Provider Adherence To Recommendations For Hpv Vaccination In A Family Practice And Pediatric Clinic, Kara Saling

DNP Projects

Background: The HPV vaccination has consistently had lower adherence rates than the goal set by Healthy People 2020. The Advisory Committee on Immunizations Practices (ACIP) now recommends that children (both male and female) 11 to 12 years of age should start to receive the HPV vaccine before exposure to the virus. However, even with the change in the new guidelines, the HPV vaccine administration rates still trail other adolescent vaccinations.

Purpose: The purpose of this project is to identify pediatric and family practice provider adherence to ACIP/CDC recommendations on HPV vaccinations in a Southeastern United States health system in …

An Examination Of The Knowledge And Screening Practices For Child Maltreatment Among Primary Care Providers, Nicole Cirincione

DNP Projects

Background: Child maltreatment can affect any race, economic status, gender, and age. Primary care providers have contact with children and their caretakers daily and develop bonds that encourage open communication. Screening for child maltreatment risk factors can help discover those in danger and decrease abuse rates. Purpose: The purpose of this study was to examine provider’s knowledge of child maltreatment risk factors and assess screening and documentation practices. Methods: This was a descriptive study that included an electronic survey to primary care providers to assess current knowledge and practices for child maltreatment risk factors. Second, a retrospective chart review was …

Initiating The Loeb Criteria In Long-Term Care, Janice Khauslender

Theses and Dissertations

Urinary tract infections are one of the most commonly reported infections in long-term care. Current practices often rely on non-specific symptoms, rather than specific genitourinary symptoms, to aid in the decision to obtain a urine culture. The literature does not support this practice due to the high prevalence of asymptomatic bacteriuria among long-term care patients, which does not have adverse outcomes when untreated. Antibiotics do not eradicate asymptomatic bacteriuria and place patients at risk of adverse reactions and increased risk of multi-drug resistant organisms. This clinical improvement project applied the Loeb criteria in two long-term care facilities to reduce the …

Home Exercise Therapy For The Treatment Of Knee Osteoarthritis, Kezia Nixon

Theses and Dissertations

Knee pain is the chief complaint of most osteoarthritis patients, and encourages them to seek medical attention. Unfortunately, pharmacological approaches to the treatment of knee osteoarthritis have been found to be inadequate. Given the prevalence and chronicity of osteoarthritic knee pain, there is an obvious need for treatments that can be provided for the course of the disease, with minimal adverse side effects. Exercise therapy has been found to significantly improve both pain and function among individuals with knee osteoarthritis. The primary objective of this quality improvement project was to investigate the effectiveness of a home-based therapeutic exercise program on …

Efficiency Of Ambulatory Blood Pressure Monitoring Vs. 5-Day Serial Monitoring In A Military Treatment Facility, Kadijatu Kakay

Theses and Dissertations

The purpose of this process improvement project is to determine efficiency of ambulatory blood pressure monitoring (ABPM) vs. 5-day blood pressure checks in a military treatment facility. The sample consists of male and female active duty soldiers ages 18 to 54 years without a previous diagnosis of hypertension (HTN). The soldiers were assigned to a unit that is physically and mentally challenging, has demanding training opportunities and duty requirements, and are rapidly deployable in support of peacekeeping, humanitarian and combat missions.

The data collection method included a retrospective chart review of 128 charts randomly selected between June 2016 and May …

Implementation Of A Depression Screening Tool For Cardiovascular Patients In The Primary Care Setting, Amber Nicole Ballentine

Theses and Dissertations

Background: Patients with cardiovascular disease (CVD) have a two-fold increased risk of depression as compared to patients without CVD. According to the American Heart Association (AHA, 2016), there is no gold-standard procedure for screening for depression in cardiovascular patients. Screening for depression varies greatly across specialties and practices, often leaving a gap for detection and treatment of depression in cardiac patients. There are many depression screening tools available; however, the AHA recommends use of the patient health questionnaire (PHQ) screening tool. The PHQ-2 and PHQ-9 questionnaires are the most brief, sensitive, and specific depression screening tool for patients with …

Health Literacy In A Primary Care Setting, Ashley Newman

DNP Projects

BACKGROUND: Low health literacy is prevalent in the United States. As a result, the Agency for Healthcare Research and Quality (AHRQ) developed universal health literacy precautions to improve patient understanding of health information. Using universal precautions and specific tools, such as teach-back, has been shown to decrease morbidity and improve patient outcomes.

PURPOSE: The purpose of this quality improvement project is to assess provider knowledge of health literacy in a primary care setting. A secondary purpose is to assess the use of patient education material for patients with diabetes, hypertension, and hyperlipidemia that meet universal precautions.

METHODS: This study was …

Assessment Of The Need For Provider Education On Screening For Depression In Patients With Select Dermatologic Problems, Sarah B. Zerhusen

DNP Projects

PURPOSE: The purpose of this project is to evaluate the knowledge, attitudes, perceptions, skills, and self-efficacy of dermatology providers’ assessment of depression in patients with chronic skin disease to determine the need for continuing education programs.

METHODS: This is a single practice, multi site, quantitative correlational design study to assess provider use, comfort, and proficiency of screening and discussion of depression in patients suffering from plaque psoriasis and atopic dermatitis. Data was collected through the use of a questionnaire dispensed in January of 2018. The sample consisted of 23 dermatology providers in a dermatology practice with clinics in Louisville, Lebanon, …

An Evaluation Of Provider Adherence To Acute Bronchitis Quality Measures In Adults, Rachel L. Lazar

DNP Projects

Background: Acute bronchitis management continues to be mistreated. Evidence based practice guidelines do not support antibiotic therapy for the treatment of acute bronchitis. Providers are encouraged to prescribe antitussives, suppressants and inhaler medications for the treatment of acute bronchitis symptoms, including cough.

Objective: The overall objective of this project is to evaluate the management of adults diagnosed with acute bronchitis in a limited services clinic.

Methods: A retrospective chart review was conducted on patients in a limited services clinic. The chart review assessed patients aged 18-64 with a diagnosis of acute bronchitis from July 1, 2016- June 30, 2017.

Results: …

Improving Fall Risk Assessment And Documentation: A Qi Project, Ashley N. Kohari

DNP Projects

BACKGROUND: Unintentional falls commonly arise and can cause significant harm including fractures, head injuries, and death. Assessing each patient for falls and performing a fall risk assessment is recommended by the American Geriatrics Society and the Center for Disease Control and Prevention, and is mandated for institutional reimbursement. Fall risk assessment has been shown to decrease the rate of falls and healthcare costs.

PURPOSE: The purpose of this quality improvement project was to improve compliance for fall risk screening and documentation to meet MACRA requirements in a family medicine clinic.

OBJECTIVES: The objectives for this project were: 1. Conduct PDSA …

Evaluating The Relationship Between Tobacco Use And Pain Perception Using The Global Pain Scale (Gps) In Opioid Dependent Adults: A Retrospective Analysis, Kristina Robinson

DNP Projects

Background: Chronic pain, smoking, and opioid use, contribute to a significant economic burden in the United States. Chronic pain affects all aspects of life, and is influenced by the use of cigarettes and opioids alike. Researchers suggest that there is a higher use of cigarettes and opioids in individuals with chronic pain. Chronic pain can promote smoking and smokers are more likely to use opioids. With the evidence that patients who smoke a higher number of cigarettes per day report higher pain, it is possible that smoking may be a stress-reducing behavioral response related to pain. Moreover, higher frequency and …

Increasing Influenza Vaccination Rates In A Primary Care Clinic: A Quality Improvement Study, Cassandra R. Roshel

DNP Projects

Background

According to the most recent CDC statistics, the influenza virus kills between 12,000 and 56,000 people per year in the United States. Although influenza vaccination is recommended each year, only about half of all Americans are actually receiving the vaccine annually. The goal of this quality improvement project was to increase influenza vaccination rates at a large academic medical center in Kentucky. At baseline, there was no standardized screening protocol in place prior to this study.

Methods

This study implemented a pre-test post-test design to evaluate the impact of a process change intervention on vaccination status from September 1, …

An Evaluation Of The Effects Of A Diabetes Self-Management Education Program On The Hba1c In Patients With Type 2 Diabetes, Katherine Schoo

DNP Projects

Introduction

Diabetes has become an epidemic in the United States. More than 30.3 29 million Americans are living with the disease, while an additional 84.1 million Americans are living with prediabetes (Centers for Disease Control and Prevention [CDC], 2018). Standards set forth by the American Diabetes Association (ADA) describe comprehensive and individualized self-management education and treatment as part of their guidelines for the management of diabetes (ADA, 2018). The “Active Steps for Diabetes” program is an example of a diabetes self-management education (DSME) program that supports national recommendations made by the ADA.

Methods

This study was a retrospective descriptive pre- …

Using Rapid Cycle Improvement To Improve Weight Management In Family Medicine, Kelly Mccormick

DNP Projects

PURPOSE: The purpose of this quality improvement project was to improve rates of nutrition screening and weight management in a Family and Community Medicine Clinic.

METHODS: This study was among several quality improvement projects being conducted at a Family and Community Medicine Clinic aimed at improving patient outcomes and quality measures for reimbursement beginning in 2019. Rapid cycle quality improvement was used to identify problems, implement changes, and evaluate workflow at the clinic in order to improve rates of compliance in BMI screening and documentation of weight management plans. Three PDSA cycles were completed. Activities included observation, staff education, visual …

A Retrospective Comparative Analysis On The Effectiveness Of Pharmacologic Weight Loss, Emily Dunn

DNP Projects

PURPOSE:Obesity costs the U.S. roughly $147 billion in health care spending annually. There has been a call for healthcare providers to initiate all possible weight loss interventions. One treatment strategy not used to its fullest potential is that of prescribing antiobesity medications. The purpose of this project was to examine and evaluate the effectiveness of three common weight loss medications used in the treatment of obesity, including discussion and recommendations.

METHODS: This project was a single-center retrospective study comparing three different groups of patients seen at a rural weight loss clinic. The sample consisted of 84 patients seen between September …

Evaluation Of Emergency Department Utilization Among Patients Who Have Primary Care Providers, Xin Zeng

DNP Projects

PURPOSE: High rates of emergency department (ED) use had little changes nationwide or in Kentucky after implementation of the Affordable Care Act. The Centers for Medicare and Medicaid Services have been calling for ways to reduce unnecessary ED usage. The purpose of this project is to identify factors associated with ED visits among adults in a primary care practice. The results are expected to serve as a needs assessment to determine ways for a primary care clinic to reduce inappropriate ED use.

METHODS A retrospective chart review was conducted to evaluate the ED use among 80 random selected adult patients …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

Retrospective Chart Review Of Abnormal Lab Results In The Primary Care Setting, Derek Summers

DNP Projects

PURPOSE: The purpose of this project was to perform a needs assessment to determine if there was a delay in addressing abnormal lab results. The objectives were: 1) to determine the amount of time it takes for providers to address abnormal lab results in the ambulatory setting at an ambulatory setting within a Southeast Health Care System and 2) evaluate the alert and order set system for abnormal lab results of thyroid stimulating hormone, lipid panels, and hemoglobin A1C.

METHODS: A retrospective chart review was performed to determine the time it takes for primary care providers to address or follow …

An Assessment Of Potentially Inappropriate Medications Among The Elderly And The Effect Of An Educational Intervention On Provider Knowledge Of These Medications, Amanda Brown

DNP Projects

Objectives: The aims of this study were to assess potentially inappropriate medications (PIMs) or Beers medications among outpatient older adults within one Midwestern healthcare system, to determine rates of patient education on Beers medications, and to pilot an educational intervention for providers.

Methods: This study involved two parts. For part 1 of the study, a randomized retrospective chart review of 493 older adult patients seen in 2017 from four practices was conducted to assess Beers medication prescriptions and rates of patient education. Following the chart review, for part 2 of the study, an educational intervention was delivered to two providers …

Evaluating The Need For A Family Nurse Practitioner Fast Track As An Alternative To The Emergency Department, Anna Czartorski

DNP Projects

PURPOSE: Emergency Departments (ED) are a vital part of healthcare and they provide lifesaving services to patients that are acutely ill. However, the latest data shows that 42% of ED visits are related to medical complaints that can be managed by a primary care provider (PCP). The purpose of this study was to assess the need for a fast track within a midwestern suburban Emergency Department (ED) that is based upon the Family Nurse Practitioner (FNP) fast track model.

METHODS: This study was a descriptive study examining the usage of the ED for non-urgent medical complaints from January 1 …

Assessing And Evaluating Health Literacy Practices In The Ambulatory Setting, Anne Marie Koch

DNP Projects

Purpose: The purpose of this study is to assess health literacy knowledge and practices among ambulatory care providers who care for patients with type 2 diabetes.

Methods: Healthcare professionals who provide diabetes care and education were invited to participate in a health literacy education session with a pre and post-intervention knowledge survey. A retrospective chart review was conducted to evaluate health literacy practices in three PCP and three endocrinology offices. An evaluation of health literacy practices was used to compare PCP and endocrinology practices and determine if health literacy practices correlated to controlled hemoglobin a1c values.

Results: …

Evaluating The Effect Of A Nurse Navigator In Increasing Colorectal Screening, Christine Njogu

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a nurse navigator in increasing colorectal (CRC) screening in primary care setting.

METHODS: This was a descriptive retrospective study of the effect of nurse navigators in increasing colorectal screening in primary care settings within Jefferson county and its surrounding counties. The sample consisted of 200 patient chart reviews for the period of September 1st through December 31st, 2017. Rates of colorectal screening were compared in those who received a nurse navigator call and those who did not.

RESULTS: Overall screening rates were 44.6%. A distinct increase in screening …

The Evaluation Of The Impact Of Controlled Substance Patient Education In The After Visit Summary On Patient Knowledge Of Controlled Substance Medication, Marie Honeycutt

DNP Projects

The use of opioids is associated with risks for misuse, abuse, addiction and diversion, which are directly related to increased healthcare utilization, increased healthcare cost, and poor patient outcomes. The purpose of this study was to evaluate the impact of controlled substance (CS) patient education that was implemented into the electronic medical record. The objectives were to 1.) assess whether patients received the CS after visit summary (AVS) and 2.) assess differences in pain management knowledge between those who received the AVS and those who did not. Methods This descriptive correlational designed study examined the differences in pain management knowledge …

Evaluation Of The Crafft Substance Use Screening Tool In Primary Care, Leanne Coleman

DNP Projects

PURPOSE: The purpose of this research study was to evaluate the use of the CRAFFT tool within a pediatric primary care setting. The specific objective was to assess the frequency of documentation of substance use screening, counseling, and/or intervention before and after the implementation of the CRAFFT tool.

METHOD: The practice site chose to implement an evidence based adolescent substance use screening tool (CRAFFT Tool) to improve practice. This practice improvement project utilized a descriptive design with a review of electronic medical records before and after a substance use screening tool was implemented. Two hundred medical records were reviewed, 100 …

The Effect Of A Provider Education Program On Tobacco Use In An Adult Population In The Primary Care Setting, Sunita Gurung

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effectiveness of an education session to promote adherence to the United States Preventive Services Task Force (USPSTF) recommendation and Clinical Practice Guidelines for Treating Tobacco Use and Dependence by providers.

METHODS: A retrospective and prospective record review was used to evaluate an education session for providers in tobacco use screening, providing cessation counseling, prescribing medication for tobacco cessation, and sending out referrals for tobacco cessation at one primary care clinic in Louisville, KY. Education sessions were held from August 1, 2018 to August 14, 2018. The sample consisted of 200 …

The Impact Of The Nurse Practitioner In Pre-Admission Testing: A Comparative Review, Laurel A. Robinson

DNP Projects

Abstract

PURPOSE: The purpose of this study was to compare the efficiency of pre-admission testing (PAT) surgical clinic pre and post implementation of the APRN for patient assessment. Cancellation and delay occurrences for scheduled surgeries will be compared during two time periods on patients on the surgical schedule at Norton Women and Children’s Hospital (NWC).

METHODS: This study was a single-center, pre and post implementation retrospective comparative study of the impact of the NP led PAT unit at Norton Women and Children’s Hospital (NWC) in terms of delay and cancellation rates for day-of-surgery. The sample consisted of 411 patients for …

Diabetes-Related Distress Screening: A Survey Of Primary Care Providers' Knowledge, Attitudes, And Practices In Treating Patients With Difficulty Meeting Glycemic Goals., Michele Patrice Paxton

DNP Projects

A patient with diabetes is two to three times more likely to be depressed than the general population. Furthermore, the combination of diabetes and depression is associated with increased morbidity and mortality. However, research has shown that treatment for depression does not correlate with lower HbA1c levels or a decrease in morbidity and mortality. Recently, a body of evidence has shown that increased HbA1c levels and depression are associated with the emotional burden of managing diabetes. The emotional burden is caused by the constant behavioral and mental demands of managing the disease and the worry and fear of the impending …

The Effects Of Hormone Replacement Therapy (Hrt) On Surgically Postmenopausal Women: A Review Of The Literature, Leslie M. Hertweck

Honors Undergraduate Theses

The primary purpose of this research was to examine the effects of HRT in women with acute estrogen deficiency from surgically induced menopause. The secondary purpose was to evaluate how HRT improves symptoms of acute estrogen deficiency and quality of life (QOL) in women using hormone supplementation. Peer reviewed articles published from 2000 to 2017 that were written in the English language with a focus on the use of HRT in women with acute estrogen deficiency after surgical menopause were evaluated for relevance. Evidence suggests the primary reason for decreased use of HRT is the associated risks outweighing the benefits; …

Exploring What It Is Like To Be An Undocumented Alien In Seek Of Healthcare, Eliany C. Torrez Pon

Honors Undergraduate Theses

Currently, there are about 11.8 million undocumented aliens in the United States who are not eligible for public insurance or any type of private coverage obtained through the American Health Care Act of 2017. This creates barriers to healthcare for this large population and has negative implications for the healthcare system. Despite the availability of clinics and low-cost healthcare, this group tends to underuse resources or seek healthcare for emergencies only which leads to increased cost totaling approximately $1.1 billion a year. The goal of this qualitative study is to better understand what it is like to be an undocumented …

Implementation Of Provider And Workflow Strategies To Increase Adherence To Tqip Guidelines In Traumatic Brain Injury, Regina Thompson

Theses and Dissertations

Traumatic brain injury (TBI) is a leading cause of death and permanent disability worldwide. The American College of Surgeon’s Trauma Quality Improvement Program (TQIP) has developed a set of recommendations for the management of trauma-related injuries, including TBI. The objective of this evidenced-based practice project was to implement provider- and workflow-based strategies to improve adherence to TQIP recommended guidelines for the placement of intracranial pressure (ICP) monitors. The primary outcome measured was number of ICP monitors placed post-intervention.

The author reviewed available literature and found six articles pertaining to guideline implementations. Analysis of the literature was performed utilizing Melynk and …