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Preparing Healthcare Staff For Cardiac Arrest Codes In The Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes, Rowan Edwards, Rn

Master's Projects and Capstones

Preparing Healthcare Staff for Cardiac Arrest Codes in the Outpatient Clinical Setting: Code Drill Training Improves Patient Outcomes

The acuity of care provided in outpatient clinical settings across the United States continues to rise. It is estimated that more than 350,000 cardiac arrests occur outside of a hospital each year (AHA, 2019). For the purpose of this clinical nurse leader (CNL)-lead quality improvement project, the relevant focus is directed towards improving the knowledge, physical skills and perceptions of healthcare staff within an urgent care center (UCC) regarding the application of advanced rescue skills. It is important to note that the …

Is It Fair To Compare? A Patient And Family Experience Of Two Healthcare Systems And Neurosurgical Teams Within A Two-Week Period, Laura Miller Cpxp

Patient Experience Journal

As the mother of a 28-year-old son with cerebral palsy and hydrocephalus, and as a healthcare consultant focused on patient experience and professional development, I have a unique perspective and skill set. Recently he experienced symptoms that included an excruciating headache, neck pain and lethargy. Fearing his ventriculoperitoneal shunt had malfunctioned, he went to the emergency room and was later admitted on the neuro inpatient floor for a three-day hospitalization. His original shunt had been placed in 1991, and he never had an issue with until August 2018. While in the hospital, he was informed that he was no longer …

Clabsi Prevention Through Prevention Huddles And Clabsi Risk Assessment And Prevention Form In Electronic Medical Record, Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, Kaitlyn Hoch

Posters

Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.

Safe Sleep In The Nicu, Ashley Mirabile, Barb Haney, Dianne Wilderson, Beckie Palmer, Ashley Domsch, Eugenia K. Pallotto

Posters

Goal: To evaluate a staff education program on approach to improve in the rate of eligible NICU infants in safe sleep in a busy 84-bed level IV NICU.

Outcome Measures; Improve safe sleep compliance for eligible patients to 90% or greater by December 2019.

Process Measures: Audits from bedside RNs showing compliance with safe sleep.

Planned Intervention: In December of 2018 a multidisciplinary work group brainstormed and implemented best practice safe sleep education for staff and parents. September 2019 a Safe Sleep Educational Toolkit was made available for staff.

Results: Safe Sleep compliance has gone from 53% to 90% in …

Improving Care Of The Small Baby, Beckie Palmer, Abdebayo Oshodi, Brandy Huitt, Kaylee Hurt, Pamela Kliethermes, Trudy Koons, Patricia Lanzer, Ashley Mirabile, Allyson Owen, Christian Anthony Schneider, Betsi Anderson, Steven Olsen

Posters

Hierarchy of Aims:

• Global Aim: Create a Small Baby Unit for infants admitted to our NICU that arebirth, in which 90% of our patients are admitted to F pod on day of admission, by March 2019
• Interim Aim: Staff 80% of our micropremie patients with a Small Baby Team nurse from admission until >32 weeks by May 2019.
• Sub Aim: Increase rates of developmentally appropriate care (2 person cares, kangaroo care compliance) by 50% by August 2019.

A Quality Improvement Project To Determine The Incidence And Prevalence Of Obstructive Sleep Apnea, Best Practice Anesthesia Guidelines, And The Incidence Of Perioperative Cardiac And Respiratory Complications After The Implementation Of The Stop-Bang Questionnaire, Bradly Diamond, Gregory Guerrier, Cody Holliman, Robert Marrero, Tyler Nelson

Doctoral Projects

Patients with obstructive sleep apnea (OSA) are at risk for perioperative respiratory and cardiovascular compromise (Opperer et al., 2016). Unfortunately, almost 90% of patients with moderate-to-severe OSA are not diagnosed and unaware of their disorder; however, they remain at increased perioperative risks (Singh et al., 2015). The STOP-BANG questionnaire was developed to meet the need for a reliable, concise, and efficient screening tool for OSA risk. The facility at which this project was conducted did not utilize a prescreening OSA risk tool. The facility not using a prescreening OSA risk tool is especially important because the State of Mississippi currently …

Lighting The Way To Ensure Safe Transition Home, Barb Haney, Ashley Mirabile, Dianne Wilderson, Beckie Palmer, Ashley Lewis, Cris Mills, Eugenia K. Pallotto

Posters

All aspects of discharge (education, screenings, appointments, plans and home services" must be completed and appropriately communicated prior to discharge to ensure safe transition to home.

Goal: Standardize all aspects of discharge in a large, busy 84-bed Level IV NICU with >1000 admissions/year and >300 nurses, >60 NNPs, and >25 neonatologists.

• 95% of patients with lengths of stay >3 days have all discharge planning completed prior to discharge/Parent Care Unit overnight stay

Increasing Kangaroo Care In A New Small Baby Unit, Dianne Wilderson, Barb Haney, Ashley Mirabile, Beckie Palmer, Jenny Heltzer, Erin Keith-Chancy Bsn,Ccrn, Brooke Smith, Christian Anthony Schneider, Abdebayo Oshodi

Posters

Project Aim: Increase the percent of eligible patients receiving kangaroo care from 19% to 30% by September 2019.

Results:

113 staff completed education

OT consults completed on all SBU patients

20 kangaroo wraps purchased

Kangaroo care rate in NICU increased from 19% (prior to SBU) to 36% (Post SBU opening).

Conclusion: Due to increased multidisciplinary awareness of importance of kangaroo care in the SBU more parents are completing kangaroo care.

The Kanga-Croo: Nurse Resident Champions Creating Momentum For Improvement, Brett Butler, Jacob Burden, Carly Creekmore, Blair Griffin, Taylor Godemann, Taylor Hagen, Theresa Koelling, Mary Anne Kucera, Halle Magid, Makenna Miller, Monica Page, Mary Riffel, Madison Stebbins, Sarah Stokes, Skylar Suppes

Posters

Topic Summary:

Kangaroo Care (skin to skin care) is a parent-led, evidence-based intervention which improves outcomes in neonatal patients including: decreased apnea, increased weight gain, increased parent satisfaction and decreased length of stay.

Results:

Nurse resident team interventions to support parent engagement and remove barriers to Kangaroo Care (KC) through iterative PDSA cycles from January 2018 to July 2019 yielded positive results within a subset of ICN patients.

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operations Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Aortic Stenosis Poster, Katonya Lawson

Nursing Student Class Projects (Formerly MSN)

Aortic stenosis is the narrowing of the aortic valve secondary to calcification and fibrosis. It is the most common valve disorder and the second most frequent reason for cardiac surgery. As the elderly population increases, the number of patients presenting with aortic stenosis will increase. RNs and APRNs need to be aware of the pathophysiology and clinical manifestations of aortic stenosis because the disease can progress quickly and be fatal if mismanaged. Patients with aortic stenosis have an increased risk of morbidity and mortality during the peri-operative period during non-cardiac surgery. Therefore, CRNAs must remain vigilant when caring for this …

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

Pediatric Pain Management During Intravenous Line Placement: Nursing Perceptions And Interventions, Kate Shaffer

Honors Theses

Children are under assessed and under treated for pain associated with medical procedures, specifically during venipuncture. Recent studies show that procedural pain is preventable and that pain management interventions are underutilized. Failure to provide adequate pain relief can mentally and physically hurt children - in addition to inducing fear, suffering and lack of trust, exposures to pain can alter the central nervous system and increase a child’s sensitivity to pain. Pediatric nurses are responsible for assessing and managing pain before, during and after a procedure. Therefore, this review of literature and pilot study examines how registered nurses practicing in the …

Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed

Posters

This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.

Developing An Evidence-Based Supportive Services Program For Cancer Survivors In A Private Oncology Practice, Joseph Ellul

Doctoral Projects

Improvements in cancer treatment have led to a rapidly increasing survivor population. In response, multiple side effects of cancer and cancer treatment as well as the various wellness needs of survivors have been recognized. Survivorship programs have been developed to care for survivors with residual effects of cancer and the side effects of treatment; however, additional support is needed. The purpose of the project was to highlight the need for a comprehensive supportive services program for the cancer survivor population and describe the steps that were required to successfully develop the program. The clinical question addressed by the project was: …

Acquiring Blood Pressures On High Risk Sepsis Patients In The Ed, Mckenna Scharlau, Jacob Schneider

Nurse Presentations

Describes a project to improve use of the Sepsis Tool in the Emergency Department and to improve documentation of blood pressure measurements in high risk sepsis patients under three years of age.

Managing Severe Tbi In The Icu Setting Using A Three Tier Approach, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Assess the effects of injury to the brain in the neurologic injured patient and implement a tiered approach to manage severe TBI
• Evaluate TBI patients using multimodality monitoring
• Apply interventions to manage brain injury & integrate the complex multi-system issues and manage these patients using an actual case study.

Temperature Management: All Shook Up! Managing Shivering In Normothermia, Mary Kay Bader

Books, Presentations, Posters, Etc.

Objectives:

• Identify key factors related to maintaining normothermia
• Describe the use of the Bedside Shivering Assessment Scale
• Provide interventions to manage shivering in the Neuro patient population

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

The Effects Of Compassion Fatigue On Burnout Among Inpatient Psychiatric And Intensive Care Unit Nurses, Amita Madan Neidlinger

DNP Projects

PURPOSE: This DNP project is relevant to nurses of the psychiatric and Intensive Care Unit (ICU) setting, as high stress environments may produce higher rates of compassion fatigue and burnout. Investigation of these areas may help illuminate unnecessary healthcare costs that are associated with these phenomena. This DNP project is important to the University of Kentucky’s healthcare system, its patients, and nurses. Increased absenteeism and increased medication errors are positively associated with the prevalence of compassion fatigue and burnout in nurses. Outcomes from this project will allow identification of unnecessary healthcare costs and encourage administrators to focus on reducing nurse …

Incidence And Predictor Variables Of Pressure Injuries In Patients Undergoing Ventricular Assist Device And Total Artificial Heart Surgeries: An Eight-Year Retrospective Review, Christopher T. Brindle

Theses and Dissertations

BACKGROUND

Cardiac surgery patients have some of the highest reported incidence and prevalence of pressure injuries (PI). A growing subset of cardiac surgery include patients with end-stage heart failure who undergo ventricular assist device (VAD) or total artificial heart (TAH) surgery. The risk of PI and their natural history of development in this population are unknown and the specific risk factors for PI development remain unexplored.

OBJECTIVES

To perform a systematic review of the literature to identify the incidence and risk factors of PI development in patients undergoing VAD-TAH surgery and thereby inform study design and variables in an eight-year …