Nursing Commons^™

Implementation Of A Turn Team To Reduce Hospital-Acquired Pressure Injuries In A Medical Intensive Care Unit, Heather A, Adair

Doctor of Nursing Practice Final Project Abstract

Implementation of a Turn Team to Reduce Hospital-Acquired Pressure Injuries in a Medical Intensive Care Unit

PURPOSE

The project aimed to reduce hospital-acquired pressure injury (HAPI) rates in a Medical Intensive Care Unit (MICU) by improving nurses' knowledge of the Braden Scale and implementing a structured two-nurse turn team workflow to reposition high-risk patients every two hours.

RESULTS

Repositioning compliance improved substantially and consistently exceeded the project goal of 90% after implementing a pod-based workflow. The HAPI prevalence rate decreased from a baseline of 8% to below the project goal of ≤5% during implementation but was not sustained in the …

Improving Remote Monitoring Compliance For Pediatric And Adult Congenital Electrophysiology Patients With Cardiac Implantable Electronic Devices (Cieds), Christine Meliones

Doctor of Nursing Practice Final Project Abstract

Improving Remote Monitoring Compliance for Pediatric and Adult Congenital Electrophysiology Patients with Cardiac Implantable Electronic Devices (CIEDs)

Purpose

The purpose of this scholarly project was to implement a quality improvement (QI) project to improve patient safety by improving cardiac implantable electronic device remote monitoring (RM) which has traditionally failed to achieve published benchmarks.

Background

The project was implemented at a healthcare institution in Houston, Texas. The practice area includes pediatric and adult patients with cardiac implantable electronic devices (CIEDs) in an outpatient setting. Current compliance with 14-day post-implementation enrollment (44%) and ongoing compliance (60%) did not meet published benchmarks.

Methodology …

Using The Dynamic Appraisal Of Situation Aggression (Dasa) Tool In An Inpatient Psychiatric Unit, Doose J. Onarinde

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project evaluated whether implementation of the Dynamic Appraisal of Situational Aggression (DASA) tool reduced aggressive incidents compared with unstructured clinical judgment.

Background: Workplace violence is a persistent safety concern in inpatient psychiatric settings, contributing to staff injury, burnout, and compromised patient care.

Methods: Guided by Lewin’s Change Model, a pre–post intervention design was implemented over eight weeks on a 23-bed male forensic psychiatric unit. Registered nurses received standardized education and completed daily DASA assessments for all admitted patients. Data were collected from incident reports, DASA scores, and pre- and post-intervention nurse surveys. Descriptive statistics were used …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

Enhancing Patient Satisfaction Through A Telehealth -Enabled Post-Discharge Follow-Up Program In An Adult Medical-Surgical Unit, Helen T. Idowu, Helen Temitope Idowu

Doctor of Nursing Practice Final Project Abstract

Abstract

Purpose: This quality improvement (QI) project evaluated the effectiveness of a telehealth-enabled post-discharge follow-up program in improving patient satisfaction among adult medical–surgical patients discharged following arteriovenous (AV) fistula placement.

Background: Ineffective communication during transitional care contributes to poor patient understanding, decreased confidence in self-management, and lower patient satisfaction. Internal organizational data identified a baseline satisfaction rate of 55%, demonstrating the need for a structured post-discharge intervention.

Methodology: A 12-week QI initiative was conducted using the Plan–Do–Study–Act framework. Registered nurses completed standardized telehealth follow-up calls within 24–48 hours of discharge to reinforce discharge education, assess symptoms, and address patient …

Nurse-Driven Initiatives To Reduce Supply Waste Produced In The Intensive Care Unit, Lance Prince

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this quality improvement (QI) project was to implement a needs-based supply retrieval system using mobile carts and evaluate its effectiveness in reducing supply costs and improving resource stewardship among nursing staff over an 8-week period.

Background

intensive care units are high-resource environments where medical supply overconsumption leads to significant financial strain and environmental impact. Preliminary audits in a high-acuity unit revealed a trend of excess waste driven by the automatic opening of standardized, pre-packaged admission kits regardless of individual patient needs.

Methodology

Guided by the Iowa Model of Evidence-Based Practice, a pre/post-intervention design evaluated 49 patient …

Facilitating Shared Reading Exposure To Promote Health Outcomes In A Rural Pediatric Primary Care Clinic, Meredith L. Longino

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this scholarly project was to address a gap in early literacy promotion for rural children by incorporating the Reach Out and Read program. This program bolsters foundational literacy by providing a book and anticipatory guidance at every well-child visit from birth through age 5. This project was expected to decrease no-show well-child attendance rates and improve provider morale.

Background

The project was implemented in an established rural pediatric primary care clinic in Northeast Texas. 

Methodology

Process implementation was measured through books distributed and EHR documentation of the intervention. Process objectives were measured by no-show rates for …

Improving Nursing Compliance With Pain Reassessment Documentation After Analgesic Administration, Dorcas Okunola

Doctor of Nursing Practice Final Project Abstract

Improving Nursing Compliance with Pain Reassessment Documentation After Analgesic Administration

PURPOSE: This quality improvement project aimed to increase registered nurse (RN) compliance with documenting pain reassessment within 30–60 minutes after analgesic administration in an adult medical–surgical trauma unit at a large academic medical center.

BACKGROUND: Timely pain reassessment is essential for evaluating treatment effectiveness and ensuring safe, patient-centered care. Baseline audits showed inconsistent documentation and compliance below institutional expectations. Evidence supports the use of electronic health record (EHR) prompts combined with targeted nursing education to improve adherence.

METHODOLOGY: A 12-week quality improvement initiative was conducted to reinforce adherence to the …

Implementing An Evidence-Based Wound Care Protocol For Inpatient End-Of-Life Residents That Aligns With Hospice Comfort Care Goals, Oge C. Okeke

Doctor of Nursing Practice Final Project Abstract

Implementing an evidence-based wound care protocol for inpatient end-of-life residents that aligns with hospice comfort care goals.

Purpose

This quality improvement (QI) project aimed to adopt a patient-centered, comfort-focused approach to wound care at the DNP project site and improve patient outcomes by increasing nursing staff's knowledge of evidence-based wound treatment strategies by 20%.

Background

Curative treatments involving aggressive methods do not align with hospice principles. Residents at the project site experience increased suffering at the end of life because of limited nursing knowledge of evidence-based, atraumatic wound care practices for end-of-life patients.

Results

Pre-intervention nursing knowledge survey scores ranged …

Improving Handoff Communication Among Uaps In A Group Home By Implementing Standardized Sbar Tool And Evaluating Its Impact On Communication Quality And Resident Safety, Ola Iweala

Doctor of Nursing Practice Final Project Abstract

Purpose

Improving handoff communication among unlicensed assistive personnel (UAPs) in a group home through Situation, Background, Assessment, Recommendation (SBAR) tool implementation.

Background

Communication failures during shift handoffs among unlicensed assistive personnel (UAPs) in a group home contributed to missed information, inconsistent care, and resident safety events. Baseline observations showed that only 37.5% of handoffs met criteria for high-quality communication, and approximately 75% of safety incidents were related to communication breakdowns.

Methodology

This project was conducted in a group home serving adults with intellectual and developmental disabilities and included 19 UAPs. The Plan-Do-Study-Act (PDSA) model and Adult Learning Theory guided implementation. …

Improving First Case-On-Time Starts In The Operating Room By Implementing A Visual Patient Readiness Assessment Tool: A Pilot Quality Improvement Project, Xochitl I. Miranda-Khayat

Doctor of Nursing Practice Final Project Abstract

Purpose

Delays in first case on-time starts (FCOTS) impact operating room (OR) efficiency, causing compounding schedule delays. This quality improvement (QI) project implemented a visual readiness tool to standardize communication and increase FCOTS rates.

Background

The project was implemented in a 5-room OR in an academic teaching hospital in the Texas Medical Center.

Methodology

Plan-Do-Study-Act (PDSA) cycles and the Consolidated Framework for Implementation Research (CFIR) guided continuous improvement and contextual factors evaluation. Following multidisciplinary education, the visual tool was implemented. De-identified FCOTS data was extracted from the electronic health record (EHR). Qualitative feedback was gathered via Qualtrics (n=17 pre-implementation) and …

Improving Prostate Cancer Patients’ Experience And Understanding With A Pre-Ct Simulation Checklist In Genitourinary Radiation Oncology, Christopher Le

Doctor of Nursing Practice Final Project Abstract

Improving Prostate Cancer Patients’ Experience and Understanding With a Pre-CT Simulation Checklist in Genitourinary Radiation Oncology

Purpose

The purpose of this quality improvement (QI) project was to implement a Pre-CT Simulation checklist for Prostate cancer patients in the outpatient Radiation Oncology Genitourinary clinic to improve patients’ experience and comprehension on their Simulation Day.

Background

The CT simulation is a critical step in treatment planning. Lack of clear, concise, consistent instruction and education preparation prior to simulation day can delay planning and treatment. Currently, there is no standardized checklist to ensure patients are educated and prepared for their CT simulation day. …

Improving Clinic Workflow To Enhance Rubeola Immunity Screening In Pregnant Patients, Courtney Mcduffie

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to improve provider adherence to Rubeola IgG serum order entry for prenatal care visits by implementing a standardized workflow and an electronic medical record (EMR)-based order-entry process in a high-risk maternal outpatient clinic.

Background: Rubeola infection during pregnancy is associated with significant maternal and fetal complications. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) to use serologic testing to determine immunity status, inconsistent provider ordering practices and workflow gaps contribute to missed opportunities for identifying non-immune patients and planning post-partum vaccination.

Methodology: A ten-week intervention period utilized …

Mid-Shift Huddle To Improve Icu Nurse Well-Being And Reduce Burnout, Jesse Cannizzo

Doctor of Nursing Practice Final Project Abstract

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Mid-Shift Huddle to Improve ICU Nurse Well-Being and Reduce Burnout

Purpose

Burnout among ICU nurses negatively affects well-being, job

satisfaction, and retention. This quality improvement project

evaluated a mid-shift support huddle to identify staff stressors

and improve nurse well-being.

Results

The mid-shift support huddle identified high-stress events during 44% of

completed huddles, with workload and unsafe assignments as the

primary concerns. ProQOL scores improved, while employee

engagement findings were mixed, with unchanged well-being and lower

perceived stress manageability.

Background

ICU nurses provide high-acuity care, manage heavy workloads, and

experience emotional fatigue. Brief team huddles and leadership

engagement may improve …

Implementation Of An Acute Critical Event Debriefing To Enhance The Quality Of Cardiopulmonary Arrest Resuscitation In The Cardiovascular Intensive Care Unit At A Safety-Net Hospital, Shara Baker

Doctor of Nursing Practice Final Project Abstract

Purpose

This scholarly project aimed to implement an Acute Critical Event Debriefing (ACED) program in an intensive care unit to improve resuscitation quality by increasing post–cardiopulmonary arrest debriefing completion rates and enhancing documentation of airway confirmation during resuscitation events. The project took place in a 12-bed intensive care unit at a large academic safety-net hospital in Dallas, Texas.

Background

Structured debriefing after cardiopulmonary arrest events was recommended to enhance team performance, clinical education, and resuscitation quality. However, debriefing following code events was inconsistently conducted across many intensive care units, limiting opportunities for team reflection and quality improvement.

Methodology

The Plan-Do-Study-Act …

Improving Timely Administration Of Scheduled Short-Acting Insulin In Hospitalized Diabetic Patients, Edward S. Qu

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this quality improvement project was to improve compliance with the administration of scheduled short-acting insulin within 30 minutes of point-of-care blood glucose testing among hospitalized diabetic patients.

Background

This project was implemented in an inpatient hospital unit caring for patients with diabetes who require scheduled short-acting insulin. Internal audit data showed that compliance with administering insulin within 30 minutes of blood glucose testing was approximately 60%, indicating an opportunity to improve workflow and care coordination.

Methodology

The Plan-Do-Study-Act (PDSA) quality improvement method was used to guide the project. Baseline data were collected from electronic health record …

Implementing An Ehr Handoff Tool To Improve Care Transitions For Patients Requiring Inpatient Dialysis, Jolly Mathews

Doctor of Nursing Practice Final Project Abstract

Purpose

The Quality Improvement (QI) project aimed to implement an electronic health record (EHR)-based SMART phrase handoff tool to improve patient safety outcomes, such as reducing Clinical Emergency Response Team (CERT) activations by 20% during dialysis treatments, minimizing treatment delays, and decreasing communication errors during care transitions. 

Background

The lack of a standardized handoff process led to adverse patient events and prolonged hospital stay. Joint Commission identifies communication failures as a leading cause of sentinel events and recommends using structured handoff tools.

Methodology

The project was implemented at a dialysis unit at Texas Medical Center, Houston. A SBAR (Situation, Background, …

Improving Breastfeeding Confidence And Initiation Rates Through Flyer-Based Education In A Labor And Delivery Setting, Janet Rebollar-Trejo

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to increase breastfeeding initiation within one hour of birth among eligible mothers and improve maternal confidence during the first feed.

BACKGROUND

Breastfeeding provides significant benefits for infants and mothers; however, many mothers receive limited education prior to delivery, contributing to low initiation rates. Early labor breastfeeding education has been shown to improve knowledge, confidence, and initiation outcomes.

METHODOLOGY

A pre-post quality improvement design using the Plan-Do-Study-Act framework was implemented in a Level IV maternal care unit. The intervention included a standardized breastfeeding education flyer with graphics and a QR code video provided during early …

Timely Transfusions In Trauma: Instituting A Transfusion Guideline For Trauma Nurses, Lauren Standiford

Doctor of Nursing Practice Final Project Abstract

PURPOSE This project aims to reduce delays in the blood transfusion process in three non-monitored trauma units at a large academic Level I Trauma Center by decreasing the mean "RN transfusion process times" (RN-TPT) by 20 minutes. The project focuses on optimizing transfusion rates, nursing practices, and electronic documentation integration to enhance transfusion timeliness and improve overall patient care.

BACKGROUND Delays in the blood transfusion process can negatively affect patient outcomes and increase healthcare costs. In three non-monitored trauma units at a Level I Trauma Center, inefficiencies in transfusion rates, nursing practices, and electronic documentation were identified. Barriers included concerns …

Reducing Falls In The Acute Care Setting: A Quality Improvement Project, Elorm M. Adzokpa

Doctor of Nursing Practice Final Project Abstract

Falls remain one of the most common adverse events in acute care settings and are associated with increased morbidity, extended hospital stays, and higher healthcare costs. Orthopedic and trauma patients are particularly vulnerable due to mobility limitations, postoperative recovery, and complex medical conditions. The purpose of this quality improvement project was to reduce inpatient falls on an adult orthopedic and trauma unit by implementing a visual aid to reinforce the 5P fall-prevention framework. A pre–post quality improvement design was used during an eight-week implementation period. The intervention included a standardized fall prevention bundle that reinforced existing Fall TIPS board use …

Parental Experiences With Financial Toxicity In The Pediatric Intensive Care Unit: A Phenomenological Research, Sohrab Alexander Sardual

Dissertations and Theses (Open Access)

Background: Parents of children admitted to the pediatric intensive care unit (PICU) encounter multiple stressors; however, there is a need to further understand their experiences with financial toxicity. Understanding parents’ experiences and perspectives on how they can be assisted is a critical first step to formulating interventions to help parents deal with financial toxicity.

Aims: The aims of this study are (a) to describe the experiences with financial toxicity of parents with critically ill children admitted to the PICU and (b) to explore parents’ perspectives on how they can be assisted in dealing with financial toxicity.

Methods: A phenomenological qualitative …

Reducing Operating Room Turnover Times Through Standardized Workflow, Trinity H. Darnell

Doctor of Nursing Practice Final Project Abstract

Prolonged operating room (OR) turnover times (TOTs) contribute to surgical delays, decreased case volume, and inefficiencies that negatively affect patient care and hospital operations. Lack of coordination in turnover processes and communication among staff are common contributors to extended TOTs. The purpose of this project was to reduce turnover times by implementing a standardized workflow carried out by efficiency teams composed of OR float staff. This project took place in the surgical department of a hospital in Sugar Land, Texas, using a single group pretest-posttest design. Baseline data was collected for 12-weeks prior to implementation and compared to 12-weeks of …

Reducing Emergency Department To Medical Icu Boarding Times: Implementing A Standardized Escalation Protocol At A Large Medical Center Hospital, Taylor A. Robbins-Ethridge

Doctor of Nursing Practice Final Project Abstract

Prolonged emergency department (ED) boarding of critically ill patients awaiting transfer to the medical intensive care unit (MICU) delays access to definitive care and is associated with increased mortality and longer hospital stays. This quality improvement project aimed to reduce ED boarding times for MICU patients by implementing the Bed Ready in 30: Just Say Yes escalation protocol. The Plan–Do–Study–Act (PDSA) framework guided the implementation of a structured escalation process to standardize nurse-to-nurse communication once a MICU bed was marked as ready in the electronic health record. A pre–post observational study was used to evaluate the intervention using electronic health …

Improving Diabetes Management Through Evidence-Based Educational Resources In A Federally Qualified Health Center, Linda F. Dunbar

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this scholarly project was to implement updated culturally tailored diabetes education materials, conduct staff training sessions, and promote consistent documentation of hemoglobin A1c values and adherence to evidence-based guidelines, aligned with current American Diabetes Association (ADA) standards of care. These interventions aimed to reduce the percentage of adults with HbA1c levels greater than 9%.

Background

The project was implemented at a Federally Qualified Health Center (FQHC) in a rural community of Tomball, Texas. The patient population is 73% Hispanic/Latino, who primarily speak Spanish, and are disproportionately affected by diabetes.

Methodology

The project was implemented using the …

Optimizing Inventory Management To Reduce Medication Waste At A Low-Resource Clinic, Maqadus A. Khan

Doctor of Nursing Practice Final Project Abstract

Introduction

This project implemented standard operating procedures for inventory management in a low-resource clinic, incorporating First Expired, First Out (FEFO), Just-in-Time (JIT) ordering, and barcode scanning to reduce medication waste and optimize inventory processes. The aim was to reduce medication waste and optimize inventory processes.

Methodology

The Lean Six Sigma framework guided this project. Root causes of waste included inaccurate demand forecasting, lack of expiration tracking, insufficient staff training, poor stock rotation, and absence of standardized procedures. Baseline waste and practices were recorded. Medications were organized with nearing expirations upfront (FEFO), PAR levels were set, and JIT ordering implemented. Waste …

Reducing Icu Delirium Through Implementation Of The Icu Liberation Bundle, Stacey C. Woodard Dnp

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of this project was to evaluate whether identifying delirium through the Confusion Assessment Method for the ICU (CAM-ICU) assessment followed by treating delirium positive patients with the ICU Liberation Bundle reduced ventilator days or length of ICU stay and increased nursing satisfaction.

Background

ICU delirium is an acute state of confusion that affects up to 80% of ICU patients and increases morbidity and mortality. Decreasing the occurrence of delirium increases patient survivability and improves patient care (Society of Critical Care Medicine, 2023). There is currently no gold standard for managing and treating ICU delirium.

Methodology

This project …

Implementing Interventions To Decrease Readmission Rates In A Behavioral Hospital For People Experiencing Homelessness, Stacy M. Alvarez

Doctor of Nursing Practice Final Project Abstract

PURPOSE This quality improvement (QI) initiative aimed to reduce 30-day psychiatric readmission rates among adults experiencing homelessness by 10% over a 3-month period. Secondary goals included a 15% improvement in medication adherence and completion of follow-up visits.

BACKGROUND Individuals experiencing homelessness and mental illness face higher risks of psychiatric decompensation and hospital readmission. At Houston Behavioral Hospital, 13.34% of psychiatric readmissions involved unhoused individuals, highlighting limitations in standard discharge planning.

METHODOLOGY A pre-post intervention model was used to implement a discharge protocol based on the Transitional Care Model (TCM). The intervention included staff training, the use of a resource guide …

Implementing A Delirium Risk Assessment Protocol For Older Adults To Reduce Post-Operative Delirium, Toni-Ann Thompson

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This quality improvement project aimed to reduce post-operative delirium (POD) in patients aged 65 years and older in a post-anesthesia care unit (PACU) through the implementation of the Confusion Assessment Method (CAM) tool.

BACKGROUND

POD is a significant issue in the PACU, especially among older adults. POD can increase the length of stay in the PACU and hospital, and also increase rates of morbidity and mortality. Prior to this QI project, there was no standardized test being used to screen patients.

METHOLOGY

The Plan-Do-Study-Act (PDSA) cycle was used throughout the implementation of the confusion assessment tool to guide quality …

Protecting Sleep To Reduce Delirium In Patients 65 Years And Older In The Icu, Jessica L. Thomas

Doctor of Nursing Practice Final Project Abstract

Protecting Sleep to Reduce Delirium in Patients 65 Years and Older in the ICU

PURPOSE

This quality improvement (QI) project aimed to reduce the incidence of delirium by 30% through a nurse-initiated, non-pharmacological sleep improvement protocol in the ICU.

BACKGROUND

This project was implemented in a large healthcare organization in Houston, Texas, in a 16-bed Intensive Care Unit.

METHODOLOGY

A pre- and post-intervention study was conducted in the ICU over a period using Plan-Do-Study-Act (PDSA) cycles. Baseline delirium (CAM-ICU) and sleep quality (RCSQ) assessments were obtained during Phase 1. Environmental adaptations, such as low lighting, noise reduction, staff education, and …

Chlorhexidine Bath Procedures To Increase Clabsi Maintenance Bundle Compliance And Decrease Clabsi And Clambi Incidence Rates., Michael Jabituk

Doctor of Nursing Practice Final Project Abstract

Purpose

The purpose of the quality improvement (QI) project was to increase the Chlorhexidine (CHG) bath compliance, to decrease Central Line-Associated Bloodstream Infections (CLABSI and Central Line-Associated Mucosal Barrier Injury Infections (CLAMBI) rates in a transplant oncology unit.

Background

CLABSI and CLAMBI are hospital-acquired infections causing morbidity and mortality worldwide. A project targeting CHG bath compliance was developed to address the increased rates of these infections at a 32-bed transplant oncology unit at a hospital in Dallas, Texas.

Methodology

Two simulation-based videos were created on the importance of CHG baths and demonstration of CHG wipe application at bedside and administered …