Quality Improvement Commons^™

Effect Of The Intern Survival Book Handbook In Medical City Fort Worth Family Medicine Residency Program, Nancy Sang, Harry Pham, Tammy Nguyen, Zara Soomro, Patrick Feng, Ali Al-Nahi

North Texas GME Research Forum 2024

Background: The optimization of medical training is a critical concern amid dynamic shifts in both medical and societal landscapes. Research indicates that a substantial proportion of medical trainees experience stress, anxiety, and depression, with an estimated depression rate of 29% among medical residents, compared to 8% among nonphysicians. Furthermore, the suicide rate among physicians is twice that of the general population. Difficulty in adapting to new environments, responsibilities, and training levels exacerbate these challenges. This study evaluates the efficacy of "The Intern Survival Handbook" in mitigating stressors among new trainees, enhancing their work performance, and promoting overall mental health. Methods: …

Gamification To Improve Ems Knowledge Of Medical Capacity Determination, Ross Sinicrope, Nasim Motaghedi, Zachary Yates, Elliott Richardson, Stephanie Schieffert, Jacob Wright, Abigail Alorda, Jeffrey Katz, Linh Nguyen, Shayne Gue, Christine Van Dillen, Ayanna Walker

North Florida Division GME Research Day 2024

No abstract provided.

Clinical Outcomes Associated With Mrsa Naat Utilization., Shannon B. Leighton, Pharmd, Emily Fox, Greg Tallman

Books, Presentations, Posters, Etc.

Abstract: A recent analysis by the Oregon Regional Antimicrobial Stewardship Program demonstrated that across the Oregon region, MRSA NAAT from the nares have a high negative predictive value (NPV) of 99.4%. These findings were consistent when stratified by culture site. The high NPV suggests that MRSA NAAT nasal swabs can be useful in promoting de-escalation (e.g., discontinuation) of anti-MRSA treatment. Few studies have evaluated if use of the MRSA NAAT influences anti-MRSA treatment de-escalation, and even fewer have assessed important clinical outcomes related to MRSA NAAT utilization and de-escalation. The goal of this study is to evaluate the frequency of …

Mastering The Ite With Em Mastermind: A Board Game For Board Review, Taylor Cesarz, Stephanie Cohen, Shayne Gue

North Florida Division GME Research Day 2024

No abstract provided.

Outpatient Fall Prevention In Ambulatory Adults 65 Years Old And Over, Dorothy L. Osborne-White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: In the United States (U.S.), falls are the leading cause of injury among adults 65 and over, resulting in 36 million falls yearly (Moreland et al., 2020). According to the Centers for Disease Control and Prevention (CDC, 2023), one in four older adults experiences a fall each year. Falls are the world's second most prominent cause of accidental deaths (World Health Organization [WHO], 2021). Falls are the leading cause of both fatal and non-fatal injuries among older adults (Moreland et al., 2020).

Methods: A quality improvement project that included a fall bundle was implemented in a primary clinic. A …

Review Of Current Dual-Antiplatelet And Triple Therapy Prescribing Practices At Providence Medical Group, Gina Kim, Christine Doran, Lauren Powell

Books, Presentations, Posters, Etc.

Abstract: Approximately 10% of patients with recent percutaneous intervention (PCI) have concomitant atrial fibrillation (AF) and others may have concomitant venous thromboembolism (VTE). This makes choosing the optimal antithrombotic regimen challenging. The ACC published a 2020 decision pathway to guide safe and evidence-based use of antiplatelet and anticoagulant combinations for certain patients. These situations include patients with prior AF on anticoagulation and the need for PCI, patients with new-onset AF requiring anticoagulation in a patient already on antiplatelet therapy for coronary artery disease (CAD), patients with prior VTE on anticoagulation and the need for PCI, and patients with new or …

Targeted Procedure Lab To Improve Self-Identified Deficiencies Among Graduating Emergency Medicine Residents, Stephanie Cohen, Andrew Bobbett, Shayne Gue, Jeffrey Thompson

North Florida Division GME Research Day 2024

No abstract provided.

Multiple Casualty Simulation Scenario Secondary To Natural Disaster At A Music Festival, Stephanie Cohen, Robert Pell, Casey Mcgillicuddy, Nidhi Sahi, Ariel Vera, Steven Nazario, Andrew Bobbett, Rebecca Beiler, Noe Navarro, Latha Ganti, Shayne M. Gue

North Florida Division GME Research Day 2024

No abstract provided.

Introduction To Atls And Emergency Preparedness, Leon Gu, Urvashi Firozi, Pradeep D'Souza

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Learning Mass Casualty Incident Triage Via Role Play Simulation, Martin Morales-Cruz, Ayanna Walker, Drake Dixon, Latha Ganti, Shayne Gue

North Florida Division GME Research Day 2024

No abstract provided.

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Senior Theses

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care-based training, with the …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Senior Theses

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Student Research Posters

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Home Blood Pressure Monitoring Bundle For Hypertension Outcomes In Adult Patients Receiving Care In Public Health Clinics, Christine Jennifer Victorian

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hypertension (HTN) that is not adequately controlled leads to cardiovascular disease, stroke, and heart disease. It affects 116 million adults (47%) in the United States (U.S.). The HTN compliance rate in a South Texas public health clinic was 64%, below the national benchmark of 76%. Home blood pressure monitoring (HBPM) was recommended in a joint statement by the American Heart Association (AHA) and the American Medical Association (AMA). Literature evidence revealed that the HBPM bundle increased BP control (< 140/90 mmHg) compliance.

Methods: A quality improvement (QI) bundle was initiated to address the low HTN compliance rate from a quality management perspective. …

Creation Of A Structured Rapid Response Team And Early Rrt Activation, Elizabeth Amaka Azie

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Cardiac arrest, unanticipated admissions to the intensive care unit (ICU), and mortality account for about 50% of serious inpatient adverse events (Ko et al., 2020). Efforts to prevent in-hospital cardiopulmonary resuscitation (CPR) require a system to identify deteriorating patients and include an appropriate interventional response, such as a rapid response team (Andersen et al., 2019). A well-structured rapid response team (RRT) has five categories that include team structure, organizational culture, expertise, communication, and teamwork (Jackson, 2017). A community hospital in Texas has been challenged in its attempts to have a well-structured RRT and had an increase in cardiac arrest. A …

Implementation Of Prognosticator Algorithm For Initiation Of Serious Illness Discussions And Improving The Rate Of Palliative And Hospice Referrals, Joy Isebor

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Context: Early serious illness conversations related to end-of-life and goals of care with seriously ill patients have been associated with improving patients' outcomes and quality of care (Bernacki et al., 2015). However, initiating these serious illness discussions has been challenging in the home-based primary care setting.

Objectives: To train and support home-based primary care clinicians in integrating best practices in serious illness discussions and decision-making engagement among patients sixty-five and older with serious illnesses, optimize the alignment between patient goals and the medical care they receive, improving their quality of life and the rate of palliative care and hospice referrals. …

Improving Competence And Confidence In Outpatient Management Of Major Depressive Disorder, Anish Pal, Pavan Anand, Brett M. Garrett

Gulf Coast Division GME Research Symposium 2024

No abstract provided.

Implementation Of A Pilot Quality Improvement Project To Guide The Administration Of Intraoperative Dexamethasone For Postoperative Nausea And Vomiting Prophylaxis In Patients With Diabetes Undergoing Orthopedic Procedures, Brittany W. Hall

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: At a local tertiary care hospital, there was no recommendation to guide anesthesia providers in the administration of intraoperative dexamethasone to patients with diabetes. While dexamethasone is a highly effective antiemetic, it may promote hyperglycemia in patients with diabetes.

Purpose: The purpose of this project was to guide and educate about current recommendations for the administration of dexamethasone for PONV prophylaxis in patients with diabetes.

Intervention: 1) Examined pre-intervention practices of dexamethasone administration. 2) Educated about current and best practices to anesthesia staff. 3) Developed badge buddy cards outlining the guideline. 4) Examined post-intervention practices. 5) Evaluated the effect …

Power Safety Plan Checklist As An Intervention In The Operating Room, Scott John Fankhauser

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Power Safety Plan Checklist as an Intervention in the Operating Room

Scott J. Fankhauser

Background: Intraoperative power failures (IOPF) force anesthesia providers to quickly make decisions to prevent patient harm when equipment does not operate as designed. Familiarity with alternative methods is critical during this decision process to deliver high-quality care during IOPF events. Purpose: The purpose of this project was to assess the impact of a checklist on anesthesia providers’ perceptions regarding continuation of care during an IOPF. Interventions: Pre- and post-intervention surveys were conducted during a simulation and education setting for annual competencies. Methods: The study …

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …

Reducing Food Scarcity: The Benefits Of Urban Farming, S.A. Claudell, Emilio Mejia

Journal of Nonprofit Innovation

Urban farming can enhance the lives of communities and help reduce food scarcity. This paper presents a conceptual prototype of an efficient urban farming community that can be scaled for a single apartment building or an entire community across all global geoeconomics regions, including densely populated cities and rural, developing towns and communities. When deployed in coordination with smart crop choices, local farm support, and efficient transportation then the result isn’t just sustainability, but also increasing fresh produce accessibility, optimizing nutritional value, eliminating the use of ‘forever chemicals’, reducing transportation costs, and fostering global environmental benefits.

Imagine Doris, who is …

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 …

A Quality Improvement Project To Increase Awareness And Utilization Of Employee Assistance Program Services Among Healthcare Providers, Scarlet Gould

Doctoral Projects

Mental health distress among healthcare providers (HCP) is a common problem, yet Employee Assistance Programs (EAP) are consistently underutilized. Unmanaged workplace stress can lead to problems such as provider burnout and increased rates of turnover, which can result in decreased access to patient care. The purpose of this project was to increase awareness and utilization of EAP services by using the Plan-Do-Study-Act cycle (PDSA) for quality improvement. Nurse Practitioners at a community-based hospital were provided with a PowerPoint^® presentation via email that contained information regarding the facility’s employee assistance program, mental health wellness education, as well as ways to …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

A Case Study Of The Political Determinant Of Health On The Public Health Crisis Of Malaria In Nigeria, Bisola M. Olumegbon

Electronic Theses and Dissertations

Abstract

Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature …

A Clear, Succinct Research Question Portends The Rest Of The Story, Jessica J. F. Kram, Lisa Sullivan Vedder, Brenda Fay, Deborah Simpson

Journal of Patient-Centered Research and Reviews

The goal of any research manuscript is to convey the story of a systematic answer to an important question in the field. A clear, succinct research or study question is what provides the storyline that connects all the sections of a manuscript. One of the most common strategies to developing a meaningful research question is the FINER approach, which encompasses five standards to determine the quality of a question: feasible, interesting, novel, ethical, and relevant. Using the FINER approach can provide the guidepost for all design and reporting decisions. This editorial recommends creating a study protocol aimed at answering your …

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 …

Utilizing Stakeholder Input Within The Tennessee Heart Health Network To Improve Cardiovascular Health Outcomes In Tennessee, Abigail C. Bennett

Longitudinal Scholar's Project

Background: Tennessee ranks sixth nationwide for most deaths related to heart disease. The Tennessee Heart Health Network (TN-HHN), an initiative coordinated by the Tennessee Population Health Consortium (TN-PHC), was created to combat this issue. The TN-HHN is a statewide network of primary care practices, health systems, and academic centers committed to implementing patient-centered outcomes research (PCOR) approaches to demonstrably improve cardiovascular disease (CVD) health outcomes and health equity across Tennessee.

Objective: Evaluate stakeholder experiences in participating in the Network in an effort to assess partner satisfaction and improve the TN-HHN as a whole.

Methods: Eligible stakeholders were invited via …

Charting And Checking For Suicidality In A Family Medicine Residency Clinic, Bridget Murphy, Stacy Ogbeide

Journal of Human Services Scholarship and Interprofessional Collaboration

Suicide is a leading cause of death in the United States, and many individuals who die by suicide are likely to have seen a primary care physician (PCP) within the month of their death. Thus, the goal of this quality improvement (QI) project was to examine suicidality documentation practices of interprofessional clinicians within a Family Medicine residency clinic, thus providing rationale for continued research and a template for other clinics to emulate. The QI project used the Plan-Do-Study-Act cycle to survey 28 Family Medicine residents, faculty, and trainees for the Plan stage of the cycle in 2022 and assessed their …

Prescribing Protocol For Postoperative Opioids In An Orthopedic Spine Practice, Kelly M. Manda

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The opioid epidemic is magnified by excessive post-surgery prescriptions. Over six months at an orthopedic spine practice, 50% of patients received two or more opioid refills beyond their first. This highlighted the absence of a clear prescribing policy and emphasized the need for a structured protocol and to promote patient safety.

Aim of the Project: The primary aim was to implement a prescribing protocol to lower opioid refills provided to post-surgical patients in this surgical practice. The desired result was to reduce the number of opioid refills provided to patients after surgery.

Review of the Evidence: Evidence highlighted …