a unique opportunity to extend health care beyond the clinic walls and engage in efforts to improve the communities where their patients grow, live, work, and age. In order to impact the health of patients, a culture of health needs to be developed. The Robert Wood Johnson Foundation culture of health action framework directed the build of a foundation of health as a shared value in a neighborhood with high morbidity and mortality rates in southwest …

Implementing Pneumococcal Vaccination Recommendations For Adults Age 19 And Over In A Family Care Clinic, Truc Le

Doctor of Nursing Practice

Pneumococcal vaccines are essential to children and adults. Having pneumococcal vaccines not only prevents pneumococcal infections but can also potentially lessen the severity of the disease. There are many scholarly articles attesting the herd effect in adults who received pneumococcal vaccines. Therefore, the purpose of this quality improvement project was to raise awareness of the pneumococcal vaccine and increase the vaccination rate in a primary care clinic in Texas. The Centers for Disease Control and Prevention’s pneumococcal vaccination schedule was utilized as guide for vaccine administration. The staff and provider were educated on screening, documenting, and administering the pneumococcal vaccine …

Implementing The Hyperlipidemia Statin Use Guideline In Patients With Diabetes Mellitus, Ifeyinwa Eribenne

Doctor of Nursing Practice

Purpose. To implement an evidence-based hyperlipidemia guideline for statin therapy use with diabetic patients. Background. In the United States, cardiovascular disease (CVD) continues to be the leading cause of mortality and morbidity for women and men with diabetes. Dyslipidemia is a modifiable risk factor for CVD and one of the leading drivers behind the development of coronary artery disease. In 2014, the American Diabetes Association issued a new recommendation guideline for using statins as a primary intervention for CVD in patients aged 40–75 with diabetes. Despite advances in prevention and treatment guidelines, the American College of Cardiology and ADA have …

Quality Improvement On Depression Protocols In The Military Training Environment, Priscilla R. Colunga

Doctor of Nursing Practice

Background: Active Duty military members are highly susceptible to depression and suicide due to separation from family during training and deployments, exposure to traumatic experiences in combat, and loss of friends during combat.

Purpose and Objectives: Depression and suicide remain a high priority among military personnel. This process improvement project aimed to improve the rate of depression screening and improve the assessment, treatment, and management of soldiers with depression in a primary care setting to prevent disease progression while waiting to be seen by a behavior health specialist.

Interventions: During the 6-week time frame, all active duty military and reservists …

Implementation Of The Human Papillomavirus Vaccine Among Health Professions Students, Emeka C. Nnabuife

Doctor of Nursing Practice

The human papillomavirus (HPV) is the most widespread sexually transmitted infection in America. College-aged students are a high-risk group for HPV transmission, but their HPV vaccination rates are low. The purpose of this evidence-based project was to implement an HPV vaccination program at a health science center university student health clinic to increase vaccination rates to meet the guidelines of the American College Health Association (ACHA) and the Centers for Disease Control and Prevention (CDC). The objectives of this project were as follows: 1) to educate providers and staff on the importance of the HPV vaccine; 2) to increase HPV …

The Implementation Of Obesity Guidelines In A Rural Clinic, Teresa M. Beard

Doctor of Nursing Practice

Background Over 36% of Americans are obese. It is estimated that, by year 2030, 51% of the population will be obese. With the increased prevalence of co-morbidities associated with obesity, it is important to gain control of this disease. Method The aim of this project is to implement the 2013 American College of Cardiology, American Heart Association Task Force on Practice Guidelines, and The Obesity Society Guidelines for the Management of Overweight and Obesity in Adults in order to identify those patients who require treatment for obesity and provide them with appropriate resources. The primary interventions are to provide color-coded …

Hiv Screening In Non-Pregnant Patients Age 13 – 64 Years Old In Primary Care Through The Implementation Of The Cdc Guidelines For Hiv Screening, Ashten M. Martin

Doctor of Nursing Practice

As many as 216,000 people living with HIV are unaware they have the disease. In order to combat the inadvertent spreading of HIV, the CDC recommends screening everyone 13 – 64 years of age. The purpose of this Quality Improvement project was to implement the 2015 Sexually Transmitted Diseases Treatment Guidelines as it pertains to HIV screening within a Southeast Texas rural health clinic. The objectives were 1) educating all staff and patients regarding the CDC recommendations for HIV screening, and 2) increase the number of eligible patients who were offered and received HIV screening. A colored checklist served as …