Nursing Commons^™

Enhancing Iana Member Communication & Engagement, Bart Bowers

Doctor of Nursing Practice Projects

The National Provider Identifier (NPI) Registry data identifies CRNAs as the sole providers of anesthesia for 29% of counties in the state of Illinois (“Illinois CRNA Map,” n.d.). These CRNAs, therefore, should play an important role in advocating for access to high quality care. While IANA is a vigorous advocate with regards to patient access to high quality, affordable health care (Bickel, 2017), the long-term patient advocacy capabilities of IANA are at risk due to a declining trend in membership numbers (Farina et al., 2016; Flores, 2014; “Keeping Pace,” n.d.; Yohn, 2016). Traditional forms of communication utilized by IANA, such …

Improving Perioperative Pain Management: Development Of An Adult Lidocaine Infusion Protocol, Kelsey Wallace

Doctor of Nursing Practice Projects

Abstract

Postoperative pain is a challenge in healthcare, with more than 50% of patients reporting inadequate pain control (Zengin, Saracoglu, Eti, Umuroglu, & Gogus, 2015). Inadequately controlled pain can negatively impact a patient’s quality of life, recovery, and cause postsurgical complications (Chou et al., 2016). Aims for acute pain management focus on reducing the incidence and severity of pain in order to improve patient function, minimize side effects, and prevent further complications (Gordon et al, 2016). Implementing a multimodal approach to pain control that includes a lidocaine bolus followed by continuous infusion has resulted in reduced opioid consumption, fewer adverse …

Update Of Blood Transfusion Protocols At A Regional Hospital In Rural Illinois, Kendra Tracy

Doctor of Nursing Practice Projects

The chief nursing officer (CNO) at a small regional hospital in rural Illinois requested an update to their blood transfusion policy and protocol based on current evidence-based information. These documents were updated with current information on safe assembly and delivery, identification of transfusion reactions, and appropriate responses to these reactions. In collaboration with the CNO and Quality Improvement Committee (QIC), drafts of a new policy and protocol and a Blood Transfusion Skills Checklist were developed. These documents were presented at a hospital-wide Skills Lab Day to registered nurses employed at the facility. A Likert Scale evaluation survey was presented to …

Treating Acute Bronchitis In Primary Care, Haylie Patterson, Stacy Wieland

Doctor of Nursing Practice Projects

There has been a significant rise in inappropriate antibiotic prescribing in the United States with at least 30 percent of antibiotics prescribed deemed unnecessary (Fiore, Fettic, Wright, & Ferrara, 2017). Overprescribing antibiotics for viral illnesses such as acute bronchitis leads to antimicrobial resistance. Based on current treatment guidelines, most upper respiratory infections do not respond to antibiotics but rather require supportive measures. Antibiotic prescribing trends for a Midwestern rural clinic were obtained through a retrospective and prospective chart review. Patients were frequently receiving antibiotics for acute bronchitis. To approach the problem a quality improvement (QI) evidence-based project was proposed. A …

Improving Acute Postoperative Pain Management For The Pediatric Patient: Guidelines On The Use Of Intravenous Dexmedetomidine, Jenna Winters

Doctor of Nursing Practice Projects

Inadequately treated surgical pain in children leads to risky complications, such as longer recovery times, infection, prolonged hospitalizations, readmissions, altered pain sensitivity, neurophysiological changes, and cognitive-behavioral abnormalities (Campbell, 2013; Ibrahim, Jones, Lai, & Tan, 2016). Review of the literature indicated intravenous dexmedetomidine, as an adjunct, may lead to improved outcomes and a reduction in postoperative pain in children undergoing surgical intervention. An evidenced-based educational presentation introduced intravenous dexmedetomidine in children to anesthesia professionals, pharmacy staff, and the pediatric care team at a tertiary care center. Concluding the educational presentation, participants completed a voluntary survey evaluating the effectiveness of the presentation. …

Implementation Of Emergency Severity Index Training To Improve Accuracy Of Triage Levels, Erinn Hileman, Douglas Mckain

Doctor of Nursing Practice Projects

This quality improvement project was created to help increase knowledge of the Emergency Severity Index (ESI) in the Emergency Department (ED), a form of triage used to categorize patients by their acuity. Proper ESI use shortens the length of stay times, door to provider times and reduces the number of patients that leave without being seen.

The goal of this project was to develop an online learning module that would increase the nurses’ knowledge of triage to enhance triage accuracy. Nineteen (19) emergency department nurses were given a pretest, an ESI educational presentation, and a follow-up post-test.

Data analysis indicated …

Increasing Utilization And Awareness Of An Existing Patient Portal Application, Amanda Graham, Jessica L. Schnebly

Doctor of Nursing Practice Projects

Patient portal applications (PPAs) are secure website or computer/mobile device applications that allow 24-hour access to a patient’s electronic health record (EHR). Patient portal applications are intended to improve quality and access to health care by engaging patients to be more active in managing and monitoring their health. A large Midwest multispecialty organization’s Follow My Healthpatient portal application (FMH app) is underutilized by patients and providers. While evidence supports the use of web-based patient portal applications, only 17% of this organization’s patients use the FMH app, and even less use its direct messaging capabilities.

The purpose of this project …

Development And Evaluation Of A Malignant Hyperthermia Computer Based Learning Project, Andrew Miller

Doctor of Nursing Practice Projects

Malignant hyperthermia (MH) is a potentially fatal, inherited disorder of muscle hypermetabolism that occurs after a person is exposed to commonly used volatile anesthetic agents (sevoflurane, desflurane, isoflurane) and/or the depolarizing muscle relaxant, succinylcholine (Diu & Mancuso, 2012). The MH mortality rate has decreased from 80% in the 1960s to less than 5% in 2006 due to increased clinical awareness of manifestations, pathophysiology, and improvement in perioperative monitoring (Rosenberg, Pollock, Schiemann, Bulger, & Stowell, 2015). Therefore,continuing education of perioperative staff is an integral part of proper MH preparedness. Computer-based learning (CBL) modules have been shown to be efficient, inexpensive forms …

Assessing Palliative Care Needs In Residents With Alzheimer's, Emily Yarnell

Doctor of Nursing Practice Projects

Current evidence indicates a lack of assessment protocols focusing on palliative care needs for patients with Alzheimer’s disease. This gap in practice supported the need to implement an evidence-based assessment protocol for early identification of palliative care needs in patients with Alzheimer’s disease residing in a long-term care facility. The protocol included using the patient’s Global Deterioration Scale (GDS) score to determine the patient’s palliative care needs according to the Dementia Progression Prioritization of Goals model. If the score indicated moderate to severe Alzheimer’s disease, then their goal was maximization of comfort, indicating a need to begin palliative care plans. …

Transition Of Care From Pediatrics To Adult Health Care, Heather Mahsman, Holly J. Henderson

Doctor of Nursing Practice Projects

Transition planning is essential for continuity of healthcare for adolescents approaching adulthood. Transition of care should start in early adolescence to help pediatric patients find and establish an adult healthcare provider. The purpose of this project was to assess and increase awareness of transition planning and assess the feasibility of instituting a transition program in a rural health pediatric clinic. Staff and providers were educated about transition of care planning and current recommendations from the American Academy of Pediatrics. Pre and post surveys were collected. Staff reported the program as beneficial to their patients and would like to see further …

Transitioning Pediatric Patients With Special Needs, Dimi Resch

Doctor of Nursing Practice Projects

Transitional care, which encompasses both the sending and receiving aspects, is essential for pediatric patients with complex care needs.A provider in a small, Midwest pediatric primary care clinic agrees with researchers that transitional guidelines are needed for consistency among pediatric and adult providers. This clinic currently has no process in place to guide the transition of patients with special needs. The primary goal of this project was to develop a communication tool that aids in the transition of patients with special needs into the adult primary care setting. The literature reviewed provided a variety of tools used to communicate healthcare …

Hepatitis C Virus Screening And Treatment, Dani Loftus, Emily Machens, Crista Jamous

Doctor of Nursing Practice Projects

Hepatitis C Virus (HCV) is classified as a contagious liver disease that can be either acute or chronic, and the illness ranges in severity from mild to lifelong. It is estimated that 2.7 million people in the United States (US) have HCV, but only half are diagnosed. The CDC recommends testing by birth-cohort, focusing on adults born between 1945 and 1965. Three main objectives for this project included implementation of a clinical decision support system (CDSS) for providers, increasing HCV screening by providing education to the support staff in primary care clinics of a local hospital which would increase the …

Improving Acute Pain Management: Development Of An Adult Dexmedetomidine Infusion Protocol, Timothy Denney

Doctor of Nursing Practice Projects

Studies have revealed over 80% of surgical patients experience acute postoperative pain: 75% of patients describe pain levels as moderate, severe, or extreme (Chou et al., 2016). Opioids continue to be the mainstay of most postoperative analgesia regimens (Tan, Law, & Gan, 2015). While effective for the treatment of severe pain, opioid use also prolongs length of hospital stay and places patients at greater risk for higher adjusted mean costs due to dose-related side effects. Multimodal analgesia is a concept that continues to gain momentum to improve perioperative analgesia while reducing the incidence of opioid-related adverse events (Buvanendran & Kroin, …

Integration Of Mental Heath Screening Protocol In Primary Care For Patients Who Have Experienced Traumatic Events, Karra N. Adams

Doctor of Nursing Practice Projects

Mental health status is not always assessed in patients involved in a physically traumatic event unless the patient expresses concern. Often times, orthopedic injuries are a result from a traumatic event. Routine mental health screening in the primary care orthopedic setting can help identify mental health care needs early so that adequate interventions can be implemented in a more effective manner. The goal of this project was to evaluate the feasibility of incorporating the use of a brief mental health screening tool in a primary care setting to assess the psychological needs of patients who have been involved in a …