Quality Improvement Commons^™

Dnp Final Report: Medication Errors: Decreasing From Day One Through Online Learning Module And Incident Reporting, Marsha Pohorelsky

DNP Final Reports

Medication administration errors remain a significant patient safety concern in healthcare and nursing education. This Doctor of Nursing Practice (DNP) quality improvement project evaluated the implementation of a standardized medication safety learning module and incident reporting process to improve medication safety awareness, medication administration competency, and error reporting among second-semester Bachelor of Science in Nursing (BSN) students. Guided by the Johns Hopkins Nursing Evidence-Based Practice Model and Kotter's 8-Step Change Model, the project incorporated medication safety education, simulation-based learning, and near-miss reporting to promote a culture of safety. Although competency outcomes were similar to previous student cohorts, participants demonstrated increased …

Dnp Final Report: Enhancing Radiation Oncology Training For Advanced Practice Providers, Katherine A. Bukolt

DNP Final Reports

Background: Rising cancer incidence and improved survivorship are straining the oncology workforce, increasing reliance on Advanced Practice Providers (APPs). However, there is a lack of standardized educational resources for APP radiation oncology training across practice settings. Most APPs receive variable, resource-dependent, and on-the-job training. Evidence shows that the lack of standardized training leads to gaps in foundational knowledge, reduced confidence in toxicity management, inconsistent role development, and variable satisfaction with training and transition into practice.

Purpose: This quality improvement project evaluated the feasibility of implementing an 18-module Advanced Practice Radiation Oncology (APRO) asynchronous online curriculum to standardize APP radiation oncology …

Dnp Final Report: An Evidence-Based Initiative To Improve Bowel Preparation Quality For Colonoscopy, Jennifer L. Gassett

DNP Final Reports

Good colonic bowel preparation (CBP) is an important component of colonoscopy but is often inadequate. Improving CBP can help increase detection of precancerous polyps, prevent procedures from being canceled or repeated, and decrease medical expenses. A quality improvement project was implemented to increase adequate CBP rates at an ambulatory surgery center specializing in endoscopy. Several factors correlate with suboptimal CBP, but the practice question focused on patient education. The PICOT question guiding evidence synthesis was posed: In adult patients preparing for outpatient colonoscopy, how do revised instructions with visual aids compared to written instructions affect CBP adequacy and patient satisfaction? …

Duty To Care And Job Turnover Intention In The Post-Pandemic Nursing Workforce, Cathleen A. Lopez

Nursing Theses and Dissertations

Natural and human-made disasters are increasing in number and intensity. In 2020, approximately 688.3 million people required assistance from disaster response personnel. During a disaster or pandemic, nurses must weigh their personal and/or family safety against the ethical code of caring for others. The purpose of this convergent mixed-methods study was to examine duty to care and job turnover intention of registered nurses working in patient-facing roles. A convergent mixed method design was used to address research questions by employing the Nash Duty to Care Scale (NDCS) and the Turnover Intent Scale (TIS-6). Open-ended survey questions were used to explore …

Dnp Final Report: Effects Of Open-Access Scheduling On Patient No-Show Rates In An Outpatient Clinic, Maria Aileen A. Wilkinson Msn, Mba, Rn

DNP Final Reports

No-show rates in a South Texas outpatient clinic have been as high as 16% to 20% which increases wait times to be seen in the clinic and decreases patient access to outpatient care. This no-show rate data has continued despite multiple interventions that have been implemented in an academic health science center. Physical, socio-economic, geographic, and health/lifestyle factors affecting no show or missed appointments are crucial to determining the most appropriate interventions to alleviate this issue. No-show rates are important metrics to improve because it directly affects the organization's revenue, access to care, and appointment wait times. Research evidence regarding …

Patient Throughput In The Emergency Department, Daniel Alanis

MSN Capstone Projects

In response to ongoing overcrowding in emergency departments, it is imperative to explore effective strategies for mitigating the capacity crises. The purpose of this project is to investigate and implement throughput strategies for a large level 1 trauma emergency department in Houston’s Texas Medical Center. The proposal involves launching a process improvement project to identify opportunity potential for two main interventions: 1. Patient classification for split clinical pathways 2. Dedicated liaison role for throughput responsibilities. The review aims to answer the question: In emergency department patients, how does the implementation of a dedicated throughput liaison compared to a split flow …

Reducing Central Line-Associated Bloodstream Infections (Clabsi) With Chlorhexidine-Impregnated Dressings, Sara Garcia

MSN Capstone Projects

Mitigating and eradicating central line-associated bloodstream infections (CLABSI) is a vital patient safety priority. These healthcare-associated infections lead to patient fatalities and incur costly, preventable expenses. Therefore, it is imperative to assess central venous catheter (CVC) maintenance protocols to mitigate the likelihood of infection. Federal guidelines advocate using chlorhexidine (CHG) dressings to lower this risk (Centers for Disease Control and Prevention, 2017). A comprehensive central line maintenance bundle includes incorporating a CHG dressing as a critical measure in reducing the risk of CLABSI (Buetti et al., 2022). Consequently, the escalating infection rates underscore the necessity for implementing CHG dressings (Buetti …

Oral Sucrose And The Relation To Neonatal Pain Perception, Meagan L. Burns

MSN Capstone Projects

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Treede, 2018). The phenomenon of pain is a personal and unique experience that many of the world’s population has experienced in some form or fashion throughout their lifetime. Neonates are exposed to many painful procedures and/or situations due to various medical ailments that may require a neonatal intensive care unit (NICU) admission. Infants have a special place in the hearts of adults all over the world, and any interventions that would increase the likelihood of diminishing or removing perceived pain in this population are likely …

Implementation Of An Evidence-Base Hospital Acquired Pressure Injury Prevention Program, Brenda Miner

MSN Capstone Projects

Covid-19 hindered many quality improvement projects. As the stressors from the pandemic began to disappear the healthcare industry was struck with new struggles. These new struggles were ensuring quality care was being provided to all patients. The decline in quality care also led to a decline in reimbursement from payor sources, such as Medicare. During the pandemic the healthcare industry was at their most vulnerable state and now that the dust is settling the ramifications of just surviving are staring the industry right in the eyes. Change is difficult, but it is even more difficult following traumatic events such as …

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 …

Are Current Pain Assessments Adequate?, Allison Caspersen

MSN Capstone Projects

“Pain is what the patient says it is” has been a big proponent to improve interventions for pain management. But how are we assessing patients’ pain? They have been asked to provide us with a number to rate their pain but what do these numbers mean to the patient? Do they rate according to pain they have experienced in the past or is it based off what they imagine the pain could be? Have we ever distinguished patient preference between unidimensional and multidimensional pain assessment? The use of unidimensional pain assessment the Numerical rating scale (NRS) has been used primarily …

Transforming Prescription Opioid Practices In Primary Care With Change Theory, Rob E. Carpenter, Dave Silberman, Jody Takemoto

Human Resource Development Faculty Publications and Presentations

The opioid epidemic continues to be an ongoing public health crisis. Many primary health care providers aptly serve as the gate keeper to opioid prescriptions. The opioid epidemic has challenged the primary care profession whilst many of these providers have opted out of opioid prescribing altogether. This unintended consequence affirms erosion to primary care that is vital to the ecosystem of opioid management. The purpose of this study was to understand strategies to deliver opioids safely and effectively. Results indicate primary care providers are uniquely positioned to make a positive opioid impact through focused change initiatives. Five common themes arose …

Dnp Final Report: The Impact Of The Care Coordination Management Tool On Children With Special Health Care Needs, Keisia N. Sobers-Butler, Ms, Bsba, Rn, Cmcn

DNP Final Reports

Children with Special Health Care Needs (CSHCN) population, account for 30% of spending or $233.5 billion of the costs (Bui et al., 2017). Identifying barriers to care in the CSHCN population can be multi-faceted and complex incorporating high utilization of time, and clinical resources. This project aims to evaluate the impact of care coordination, and utilization on the CSHCN population through a Patient-centered Medical Home, use of embedded case management assessing this population through using the evidence-based Care

Coordination Management Tool (CCMT). CSHCN (N=117) and families were assessed using the CCMT at every interaction from September 1, 2020 – November …

Dnp Final Report: Breaking The Cycle: Care Coordination Interventions And Sickle Cell Readmissions, Naphtali Edge

DNP Final Reports

Background

Approximately 100,000 people in the United States are affected by Sickle Cell Disease (SCD). Sickle Cell Disease represents the second highest readmitting diagnosis at Houston Methodist Hospital. The purpose of this study is to determine the impact of implementing care coordination interventions to reduce hospital readmissions of patients with SCD.

PICOT

In adult patients with SCD in the acute care hospital setting, how does care coordination intervention compared to no care coordination intervention affect the readmission rate for patients with SCD over a 3 – 6-month period?

Body of Evidence

Eleven studies were critical appraised and included in the …

Heart Failure Transitions Of Care Benchmark Project, Tamera M. Brandon

MSN Capstone Projects

Heart failure (HF) is a major cause of death associated with extensive morbidity and impaired quality of life. The incidence and prevalence of HF has also increased dramatically in the past three decades (Whitaker-Brown et al., 2017). HF now affects approximately 5.7 million people in the United States and is the cause of more than 55,000 deaths annually (Whitaker-Brown et al., 2017). Consequently, readmission rates of HF patients are an area of great concern. The purpose of this benchmark project is to decrease HF readmission rates in adults who had a recent HF related hospitalization by providing comprehensive transitional care …

Impact Of Hourly Rounding On Fall Rates: A Benchmark Paper, Monica D. Smith

MSN Capstone Projects

Falls and fall-related injuries create a significant financial burden on patients and healthcare organizations, particularly in adult inpatient hospital units such as rehabilitation and medical-surgical units. Costs associated with additional hospital days, diagnostic testing, and potentially fall-related surgeries can average about $14,000 per fall (The Joint Commission, 2015). Moreover, falls can be devastating in older adults, impacting their overall quality of life. According to Abou et al., 20% of yearly individual costs associated with falls are among patients with Parkinson's disease (2020). This is a proposal to implement a pre-and post-implementation change project. This paper addresses the use of evidence-based …

Opioid Dependency And Its Effects On Alcohol Consumption, Emily V. Flores

Psychology and Counseling Theses

Previous research has found dualistic effects on alcohol consumption with low doses of buprenorphine increasing alcohol and higher doses of buprenorphine reducing alcohol consumption in rats (Ciccocioppo et al., 2006). Other existing research on naloxone treatment and alcohol consumption in opioid use has demonstrated that alcohol consumption decreases after naloxone treatment in rats (Hyytia & Sinclair, 1993). Yet, no research has been conducted on either rats or humans on the effects of buprenorphine and naloxone medication combined. The effects of opioid maintenance therapy are controversial and the relationship between alcohol consumption and opioid dependency treatment is mainly based on literature …

Start Stop-Bang, Valerie D. Reeve

MSN Capstone Projects

Currently standard of care in the perioperative unit is not conducive when caring for patients with obstructive sleep apnea (OSA). OSA is highly prevalent and often undiagnosed. Screening patients with a STOP-Bang questionnaire is quick, effective, and cost efficient. OSA is linked to poor postoperative outcomes. Patients at high risk for OSA often encounter complications such as: additional airway management, respiratory complications, cardiovascular complications, and increased length of stay. Screening creates awareness and identification of patients at risk for postoperative complications.