Health and Medical Administration Commons^™

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Patient Reported Outcomes In Sickle Cell Disease Examined Within A Conceptual Model, Swapandeep Mushiana, Marsha Treadwell Phd, Sherif M. Badawy Md, Ms, Liliana Preiss Phd, Allison King Md Mph Phd, Barbara Kroner Phd, Yumie Chen Bs, Jeffrey Glassberg, Victor Gordeuk Md, Nirmish Shah Md, Angie Snyder Phd Mph, Theodore Wun Md

Doctoral Dissertations

Objective: To examine the relations between patient reported outcomes (PROs) within a conceptual model for adults with sickle cell disease (SCD) ages 18 – 45 years enrolled in the Sickle Cell Disease Implementation Consortium (SCDIC) registry. We hypothesized that patient and SCD related factors and barriers to care would independently contribute to functioning as measured using the PRO domains. Additionally, pain and other SCD related complications are expected to impact the relation between the variables. Methods: Participants completed a 48-item survey that included socio-demographics and PRO measures, such as social functioning, pain impact emotional distress, and cognitive functioning. …

The Use Of Isbared/Ishaped And Elimination Of Reviewing Patients’ Chart Before Handoff To Decrease Incremental Overtime, Sheila Bucao

Master's Projects and Capstones

Problem: Incremental overtime was found to majorly impact the financial well-being of a stroke unit. From an allocated budget of 22 hours per pay period, the unit’s incremental overtime averaged 40 hours. The stroke unit had skilled-mix competencies, further complicating handoffs. The absence of a standard reporting method means that reviewing patients’ charts takes approximately 10 to 15 minutes, extending what should be a quick, but thorough nurse knowledge exchange.

Context: The body of evidence reviewed indicated that pertinent information to patient care is not left out or missed when a standardized tool is used during handoff. Based on Lean …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Utilizing Tracer Methodology To Evaluate The Effectiveness Of A Hospital Antimicrobial Stewardship Program, Christine Smyth

Doctor of Nursing Practice (DNP) Projects

Antimicrobial resistant organisms are a growing threat in the United States and globally. It has become the expectation that healthcare institutions, including hospitals, contribute resources to create and maintain antimicrobial stewardship programs to decrease antimicrobial resistance, improve patient outcomes, and decrease the spread of multi-drug resistant organisms. The methods utilized to evaluate antimicrobial stewardship at hospitals often only evaluate outcome measures and fail to capture knowledge of the hospital antimicrobial stewardship program among prescribers, clinical pharmacists, and nurses, as well potential barriers to antimicrobial stewardship among healthcare providers. The purpose of this Doctor of Nursing project is to implement and …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Three Good Things To Extinguish Caregiver Burnout, Justin Haley

Master's Projects and Capstones

Caregiver burnout is a widespread issue in healthcare and institutions should be increasingly concerned about burnout because of the significant impact on quality of patient care, employee health, and financial stability. Many interventions and studies regarding burnout are focused on improving systems issues or removing negative stressors on caregivers. Although such interventions may be necessary to attempt, comprehensive systems-wide changes can be cumbersome and expensive, while removing negative stressors may be an unrealistic goal in a fast-paced, demanding healthcare environment. The Three Good Things method is an evidence-based, effective, simple, low-cost intervention to improve feelings of caregiver burnout in which …

Continuous Glucose Monitoring And Diabetes Management During Pregnancy, Nicole Beamish

Doctor of Nursing Practice (DNP) Projects

Continuous Glucose Monitoring and Diabetes Management During Pregnancy

Abstract

According to the Scope of Practice, Standards of Practice, and the Standards of Professional Performance for Diabetes Educators, registered nurses play an integral role in the promotion of diabetes self-management education and training in diabetes care (AADE, 2017). This paper upholds the standards set forth by the American Association of Diabetes Educators (2017) governing body, to stimulate the process of peer review, promote documentation of the outcomes of diabetes self-management education and training (DSME/T), encourage research to validate practice and improve quality DSME/T and diabetes care for pregnant women who use …

Workplace Violence: An Urgent Call For Integrated Staff Education In Acute Care Hospitals, Nicole Bellisario

Doctor of Nursing Practice (DNP) Projects

Problem: Type II workplace violence (WPV) in acute care hospital settings has become an epidemic of costly proportions in the United States. Regulatory mandates and healthcare accreditation standards increasingly require healthcare employers to provide a safe and healthy healing environment for patients and a safe work environment for staff. Implementation of a comprehensive WPV prevention program depends largely on organizational culture, participation and commitment from key stakeholders, and readiness for change.

Context: The patient-clinician relationship has drawn urgent attention, as healthcare organizations around the world implement key components of WPV prevention programs. The clinical management of patient aggression …

Understanding The Significance Of Virtual Support During Global Pandemic In Young Adults Diagnosed With Hepatitis C, Veronika Arkhipova

Master's Projects and Capstones

Hepatitis C is a viral infection that attacks the liver and leads to inflammation. In recent years, the prevalence of hepatitis C infections among 20 and 30 years of age has increased by 300 percent, and between 30 and 39 years by 400 percent. Due to the global coronavirus pandemic, people diagnosed with Hepatitis C have lost access to mental health services and resources, including in-person meetings with support groups. Since most states enforced stay-at-home order, many community centers, non-profit organizations that work with Hepatitis C patients and the affected population provide limited to no access to support group meetings …

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 …

Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Root Cause Analysis To Improve Incident Reporting In An Ambulatory Care Setting, Lisa Ann Duncan

Doctor of Nursing Practice (DNP) Projects

Problem: The subject organization (SO) is a Federally Qualified Health Center (FQHC) with an internally developed incident reporting system. The SO wanted to improve patient and employee safety using data from incident reports, but the incident reporting system did not give enough information to recognize patterns and develop countermeasures.

Context: Supervisors welcomed the opportunity to learn more about incident report follow-up and conducting root cause analysis (RCA). Members of the Safety Committee were eager for data to use to develop countermeasures to improve patient and employee safety. Decreases in employee injuries can save the SO from increases in the …

Finding The Narrative In Incident Reports, La'eeqa Aslam

Master's Projects and Capstones

The Progress Foundation, as licensed by the state of California and the Community Care Licensing, is required to use incident reports for internal audits and remain in compliance as a health facility. Incident reports are used to record events or accidents that have occurred within an organization. Often times, reports are made, handed off, and given from the residence home to the Community Care Licensing with little to no information of how an incident was managed. The Progress Foundation is working towards tracking information from the incident reports to improve internal management and understand the trends in the reports.

In …

Hazardous Drug Administration In The Home Setting: Reducing Exposure Risks, Cynthia D. Huff Msn, Rn, Ocn, Crni, Cnl

Master's Projects and Capstones

Hazardous drug (HD) administration used to be contained in controlled-healthcare settings, however, the introduction of HDs for home administration has become a growing area of concern for home health agencies. The objectives of the Clinical Nurse Leader (CNL) project aims to improve homecare nurses' knowledge of HDs and improve competency with personal protective equipment (PPE). The microsystem provides short-term homecare services for acute and chronically-ill patients. One team leader, two home infusion coordinators, and twelve registered infusion nurses participated in learning about exposure risks and PPE use with HD administration. Kotter's 8-step change theory was used to develop behavior change …

The Role Of The Clinical Nurse Leader In Reintroducing And Sustaining A Successful Cancer Risk Assessment Program In A Community Hospital Setting, Tiffany Gishizky

Master's Projects and Capstones

Abstract

The goal of implementing a comprehensive cancer risk assessment (CRA) program prompted the evaluation of a community-based breast center microsystem and previous CRA program for feasibility and sustainability. The development of a value proposition by the Clinical Nurse Leader student highlights the role in the advancement of the nursing profession as an interdisciplinary leader. Review of current literature facilitated development of program structure and identification of downstream revenue sources. Data analysis includes historical patient volume, screening and procedural reimbursement rates, population statistics and organization market share, and program financial impacts. Data synthesis reveals a CRA program demonstrates potential revenue …

Business Intelligence Competencies: Making Healthcare Data Come Alive, Christina Bivona-Tellez

Doctor of Nursing Practice (DNP) Projects

Business Intelligence Competencies: Making Healthcare Data Come Alive While a wealth of healthcare related data exists, nurse leaders (NL) have yet to understand its implications and adopt analytical skills to lead in the transformation of care delivery. Information science is at a new frontier for nursing to embrace. It is critical for nursing leadership to advance and support business intelligence (BI) and interactive data visualization (IDV) skills across the organization and advocate for greater engagement of nurses in health system decision making. With these new tools and competencies, nursing and other health professions can innovate best practices, providing enhanced quality, …

Readiness For Improving Safe Care Delivery Through Web-Based Hospital Nurse Scheduling & Staffing Technology: A Multi-Hospital Approach, Lisa Massarweh

Doctor of Nursing Practice (DNP) Projects

Hospital scheduling and staffing practices are linked to patient safety, nurse satisfaction, and cost outcomes (Steege & Rainbow, 2017). Staffing, while complex, is ultimately central to the overall success of the hospital. Demands to eliminate events that cause death or serious harm, produce high patient satisfaction scores while maximizing workforce productivity, test any administrator’s skillset. Providing qualified staff in the right place at the right time can be challenged by restrictive union contracts, variable patient acuities, staff attendance, and mandated staffing ratios. These demands may lead to overtime utilization. There is a growing understanding of the negative effects of healthcare …

Process Improvement Manual: Front And Back Office, Hafsah Badar

Master's Projects and Capstones

The global aim of this project is to decrease variations and improve efficiency in the tasks assigned to the support staff at an outpatient breast clinic. The breast center has a five-person administrative team who rotate through four positions monthly. The specific aim is by May 1, 2017, 100% of the five employees will have a comprehensive knowledge of their role, and adhere to a standardized way of completing tasks. The CNL Leadership themes used were Educator, Team Leader Manager, and Outcomes Manager. Informative interviews were conducted with the staff to gauge the unique needs of the team. 100% of …

Improving Employee Engagement Through The Development Of An Enterprise Performance Management System, Carlton D. Abner

Doctor of Nursing Practice (DNP) Projects

There is ample evidence of our health care delivery system relying heavily on value-based outcomes. The increased focus on outcomes has required health care organizations to adjust how they approach data and how they successfully implement performance management systems. These performance management systems help the organization identify, measure, and report the organization’s performance at an enterprise level using key performance indicators clearly linked to the organization’s overall strategy. As one organization began implementing an enterprise performance management system, the goal of this project was to show how participating in projects with that level of strategic impact can lead to improved …

Strategic Community Healthcare Management, Stephanie Penrod

Master's Projects and Capstones

Federally Qualified Health Centers(FQHC) and Community Health Centers are growing with the Affordable Care Act. This paper introduces literature that supports the need for Community Health Centers and management of low income patients with chronic illnesses. This paper also reviews the fieldwork experience at a FQHC. It reviews the goals, project, methods and findings of the fieldwork. This paper also elaborates on the scope of the project and a quality improvement report for the FQHC in observation. It discusses the future potential implementation of the recommendations and the benefits for both employees and patients. This paper concludes with follow up …

Transforming A Primary Care Practice Into A Patient Centered Medical Home, Heloise Lim

Doctor of Nursing Practice (DNP) Projects

Patient-Centered Medical Home (PCMH) recognition is a process and a road map to improving quality of and access to care. Extant studies have shown that adoption of the PCMH model of care has lowered healthcare expenditure by 15-20% (Nielsen, Langner, Zema, Hacker, & Grundy, 2012). In an effort to reduce healthcare cost in the United States, private and public sectors have embraced the philosophy of PCMH by developing national programs and initiatives for primary care practices to obtain PCMH recognition. A number of payers and health plans have used PCMH recognition as a means to validate high-performing practices and reward …

Building A Framework For Professional Nursing Practice Across The Continuum Of Care, Elizabeth S. Bigby

Doctor of Nursing Practice (DNP) Projects

Nursing professional practice models are designed to unite and align nurses under one vision, set of values, and a professional practice model. The goal of this project was to implement and enculturate a professional practice model of nursing with assistant nurse managers and leaders across the continuum of care at an urban medical center and associated ambulatory medical offices. Staff engagement has been shown to improve satisfaction and decrease turnover and implementation and enculturation of a professional practice model improves engagement. The target population was nurse managers and leaders as they needed to embrace professional practice before the project was …

Improving The Patient Experience By Implementing Patient-Centered Care In A Community Hospital, Richard A. Billingsley Dnp, Mha, Rn

Doctor of Nursing Practice (DNP) Projects

Health care is a complex business currently undergoing extensive reform. These changes require new methods of care deliver and ways in which health care organizations are operating. At the forefront of this change effort is the 2010 Patient Protection and Affordable Care Act, which is transforming health care from a volume-based, fee-for-service process to the delivery of services that have value, improve quality outcomes, increase satisfaction, elicit greater efficiency, demonstrate improved safety outcomes, show cost-effectiveness, promote better access to services, and result in high reliability between providers and organizations. The goal of providing a more positive health care experience is …

A Population Health Approach For Community Health Improvement, Sandra Gregg

Doctor of Nursing Practice (DNP) Projects

Providence Health & Services (Providence), a not-for-profit Catholic health care system serving five western states, established an organizational vision of Creating healthier communities, together (Providence Health & Services, 2014). This vision served as the catalyst for the alignment of divisional initiatives to positively impact community health status. To effectively achieve its vision, the organization committed to the incorporation of population health principles in the development of an infrastructure to expand the reach and impact of community investments, along with the establishment of effective processes for inter-divisional collaboration and compliance with community benefit mandates. Thus, in 2015, Providence established a community …

Minimizing Avoidable Interruptions During Medication Administration, Jaleel Anne Arnado

Master's Projects and Capstones

The objective of this CNL Internship Project is to improve patient outcomes and nurse satisfaction by minimizing the avoidable interruptions that occur during medication administration. The microsystem is a pediatric and adult medical-surgical overflow unit at a large, urban teaching hospital in Northern California. A series of surveys for nurses and patients and observations of medication administrations were conducted to assess barriers during mediation administration. It was determined phone calls interrupt a nurse the most during medication administration. Interruptions leave the medication administration process vulnerable to errors because it disrupts the nurse’s workflow and thought process. Because most pediatric medication …

Avoiding 30-Day Readmissions Of Acute Mi Patients Utilizing Cardiac Rehabilitation, Patricia T. Forsberg

Doctor of Nursing Practice (DNP) Projects

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more …

Implementation Plan For Emr And Beyond, Lori Katterhagen

Doctor of Nursing Practice (DNP) Projects

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties …