Reducing Hospital-Acquired Pressure Injuries: A Quality Improvement Project Implementing A Visual Reminder System In The Intensive Care Unit, Henry H. Remschel Iii

Doctor of Nursing Practice Final Project Abstract

Purpose

This quality improvement (QI) project aimed to reduce hospital-acquired pressure injuries (HAPIs) by 10% in an intensive care unit through the implementation of a skin risk assessment form and a visual reminder system.

Background

Hospital-acquired pressure injuries negatively impact patient outcomes and can increase costs associated with a hospital stay. Studies have shown that visual reminders can improve nursing intervention compliance and correlate with improved patient outcomes.

Methodology

The project implemented a skin-risk assessment form to identify patients at risk for developing pressure injuries during their hospital stay. For high-risk patients, a “High Skin Risk” magnet was placed outside …

Implementation Of An Electronic Medication Management System To Increase Medication Safety, Sierra R. Brown

Doctor of Nursing Practice Final Project Abstract

Abstract

Purpose: Medication errors compromise medication safety by increasing patient harm. This quality improvement project aimed to increase medication safety through the implementation of an electronic medication management system (EMMS) at a residential treatment center for women with substance use disorders.

Background: The facility previously relied on paper-based systems and was overseen by unlicensed personnel, which contributed to the frequent medication and documentation errors, delayed refills, inconsistent audits, and limited oversight. These challenges posed a significant risk to client safety and treatment outcomes.

Methodology: The Model for Improvement guided the intervention, which involved three Plan-Do-Study-Act cycles. Customized EMMS was developed …

Evaluating The Impact Of Epic Integration And Dual Registered Nurse Check-Off On Pressure Injury Prevention Workflow Compliance, Darlene Y. Olowu

Doctor of Nursing Practice Final Project Abstract

Background

Hospital-acquired pressure injuries (HAPIs), particularly sacral and heel injuries, remain a persistent challenge in critical care settings, leading to increased morbidity, mortality, and healthcare costs.

Purpose

This quality improvement project aimed to improve compliance with a pressure injury prevention (PIP) workflow by integrating a dual RN check-off system within EPIC, thereby reducing sacral and heel pressure injuries. The project sought to enhance accountability, standardize documentation, and optimize compliance with evidence-based PIP measures.

Methodology

A Plan-Do-Study-Act (PDSA) framework guided the project implementation in an oncologic intensive care unit (ICU). Key interventions included: (1) EPIC integration of a dual RN check-off …

Navigating Sexual And Gender Diversity: A Quality Improvement Project To Increase Provider Cultural Competencies For Sexual And Gender Minorities In Mental Health Outpatient Facilities, Shermeen Chandani

Doctor of Nursing Practice Final Project Abstract

Purpose: Sexual and gender minority (SGM) populations experience healthcare disparities related to stigma, discrimination, and limited provider cultural competency. In outpatient psychiatric settings, non-affirming practices can negatively affect patient engagement, trust, and continuity of care. This quality improvement project aimed to enhance staff sexual and gender minority cultural competency (SGMCC) and strengthen affirming clinical processes.

Background: The project was implemented across two outpatient psychiatric clinics with approximately 28 multidisciplinary staff members. At baseline, no formal SGM cultural competency training or standardized documentation practices for preferred names and pronouns existed.

Methodology: A Plan–Do–Study–Act framework with a pre/post-test design was used. The …

Implementation Of Behavioral Emergency Response Team In Triage, Brianna Millen

Doctor of Nursing Practice Final Project Abstract

Introduction: The aim of this project is to improve the admission process of psychiatric patients in the emergency department (ED) by implementing a Behavioral Emergency Response Team (BERT). The goal is to reduce wait times, decrease patient aggression, and enhance overall patient and staff safety.

Background: Emergency departments are experiencing an influx of psychiatric patients presenting with acute psychosis. Long wait times often lead to increased agitation, requiring physical or chemical intervention. Literature suggests that timely care can reduce aggression and psychiatric admissions. Currently, no similar interventions exist at Houston Methodist West Hospital.

Methodology:

This quality improvement project follows a …

Accessing Facility Electronic Health Record For Payer Utilization Review Review, Betsey Denton

Doctor of Nursing Practice Final Project Abstract

PURPOSE The purpose of this project was to improve the prior authorization process for payer, provider, and patients by reducing the number of medical necessity denials, peer-to-peer calls, appeals, and increasing payer and provider satisfaction.

BACKGROUND A literature review indicated opportunities for improvement in prior authorization processes. Medical necessity denials are issued by payer if clinical documentation is not available for review. Implementation setting was a large academic medical center. Studied populations included patients who are members of a large Medicaid HMO health plan, payer utilization review registered nurses (RN), and hospital utilization review staff. METHODOLOGY Payer RNs began utilizing …

Decreasing Antibiotic Turnaround Time In The Medical Intensive Care Unit: A Quality Improvement Project, Kacie Wright

Doctor of Nursing Practice Final Project Abstract

Purpose: This QI project aimed to increase the percentage of first-dose antibiotics administered within one hour of order placement to 80% in the ICU by 12/31/24.

Background: Antibiotic Turnaround Time (ATT) is the time between antibiotic order placement and administration. Prolonged ATT can cause adverse outcomes by delaying treatment. In 2023, only 54% of first-dose antibiotics were given within the EBP standard of one-hour in our 36-bed Medical ICU.

Methodology: The Six Sigma DMAIC model identified barriers and interventions to achieving target ATT using stakeholder input, process mapping, and root cause analysis. Multidisciplinary Plan-Do-Study-Act (PDSA) cycles were created to evaluate …

Implementing The Morisky Medication Adherence Scale To Improve Medication Adherence In Patients With Hiv And Mental Illness, Kyle Ransom

Doctor of Nursing Practice Final Project Abstract

PURPOSE The purpose of this scholarly project was to implement a standardized process for assessing patient medication adherence through the use of a high-quality self-report questionnaire.

BACKGROUND The project was implemented at a federally funded outpatient HIV specialty clinic.

METHODOLOGY Patients seen by the clinic’s psychiatric/mental health nurse practitioners completed the Morisky Medication Adherence Scale during the nurse triage encounter. Patients who scored poorly (below 6) were then referred to the clinic’s interprofessional team (e.g., social workers and pharmacists) to address barriers to medication adherence. Medication adherence was measured using data collected from the on-site pharmacy records in order to …

Reducing Restraints In Adolescent Psychiatric Inpatient Units Through Trauma-Informed Care, Alanna G. Mejia

Doctor of Nursing Practice Final Project Abstract

Purpose: This Doctor of Nursing Practice project explores the impact of implementing trauma-informed care (TIC) training and screening interventions within an inpatient adolescent psychiatric unit. The goal is to reduce physical restraint use and improve patient care by fostering a more compassionate and effective treatment approach.

Background: Adolescents in psychiatric settings often experience restraints, which can cause trauma and harm therapeutic relationships. Implementing TIC strategies equips staff with de-escalation techniques and structured trauma screenings, creating safer environments and improving patient outcomes.

Methodology: The Plan-Do-Study-Act (PDSA) cycle was chosen to guide improvements, aligning with best practices in quality improvement by allowing …

Implementation Of Peer Mentorship Process Within A Nurse Fellowship Program, Julie Edwards

Doctor of Nursing Practice Final Project Abstract

PURPOSE: The purpose of this scholarly project was to implement a peer mentorship program within an inpatient labor and delivery nurse fellowship program. This program was intended to increase the job satisfaction of experienced nurses transitioning into an inpatient labor and delivery unit.

BACKGROUND: The project was implemented within a large healthcare organization in Houston, Texas, in an established nursing fellowship program in the Labor & Delivery inpatient practice area.

METHODOLOGY: A nursing workplace satisfaction questionnaire was administered to access job satisfaction using the Microsoft Forms platform. This method was chosen as it allowed for easy access, at any time, …

Empowering Staff Through Trauma-Informed Care: A Quality Improvement Initiative For Enhancing Patient Satisfaction And Care Delivery, Ijezie G. Anozie

Doctor of Nursing Practice Final Project Abstract

The quality improvement project aimed to implement a Trauma-Informed Care (TIC) care delivery model to increase patient satisfaction with their hospital experience. Increasing patient satisfaction was measured by the Net Promoter Score (NPS), and improvement would be evidenced by an increase of 40% (NPS) within four months of the implementation of trauma-informed care (TIC) principles in the inpatient psychiatric facility. The NPS served as a proxy measure for the successful implementation of this quality improvement project. The intervention integrated TIC training through the HealthStream platform, a skills fair, interactive sessions, a guidebook, and continuous data monitoring. Weekly meetings, educational materials, …

Optimizing Laboratory Appointment Adherence Among Patients Prescribed Psychoactive Medications, Tamara N. Blake

Doctor of Nursing Practice Final Project Abstract

PURPOSE

The purpose of this scholarly project was to implement a standardized nurse-driven phone call reminder protocol to improve adherence to scheduled laboratory appointments among patients prescribed psychoactive medications requiring bloodwork. This protocol is aimed to increase appointment adherence and reduce no-show rates within the clinic.

BACKGROUND

The project was implemented within a small outpatient community-based clinic in Round Rock, Texas which provides mental health services. The clinic experienced high no-show rates for scheduled laboratory appointments among patients prescribed psychoactive medications. Monitoring these patients is essential to ensure medication safety and prevent potential adverse effects.

METHODOLOGY

The six-week quality improvement …

Churning The Tides Of Care: When Nurse Turnover Makes Waves In Patient Access To Primary Care, Kelley Arredondo, Ashley M Hughes, Houston F Lester, Trang N D Pham, Laura A Petersen, Lechauncy Woodard, Richard Sorelle, Cheng Rebecca Jiang, Frederick L Oswald, Daniel R Murphy, Hilary N Touchett, Joshua Hamer, Sylvia J Hysong

Faculty, Staff and Students Publications

BACKGROUND: Team-based primary care (PC) enhances the quality of and access to health care. The Veterans Health Administration (VHA) implements team-based care through Patient Aligned Care Teams (PACTs), consisting of four core members: a primary care provider, registered nurse (RN) care manager, licensed vocational nurse, and scheduling clerk. RNs play a central role: they coordinate patient care, manage operational needs, and serve as a patient point of contact. Currently, it is not known how varying levels of RN staffing on primary care teams impact patient outcomes.

OBJECTIVE: This study aims to empirically assess how the stability of RN staffing within …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

Improving Adherence Amongst Post-Stroke Patients In The Outpatient Setting, Olivea Adetu

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement (QI) project aimed to enhance medication adherence and follow-up rates through structured, personalized phone calls to recently discharged post-stroke patients. The project was implemented at an outpatient neuroscience clinic in Greater Houston.

BACKGROUND

Low medication adherence and poor attendance at the first neurology follow-up appointment among post-stroke patients contribute to increased morbidity and higher risk of recurrent stroke. Despite receiving discharge instructions, many patients do not consistently take their prescribed medications or attend their initial neurology visit.

METHODOLOGY

Guided by the Plan-Do-Study-Act (PDSA) cycle, this project engaged a medical assistant to call recently discharged stroke patients …

Increasing The Frequency Of Behavior Assessment To Reduce Physical Restraint, Breanne N. Ford

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to implement a system that routinely assesses for behavior changes in psychiatric patients presenting to the emergency department to improve staff intervention of escalating behaviors and decrease physical restraint use.

Background: The project was implemented in a 45-bed emergency department in a community-based hospital affiliated with a large hospital system in Houston, Texas.

Methodology: The project utilizes the Behavioral Activity Rating Scale (BARS) to assess patients' behaviors at routine intervals throughout shifts and a comfort cart that houses several non-pharmacological intervention items to use to de-escalate adverse behaviors. The staff …

Introducing Therapeutic Music As An Alternative Therapy To Reduce Anxiety In The Emergency Department, Azuka Debbie Onyekwe

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project evaluated the feasibility of implementing therapeutic music in the emergency department (ED) to decrease anxiety levels by 10% over three months at a hospital in West Houston.

Background: Anxiety in the ED can exacerbate patient conditions and lead to increased use of anxiolytic drugs. Prior studies suggest that therapeutic music is effective in lowering anxiety across clinical settings. Anxiety in emergency department settings can negatively impact patient outcomes and increase reliance on pharmacological treatments. Evidence from previous research has demonstrated that therapeutic music interventions can significantly reduce anxiety, making it a promising non-pharmacological approach. However, …

A Comprehensive Community Awareness Website To Increase Screening Colonoscopy Rates Among Adults In Flower Mound, Tx, Alexandra Biltz

Doctor of Nursing Practice Final Project Abstract

PURPOSE Colorectal cancer is the second leading cause of cancer-related deaths in both men and women. The purpose of this scholarly project was to implement a website and flyer to increase screening colonoscopy rates in adults ages 45 to 75.

BACKGROUND There are no formal models or guidelines for increasing screening colonoscopies in the United States. The literature search also revealed that many Americans do not have a good general knowledge of colorectal cancer and colonoscopies.

The project was implemented at an ambulatory gastrointestinal endoscopy center in Flower Mound, Texas.

METHODOLOGY The website was created using Wix and a flyer …

Addressing Medication Adherence Barriers In Hispanics Diagnosed With Diabetes Type Ii, Solmayra Solis

Doctor of Nursing Practice Final Project Abstract

The purpose of this scholarly project was to identify and mitigate the barriers of medication adherence in an underserved population of Hispanic patients diagnosed with Type II diabetes through a nurse-driven telephone follow-up program. The program aims to assess and offer solutions available in the clinic to barriers of medication adherence. The project was implemented at the non-profit Christ Clinic located in Katy, TX. About 94% of the population are Spanish-speaking Hispanics and 200% below the federal poverty level. The patients do not have insurance due to their immigration status. Of the 5,000 clinic patients, an estimated 40% are non-medication …

Improving The Quality Of Nursing Documentation Among Nurses In Home Healthcare, Mavis Amponsah

Doctor of Nursing Practice Final Project Abstract

PURPOSE

Accurate nurses’ notes are important for patient safety, complete nursing care, coordination and continuity of care, communication, reimbursement, and regulatory requirements. The purpose of this quality improvement project was to use standardized training to improve the percentage of nurses’ notes that pass auditing by 50%. The project also aimed at reducing by 50% the number of notes returned by reviewers to nurses because they were incomplete.

BACKGROUND

The project was implemented in a home healthcare agency with an average of 200 patients and 30 field nurses. Current nurses’ notes returned as incomplete were 30%.

METHODOLOGY

A training program was …

Enhancing Discharge Process For Home Iv Milrinone Patients With Advanced Heart Failure, Kaitlyn Bauer

Doctor of Nursing Practice Final Project Abstract

Purpose: Discharge processes for patients with heart failure on home intravenous inotrope support is fraught with barriers and complexities, and causes patients, caregivers, and bedside nurses’ high levels of stress leading to potentially unsafe, complicated discharges. This project aimed to decrease discharge times and improve nurses’ ability to safely and effectively discharge patients.

Background: The project was implemented in a 42-bed advanced heart failure IMU in the Texas Medical Center, where discharge times were longer than hospital standards at over 6 hours.

Methodology: Using elements of the Transition of Care Model, a discharge checklist was created to help staff prepare …

A Qualitative Exploration To Inform An Oral Health Training For Disability Care Workers In Burkina Faso, Ave Põld, Dan Filwendé Kientega, Jocelyne Valérie Garé, Michael Lorenz

Faculty, Staff and Student Publications

AIM: To explore enablers and barriers to the creation of an oral health training for care workers at specialized centres for children with disabilities in Ouagadougou.

DESIGN: This was a formative study informed by the Theoretical Domains Framework using qualitative methods.

METHODS: Qualitative observations and 14 semi-structured interviews were conducted with care workers from six specialized centres for disability.

RESULTS: Carer workers emphasized that a successful oral health training must account for available resources and competencies in each specific centre. Part of the training must be dedicated to oral hygiene targeted for people with disabilities and provide knowledge about risk …

A Quality Improvement Project: Implementing A Mental Health Screening Program For International Business Travelers., Joyce Ighedosa

Doctor of Nursing Practice Final Project Abstract

A Quality Improvement Project: Implementing a Mental Health Screening Program for International Business Travelers.

PURPOSE The purpose of the Quality Improvement project was to implement a mental health screening program for international business travelers in an oil and gas organization. The Patient Health Questionnaire (PHQ-2) was implemented

BACKGROUND The project was implemented in a global oil and gas organization. The original medical screening for pre-travel preparation was on identification of physiological disorders, proper management of identified disease processes; infectious disease prevention; vaccine review and update; malaria chemoprophylaxis and vector control. Mental Health was not reviewed.

METHODOLOGY The PHQ-2 was …

Improved Pediatric Icu Mortality Prediction For Respiratory Diseases: Machine Learning And Data Subdivision Insights, Johayra Prithula, Muhammad E H Chowdhury, Muhammad Salman Khan, Khalid Al-Ansari, Susu M Zughaier, Khandaker Reajul Islam, Abdulrahman Alqahtani

Faculty, Staff and Student Publications

The growing concern of pediatric mortality demands heightened preparedness in clinical settings, especially within intensive care units (ICUs). As respiratory-related admissions account for a substantial portion of pediatric illnesses, there is a pressing need to predict ICU mortality in these cases. This study based on data from 1188 patients, addresses this imperative using machine learning techniques and investigating different class balancing methods for pediatric ICU mortality prediction. This study employs the publicly accessible "Paediatric Intensive Care database" to train, validate, and test a machine learning model for predicting pediatric patient mortality. Features were ranked using three machine learning feature selection …

Improving Outcomes In Patients With Major Depressive Disorder Through The Utilization Of The Patient Health Questionnaire-9 Screening Tool In A Mental Health Setting., Murielle Nankeu

Doctor of Nursing Practice Final Project Abstract

Improving Outcomes in Patients with Major Depressive Disorder Through The Utilization of The Patient Health Questionnaire-9 Screening Tool in a Mental Health Setting.

PURPOSE This scholarly project focused on the implementation and adherence of the PHQ-9 screening tool by nurses and healthcare staff in patients diagnosed with MDD, aiming to improve patient outcomes and reduce readmission rates.

BACKGROUND There is a lack of a standardized validated screening tool. Utilizing depression screening is crucial in preventing poor outcomes. Q.I. was initiated in a 23-bed inpatient psychiatry geriatric unit in a large city in Texas.

METHODOLOGY The methodology utilizes a standard analytical …

Prevalence And Predictors Of Secondary Traumatic Stress In A National Sample Of Emergency Nurses: A Cross-Sectional Study, Christian Paige Owen

Dissertations and Theses (Open Access)

Background: Emergency nurses experience traumatic situations as part of their professional role, leaving them vulnerable to secondary traumatic stress (STS). The distressing behaviors and symptoms of STS negatively impacts their well-being and ability to provide high quality care. Studies report that emergency nurses experience high levels of STS but less is known about how STS is influenced by their coping strategies and work-related factors. Further evidence is needed to better understand predictors of STS in order to support strategic efforts to improve the well-being and retention of nurses working in trauma-prone environments.

Aims: The specific aims of this study sought …

The Association Of Discrimination And Coping Style On Cardiovascular Health Among South Asian Individuals In The Masala Study, Raji Pillai

Dissertations and Theses (Open Access)

Objectives: South Asian individuals (SAs) are found to have a heightened state of inflammation contributing to increased cardiovascular disease (CVD). Additionally, social determinants like discrimination are also associated with risks for CVD in SAs. This study examined the associations between discrimination and inflammation and whether an association between discrimination and self-rated health (SRH) is moderated by coping styles among SAs living in the United States to inform effective coping strategies against discrimination.

Design: This secondary data analysis used data from 1164 SAs (mean age = 57 years, SD 9.4, 48% women) enrolled in the Mediators of Atherosclerosis in South Asians …

Implementing A Two-Nurse Indwelling Urinary Catheter Insertion Process With A Checklist To Decrease Catheter-Associated Urinary Tract Infections In The Intensive Care Unit, Alexa Austin

Doctor of Nursing Practice Final Project Abstract

Implementing a Two-Nurse Indwelling Urinary Catheter Insertion Process with a Checklist to Decrease Catheter-Associated Urinary Tract Infections in the Intensive Care Unit

PURPOSE The purpose of this quality improvement project was to decrease CAUTI rates within the Intensive Care Unit (ICU) by implementing a two-nurse indwelling urinary catheter (IUC) insertion process utilizing the Agency for Healthcare Research and Quality (AHRQ) IUC evidence-based checklist.

BACKGROUND The project was implemented in a 52-bed Medical-Surgical ICU of a large academic specialty hospital in the Southwestern United States of America (USA). At the project site, there was an increase in CAUTI rates above the …

Improving Patient Safety By Reducing The Use Of Restraint And Seclusion Through De-Escalation In An Inpatient Psychiatric Unit, Ndidiamaka Okafor

Doctor of Nursing Practice Final Project Abstract

Improving Patient Safety by Reducing the Use of Restraint and Seclusion through De-escalation in an Inpatient Psychiatric Unit

PURPOSE:

The purpose of this quality improvement project is to improve safety among adolescent patients ages 13 – 17 on an inpatient psychiatric unit through improved staff de-escalation techniques as evidenced by a decrease in the use of restraint and seclusion combined by 23% from 65% to 50% within 3 months. A secondary aim is that staff will provide self-reported improvement in confidence.

BACKGROUND:

Aggression from adolescents admitted to the inpatient psychiatric unit is one challenge nursing staff face when providing care. …

Use Of A Mindfulness-Based Mobile App To Decrease Nurse Burnout, Vivian Ugwu

Doctor of Nursing Practice Final Project Abstract

PURPOSE The aim of this quality improvement project was to decrease Oldenburg Burnout Inventory (OLBI) scores by 5% among nurses working in a joint and rehab unit after using the mindfulness-based mobile application Headspace for 2 months.

BACKGROUND Indicators of rising burnout were noted on a 27-bed joint and rehab unit at a general medical and surgical facility in Houston, Texas.

METHODOLOGY The OLBI survey was used to measure burnout risk. The Plan-Do-Study-Act cycle was used to plan and identify necessary changes. Champions on each shift led selected brief Headspace app mindfulness-based activities once a shift daily for two months. …