Nursing Commons^™

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Scholarly Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Scares: A Clinician Guide To Spinal Cord Awareness, Response, And Emergency Support Creation And Implantation Of Scares Protocol Among Hospitalist Advanced Practice Providers, Brittany Biega

DNP Scholarly Projects

While they are more common in patients with oncological disease and trauma, SCE still exist among patients without these comorbidities. Less has been established regarding care protocols in this population. The absence of standardized procedures has been linked to preventable, adverse patient outcomes, including cases of permanent damage due to delayed treatment. This project employs Lean Six Sigma methodologies and Johns Hopkins Evidence- Based Practice to devise a robust SCE protocol, aimed at standardizing care and improving patient outcomes. A multidisciplinary team including general medicine, neurology, neurosurgery, and neuroradiology developed “Spinal Emergency Management Guidelines” protocol, which was implemented within the …

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

DNP Scholarly 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 …

Improving Patient Access To Gastroenterology Through A Nurse-Practitioner-Led Clinic: A Quality Improvement Project, Kayla Northam

DNP Scholarly Projects

The United States has a critical healthcare access issue for gastroenterology patients. Delays in treatment can lead to expensive complications, including emergency room visits, hospitalization, and surgery. Creating a rapid-access clinic (RAC) for gastroenterology so that patients can obtain a quick and efficient evaluation of their symptoms in a shorter appointment time can help decrease the delay in care and generate more revenue for the hospital. Over 8 weeks in 2023, Dartmouth Hitchcock Medical Center Department of Gastroenterology used a telemedicine-only RAC to see patients for 20 minutes rather than the traditional 60-minute period. As a result, the RAC saw …

Increasing Access And Adherence To Cognitive Behavioral Therapy For Insomnia (Cbti) For Adults: A Quality Improvement Project, Kristen Newell

DNP Scholarly Projects

BACKGROUND: Insomnia is a sleep disorder that is becoming more prevalent. It can significantly impact a person's quality of life and it contributes to a substantial economic financial burden. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for insomnia, but patients are rarely referred for this treatment. This quality improvement project focused on implementing motivational interviewing to increase patient utilization of CBTi. It also encouraged utilization of CBTi Coach, a free phone application that has all of the CBTi components, a rigid sleep behavioral plan and frequent follow-up appointments to improve sleep quantity and quality.

INTERVENTION: Patients that …

Quality Of Care Improvement: A Process To Standardize Handoff Communication Between Anesthesia Providers And Post-Anesthesia Care Unit Nurses, Maria Chernyak, Courtney Posten

DNP Scholarly Projects

Introduction: Transition of care is the process in which sending provider teams and receiving provider teams release the care of the patient from one provider team to the next utilizing a communication process. Review of the literature has identified several different protocols in place to systematize communication among providers, however, there is no standardized instrument or process that encompasses the post-anesthesia transfer of care process. Our project goal is to develop a standardized evidence-based handoff communication instrument to be utilized during the transition of care process between anesthesia care teams to the post-anesthesia care (PACU) teams to improve quality of …

Implementation Of A Standardized Medication Reconciliation Protocol In A Psychiatric Stabilization Setting, Sara Robinson

DNP Scholarly Projects

BACKGROUND: Medication errors are a prevalent patient safety concern across healthcare settings. High-quality medication reconciliation is an intervention and expected standard of care that can help to prevent adverse drug events. This quality improvement project focused on implementing a standardized medication reconciliation protocol on a short-stay psychiatric unit.

INTERVENTION: An evidence-based toolkit supported by the Agency for Healthcare Research and Quality (AHRQ), Medications at Transitions and Clinical Handoffs (MATCH) was selected as the framework for developing and implementing this protocol.

Congruent with the evidence-based toolkit recommendations, baseline data collection and needs assessment provided context for tailoring the intervention to the …

Implementing A Health-Related Quality Of Life Assessment Tool In An Outpatient Hematology/Oncology Clinic: A Pilot Quality Improvement Project, Jennifer Holl

DNP Scholarly Projects

BACKGROUND: Although overall and disease-free survival remain the goals of cancer care, health-related quality of life (HRQOL) during and after treatment is increasingly acknowledged as vital to the patient’s outcomes. The purpose of this project was to identify and implement a valid, reliable HRQOL assessment tool into daily clinical practice in an outpatient hematology/oncology clinic at a 25-bed critical access hospital in rural New Hampshire.

METHODS: This project used a methodological design. Descriptive and inferential statistics, plus qualitative analysis were used to determine results. Three nurses and seven patients participated in this quality improvement project.

INTERVENTIONS: The interventions …

Implementation Of Oncology Standardized Scheduling Bundle Impacting Staff Productivity And Patient Satisfaction, Carolyn Brausch

DNP Scholarly Projects

BACKGROUND: Patients having timelyaccess to healthcare services is the entryway to quality of care and patient safety. Timely access is essential in cancer treatment and often requires complex scheduling requiring multiple, highly coordinated, time sensitive appointments. To facilitate optimal clinical care, timely appointment scheduling must be patient-centered. With the heavy scheduling workload growing at the the Cancer Network at Froedtert & the Medical College of Wisconsin and recognition of timely scheduling as a quality indicator, the need to examine the workflow and improve the process became apparent.

METHODS: The goal of the quality improvement project was to provide patients with …

Tackling Burnout: Investing In Nurse Managers To Secure The Future Of Nursing, Enhance Manager Effectiveness, And Support High Quality Patient Care, Corey French

DNP Scholarly Projects

Background: Burnout is a widespread, pervasive issue the healthcare industry. Many efforts related to burnout reduction have been focused on front line caregivers but there is continued opportunity to address burnout in leadership. The global aim of this quality improvement project was to reduce burnout among the nursing leadership team at a large, academic medical center in the greater Boston area.

Problem Description: A preliminary survey was completed to assess for the presence of burnout within the leadership team. Results revealed that more than half of the nurse leaders surveyed were experiencing burnout at least 50% of the time. This …

Use Of A Simplified Protocol For The Prevention Of Postoperative Nausea And Vomiting In Adult Ambulatory Surgical Patients, Roger Horne

DNP Scholarly Projects

Postoperative nausea and vomiting (PONV) remains a common complication affecting surgical patients after receiving anesthesia. Prevention of PONV is important in an ambulatory surgical setting where patient access to rescue treatment is limited after discharge. A quality improvement (QI) project introduced a simplified PONV prevention strategy to decrease the incidence of PONV at a Veterans Health Administration ambulatory surgery center. A retrospective chart audit of all facility surgical patients receiving anesthesia care (n = 94), excluding ophthalmology patients, was conducted prior to COVID-19 restrictions to establish baseline PONV incidence. An evidence-based, simplified PONV prevention protocol was developed and implemented. …

Reducing Turnaround Time From Pathology Collection To Patient Awareness In Gastroenterology Practice, Adrianna Hyams

DNP Scholarly Projects

Background: Means of improving the turnaround time from specimen completion to the patient being notified of results are not well known or researched. The aim of this study is to decrease the turnaround time (TAT) from when the specimen is collected to the time the patient is notified from 4 weeks to 2 weeks. This quality improvement project took place in a privately owned gastroenterology office in southern Indiana.

Methods: An exhaustive literature review was completed to determine the best means of improving pathology TAT. The Plan Do Check Act (PDCA) method of quality improvement was used for this project. …

Health Risks Of Firearm Ownership: A Patient Screening And Education Intervention, Aaron Kahn

DNP Scholarly Projects

BACKGROUND

There is significant health risk associated with firearm ownership. To address this risk a primary care-based intervention was designed and implemented to screen for firearm ownership, educate patients on the risks of gun ownership, and provide patients with resources for reducing associated health risks.

METHODS

A mixed methods study design was employed. Four primary care providers (PCP) practicing in family health volunteered to participate in this intervention. Focus groups with participating PCPs were conducted prior to the intervention to solicit recommendations for intervention protocol and assess participating PCPs current understanding of the health risks of firearm ownership, and after …

Quality Improvement On The Long-Term Care Ventilator Unit: Interventions To Increase Patient Safety And Prevent Patient Harm, Billie Anderson, Joanne Samuels

DNP Scholarly Projects

BACKGROUND: Tracheostomy patients are susceptible to life-threatening emergencies when their airways are compromised. Epidemiologic data suggests that 3.2% to 30% of tracheostomy patents have a complication. The long-term care ventilator unit (LTCVU) is a 25-bed unit in a nursing home. It has noted that 40% of patients have a complication. A group of hospitals demonstrated a 90% reduction in complications through five interventions.

METHODS: The Johns Hopkins Nursing Evidence-Based Practice model was utilized to take the Global Tracheostomy Collaborative interventions and apply them to the LTCVU with the aim of reducing the number of airway complications on the unit by …

A Pilot Of Emergency Department-Initiated Buprenorphine For Opioid Withdrawal And Opioid Use Disorder: A Quality Improvement Project, Jason Lucey

DNP Scholarly Projects

Background: Emergency department (ED) visits for opioid related visits have increased dramatically during the opioid epidemic. Buprenorphine is an evidence-based therapy for treating opioid use disorder (OUD) and withdrawal. Unfortunately, lack of access to pharmacotherapy for OUD, including buprenorphine, remains a challenge. Research supports ED-initiated buprenorphine as a practical, cost-effective strategy which engages patients in treatment better than non-pharmacologic alternatives.

Purpose: The aims of this improvement project were to 1) develop a pilot process in an ED for providing buprenorphine to patients in opioid withdrawal or for OUD; 2) recruit and train a cohort of ED staff on the process; …

An Inpatient Rehabilitation Interprofessional Care Pathway For Traumatic Hip Fracture: A Pilot Quality Improvement Project, Sarah Plante

DNP Scholarly Projects

Background: Each year over 300,000 older adults are hospitalized for hip fracture. The impact of the cost of hip fracture on the US health care system is estimated to be as high as $9 billion, with the typical cost of a hip fracture episode around $30,000. Formalized pathways have been developed and successfully utilized for many patient presentations, including hip fracture, in the acute setting. Although this research is important to the comprehensive care of the elderly hip fracture patient, very little research exists that outlines evidence-based best-practice for patients in the post-acute recovery period.

Purpose: The primary aim of …