Quality Improvement Commons^™

A Survey To Highlight Areas Of Focus For Patient Care In Settings Utilizing Medical Interpretation, Azayzel Deregis

Undergraduate Honors Theses

This thesis recounts my personal experience working as a volunteer medical interpreter for the Language and Culture Resource Center at East Tennessee State University. The result of my time spent volunteering as a medical interpreter, shadowing professional medical interpreters, and witnessing patient-provider interactions during interpreted sessions was an inspiration to study medical interpretation further and delve into the challenges faced by patients who require medical interpreters. During my time researching this topic, I found that the United States is severely lacking in Spanish medical interpreters—with some healthcare facilities employing no medical interpreters—even though the size of the Hispanic population is …

Community Health Worker Intervention To Improve Hba1c In Adult Diabetic Patients, Megan Wojtko

Doctor of Nursing Practice Projects

Type 2 Diabetes Mellitus (T2DM) is a disease that disproportionally impacts patients with multiple socioeconomic barriers that are often difficult to address during a primary care visit. Several provider and practice-level barriers also exist including time limitations within the visit and lack of trained staff to help with patient education and case management. Uncontrolled T2DM leads to poor health outcomes and increased healthcare costs. Community Health Workers (CHW) are trained lay persons that can successfully address the patient’s unmet needs and assist with the provider’s recommendations. The purpose of this project was to explore if a CHW led intervention focused …

Biomarkers And Factors Related To Risk Of Acute Kidney Injury, Mary Ann David

Dissertations

Background: Acute kidney injury (AKI) is associated with increased mortality, morbidity, length of hospital stay, and in-hospital cost. Timely intervention is needed to prevent disease progression, but the delay in diagnostic process often results in delayed treatment. Recent studies show a significant increase in novel urine biomarkers (UB), TIMP-2 and IGFBP7, has been linked to an increased risk of AKI.

Objectives: The purpose of this study was to examine the relationships among participants’ sociodemographic and clinical characteristics, including select biomarkers, care management processes, treatments, and patient outcomes in a sample of hospitalized critically ill patients in southern California.

Findings: Study …

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …

Civility And Communication Interventions To Improve Patient Outcomes, Lane Denney

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Communication in health care is vital for the successful care of patients and their outcomes while they are hospitalized. Healthcare workers are responsible for communicating patient information whether it is between change of shifts or reporting to a patient’s provider. It is important that this information is communicated effectively. This review evaluates how nurses communicate in shift- report and how this affects patient outcomes and civility between nursing units and teams. Overall, bedside shift reports promoted the best patient outcomes and increased teamwork on hospital units.

The Impact Of Patient-Centered Care On Health Outcomes In Adolescents Living With Diabetes, Rashida Farhad Vasanwala Dr, Amos Lim, Lim Soo Ting, Lim Pei Kwee, Hui Yuen Ching, Tan Xiang Feng

Patient Experience Journal

There is increasing evidence from research studies that suggest patient-centered care has a relationship with good clinical outcomes. In Singapore, there are no studies done to assess and address the issue of patient-centered care and its association with the adolescent’s ability to manage their chronic medical condition, such as Type 1 Diabetes Mellitus. The relationship between the patient and clinicians has changed from a paternalistic form to a position which aims to foster patient-centered care. More importantly, this study aims to show the adolescent’s readiness and ability to assume a more mature role in management of their own medical condition. …

Prevention Of Diabetes-Related Hospital Readmission Following Initial Diagnosis Of Diabetes In Patients Over The Age Of Fifty: A Scoping Review, Nathan Miller Dnp, Agacnp, Fnp, Jasmine Harris Dnp, Fnp, Michael Clardy Dnp, Agacnp, Diana Dedmon Dnp, Acnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background: By reviewing multiple studies related to the treatment of patients with new diagnoses of diabetes, this scoping review will endeavor to determine which interventions, when implemented for patients over 50 years old which are newly diagnosed with type 2 diabetes, can decrease the likelihood of hospital readmission related to diabetes within 90 days when compared with those patients who did not receive or participate in follow-up.

Methods: For resources to be eligible to review they had to be from 2015 or after. Studies selected included patients over the age of 50 newly diagnosed with type 2 diabetes subject to …

Comparing The Effectiveness Of Perioperative Ketorolac To Opioids: A Scoping Review, Kruze T. Vanderford Bsn, Ccrn, Srna, Abbie E. Walter Bsn, Ccrn, Srna, Anastasiya V. Woodard Bsn, Ccrn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Abstract Purpose/Background Opioids are commonly administered in the perioperative period to manage surgical pain. However, the ongoing opioid epidemic in the United States makes it necessary to evaluate other modalities of pain management that do not cause respiratory depression, nausea, vomiting and addiction. Ketorolac is a nonsteroidal anti-inflammatory drug that can manage pain safely and effectively. This scoping review examines the available literature on the effectiveness and feasibility of using ketorolac to minimize perioperative opioid use.

Methods A comprehensive literature review was performed between October 2020 and September 2021 utilizing five scholarly databases: GoogleScholar ™, PubMed, Ovid, Cochrane Library, and …

Annual Hepatitis C Screening Qi: A Scoping Review, Sadiat Omowunmi Adebiyi Bsn, Rn, Sakinah Shaw Bsn, Rn, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Sharon Little Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Despite the surge in HCV prevalence among pregnant women and the threat of perinatal HCV transmission, infants exposed to HCV in the United States are inadequately screened (Chappell et al., 2018). It is estimated that between 4% and 8% of babies exposed to HCV during pregnancy become infected (Watts et al., 2017). Incorporating Hep C screening with other mandated prenatal screening will play an essential role in reducing the complications associated with Hep C transmission to the newborn.

Methods Article search was done in the first three weeks of the fall 2021 semester, and a total of 63 articles …

Impact Of Social Determinants Of Health On Adherence To Urinary Tract Infection Treatment Recommendations: A Scoping Review, Charles W. Stewart Cpnp, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background: Pediatric health is significantly affected by social determinants of health. Screening for and addressing social determinants of health helps to decrease negative effect on health outcomes. The purpose of this project is to determine if there is an association between addressing or not addressing social determinants of health by the healthcare provider and parents’ adherence to treatment recommendations in children with urinary tract infections.

Methods: Between October 2020 and November 2021, a literature review was performed to obtain data from studies regarding urinary tract infections, social determinants of health and adherence to treatment recommendations. The University of Tennessee Health …

Appointment Reminder System Benchmark Study, Anthony Rawlinson

MSN Capstone Projects

The average appointment “no-show” rate is 23% across 105 studies (Dantas et al., 2018). These “no-shows” cost an estimated 150 billion dollars a year to the American healthcare industry (Ruiz-Hernandez et al., 2020). Previous estimates place the cost of one no-show event at a primary office in the range of $125 to $274 (Aysola et al., 2020). These missed appointments not only cause a loss in office revenue, but also harm the patients missing the appointment (Marbouh et al., 2020). Some of the repercussions patients suffer from are longer wait times for appointments, higher Emergency Room (ER) admission rates, and …

A Better Way To Non-Invasively Measure Bilirubin Levels To Protect Infant Health, Kristen Mackeil

Symposium of Student Scholars

Background: Jaundice screening using transcutaneous bilirubin(TcB) monitors often produce inaccurately low results for lighter skin tone newborns and inaccurately high results for darker skin tone newborns. While high jaundice levels for lighter skin tone newborns risk going undetected, darker skin tone newborns receive unnecessary follow up heel sticks for serum bilirubin determination. This is a problem because dangerous jaundice levels may be under or over reported. Additionally, unnecessary heel sticks for darker skin tone newborns increase the risk of complications from puncture and increase newborn discomfort. Performing the heel stick and processing the blood sample also cost nurses and …

Boarding Barriers For Psychiatric Patients In Emergency Departments, Emmeline B. Martin Bsn, Rn, Alison Rossano Bsn, Rn, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Objective To identify past or current literature about emergency department holds and psychiatric patients consisting of the evaluation of patient outcomes, satisfaction and equity of care. It is already known that shorter boarding times from the emergency department to a psychiatric unit have positive patient outcomes such as a decrease in readmissions, increase in patient satisfaction and efficiency in appropriate treatment.

Method A scoping review to analyze data by grouping articles into themes which included authors, date of publication, aims/purpose, methodology, sample, interventional details, and the key findings in each article. Excluded articles included those discussing COVID-19 and case management. …

Implementation Of Daily Nhppd Calculator In The Acute Care Setting, Spencer Y. Cho

Student Scholarly Projects

Practice Problem: In the United States, it is estimated that hospitalized patients experience an adverse event that require a rapid response and/or code blue event in 3% to 18% of hospitalizations.

PICOT: In the adult medical-surgical inpatient (P), does the implementation of a daily NHPPD calculator (DNC) (I) compared to an annual staffing methodology for calculating NHPPD (C) reduce rapid response calls, code blue episodes, and unplanned admission to critical care (O) over 8 weeks (T).

Evidence: Seven studies provided evidence that implementation of staffing methodology, nursing surveillance, and nurse staffing that supports meeting targeted nursing hours per patient …

Uncovering The Educational And Self Management Need In People With Inflammatory Bowel Disease, Zachary Palumbo

Doctor of Nursing Practice Scholarly Project

The purpose of the study was to assess the current knowledge of inflammatory bowel disease (IBD), self-management skills, and resources for IBD in people suffering from the condition. Self-management skills and education have been shown, along with medical treatment, to show improvements in symptom activity and overall quality of life (Conley & Redeker, 2016).The study used Orem’s Self-Care deficit theory as the theoretical framework. A mixed methods design was chosen for this particular study. The project provided an educational video and a pre and post-survey through email. The questionnaire and pre-test (Appendix A) was given before the education, and Appendix …

Non-Opioid Pharmacologic Agents In The Treatment Of Non-Cancer Chronic Pain In The Outpatient Setting, Diane Eannotti

DNP Projects

Opioid prescription related overdose deaths have increased substantially with evidence demonstrating only modest short-term benefits in chronic pain and thus represents the need to identify alternative treatments to opioids. A needs assessment performed for a federally qualified community health center revealed patients presently taking non-opioid pharmacologic agents in the treatment of chronic non-cancer pain (CNCP) needed additional education in managing multiple non-opioid medications. A targeted approach at improving patient experience and population health supporting the quadruple aim was undertaken with this project.

Purpose: The purpose of this quality improvement project consisted of performing medication management visits for 28 referred patients …

Oral Care Bundle Impact On Staff Assisted Oral Care, Sabrina Oliver

Student Scholarly Projects

Practice Problem: Non-ventilator hospital acquired pneumonia (NV-HAP) is more common than ventilator acquired pneumonia. Oral care is the only modifiable risk factor for all patient populations.

PICOT: The PICOT question that guided this project was: In non-ventilated patients in a tertiary care setting (P), how does implementing an oral care bundle (I) compared to the current practice of individual tasks without a bundle (C) affect adherence to facility oral care standard of patients receiving oral care at least once a day (O) over six weeks (T)?

Evidence: Lack of an oral bundle that has been proven to decrease …

Perception Is Everything: Implementation Of A Peer Evaluation Program For Nurse Leaders In A Hospital Setting, Teruko Williams

Student Scholarly Projects

Practice Problem: A hospital in the Sacramento County area seeking the ANCC Pathway to Excellence Program^® designation determined upon performing a gap analysis that Element of Performance 2.8, a peer evaluation program, was absent, thus creating a deficiency in the fulfillment of the requirements for the designation.

PICOT: The PICOT question that guided this project was: In nurse leaders (P) how does the development of a formal peer evaluation process (I) compared to no formal process (C), influence the performance outcome score of self-efficacy (O) over 8 weeks (T)?

Evidence: The evidence demonstrated that if a …

Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern

The University of Louisville Journal of Respiratory Infections

Background: Response to the COVID-19 pandemic has required innovative approaches to vaccination, including methods to rapidly and safely immunize communities. A major challenge to such a response involved access to untapped healthcare worker resources. The Louisville, Kentucky, response involved the use of a large volunteer workforce to supplement local public health employees in planning and implementing a large-scale drive-through vaccination event. The objective of this manuscript was to outline processes involved in training a mass immunization workforce and implementating a large-scale COVID-19 community vaccination.

Approach: Competency-based and standardized training was provided for every volunteer before working their shift. Volunteers worked …

Cesarean Skin-To-Skin Contact: Who Gets The Experience In The Operating Room?, Jessica S. Junk-Wilson

Graduate Theses/Dissertations

For the past decade, skin-to-skin contact immediately after birth has been the general recommendation for all births, as there is evidence that it provides many benefits for mothers and infants. Yet, research has shown that immediate skin-to-skin contact is not the standard practice after most Cesarean births. This study assessed access, incidence, and circumstances surrounding Cesarean skin-to-skin contact (CSSC) in the operating room and examined influencing maternal characteristics of age, education, race, and number of births via a survey of 2327 people. Women who experienced a Cesarean section birth in the past 10 years were recruited through Facebook groups for …

Developing An Evaluation Process For Telehealth In A Copd Clinic, Jodi H. Biller

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Telehealth was broadly implemented as a care modality in response to a worldwide pandemic in 2020. Before the COVID-19 pandemic, while telehealth was not new, it was not widely utilized at the project site location, and a uniform method of evaluating its effectiveness was needed. This quality assurance project developed and piloted a uniform process to evaluate telehealth in a Chronic Obstructive Pulmonary Disease (COPD) clinic, then evaluated stakeholder perceptions about the process used in developing the evaluation tool.

Methods: The telehealth evaluation tool was developed using the National Quality Forum (NQF) framework and Global Obstructive Lung Disease (GOLD) …

Implementation Of Lean Principles During Operating Room Turnovers, Makenzie Marshall

Doctor of Nursing Practice Projects

Background

Many operating rooms across the country face the daunting task of making their turnovers between surgical patients quicker and more efficient. Turnover time is defined as the time it takes to clean an operating room and set up the next sterile field between surgical patients. The time begins when the patient leaves the operating room suite and stops when the next patient enters the same suite. Running an operating room is a complex and costly endeavor, and even small shortfalls can have a snowball effect, leading to delays, wasteful spending, and substandard patient outcomes; therefore, it is imperative to …

Nurse Managers' Patient Safety Communication, Christine Deatrick

Electronic Theses and Dissertations, 2020-2023

Medical errors are a continuing issue for healthcare organizations and can lead to patient harm or death. To bring about organizational learning and therefore reduce medical errors, information must successfully flow through an organization. Nurse managers play an essential role as the conduit of information between frontline staff and the organization. The primary purpose of this study is to describe the decision-making process of how nurse managers actively select and transmit information on patient safety concerns. A qualitative constructivist grounded theory approach was used. Nineteen unit-level nurse managers, working full-time in an acute care hospital with a minimum of one-year …

Blood Administration Documentation Audit Automation, Tonya Lawson, Harriette Lober, Andrea Nordmark

All Poster Presentations

Background: Blood administration is a high risk, low volume, complex procedure. It has strict regulatory requirements for documentation of at least 15 elements over the course of the procedure. There are frequently findings for deficient documentation during survey. Manual audits are time consuming and inaccurate. Every facility in the Providence system faces the same challenges to audit for compliance.

Problem: Detecting the rate of compliance for documentation of blood administration manually is difficult. Nursing documentation for blood administration is often incomplete. Manual audits are labor-intensive and have proven to have limited impact to increase documentation compliance.

Methods: We created an …

Implementation Of A Nonverbal Scrub Cap Identification System To Improve Communication And Perception Of Patient Safety Among Unfamiliar, De-Identified Staff Members In The Operating Room., Keri Ann Roskowinski

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: Operating room (OR), professionals deliver patient care with brief introductions, and roles were not always identified, and although team members wear identification (ID) badges, they were usually covered by sterile gowns and other routine personal protective equipment (PPE). Purpose: The aim of this Doctor of Nursing Practice (DNP) project was to determine if a simple intervention to apply the individual’s name and role to a scrub cap could improve identification, OR team communication, and consequently, patient safety. The participants in this project consisted of nurses, physicians, anesthesia providers, scrub technicians, students, medical sales representatives, and those that identified as …

Improving Disinfectant Cap Use On Central Lines In The Icu To Reduce Patient Risk For Clabsi: A Quality Improvement Project, Tali Cherim

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common type of preventable healthcare-associated bloodstream infection, and may increase length of stay (LOS), facility treatment costs, and patient mortality rates. Intensive Care Unit (ICU) patients are especially vulnerable to CLABSI due to their critical health conditions and other comorbid factors. A literature review provided evidence supporting the use of alcohol-impregnated disinfectant caps, such as SwabCap®, on central line (CL) ports to significantly reduce patients’ risk for CLABSI. This quality improvement project took place within an adult ICU of a Level II trauma facility in New England, where the Infection Prevention …

Black Hearts Matter: A Comparative Study Of Sociodemographic, Clinical, And Psychosocial Characteristics In Black And White Persons With Heart Failure, Hannah M Anderson Hughes

Theses and Dissertations

Heart failure (HF) is a chronic, progressive, debilitating illness that disproportionately affects Black individuals, often leading to poor quality of life (QOL). Various sociodemographic, clinical, and psychological characteristics are related to QOL in patients with HF. Because most studies do not include representative Black samples or report findings from racial subgroup analyses, these relationships and any existing racial differences are not well understood. The purpose of this descriptive, comparative study was to explore the relationships among sociodemographic, clinical, and psychological characteristics and QOL in patients with HF and to determine if there were racial differences between Black and White individuals. …

Patient Factors Associated With Different Hospice Programs In Korea: Analyzing Healthcare Big Data, Young-Taek Park, Daekyun Kim, Su-Jin Koh, Yeon Soon Kim, Sang Mi Kim

Nursing Faculty Publications

The Korean government has implemented a pilot project that introduces a new type of hospice care program called “Consultative Hospice Care” (COHC) since August 2017. The COHC is a new type of hospice program for terminally ill patients in acute care wards, which is different from the Independent Hospice Unit (IHU) care. This study aimed to compare the characteristics of two groups of hospice patients: COHC care only and both IHU care and COHC groups. Healthcare claim data from 1 April 2018 to 31 March 2020 were retrieved from the HIRA data warehouse system. The main outcome variable was patients …

Implementation Of A Standardized Medication Reconciliation Protocol In A Psychiatric Stabilization Setting, Sara Robinson

DNP Scholarly Projects

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit.

INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol.

Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the …

Discharge Process Optimization, Erin M. O’Neal

Doctor of Nursing Practice Projects

As the demands of the nurse become increased with higher acuity and documentation requirements, the delivery of discharge instructions is often one of the most, and at times, only, formal education opportunities between the nurse and the patient. It is imperative to modify the discharge process to ensure patients have the ability to confidently care for themselves after they leave the hospital. The aim of this project was to create a nursing discharge workflow that meets the educational needs of the patients. This project was a quality improvement project designed to change the nursing workflow to provide a better discharge …