Nursing Commons^™

Preventing Maternal Falls, Blair Burkhart

Master's Projects and Capstones

Patient falls are unfortunate events in healthcare that are an essential quality improvement focus during patients’ hospital stays. At Hospital X, a private institution located in the suburbs of a large city, there had been 23 maternal falls within the last three years. This increase in maternal fall rate puts this hospital’s maternity unit above the average of other hospital’s fall rates according to the National Database of Nursing Quality Indicators. This quality improvement project aimed to reduce the rate of maternal falls on postpartum units through various forms of staff education. Education included Morse Fall Scale scoring, Sara Stedy …

Reducing Postpartum Maternal Falls: A Quality Improvement Project, Sarah L. Iroz

Master's Projects and Capstones

Falls are an unfortunate, common occurrence in the healthcare system and are often not thought to be a problem in the obstetrics population. Key stakeholders in a Northern California hospital brought the issue of maternal falls to leaders of the quality improvement team on the maternity unit. In the last three years, there have been 23 falls on the maternity floor, making their fall rate above the national average. It is the purpose of this project to aid the quality improvement team in reducing postpartum maternal falls over the next three years. After conducting a unit assessment, performing a literature …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Motivated2move: Icu Liberation And Early Progressive Mobility In Ventilated Patients, Leslie S. Bigler

Master's Projects and Capstones

The Motivated2Move: ICU Liberation and Early Progressive Mobility in Ventilated Patients project was implemented in a 24-bed intensive care unit (ICU) in a 241-bed general care, stroke certified not-for-profit community hospital in northern California. The primary purpose of this project was to educate the nurses on the structure and implementation of the Society of Critical Care Medicine’s evidence-based ICU Liberation (ABCDEF) Bundle (Society of Critical Care Medicine, n.d.). A secondary purpose of this project was to coordinate an early progressive exercise and mobility protocol for all ventilated patients. The primary goal of the project is 100% compliance with the ICU …

Reducing Hospital Readmission Rate In Chf Patients Through Early Individualized Patient Discharge Education, Anthony Ensah

Master's Projects and Capstones

The term congestive heart failure (CHF) is a chronic condition that occurs in a person when the heart stops doing its normal activity of pumping blood to the rest of the body for the body. Heart failure normally occurs when the heart can no longer pump (systolic) or fills (diastolic) pressure adequately to the body. Because heart failure is one of the leading causes of death in the United States this project was conducted on one of the Northern California San Francisco Bay- Area hospitals to assess patients understanding and knowledge on the presenting signs and symptoms of heart failure …

Reducing The Postpartum Readmission Rate With Standardized Discharge Teaching, Darlene Day-Herzog

Master's Projects and Capstones

Problem: Hospital readmission rates are one of the quality metrics that matter for hospital reimbursements. In a large Northern California healthcare system, the postpartum readmission rate is often above the national average.

Context: The hospital designated as the main location for high-risk deliveries within a 30-mile radius has an Acute Care Obstetric postpartum population where twenty percent of the patients are at an increased risk for readmission.

Interventions: The project implemented the use of a standardized discharge teaching script and educational materials to be used by nursing staff throughout the patient’s hospital stay to see if multimodal standardization leads to …

Decreasing Maternal Breastfeeding Dissatisfaction During The Night Shift Related To Lactation Support, Robyn Caston

Master's Projects and Capstones

Abstract

Problem

This paper will discuss the Clinical Nurse Leader (CNL) project's specific aim: to decrease maternal dissatisfaction during the night shift related to lactation support in a high-risk maternal department.

Context

Research has shown that adding lactation support improves the decision to exclusively breastfeed and increases the duration. Breastfeeding for all infants starting at birth and continuing until at least 6 months of age has been recommended by the World Health Organization, UNICEF, and the American Academy of Pediatrics. Many studies about lactation support have demonstrated the health benefits to mothers and their infants.

Interventions

A baseline survey will …

Improving Medical-Surgical Nurses’ Confidence In Initiating The Code Blue Process, Moung Sui A. Lee

Master's Projects and Capstones

Lack of confidence in responding to codes can decrease patient outcomes, for any delay in care reduces the chances of revival. As codes occur less frequently in medical-surgical units, nurses who work in this specialty are not as equipped to respond to codes like their ICU or ER colleagues. To address this concern, a code blue readiness training was implemented in six different medical-surgical units of an East Bay hospital. Pre and post surveys were utilized for data comparison on nurses’ confidence in responding to various steps of a code. The results revealed an overall increase in confidence. For this …

Employee Engagement And Increasing Patient Satisfaction In The Pediatric Outpatient Setting, Carol Liang

Master's Projects and Capstones

Problem: An ambulatory pediatric surgical center in the San Francisco Bay Area has an organizational goal of reaching the 85th percentile in NRC patient satisfaction scores. The annual compliance report states the current score is at 80.7 as of September 2021. These NRC findings indicate several areas for improvement including: (1) trust providers with care, (2) care providers listened, (3) was told when could leave, (4) got help as soon as wanted, (5) care provider explain things, (6) NPS: facility would recommend, and (7) procedure began on time.

Context: Priorities include implementing strategies to increase employee engagement and patient satisfaction. …

It’S Hapi Hour: An Action Plan On Preventing Hospital-Acquired Pressure Injuries, Emira Maureen A. Romero

Master's Projects and Capstones

Hospital-Acquired Pressure Injuries (HAPIs) are detrimental to both the hospital and the patient as they are costly, painful, and can lead to further infection and an increased length of stay. Although this problem is seen across the country, this action plan focuses on a microsystem (i.e. medical-surgical telemetry unit) in Hospital A in the San Francisco Bay Area. The target population includes medical-surgical telemetry patients at high risk for HAPIs (i.e. Braden score <18, moisture/mobility scores <2, patients with devices at risk for device-related pressure injuries). The proposed intervention is an evidence-based HAPI prevention bundle that includes utilization of wound care champions and turn teams, increasing attendance of daily huddles, implementing a standardized algorithm for escalation and documentation, and reinforcement of evidence-based HAPI prevention measures. Effectiveness of this bundle will be measured through chart audits, nursing questionnaires, and staff interviews. These measures will be conducted 12 months post-implementation and findings will be compared to the baseline data in order to investigate whether there is a reduction in HAPI incidence. Since this project is currently in the Study phase of the proposed Plan, Do, Study, Act (PDSA) cycle, this action plan concludes with recommendations of how the team can continue to move forward in addressing the project’s specific aim.

Hapi Prevention Bundle: An Initiative To Prevent Hospital-Acquired Pressure Injuries, Karla D. Penilla Lozano

Master's Projects and Capstones

Problem: Hospital-Acquired Pressure Injuries (HAPI) are a serious health problem as they increase patient morbidity and mortality. They are detrimental to patients, families, and healthcare systems. Context: Research supports HAPI prevention bundles are a way to standardize care processes and reduce the incidence of pressure injuries. This evidence-based practice intervention was initiated to develop a HAPI prevention bundle in an adult Medical-Surgical Telemetry unit. A literature review was conducted to identify the best HAPI prevention practices. Intervention: The evidence-based pressure injury preventive bundle includes interventions consistent with proper skin assessments and documentation, patient risk identification, development of Wound Care Champions, …

The Relationship Between Surgical Site Infections And Hand Hygiene Discharge Teaching, Eishlee Renel A. Jasa

Master's Projects and Capstones

Problem: In the span of a nine-month period, the incidence of surgical site infections (SSIs) in a singular perioperative unit reached 13. SSIs have been linked with negative consequences for both the patient and healthcare system, decreasing quality of life and increasing costs.

Context: The 20-bed post-anesthesia care unit (PACU) primarily serves adult patients in the East Bay Area, where a variety of surgeries including elective and emergent procedures are performed. This facility specializes in general surgeries, where laparoscopic excisions and hernia repairs were the most commonly observed.

Intervention: The Standardized 3-Step Hand Hygiene Discharge Teaching is aimed to improve …

Enhanced Recovery After Surgery: Necessity Of Real Time Tracking In Quality Measures And Outcomes, Emily Owens

Master's Projects and Capstones

Abstract

A High Reliability Organization (HRO), such as this Northern California Medical Center, holds itself to high standards of performance in the areas of recognition, ranking, and accreditation. The commonality between these high-scored and valuable acknowledgements is the pillars of Quality Outcomes. As benchmarking and reporting allow this facility to measure outcomes against self and other plans, it greatly strengthens the internal focus for continual improvement and goal setting in direct patient care and outcomes. A deeper layer of the Quality Department includes the bundle “ERAS – Enhanced Recovery After Surgery”, which is compiled of principles aiming to minimize opioid …

Improving Patient Hand-Off Communication By Utilizing The Situation-Background-Assessment-Recommendation (Sbar) Tool Between The Perioperative Services Departments, Maureen Mijares

Master's Projects and Capstones

Problem: The Situation-Background-Assessment-Recommendation (SBAR) patient handoff communication is required when the patient is transferred from one department/unit to the next phase of care. There is no standard SBAR utilized within the perioperative services departments.

Context: There are three types of patient handoff communication utilized in the perioperative services departments; Electronic Health Record (EHR), paper form, and verbal via phone.

Intervention: A standardized SBAR patient handoff communication tool to provide a framework to improve patient handoff communication between nurses within the perioperative services departments.

Measures: The outcome measure for this process improvement project is defined as the number of patient handoff …

Code Blue Readiness: Improving Nurse Confidence And Performance, Michelle Zia Sultani

Master's Projects and Capstones

In the event of a code blue, otherwise known as a cardiac arrest, in a hospital setting, the nurse is usually the first to respond. A nurse must be confident in themselves and their skills to provide quality compressions and other BLS skills. Many nurses on medical surgical floors do not experience a code blue. This quality improvement project aims to improve the confidence, and quality of Code Blue readiness in nurses working on Medical Surgical units. The process begins with nurses answering a pre-survey about their current confidence in handling a code. The process ends with nurses answering a …

Targeting Nstemi Readmissions: Education To Protect The Hearts Of Our Patients, Gisha Gireesan

Master's Projects and Capstones

Section I: Abstract

Problem: January and February 2021 data showed a rise in readmissions for the NSTEMI population. This is significant as 2020 had a readmission rate of 5.6% and 7.3% in 2019. This sudden increase in readmissions within the first two months of the year is a cause for concern and immediate action is needed.

Context: 2020 had a reduction in cardiac catheterizations due to the multiple canceled cases during the COVID 19 pandemic. As the cases were being rescheduled along with new cases in 2021, the institution experienced an uptake in readmissions.

Interventions: The staff of department 220 …

Improving First Case Starts For A Neurosurgery Or, Tara L. Goodall

Master's Projects and Capstones

Problem: On-time first cases for operating rooms (OR) is a worldwide focus for improvement. OR delays have many adverse effects, including economic costs and patient and facility staff satisfaction.

Context: The site for this improvement project is a medium-sized hospital in Northern California. There are 12 ORs, with an average of 600-700 cases. Neurosurgery was the chosen specialty due to low on-time starts and long delay minutes. The focus was working with one OR to improve first case on-time starts by 20%.

Interventions: A worksheet was created to track room setup, delay reasons, and delay minutes. A visual setup guide …

Specialty Palliative Care: A Quality Improvement Project, Leticia Ries

Master's Projects and Capstones

Abstract

Problem: Patients identified on the regional database as specialty palliative care (SPC) patients with congestive heart failure (CHF) have not been consulted annually, as expected by evidence-based practice.

Context: Twenty-three percent of patients with a life-limiting illness on the SPC registry were seen year to date. Patients with CHF are vulnerable populations who benefit from an SPC consult to address quality of life, frequent admissions, and suffering.

Interventions: A rapid experiment of two interventions was evaluated for a solution approach. An electronic report identifying hospitalized registry patients and a standardized triage process were the critically assessed interventions to mitigate …

Optimizing Interprofessional Rounds To Reduce Extended Length Of Stay In Complex Patients, Christina May P. Santiago

Master's Projects and Capstones

Problem: Organizations have taken measures to reduce the length of stay by addressing logistical issues such as care coordination across the continuum. This becomes especially important for patients being discharged to skilled nursing facilities (SNF), where placement can be impeded due to complex care needs. In March 2021, the facility accounted for 20% of all extended length of stay (ELOS) patients across the organization. The average ELOS was 36 days, with 42% of these patients being discharged to a SNF.

Context: The Extended Length of Stay (ELOS) team functions at a mesosystem level within twenty-one medical centers across Northern …

Enhanced Recovery After Surgery: Effectiveness Of Real Time Data Tracking Tools, Alatia S. Jentons

Master's Projects and Capstones

Enhanced Recovery after Surgery (ERAS) has been proven by evidence to lower both recovery time and postoperative complication rates while also being cost-effective. It is a new recovery process that consists of several bundles in order to meet adherence. The hospital site where this project was conducted was at a Northern California Medical Center which provides care for in-patient postoperative, urgent and non-urgent cases. On our assigned units, we identified the potential for improvement after observing a lack of standardization of real-time charting for ERAS. This resulted in retro data, which is not an effective way to collect data when …

Increasing Lactation Consultant Support To The Mch Unit, Daniella Grace Mcclendon

Master's Projects and Capstones

Problem: Breastfeeding is the most beneficial feeding choice for newborns and one of the best ways for mothers to bond with their newborns. In the current Maternal Child Health (MCH) unit, exclusive breastfeeding rates have fallen lower than the unit’s goal of 82%.

Context: Exclusive breastfeeding, when a newborn consumes only human breastmilk, is not always an easy process to initiate immediately after birth and in the early postpartum period. On this specific unit, there is not enough lactation consultant support to provide all patients on the unit.

Interventions: This project considers adding additional lactation consultants to support the MCH …

Preventing Pressure Injuries On Patients Undergoing Treatment With Extracorporeal Membrane Oxygenation (Ecmo), Hediyeh Shakeri

Master's Projects and Capstones

One of the top National Patient Safety Goals by The Joint Commission is to prevent hospital-acquired pressure injuries, which is reiterated by Centers of Medicare and Medicaid as a valuable metric in determining the quality of patient care and safety as well as hospital performance. The Agency for Healthcare Research and Quality reports over 2.5 million patients affected by hospital-acquired pressure injuries per year, costing between $9.1-$11.6 billion per year with the cost of individual patient care ranging from $20,900 to 151,700 per pressure injury (Agency for Healthcare Research and Quality, 2014). Approximately 30% of these cases are related to …

Patient Coordinated Care Response Team, Joshua Fox

Master's Projects and Capstones

Section I: Abstract

Problem: Communication between medical professionals and patients is a critical element to patient satisfaction and safety. The 2020 patient overall satisfaction scores for the local Roseville hospital were 73%. These data demonstrated an opportunity to enhance processes and the culture at the local Roseville hospital to meet the communication needs of its patient population.

Context: A patient coordinated care response team was developed to improve communication for newly diagnosed cancer patients or other life-altering diagnosis patients.

Interventions: A survey was completed to establish the current state of patient satisfaction with communication practices with healthcare providers in the …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

A Peer Feedback Process To Improve Assistant Nurse Manager Job Satisfaction, Juanita A. Jularbal-Walton

Doctor of Nursing Practice (DNP) Projects

Problem

Healthcare organizations offer different methods of training for emerging and newly hired Assistant Nurse Managers (ANM). Without sufficient orientation to what the role requires, new ANMs receive many requests without adequate guidance on how to respond to patient, staff, and leadership requests. This experience creates unhealthy work environments with low job satisfaction and high turnover rates.

Context

Peer feedback provides an opportunity to reflect on the purpose of the Assistant Nurse Manager role. With sufficient orientation and peer feedback, front-line assistant nurse managers develop competency and role satisfaction, as evidenced by reduced turnover and improved retention.

Intervention

This project …

Bullying In The C-Suite: A Nurse Leader Perspective, Kimberly Ann Colonnelli

Doctor of Nursing Practice (DNP) Projects

An estimated 35% of American workers have experienced bullying, and in 80% of those situations, the perpetrator was a supervisor or boss. 1 However, the reality is that bullying can come from anyone in the workplace, including subordinates. Victims are generally well liked and good performers, making them feel like threats to a bully’s power base. Bullying, unlike harassment, is not a legally defined behavior, so no laws currently exist to punish it. Victims are, therefore, at the mercy of their bosses, supervisors, co-workers, and human resource departments for protection or relief. Bullying is not a singular event, but rather …

Manager Onboarding To Improve Retention, Knowledge, And Confidence To Lead, Christine Asiimwe

Doctor of Nursing Practice (DNP) Projects

Objective: The purpose of this paper is to review the literature on manager onboarding best practices and their impact on turnover intention, knowledge, and confidence to lead teams in primary healthcare settings.

Background: Primary care onboarding is often insufficient due to competing operational priorities, time constraints, lack of mentorship, and cost. With primary care increasingly the setting for affordable, coordinated, end-to-end patient care, primary care managers must be well-prepared to lead the care team.

Methods: A review of the literature identified best onboarding practices associated with job satisfaction and turnover, reduced time to proficiency, increased knowledge, and confidence to lead. …

Development And Implementation Of An Evidence-Based Practice Mentor Fellowship, Stacy L. Alves

Doctor of Nursing Practice (DNP) Projects

Background: The Institute of Medicine (2008) set a goal that 90% of healthcare decisions would be based on the best evidence possible by 2020, yet many challenges remain. Common barriers include clinicians’ beliefs about the value of evidence-based practices, their competency to implement it, and systems issues such as time, resources, and organizational value and preparedness (Melnyk et al., 2017).

Local Problem: A hospital within an integrated health care system sought to increase the use of EBP for clinical decision making. A gap analysis revealed a lack of sufficient EBP mentors to lead efforts to promote system-wide EBP implementation.

Context: …

Patient Placement Matters: A Systematic Review Of The Impact Of Multiple Patient Placement, Jacqueline Strinden

DNP Qualifying Manuscripts

Abstract

Background

Inattention to the frequency of patient movement has been correlated with system-induced harm events, diminished favorable health outcomes, and reduction in patient and staff satisfaction. The incidence of adverse events increases significantly when multiple unnecessary lateral relocations result from secondary efforts to relieve hospital capacity constraints and improve efficiency.

Methods

A systematic review of literature was conducted to evaluate the impact of adverse events, patient and staff perceptions, and resource utilization on frequent patient placement events.

Results

Results of the analysis demonstrate that increased adverse events, negative patient and staff perceptions, increased workload, and resource utilization is significantly …

Leveraging High Reliability And Transformational Leadership To Create A Healthy Work Environment, Megan Gillespie, Megan Gillespie

DNP Qualifying Manuscripts

Background: Nurse leaders must create a collaborative work setting to promote a healthy work environment (HWE). The Joint Commission reported in 2014 that 71% of physicians and nurses reported disruptive behavior was linked to medical errors. The culture of a team sets the foundation of safety for patients and nurses. A HWE is necessary to ensure agility, progress and effectively strive for zero harm. Nurse executives are challenged to empower front-line leaders to create a HWE conducive to open communication, psychological safety and results in a setting where employees can thrive.

Problem Description: There is an epidemic of bullying and …