Nursing Commons^™

Prevention Of Medical Device-Related Pressure Injuries: A Quality Improvement Project, Monika Grzelczak

DNP Projects

Significance and Background: Hospital-acquired pressure injuries (HAPI) continued to rise, costing the healthcare system about $ 11 billion annually. Medical device-related pressure injuries (MDRPI) account for about 10% of HAPI. They are also noted to be on the rise, especially in the Intensive Care Units (ICU), where multiple medical devices are placed on patients for monitoring and treatment. An intervention to reverse those unfavorable trends is needed. Evidence supports poster education to improve rates of MDRPI.

Purpose: This quality improvement project was conducted to eliminate incidents of MDRPI in the ICU and improve nurses’ perception of the importance of preventing …

Implementing A Fall Screen And Prevention Program In The Primary Care Setting: A Quality Improvement Project, Manpreet Singh

DNP Projects

Significance and Background: Falls are a major health concern in the inpatient and outpatient clinical setting. They are costly for our healthcare system and lead to a sequela of challenges for patients, families and society. These challenges include fear of falling, injury, reduced quality of life, disability and death. Within the primary care setting, a fall risk assessment is required as part of the Welcome to Medicare examination. Primary care providers are reimbursed through the Medical Annual Wellness Visit. The goal of this quality improvement project was to implement a fall risk screening and intervention too for primary care patients …

Utilizing The Phq9 Survey To Improve Depressive Symptoms In Opioid Dependent Adults: A Quality Improvement Project, Taylor Fuhr

DNP Projects

Significance and Background: Opioid dependence continues to be a fighting battle in our country. While many individuals do well on maintenance therapy such as suboxone, they often are faced with comorbid challenges including depression and anxiety. Research shows that the risk for depressive symptoms in opioid dependent adults increases along with the duration of use and increase of dosage (Semenkovich et al., 2014). There is no consistency among depression screening for opioid dependent adults despite the research that suggests the two often coincide with one another. The goal of this quality improvement project was to implement routine depression screening using …

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

Increasing Job Satisfaction Of Nurses Using A Mindfulness-Based Program: A Quality Improvement Project, Melissa A. Haggerty

DNP Projects

Significance and Background

Job dissatisfaction among critical care nurses can result in poor mental health, increased incidences of burnout, increased stress levels, and lower quality patient care. Evidence supports mindfulness practices and their ability to improve job satisfaction by promoting calmness, decreasing stress, and reducing anxiety. In a cardiothoracic intensive care unit (CTICU) in a large teaching hospital in the New York metro area, there was no strategy in place to address low job satisfaction among nurses.

Purpose

Implement a Mindfulness-Based program for CTICU nurses to engage in mindfulness exercises during their shifts and at home. Compare reported job satisfaction …

Application Of Teaching Regarding Injury Appearance In Darker Pigmented Skin Patients: A Quality Improvement Project, Tiffany Akiba

DNP Projects

Significance and Background: The skin is the largest organ of our body, and skin injury prevention begins with accurately inspecting skin. Current practices stress on looking for any signs of redness which often signify that the skin is possibly injured or compromised. However, darker skin tones do not appear red when injured. Assessing for redness is a practice that is suited better for lighter skin tones.

Purpose: Provide education to providers on current skin assessment practices of darker skin tones.

Methods: The IHI Model of Improvement was used for this project, and the Plan-Do-Study-Act cycle was used to test for …

Drug Diversion Education For The Anesthesia Provider Plus One, Denise M. Christie

DNP Projects

The purpose of this quality improvement project was to determine awareness, knowledge, and the value of educating both the anesthesia provider and their spouse/significant other/family member/close friend (plus one) on the risks of drug diversion. Surveys revealed only 20% of plus ones had received previous education on drug diversion. After the educational session, anesthesia providers and plus ones showed increased awareness of the risks of drug diversion (p 0.08), increased knowledge of signs and symptoms, and perceived protection from diversion through education of the plus ones (p 0.08). Further investigation of the persistence of these effects is warranted.

Oxygen Therapy Education To Improve Oxygen Safety In The Emergency Department: A Quality Improvement Project, Latania Wolfe

DNP Projects

Background and Significance: Oxygen is often administered in emergency departments (ED) in US without the nurses and other healthcare staff inputting orders for this medication. This gap in placing orders poses a risk to patient safety and poses a regulation issue.

Purpose: The goal of this quality improvement project is to increase the rate of orders placed for patients using oxygen in ED staff by 12% from March 1, 2023 to May 31, 2023.

Methods: The Model for Improvement guided this quality improvement project. Two PDSA cycles were completed.

Results: PDSA #1 Completed SWOT analysis and used information to …

Spirituality Education For End Of Life Clinicians: A Quality Improvement Project, Mark S. Valigorsky

DNP Projects

Significance and Background: The focus of this project was to strength the knowledge, comfort, and training of end of life(EOL) clinicians working with patients in the palliative care and hospice environments. While spirituality is considered one of the essential domains of hospice care, it is an area that is often brushed aside by staff and patients and their families. Spirituality is inadequately addressed due to knowledge deficits, time issues, and lack of self-efficacy. Addressing spiritual care is particularly important for patients with chronic and end stage illnesses. Patients and their families view spirituality as a way of coping with suffering. …

Naloxone Education To Improve Distribution In Primary Care: A Quality Improvement Project, Joanna Boback

DNP Projects

Significance and Background: Opioid overdose is a major public health problem in the United States. The Centers for Disease Control and Prevention (CDC) developed guidelines for prescribing opioids which have not been widely integrated into practice. These guidelines specify co-prescribing naloxone with opioids as a form of harm reduction. A policy to reflect these recommendations was needed to guide prescribing at a Federally Qualified Health Center (FQHC) in Connecticut to increase low naloxone prescribing rates. Evidence supported the use of provider education to increase prescribing rates.

Purpose: Deliver education to providers across the health system on best practices related to …

Implementation Of The Stop-Bang Screening Tool In The Primary Care Setting: A Quality Improvement Project, Thriciana Powell

DNP Projects

Significance and Background. There are approximately 25 million adults in the United States with obstructive sleep apnea (OSA). OSA is a sleeping disorder that is caused by periodic airflow blockage during sleep. It has been linked to numerous health problems and within the primary care setting OSA is not routinely screened for at visits. This leads to delayed diagnosis of a serious health issue and the potential for poor health outcomes. The STOP-BANG questionnaire (SBQ) is a simple eight-question tool that is used to screen patients for OSA. The STOP section focuses on snoring, tiredness, observed apnea, and high blood …

Reducing Urinary Catheter Usage In The Intensive Care Unit Setting And Education Related To Preventing Cautis: A Qi Project, Kristina Diurno

DNP Projects

Significance and Background: Catheter-associated urinary tract infections (CAUTIs) are common but preventable hospital-associated infections. The inappropriate and prolonged use of indwelling urinary catheters can pose a significant risk for patients and healthcare organizations. The Centers for Disease Control and Prevention identified that the most important factor related to an increased risk of CAUTI is the length of time an indwelling catheter remains in place. This DNP (Doctor of Nursing Practice) project assessed the barriers to removing indwelling catheters in the intensive care unit (ICU) while providing encouragement of prompt removal.

Purpose: Three aims were developed for this quality improvement project: …

Use Of An Alarm Bundle To Reduce Alarm Fatigue In The Icu: A Quality Improvement Project, Blerina Petitti

DNP Projects

Significance and Background: In the critical care setting, frequent false alarms can lead to sensory overload and delayed reactions to alarms (aka, alarm fatigue). Patients are at risk because overtime staff may ignore or become desensitized to all alarm sounds, even true ones.

Purpose: The purpose of this QI project is to establish alarm management protocol in a 14-bed ICU. The goals were to reduce alarm fatigue and create a safe environment for patients and clinical staff.

Methods: The Model of Improvement (IHI, 2023) with cycles of the Plan-Do-Study-Act (PDSA) was used to implement an alarm bundle checklist that …

Evaluating The Impact Of A No-Show Policy: A Quality Improvement Project, Adrianne S. Harding

DNP Projects

Significance and Background: No- shows are a global problem that creates a significant challenge for the healthcare system. When a patient misses an appointment, it decreases health care staff productivity, creates a waste of resources and it negatively impacts revenue (Lance et. al, 2021). Current evidence supports interventions that incorporate voluminous data and artificial intelligence with strategies such as overbooking, appointment notification systems and financial incentives to reduce outpatient no-shows (Oikonomidi et al., 2022). This project will evaluate the impact of a no-show policy and provide insights to improve primary care attendance and inform decisions.

Purpose: To evaluate an outpatient …

Preoperative Pain Management Education And Narcotic Use: A Quality Improvement Project, Sarah Scheller

DNP Projects

Introduction: Comprehensive preoperative education is an important aspect of pain management and helps empower patients prior to their surgery. Evidence supports the use of a combination of the teach-back method, videos, and pamphlets to educate patients prior to their surgery. A quality improvement project was initiated for patients having total shoulder arthroplasty surgery with an orthopedic surgeon in Connecticut.

Methods: An educational video and handout were created, and preoperative education sessions using the teach-back methods were performed. Postoperative phone calls were placed at 24 and 72 hours to assess the patient’s use of narcotic pain medication, alternative pain management medication …

Decreasing Hospital Readmission Rates Of Heart Failure Patients: An Evidence-Based Quality Improvement Project, Elizabeth Rodriguez

DNP Projects

BACKGROUND: Teach back is an evidence-based health literacy intervention that encourages patient engagement in own treatment, adherence to treatment, medications, and quality of care. Implementation of teach back method could positively impact readmissions to the hospital in patients experiencing heart failure and any other chronic diseases and it could improve patient’s outcomes.

OBJECTIVE: The objective of this project was to implement teach back method in a home care agency in the Hartford area in patients with HF to prevent readmission to the hospital.

METHODS: The IOWA model was used and PSDA as tools to support EBP project.

RESULTS: Pre and …

Defining Success In Patient Care Technician Development, Ferrol A. Thomas

DNP Projects

The national nursing shortage has created a need for unique staffing models in healthcare organizations that incorporate unlicensed assistive personnel such as, patient care technicians (PCT). As part of the healthcare team, PCTs provide support to registered nurses contributing to positive patient outcomes. Recruitment and training for PCTs is successful in workforce development programs through employer academic partnership programs. The Success Case Method (SCM) was used to evaluate a local workforce development program for PCT at Nashville State Community College. Participants were evaluated to gain demographic data (n=25) and qualitative interviews (n=6) to provide insight about what made the program …

Implementation Of A Rounding Tool To Promote Compliance With Central Line Dressing Changes In An Adult Intensive Care Unit, Fabiola Demuth

DNP Projects

Abstract

Evidence supports implementing central line (CL) maintenance bundles and nurse-led rounding interventions to prevent central line-associated bloodstream infections (CLABSIs). In a Tennessee intensive care unit (ICU), increased CLABSI rates were associated with inconsistent CL dressing maintenance and documentation. This Doctor of Nursing Practice scholarly project was implemented to improve ICU CLABSI rates and reinforce nursing standard practices for CL dressing care. This quality improvement project used the Institute for Healthcare Improvement (IHI) model for improvement, which used the plan, do, study, act (PDSA) cycles as part of the framework to implement a daily nurse-led rounding tool in the ICU, …

Increasing Colorectal Cancer Screening Uptake Among Hispanic/Latino Patients: A Quality Improvement Initiative, Erick Hernandez Campos, Elizabeth Morse, David Phillippi

DNP Projects

Background: In 2021, cancer (CRC) screening rates for Latino men (42%) and women (47.5%) remain well below the Health People 2020 target (70.5%). Extensive documentation of barriers for screening include language, insurance status, and other sociocultural barriers which contribute to delays in diagnosis and/or diagnosis at advanced stages of the disease, and worse health outcomes. Latinos need culturally and linguistically appropriate health promotion interventions aimed to increase CRC screening rates with any modality (FIT, Cologuard, or Colonoscopy).

Methods: The Donabedian Structure-Process-Outcome (S-P-O) Model for quality improvement was used to develop and target a provider-driven, language-concordant communication interventions for …

Learn, Reflect, Practice, Discuss: A Professional Development Pilot For Clinical Nurse Educators, Jessica Savage, Linda Wofford Dr., David Phillippi Dr.

DNP Projects

Abstract

AIM: The aim of this project was to assess the effect of a professional development pilot on the self-efficacy among clinical nurse educators toward evaluation and assessment of students in the clinical setting.

BACKGROUND: Nursing schools employ clinical nurse faculty with varied levels of experience and formal education in teaching. Positive student outcomes are dependent on the competency of their nursing faculty, yet best practices to train and support the professional growth of clinical faculty have not yet been identified.

METHOD: A multi-modal professional development pilot including online-learning modules, self-reflection, practice-learning, and peer-mentoring components was designed and implemented with …

Women's Stories Of Reaching A Diagnosis Of Endometriosis: A Qualitative Study, Susan C. Debolt

DNP Projects

Endometriosis is a chronic gynecological condition affecting 10% of reproductive-aged women worldwide. Women with endometriosis often experience a decreased quality of life compared to women without endometriosis. The average time to diagnosis is greater than six years for adult women and greater than 11 years for adolescents. Yet, there is little research investigating the pre-diagnostic experiences of women with endometriosis. This study aims to inform healthcare providers of patients' pre-diagnostic experiences of endometriosis in an effort to improve patient care. Using one-on-one, semi-structured online interviews and a qualitative design, this study explored six women's pre-diagnostic experiences of endometriosis. The main …

Culturally Sensitive Emergency Care For Sexual And Gender Minority Youth, Kaysi Goodall

DNP Projects

There is substantial evidence of disparities in access to healthcare and health outcomes affecting sexual and gender minority youth (SGMY). However, evidence of SGMY cultural sensitivity training for pediatric emergency health professionals is limited. This quality improvement research project in an urban pediatric emergency department (PED) used a cross-sectional, pre-test post-test design to improve health professionals’ knowledge, attitudinal awareness, and clinical preparedness in caring for this population. It was informed by the Institute for Healthcare Improvement’s Model for Improvement and completed in four Plan-Do-Study-Act (PDSA) cycles. Evidence-based pedagogical strategies were utilized for a 60-minute staff training session, including introducing foundational …

Exploring Factors Influencing Nursing Engagement In 4ms Initiatives On An Inpatient Older Adult Unit, Sarah Nelson

DNP Projects

Background: The older adult population is growing, and these individuals often have health challenges that require complex nursing care. On an older adult unit in Tennessee, a 4Ms (What Matters, Medication, Mentation, and Mobility) Age-Friendly care initiative was implemented to improve care and outcomes. Early data showed inconsistent nursing engagement with 4Ms initiatives and qualitative data on engagement factors was needed to increase nursing support and improve patient outcomes. Purpose: Therefore, this scholarly project explored factors influencing nursing staff engagement with the 4Ms initiative on an older adult unit. Methods: Nurses and …

Early Progressive Mobility In The Micu: A Qi Project, Kenneth Johnson

DNP Projects

Abstract

Background: Immobility causes grave harm to ICU patients. There is not a body system that bedrest does not affect negatively. The MICU has an early mobility protocol; however, patients are often left in bed, PT/OT is underutilized, and nurses are unfamiliar with the current early mobility protocol.

Methods: The Plan Do Study Act quality improvement method was used for this project which ran from September 1 to November 30, 2022, and involved the MICU RN staff. This QI project evaluated the current early mobility protocol, assessed barriers, determined the nurse’s perceptions, and offered recommendations for sustainability.

Intervention: The project …

Impact Of Teamstepps On Team Performance In An Oral And Maxillofacial Surgery Practice, Katherine E. Lee

DNP Projects

Effective communication and teamwork skills among oral and maxillofacial surgery (OMS) teams are essential for quality and safe patient care. As some in the profession assert that the team model for delivering anesthesia care is integral to their history of safety, the model continues to be scrutinized by professional groups whose members seek to limit oral surgeons’ ability to provide anesthesia services in the office setting. This quality improvement project assessed how introducing the TeamSTEPPS Office-Based Care (OBC) program in an OMS clinic impacted team dynamics. The impact of TeamSTEPPS OBC training on attitudes and perceptions of teamwork was evaluated …

Exploring Hapi Incidence In Patients Admitted Through The Ed: A Quality Improvement Initiative, Alexa L. Tietgens

DNP Projects

Each year in the U.S., pressure injuries, or PIs, are responsible for more than 60,000 patient deaths and billions of dollars’ worth of treatment costs. Research shows that roughly 95% of all PIs are preventable by following evidence-based practice guidelines which include early identification of patients at risk, frequent skin assessments, and implementation of prevention strategies. However, the ED environment creates unique risks for PI development due to the routine use of hard surfaces (i.e., stretchers, backboards, exam tables) and frequent hospital overcrowding. Although nurses play a pivotal role in PI prevention, frequent staffing shortages, high patient acuity levels, and …

Perceptions Of Preparedness Among New Graduate Nurses: Traditional Curriculum Versus Concept-Based Curriculum, Ashley A. Wheeler, Steven Busby, David Phillippi, Tammy Legge

DNP Projects

Concept-based curriculum (CBC) is a newer trend in nursing education curriculum aimed at preparing new graduates to enter the workforce as generalist nurses better suited to care for a more medically complex population. Using CBC, students are introduced to concepts in order to build conceptual understandings as they engage in knowledge and skill learning, as opposed to a traditional nursing curriculum that is taught in sections grouped by patient population and medical complexity. At a nursing school housed within a private university in the southeast, the traditional nursing curriculum was replaced with CBC in 2016. To better understand the preparedness …

Implementation Of A Patient Satisfaction Survey At A Free Community Clinic: A Quality Improvement Project, Nora O'Sullivan

DNP Projects

Background: The uninsured, underinsured, and underserved populations in the US are impacted by health disparities and have unique experiences with healthcare. Yet, settings which serve these populations – the “safety net”- are not adequately supported to gather patient experience data. In Connecticut, Fairfield County has a higher percentage of uninsured people than the overall state. Additionally, this population has demonstrated higher frequency of emergency department utilization than the overall population. Therefore, processes to measure the barriers to accessing quality care and patient experience and satisfaction with care are needed in safety net clinics to promote elimination of health disparities and …

Use Of A Worksite Physical Activity To Improve Subjective Daytime Sleepiness Among Night Shift Healthcare Workers: A Quality Improvement Project, Marthe Sooh Nkongo

DNP Projects

Background and Significance: Shift work including work schedules beyond the typical "nine-to-five," causes the disruption of sleep-wake behaviors (Healy et al., 2021). The circadian misalignment is a potential pathway for the development of metabolic diseases, excessive daytime sleepiness, sleep deprivation, and declines in alertness and performance among night shift workers (James et al., 2017; McHugh et al., 2020; Parry et al., 2018). Emerging evidence suggests that physical activity synchronizes the sleep-wake cycles (Healy et al., 2021).

Purpose: This quality improvement project (QI) aimed to improve night-shift nurses ‘subjective daytime sleepiness by incorporating a 4-week worksite walking activity during working hours. …

Implementation Of A Daily Central Line Maintenance Audit Form In An Outpatient Infusion Center: A Quality Improvement Project, Sarah E. Christiana

DNP Projects

Significance and Background: Best evidence supports central venous access device (CVAD) dressing changes occur every 7 days or sooner, if indicated. At a community hospital in New England, patients receive outpatient antimicrobial therapy via CVADs. It is vital that nurses adequately maintain CVAD dressings according to evidence-based protocols to reduce the risk of central line-associated bloodstream infection (CLABSI). CLABSIs, associated with increased morbidity, mortality, and health care costs, are largely preventable through proper CVAD maintenance. At the project site, a review identified that dressing changes were frequently changed beyond the 7-day parameter. Documentation and surveillance processes were identified as opportunities …