Quality Improvement Commons^™

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Hypertension: Care Management Program And Medication Adherence, Courtney Montgomery

Student Scholarly Projects

Practice Problem: Medication adherence is a major concern in healthcare as it is a contributing factor to uncontrolled hypertension and resistant hypertension. Uncontrolled hypertension can lead to strokes, heart attacks, kidney failure, and even death.

PICOT: The PICOT question that guided this project was in Medicare Advantage members with hypertension located in Kansas, who were admitted to the hospital or emergency room identified by stratification (P), does care management utilization using hypertension clinical guidelines (I), compared to the stand-alone hypertension clinical practice guideline (C), improve medication adherence (O) over 10 weeks (T)?

Evidence: Hypertension is one of the leading preventable …

Fostering Patient Safety: Importance Of Nursing Documentation, Shamsa Samani, Salma Amin Rattani

School of Nursing & Midwifery

Background: Nurses are professionally accountable for assessing and documenting patients’ vital signs. Nurses failing to fulfill this responsibility position their patients at risk. This paper presents two real-life cases pertaining to patients’ safety resulting in fatal outcomes, leading to the professional, legal, and ethical liability of nurses as the providers of patient care.
Objective: This paper focuses on the role of organizational culture in fostering patient safety specifically in monitoring and documentation of patients’ vital signs and early recognition of warning signs.
Methodology: A comprehensive literature search was conducted using various databases, examining the significance of vital signs monitoring and …

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Top 10 Things To Know About Falls In Older Adults, Alexander W. Zirulnik, Shan Liu

Journal of Geriatric Emergency Medicine

No abstract provided.

Feasibility Of Family Focused Obesity Screening In Primary Care, Adrianne Griffiths

Doctor of Nursing Practice Final Manuscripts

Background: Obesity is associated with serious medical conditions including diabetes, hypertension, and heart disease. It also contributes to decreased productivity at work and school, financial strain, and reduced quality of life.

Purpose of Project: To address this problem, a nurse practitioner-led screening and intervention program was piloted at a primary care clinic in southern San Diego. The tool provides a standardized method for screening individuals and their families for nutrition and physical activity deficits associated with obesity, as well as appropriate and effective interventions to prevent and manage obesity.

Methods: The Family Nutrition and Physical Activity (FNPA) screening tool is …

Using Drama Therapy To Foster Peer Support Among Nurse Leaders, Chyela Rowe

Expressive Therapies Dissertations

This study explored the use of drama therapy to support the social-emotional experiences of nurse leaders at a mid-sized regional hospital system in the Southeastern United States. Nurse leaders have experienced profound changes to their work environments in recent years and burnout has been at an all-time high among healthcare workers globally. Organizational supports for nurses and nurse leaders are both inadequate to meet the needs and under-resourced. The research questions explored 1) whether the drama therapy peer support initiative improved outcomes and 2) whether there was a significant relationship between measures, and 3) what nurse leaders described as facilitators …

How Does Facilitation In Healthcare Work? Using Mechanism Mapping To Illuminate The Black Box Of A Meta-Implementation Strategy, Amy M Kilbourne, Elvin Geng, Ingrid Eshun-Wilson, Shannon Sweeney, Donna Shelley, Deborah J Cohen, Joann E Kirchner, Maria E Fernandez, Michael L Parchman

Faculty, Staff and Student Publications

BACKGROUND: Healthcare facilitation, an implementation strategy designed to improve the uptake of effective clinical innovations in routine practice, has produced promising yet mixed results in randomized implementation trials and has not been fully researched across different contexts.

OBJECTIVE: Using mechanism mapping, which applies directed acyclic graphs that decompose an effect of interest into hypothesized causal steps and mechanisms, we propose a more concrete description of how healthcare facilitation works to inform its further study as a meta-implementation strategy.

METHODS: Using a modified Delphi consensus process, co-authors developed the mechanistic map based on a three-step process. First, they developed an initial …

Medical Interpreters' Work Impact On Their Lives: Understanding Medical Interpreters' Work Experience, Nicholas M. Herrarte Smith

Senior Honors Projects, 2020-current

Medical interpreters in the US are crucial health workers that specialize in facilitating communication between non-English-speaking patients and English medical professionals. Although much research has been done regarding the positive impact of professional medical interpreters on LEP (limited English proficient) patients' health, it is less known how medical interpreters’ lives are impacted in this line of work. Thus, this study was aimed at gaining a better understanding on the impact that this line of work has on the lives of medical interpreters. For this study, a survey was created with questions regarding demographics, interpretation’s certification process, interpreter’s satisfaction/experience, and mental …

Ethical Considerations Of Clinical Research In Emergency Care Settings: A Review, Adith Velavan

Honors Scholar Theses

Emergency and acute care settings are some of the most volatile and high intensity areas of any healthcare operation. Better understanding of systems and treatments in these spaces are critical to improving outcomes for the high risk patients that are treated there. Clinical research serves as a cornerstone of modern medical research, and is critical to the further improvement of clinical care in these settings. This thesis serves to explore the ethicality of such research given the constraints of emergency medicine settings. Not only does this thesis provide a strong foundation regarding the history and current practices of clinical research, …

How Medical Cannabis Took Root In Mississippi, Loral Winn

Honors Theses

How Medical Cannabis Took Root in Mississippi

(Under the direction of Dr. Iveta Imre)

How Medical Cannabis Took Root in Mississippi is a multimedia journalism piece that follows the timeline of medical cannabis’ legalization in Mississippi through the lives and lenses of characters from each sector of the medical marijuana industry. Written in a journalistic style with hints of narrative methods, the article tells the story of medical cannabis advocates, current patients, state registered practitioners, dispensary owners and employees, and a family-owned cultivation facility while also providing concrete evidence and facts about the legislation and regulations included in the state’s …

Addressing The Health Needs Of The (D/D)Eaf And Hard Of Hearing Community, Zainab Krayem, Rachel Jeff-Macauley, Nicolette Falco, Vanesa Pizutelli

Rowan-Virtua Research Day

The term deaf refers to individuals with total or partial hearing loss. However, it encompasses much more, representing a culture—Deaf culture. The distinction in spelling is important: "Deaf," with an uppercase "D," refers to individuals born Deaf who have been raised within Deaf culture, while "deaf," with a lowercase "d," typically refers to those who lost their hearing later in life and may not have grown up in Deaf culture. People who identify as deaf, Deaf, or hard of hearing (d/D/hoh) are often mistakenly assumed to have cognitive impairments or are broadly categorized as disabled. However, many in the community …

The Effectiveness Of Cleaning Protocols In Medical School Omm Labs By Medical Students, Harrison Patrizio, Riley Phyu, Thomas Boyle, Todd Schachter

Rowan-Virtua Research Day

In light of the COVID-19 pandemic, disinfection in healthcare has taken center stage. Healthcare has adjusted workflows to accommodate for more robust cleaning regimens to help protect the community. This has resulted in the need for medical institutions to reevaluate the current cleaning protocols down to the student level. Osteopathic Manipulative Medicine (OMM) lab provides an optimal avenue for assessing medical student’s examination table cleaning effectiveness. With OMM labs being an activity with a high level of interaction, the quality of examination table cleaning is important for the health and safety of students and teaching faculties. Our study highlights that …

Healthcare Disparities In The Lgbtqia+ Community: A Scoping Review Of Community Vs Provider Experiences, Uttara Hardikar, Alisha Vincent, Venkateswar Venkataman, Millicent Channell

Rowan-Virtua Research Day

Background: It is well-established that healthcare disparities exist in the LGBTQIA+ community. The divide is a growing concern exacerbated by recent changes in the healthcare and sociopolitical climate. To eliminate this divide and find ways to deliver better outcomes to the LGBTQIA+ is a dire need. This report analyzes the possible reasons from the community as well as the providers perspective, with a goal to find best practices that could be implemented in both components.

Methods: A scoping literature review was carried out as described below to collect perspectives from both sides: patients as well as providers.

Results: From patient …

Clinical Practice Workflow Implementation For The Improvement Of Diabetic Metric Compliance, Sugosh Anur, Sohil Khanna, Alison Mancuso, Alexander Kowalski

Rowan-Virtua Research Day

Recent guidance suggests the management of screen-detected diabetes can be optimized using multifactorial interventions to improve overall disease burden, patient outcomes, and cost-savings. We explored preventive diabetic care and implemented interventions to increase recommended testing compliance among patients with Type II Diabetes Mellitus. This study employed a multi-faceted approach beginning with the distribution of surveys to patients in the Stratford Family Medicine Office in order to gauge their health literacy level pertaining to Diabetes management. Patient electronic medical records were evaluated to determine baseline levels for all laboratory values. Data analysis was completed using Statistical Package for the Social Sciences …

Gestational Diabetes Among The South Asian Diaspora In The United States Of America: A Scoping Review, Anudeep Deevi, Mariam Sharobeem, Gabrianna Andrews, Rahul Ubrani, Venkateswar Venkataraman

Rowan-Virtua Research Day

Aim: The scoping review was conducted to review the current knowledge base regarding gestational diabetes mellitus (GDM) among South Asians in the United States. In addition, the review was meant to identify any gaps in knowledge, specifically about the current care received by South Asians as well as the associated adverse health outcomes.

Methods: A systematic search of PubMed, Web of Science, Embase, and Scopus was conducted. Key words ""gestational diabetes South Asians in the United States" were used as search terms. Search was restricted to U.S. articles published on or after 01/01/2013 with key words. Articles were screened by …

The Effectiveness Of Examination Table Cleaning Protocols In Osteopathic Family Medicine Offices, Riley Phyu, Harrison A. Patrizio, Thomas Boyle, Todd Schachter

Rowan-Virtua Research Day

Contaminated environmental surfaces are responsible for acquisition of healthcare associated infections. In 2002 there were approximately 1.7 million healthcare associated infections, resulting in about 99,000 annual deaths. Appropriate disinfection of environmentally contaminated surfaces are required to reduce transmission of pathogens. Adenosine triphosphate (ATP) bioluminescence is being used in hospital settings to audit the cleanliness in the hospital settings. However, there is a paucity of literature in different healthcare settings outside of hospital settings. This may unintentionally result in a more relaxed cleaning protocol in outpatient settings.

Objective: To assess the effectiveness of disinfecting protocol in osteopathic family medicine offices using …

Case Report: The Challenge Of Balancing Stewardship And Advocacy, Samuel Thalathoti, Kishan Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 62-year-old female who presented with chief complaint of generalized weakness and was ultimately diagnosed with hypereosinophilia. This chief complaint is challenging for many EM physicians, and the differential diagnosis of generalized weakness is vast. Etiologies of generalized weakness in the adult population ranges from infection, dehydration, cardiovascular disease, to neurologic compromise. It is crucial for the Emergency Physician to put emphasis on proper history collection, detailed physical exam, and appropriate ancillary testing. In this case report we showcase the significance of the optimal evaluation of life-threatening disorders that presents as generalized weakness, as well …

Lesbian, Gay, Bisexual, Transgender, Queer (Lgbtqia+) Health Disparities In Sexual Health And Sexual Education, Cole T. Mcbride

Curriculum and Instruction Undergraduate Honors Theses

Background: Comprehensive sex education instills knowledge and promotes the health of all youth, however, most sex education remains heteronormative. School-based programs in the United States (US) emphasize monogamous, heterosexual relationships. In 2021, only 7.4% of students received sex education that included positive representations of both LGB and transgender people and nonbinary topics, while 72% of programs across the US omit LGBTQ+ topics. Most new HIV diagnoses occur in gay and bisexual men aged 13-34, but the sex education environment for this group is increasingly hostile as more states prohibit addressing these topics in public schools.

Purpose: The purpose …

A Qualitative Survey Research Study: The United States Department Of Agriculture Commodity Supplemental Food Program: An Examination Of Operational Challenges And Recommendations, Brianna Cochran

Capstone Experience: Master of Public Health

Background

The United States Department of Agriculture (USDA)’s Commodity Supplemental Food Program (CSFP) has been nationally adopted in 60 states or Indian Tribal Organizations (ITOs) to improve the health of low-income persons at least 60 years of age by supplementing their diets with nutritious USDA Foods. Despite the potential effectiveness of the program, less is known about the operational challenges in the program implementation at the state and local health department. The goal of the study is to identify factors related to program operations including facilitators and barriers of implementation of the USDA CSFP under a national lens.

Methods

An …

Operationalizing A Medication Safety Gap Assessment For A Large Health System, Carley Warren, Joan Kramer, L Hayley Burgess

HCA Healthcare Journal of Medicine

Background

Medication errors continue to be a leading cause of medical errors. In the United States alone, 7000 to 9000 people die annually due to a medication error, and many more are harmed. Since 2014, the Institute for Safe Medication Practices (ISMP) has advocated for several best practices in acute care facilities derived from reports of patient harm.

Methods

The medication safety best practices chosen for this assessment were based on the 2020 ISMP Targeted Medication Safety Best Practices (TMSBP) and health system-identified opportunities. Each month, for 9 months, select best practices were covered with associated tools to assess the …

Patient And Provider Experience With Artificial Intelligence Screening Technology For Diabetic Retinopathy In A Rural Primary Care Setting, Brian M. Nolan, Emma R. Daybranch, Kerri Barton, Neil Korsen

Journal of Maine Medical Center

Introduction: The development of autonomous artificial intelligence for interpreting diabetic retinopathy (DR) images has allowed for point-of-care testing in the primary care setting. This study describes patient and provider experiences and perceptions of the artificial intelligence DR screening technology called EyeArt by EyeNuk during implementation of the tool at Western Maine Primary Care in Norway, Maine.

Methods: This non-randomized, single-center, prospective observational study surveyed 102 patients and 13 primary care providers on their experience of the new screening intervention.

Results: All surveyed providers agreed that the new screening tool would improve access and annual screening rates. Some providers also identified …

Implementation Of A Patient Satisfaction Survey At A Free Community Clinic: A Quality Improvement Project, Nora O'Sullivan

DNP Projects

Background: The uninsured, underinsured, and underserved populations in the US are impacted by health disparities and have unique experiences with healthcare. Yet, settings which serve these populations – the “safety net”- are not adequately supported to gather patient experience data. In Connecticut, Fairfield County has a higher percentage of uninsured people than the overall state. Additionally, this population has demonstrated higher frequency of emergency department utilization than the overall population. Therefore, processes to measure the barriers to accessing quality care and patient experience and satisfaction with care are needed in safety net clinics to promote elimination of health disparities and …

Covid-19 Vaccine Hesitancy And Vaccination Rate Among The Latino Population In South Carolina, Brynn E. Lynagh

Senior Theses

It is common knowledge that COVID-19 disproportionately impacts racial and ethnic minorities in the United States. Furthermore, these sects of the population exhibit increased vaccine hesitancy and lower vaccination rates as compared to the aggregated population of the United States, furthering the risk posed by COVID-19 to these communities. In particular, this study focuses on the Latino population in South Carolina, the vaccination rate among this community, and the perspectives which contributed to their vaccination decision. Two hundred Spanish and Portuguese speaking residents of South Carolina were interviewed using a paper survey conducted by pre-trained interviewers. The survey gathered data …

Institutional Strategies To Maintain And Grow Imaging Research During The Covid-19 Pandemic, Mai-Lan Ho, Corey W Arnold, Summer J Decker, John D Hazle, Elizabeth A Krupinski, David A Mankoff

Faculty, Staff and Student Publications

Understanding imaging research experiences, challenges, and strategies for academic radiology departments during and after COVID-19 is critical to prepare for future disruptive events. We summarize key insights and programmatic initiatives at major academic hospitals across the world, based on literature review and meetings of the Radiological Society of North America Vice Chairs of Research (RSNA VCR) group. Through expert discussion and case studies, we provide suggested guidelines to maintain and grow radiology research in the postpandemic era.

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

A Scoping Review Of Digital Health Interventions For Combating Covid-19 Misinformation And Disinformation, Katarzyna Czerniak, Raji Pillai, Abhi Parmar, Kavita Ramnath, Joseph Krocker, Sahiti Myneni

Faculty, Staff and Student Publications

OBJECTIVE: We provide a scoping review of Digital Health Interventions (DHIs) that mitigate COVID-19 misinformation and disinformation seeding and spread.

MATERIALS AND METHODS: We applied our search protocol to PubMed, PsychINFO, and Web of Science to screen 1666 articles. The 17 articles included in this paper are experimental and interventional studies that developed and tested public consumer-facing DHIs. We examined these DHIs to understand digital features, incorporation of theory, the role of healthcare professionals, end-user experience, and implementation issues.

RESULTS: The majority of studies (n = 11) used social media in DHIs, but there was a lack of platform-agnostic generalizability. …

Sulopenem For The Treatment Of Complicated And Uncomplicated Bacterial Urinary Tract Infection (Uti), Aiyi Chen, Thanh-Liem Vu, Daniel J. Yang, Landon Olsen

Annual Research Symposium

No abstract provided.

Post-Partum Depression (Ppd) Screening Tools Effectiveness In Refugee Populations, Joshua Jensen

Annual Research Symposium

Purpose:

Immigrant mothers check all the boxes that are significant risk factors for developing or exacerbating Postpartum Depression (PPD). These risk factors include, suffering in solitude, cultural conceptualizations, barriers to help seeking, and a lack of facilitators to help seeking. Despite this very little research has been done to find effective screening methods for this population.

The purpose of this research project is to compile the works of those before me to determine whether the Edinburgh Postnatal Depression or the PHQ 9 screening tool is the most effective for immigrant mothers.

Methods:

Research determining the effectivity of the two tests …