Quality Improvement Commons^™

Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

Implementing A Fall-Prevention Bundle To Reduce Falls In A Skilled Nursing Facility, Ginette Lubin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a persistent patient-safety concern in skilled nursing facilities (SNFs), contributing to injury, functional decline, reduced quality of life, healthcare utilization, and costs. At the project site, a short-term rehabilitation unit in an urban SNF, 13 resident falls occurred during the baseline period, with 23% resulting in injury, and prevention relied on routine risk assessments, environmental checks, and post-fall reporting rather than proactive strategies.

Aim: To decrease the overall fall rate by 20%, reduce fall-associated injuries from 23% to 15% or less, and raise staff adherence to evidence-based fall-prevention interventions to 90% or higher within 12 weeks.

Evidence: …

Improving Fluoride Varnish Application Rates In A Pediatric Primary Care Microsystem, Roman G. Roxas

Master's Projects and Capstones

Problem

Childhood caries is a preventable public health issue disproportionately affecting the underserved. National guidelines recommend fluoride varnish (FV) application during well‑child visits. In California, fewer than 15% of children under age six received FV. In a pediatric primary care clinic, baseline performance was 11% in 2025.

Context

A six‑month quality improvement project was implemented. Key barriers included reduced team cohesion, workflow variability, unclear roles, and underutilized electronic health record (EHR) prompts.

Interventions

The change package standardized medical assistant–led workflows, activated EHR prompts, and provided targeted education. Leadership reinforcement through regular huddles supported adoption, consistency, and team engagement.

Measures

Outcome …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Implementation Of A Language-Concordant Follow-Up Protocol To Reduce Percutaneous Nephrostomy Tube Complications: An Evidence-Based Practice Project, Marisol Ornelas

Loma Linda University Electronic Theses, Dissertations & Projects

Purposes/Aims: Complications of percutaneous nephrostomy tubes (PCN) are common after discharge. Language barriers place patients at higher risk for misunderstanding discharge instructions. This evidence-based project evaluated whether a bilingual follow-up protocol three days post-discharge reduces PCN complications in patients.

Methodology: This project utilized the Johns Hopkins Nursing Evidence-Based Practice Model. The project leader reviewed the literature, synthesized the evidence, and developed a standardized PCN discharge training and bilingual PCN follow-up protocol.

Implementation: Unit nurses received training to standardize the PCN discharge process. Nurses educated PCN patients using the standardized process at the time of discharge. Three days …

Transforming Obesity Management In Primary Care: Shared Medical Appointments (Smas) – An Evidence-Based Practice Project, Glendy Chen

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose/Aims

The purpose of this DNP project is to implement a 10-week Lifestyle Intervention Shared Medical Appointment (LISMA) program in primary care to improve obesity outcomes. Aims include increasing structured visit frequency, enhancing multidisciplinary engagement, and improving metabolic indicators, mindful eating behaviors, and self-efficacy.

Background of Problem & Description of Current Practice

Obesity affects over 40% of U.S. adults and is associated with cardiometabolic morbidity, reduced quality of life, and rising healthcare costs. Guidelines recommend intensive, multicomponent behavioral interventions with frequent contact. Current practice primarily offers one-on-one visits at insufficient frequency with limited team integration, contributing to suboptimal management. LISMAs …

Evaluating The Impact Of A Standardized Intimate Partner Violence Screening Tool In A Clinical Setting, Dylan Bogucki

Evidence-Based Practice Project Reports

Intimate partner violence (IPV) is defined as any act of violence, including physical, sexual, stalking, or psychological aggression by an intimate partner, former or current. Despite being preventable, IPV remains a leading nonobstetric cause of morbidity and mortality among women, which highlights the need for systematic screening in clinical settings. The purpose of this quality improvement project is to identify women who have previously experienced or are currently experiencing IPV and to connect them with appropriate resources. Twenty-one studies were identified, all demonstrating moderate to high methodological quality and supporting the need for routine IPV screening in women’s health settings. …

A Quality Improvement Project To Increase Identification And Treatment Of Obstructive Sleep Apnea In Patients With Type 2 Diabetes In A Rural Clinic, Paige Spence

Evidence-Based Practice Project Reports

No abstract provided.

Improving Identification And Referral Of Xylazine‑Associated Wounds In Homeless Healthcare, Ramon A. Gambino

Doctor of Nursing Practice Scholarly Projects

Background: Xylazine-adulterated fentanyl is linked to distinctive necrotic wounds and complex care needs in unsheltered populations. This quality improvement (QI) project implemented a brief survey and referral log at Albuquerque Health Care for the Homeless (AHCH) to track suspected xylazine-associated wounds and referrals to advanced care. Methods: Final data were exported from Qualtrics, cleaned to retain finished responses, standardized categories, and de-identified. The analytic sample included 18 encounters. Results: Results showed that 55.6% (n = 10) documented suspected xylazine-associated wounds; 5.6% (n = 1) reported no suspicion; 38.9% (n = 7) were uncertain. Referrals were rarely documented overall at AHCH …

Nursing Migration And The Global Workforce: How The U.S. Nurse Shortage Impacts Developing Countries, Mololuwa Faithful Lasekan

Honors Thesis

As United States (U.S.) healthcare organizations face persistent staffing gaps driven by an aging population, burnout, and limited educational capacity, many institutions increasingly rely on internationally educated nurses (IENs) to stabilize their workforce. This reliance intersects with longstanding structural challenges in low- and middle-income countries (LMICs), where inadequate compensation and limited professional opportunities contribute to high migration intentions among nurses. Using a systematic literature review guided by PRISMA principles, this study synthesized evidence and five major themes emerged: (1) push factors driving nurse emigration from LMICs, (2) pull factors attracting nurses to the U.S., (3) digital globalization and post-COVID recruitment …

Nurse-Led Interventions To Reduce Occupational Hand Injuries In Manufacturing, Patti Harter

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Occupational hand injuries cause preventable morbidity, lost productivity, and workers’ compensation costs in manufacturing. Although safety policies and personal protective equipment (PPE) are in place, inconsistent glove use, slow hazard identification, and delayed response still cause injuries. This quality improvement (QI) project evaluated an eight-week, nurse-led injury-prevention bundle at a Texas heavy-vehicle manufacturing facility. The intervention required daily glove inspections, Safety Champion participation, real-time electronic hazard reporting, and corrective action within the shift. Injury outcomes were measured using Occupational Safety and Administration (OSHA) rates per 200,000 work hours and percentage change from baseline. After implementation, hand injury rates fell from …

Sexually Transmitted Infections And Screening: An Educational, Evidence-Based, Quality Improvement Bundle, Misty D. White

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: With sexually transmitted diseases on the rise in central Texas, advance practice providers were not following evidence-based practice recommendations for sexually transmitted infection screening, treatment, and follow-up. Screening for sexually transmitted diseases occurred at a rate of less than one patient every 7.75 days.

Objective: The objective of this project was to develop and implement an advanced practice provider training tool to educate the clinic providers on sexually transmitted infections, collect pre- and post-data for the educational sexually transmitted infection bundle, and collect sexually transmitted infection screening, identification, treatment, and follow-up data generated by the clinic advanced practice providers …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

Transition To Home Guideline For Patients With Diabetes, Kathleen R. Burgner

Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Diabetes is a leading contributor to preventable hospital readmissions. These hospital readmissions often result from fragmented discharge planning, poor care coordination, and limited post-discharge support. At a 915-bed academic medical center in Southern California, the diabetes-related readmission rate was 13.3%, compared with 11.4% among patients without diabetes. This project aimed to develop an evidence-based Transition-to-Home (TTH) guideline for hospitalized patients with diabetes and evaluate the strength of its recommendations through multidisciplinary stakeholder review.

Methods: An evidence-based guideline development project was conducted over 8 weeks. A comprehensive literature search in CINAHL, MEDLINE, PubMed, and ScienceDirect identified current evidence on transitional …

Empowered Choices: A Quality Improvement Women’S Health Initiative In Faith-Based Nursing For Women Recovering From Substance Use Disorder, Jennifer Mewshaw

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Women with substance use disorder (SUD) face higher rates of unplanned pregnancy, reproductive infections, and delayed prenatal care. Faith community nurses (FCNs) often already serve within this community and have a long history of promoting public health interventions. However, they lack the knowledge and confidence in sexual and reproductive health (SRH) education.

Evidence Review: A literature review identified barriers to SRH care for women with SUD and the role of FCNs in community and public health interventions. Evidence supports providing FCNs with the knowledge and skills to deliver SRH education and support for women with SUD using trauma-informed and …

Improving Clinic Workflow To Enhance Rubeola Immunity Screening In Pregnant Patients, Courtney Mcduffie

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to improve provider adherence to Rubeola IgG serum order entry for prenatal care visits by implementing a standardized workflow and an electronic medical record (EMR)-based order-entry process in a high-risk maternal outpatient clinic.

Background: Rubeola infection during pregnancy is associated with significant maternal and fetal complications. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) to use serologic testing to determine immunity status, inconsistent provider ordering practices and workflow gaps contribute to missed opportunities for identifying non-immune patients and planning post-partum vaccination.

Methodology: A ten-week intervention period utilized …

Clinical Challenges Associated With Enhancing Hypertension Among The Underserved African American Population, Ashley Richardson

Doctor of Nursing Practice (DNP) Scholarly Projects

Background 

African Americans face a significantly higher prevalence of hypertension, tend to develop complications at younger ages, and have disproportionately higher mortality rates. Key social determinants of health (SDoH)—including food deserts, unequal access to healthcare, and geographic disparities in healthcare resources—contribute to these ongoing inequities. Addressing both systemic and individual barriers is crucial for effective hypertension management.

Objective

This study aims to assess the effectiveness of a culturally relevant, community-based intervention designed to reduce both systolic and diastolic blood pressure among Black adults with uncontrolled hypertension.

Methods 

Quality improvement (QI) initiatives typically employ multicomponent, equity-focused models. The primary components of …

Moving Toward Healthy Ageing: The Role Of Physical Activity In Cognitive Function And Self-Esteem Among Older Adults In Türkiye, Canan Birimoglu Okuyan, Müjde Kerkez

Makara Journal of Health Research

Background: This study aimed to evaluate the relationship between religious attitudes and breastfeeding attitudes and the effect of this relationship on breastfeeding practices.

Methods: A cross-sectional study was conducted with 251 older adults. Data were collected using the International Physical Activity Questionnaire, the Standardized Mini-Mental State Examination, and the Rosenberg Self-Esteem Scale. Spearman’s correlation and chi-square tests were employed for statistical analysis.

Results: Physical activity levels were positively correlated with both cognitive function (r = 0.546, p < 0.001) and self-esteem (r = 0.168, p < 0.05). No significant association was observed between cognitive function and self-esteem. Physical inactivity, cognitive decline, and low self-esteem were more prevalent among women, participants with lower educational attainment, those with chronic diseases, and individuals engaged in polypharmacy.

Conclusions: The findings emphasize the importance of integrating physical activity promotion into national healthy ageing policies, particularly in Mediterranean contexts such …

A Quality Improvement Initiative To Streamline Flu Vaccine Documentation And Increase Staff Engagement, Carla E. Giron

Master's Projects and Capstones

Objective: This quality improvement project was implemented in an urban community health clinic primarily serving low-income and Latinx patients. Factors such as demographics, socioeconomic status, health, and transportation contribute to low U.S. influenza vaccination rates (Chen et al., 2020), while EHR training can improve provider satisfaction and efficiency (DiAngi et al., 2019). This microsystem faced inconsistent workflow processes, limited EHR training, and documentation errors that contributed to low staff satisfaction rates and influenza vaccination rates. An average of 11.4% of patients received a flu vaccine in October 2023 and 2024. Medical assistants (MAs) completed a pre-intervention survey indicating that 35% …

Increasing Pediatric Hpv Vaccination Rates, Brooke A. Nicholas

Dissertations

Increasing Pediatric HPV Vaccination Rates

Abstract

Problem: The human papillomavirus (HPV) is a sexually transmitted infection that affects more than 80% of the population within the United States (Eisenhauer et al., 2020). HPV can develop into cervical, anogenital, and oropharyngeal cancers (Eisenhauer et al., 2020). About 4,000 individuals die from cervical cancer alone each year (O’Leary, 2022). The HPV vaccine, though recommended by the ACIP and AAP, is below national vaccination rates in comparison to other vaccines (O’Leary, 2022).

Methods: This quality improvement project is a non-randomized controlled trial that observed HPV vaccine dose completion rates for patients aged 9-14 …

Orthostatic Hypotension In Older Adults And Its Economic Impact On The Healthcare System: A Systematic Literature Review, Olushola E. Ilogho, Jennifer Broyles, Viet Le, Denise Rizzolo

Lynchburg Journal of Medical Science

ABSTRACT

Orthostatic Hypotension (OH) has been shown to lead to poor quality of life, falls, and death. Literature suggests that falls from OH may be preventable, therefore opportunities to reduce its associated cost to the healthcare system exist. This literature review aims to evaluate the importance of diagnosing and treating OH in older adult patients. OH is the drop in blood pressure upon changing to an upright position. This acute hemodynamic drop in blood pressure causes hypoperfusion in the brain, leading to dizziness, syncope, and falls. An extensive literature search for publications in PubMed and Cumulative Index in Nursing and …

Reducing Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate, Roseanna Juarez

Master's Projects and Capstones

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, …

Unsuitable Underlying Cause-Of-Death Statements: Implementation And Evaluation Of A Structured Process For Healthcare Providers Certifying Natural Causes Of Death In An Outpatient Setting, Naida Rutherford

Doctor of Nursing Practice Projects

Background: Accuracy in death certification is crucial for effective public health initiatives. Inaccuracies in unsuitable Underlying Cause-of-Death (UCOD) statements can distort mortality statistics, influence health policy, and impact resource allocation. In South Carolina, changes in the death registration process and the introduction of an unsuitable cause-of-death list highlighted an urgent need for structured training among certifiers to enhance accuracy in death documentation.

Purpose: The purpose of this project was to implement a standardized training program for healthcare providers certifying natural causes of death and assessing the impact of reducing the unsuitable underlying cause-of-death inaccuracies in an outpatient hospice setting.

Project …

Increasing Colorectal Cancer Screening Rates For Patients Without Insurance, Andrea F. Day

Doctor of Nursing Practice Projects

Background: Colorectal cancer is a leading cause of cancer-related death in the United States (U.S.), ranking as second most prevalent overall. Despite many initiatives, screening rates remain low, especially among clinic patients without insurance. The lack of an evidence-based screening protocol exacerbates these issues and increases the risk of advanced cancer and death. Initial data showed that 0% of patients were screened according to recommended guidelines.

Purpose: The project implemented a standard screening protocol to increase colorectal cancer screening rates in a rural Alabama free clinic for patients ages 45-64 lacking insurance.

Project Design: This quality improvement …

Psychoeducational Training For Community Health Workers To Improve Confidence In Providing Mental Health Services To Migrants, Nimota M. Akintoye

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

There is a higher prevalence of mental health illnesses among migrants. This minority group is faced with challenges in accessing healthcare due to poverty, stigmatization, and fear of discrimination. Research has shown that community health workers (CHWs) bridge the gap between the health and social service sectors and the patients by improving patient access to care and healthcare outcomes. A translational project was implemented to evaluate how psychoeducational training improved the CHWs’ confidence and knowledge level in providing mental health support to the patients and community members. Sister Calista Roy’s Adaptation Model was used to guide the study by incorporating …

Gad-7 Screening In Middle School Students: Evaluating The Effectiveness On Referral Rate Scoping Review, Bailey Hall, Cara Dennis, Kayla Drennen-Ferguson, Pamela B. Taylor, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

The prevalence of anxiety disorders among adolescents, mainly middle school-aged students, highlights the critical need for practical screening tools to support early detection and intervention. The Generalized Anxiety Disorder-7 (GAD-7) scale is widely utilized in various settings, but its efficacy in this specific population remains underexplored. This scoping review examines the use of the GAD-7 in middle school-aged students, evaluating its reliability, validity, and impact on referral rates to mental health services. The review also considers factors influencing anxiety and identifies gaps in current research.

Methods

Ten articles, published in peer-reviewed journals within the past decade and involving human …

Social Determinants Of Health Screening In The Pediatric Population: Evaluating The Effectiveness Of Staff Education, Brenda Awuah, Kansas S. Logan, Sally Humphrey Dnp, Aprn, Cpnp-Pc, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Social Determinants of Health (SDOH) are conditions that influence health outcomes. SDOHs are screened and addressed in many clinics and hospitals to reduce patients' social needs. Research indicates how unaddressed SDOH can negatively impact chronic illness, along with the daily life of pediatric patients. SDOH's role in pediatric patients includes food security, housing stability, access to healthcare, caregiver education, and parental mental health. Previous research has addressed these factors; however, the lack of staff education prevents effective compliance and follow-up on SDOH screening. Challenges remain in implementing and integrating SDOH into routine well-child visits. This scoping review will evaluate and …

The Effectiveness Of Gad-7 Screening In High School Students, Tamara L. Smith, Allison Darnell, Margaret Harvey, Phd, Acnp-Bc, Chfn, Jacqueline Sharp Dnp, Aprn, Pmhp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Adolescent mental health is a growing concern, with anxiety disorders being particularly prevalent among high school students. Left untreated, anxiety can significantly impact academic performance, social functioning, and long-term mental health. The COVID-19 pandemic exacerbated these challenges, highlighting the critical need for effective screening and intervention strategies. The Generalized Anxiety Disorder 7-item scale (GAD-7) is a validated tool for identifying anxiety disorders, yet its application in high school settings is limited. This scoping review explores the effectiveness of GAD-7 in increasing mental health referrals and improving anxiety outcomes in high school students.

Methods

A comprehensive search was conducted across …

Colorectal Cancer Screening And Correlating Gender Disparities, Kara Marr, Megan Janssen, Margaret Payne, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

In 2023, colorectal cancer (CRC) was the second leading cause of cancer-related deaths in the US, equating to approximately 50,000 total deaths (National Cancer Institute, 2024). Further, it is estimated that an additional 1.4 million Americans are living with CRC (National Cancer Institute, 2024). Early detection screening modalities remain imperative since the NIH has released a combined survival rate of 70% when utilized (National Cancer Institute, 2024). Different derivatives of CRC develop from pre-cancerous polyps and are often without signs or symptoms of disease progression; this asymptomatic period emphasizes the importance of early detection and prevention of colorectal cancer …

Improving Knowledge And Confidence Of Family Nurse Practitioners In Offering The Hpv Vaccine, Leni Terano Fisher

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Abstract

Introduction

Despite the recommendations of the United States Advisory Committee on Immunization Practices, HPV immunization lags behind other routine vaccines by up to 31%. Although there are many reasons for the low vaccine rate, provider hesitancy and lack of confidence significantly contribute to suboptimal HPV vaccine uptake.

Objectives

This project aimed to utilize evidence-driven interventions to increase family nurse practitioners' (FNPs) knowledge and confidence in offering the HPV vaccine.

Methods

Participants were given pre- and post-questionnaire surveys. The Wilcoxon Rank Test was used to compare, quantify, and measure the results of the eight-week data collection.

Results

The subjects were …