Nursing Commons^™

Safe Sleep Modeling In The Neonatal Intensive Care Unit, Barbara Garrison

Doctor of Nursing Practice Projects

Abstract

Approximately 3,500 babies die each year due to sleep related deaths. The 2016 American Academy of Pediatrics Policy Statement clearly states that all health care workers should model safe sleep for infants less than 12 months of age prior to discharge from the hospital. However, at a large, Midwest, level IV, University-based neonatal intensive care unit (NICU), safe sleep was not being modeled. The purpose of this project was to increase adherence to the American Academy of Pediatrics recommendations by implementing a unit-based quality improvement project focusing on policy development, staff education, and parent education.

Although starting out as …

Implementation Of A Depression And Domestic Violence Screening Protocol In An Internal Medicine Setting, Laurie Hopper

Doctor of Nursing Practice Projects

Depression is a widespread problem in the United States, yet only 35% of sufferers seek help for their symptoms. Additionally, almost 25% of women and 14% of men report experiencing some form of domestic violence. Both of these conditions can impact short-term and long-term health and overall function. Early detection, treatment, services, and support can improve patient outcomes.

This project initiated the use of two standardized screening tools, the PHQ-2 for depression and the PVS for domestic violence, in an internal medicine practice where no formal screening process had been in place. During the 3-month implementation period, patients of the …

Sharp Safety And Supply Containment In Procedural Areas, Ariel Wright

Doctor of Nursing Practice Projects

To improve safety in procedural areas, a Midwest hospital piloted supply and sharps counts to reduce both sharp injuries and patient retained supplies. Supply counts are a standard of practice for decades within surgical-operational departments. Despite improved standards within surgical-operational departments, safety measures within procedure areas are limited. With current recommendations for sharp and supply counts and reported sharp injuries in the procedural area, the need to develop and implement a supply count and sharp containment policy was evident. A four-week doctoral project was implemented within the electrophysiology studies (EP) procedural area. EP staff reported using non-standardized techniques to count …

Managing, Mitigating And Minimizing Patient Violence In The Emergency Department, Denise Thompson

Doctor of Nursing Practice Projects

Patient violence in the Emergency Department (ED) is common, varied, and has lasting effects on nurses. Survey and questionnaire responses from 18 nurses in a Midwestern hospital ED revealed mindsets and perceptions of short and long term effects of potential and realized patient violence situations. Patient verbal and physical abuse directed at nurses is generally viewed as an acceptable job risk by the general public, hospital administrators, and nurses. Nurse surveys indicated daily anticipation of physical harm, a sense of helplessness from lack of administrative support, and emotional stress related to acts of patient violence. Support from Occupational Safety and …

Dedicated Preceptors Improve Nurse Residency, Anne Hustad

Doctor of Nursing Practice Projects

Research and evidence support the use of dedicated preceptors during new nurse residency programs to increase nurse retention after the orientation period. A small rural Illinois hospital introduced a nurse internship program in 2017 without the use of dedicated preceptors. The program continued throughout 2018 and nurse retention did not improve as anticipated by the hospital leadership. In early 2019, this author collaborated with the education department to implement a new nurse orientation program that introduced the use of dedicated preceptors. An education bundle was developed and presented to the dedicated preceptors outlining expectations and an orientation checklist. Pre-implementation focus …

Optimizing Data Accessibility To Impact Bcma Compliance, Lucy A. Bischof, Margott Montesinos

Doctor of Nursing Practice Projects

Background: The integration of health information technology (HIT) is an expectation during the healthcare delivery process to ensure quality and accuracy. Data generated from HIT can help facilitate quality initiatives. HIT such as Barcode Medication Administration (BCMA) has been successfully introduced in the healthcare industry with a demonstrated positive impact on patient safety. A small test of change was implemented on a Medical Surgical (MS) and Intensive Care Unit (ICU) which included automated daily BCMA compliance reports sent to leadership compared to the current standard process.

Objectives: To examine impact of reports on the BCMA compliance data. To examine leadership …

Reducing Emergence Delirium In Combat Veterans Through The Development Of A Decision-Tree Utilizing Ketamine And Precedex, Joseph Oldani, Russell Arendt

Doctor of Nursing Practice Projects

Emergence Delirium incidences in the combat veteran population warrant unique anesthetic considerations. Examples of these considerations include the exclusion of a benzodiazepine and the use of low dose Ketamine or Precedex infusions. Researching these considerations, an anesthetic decision tree coupled with a screening questionnaire was developed and implemented in a hospital in Southern Illinois. The tool was developed based on a thorough literature review and a need to condense this information into a working knowledge for clinical application. Implementation of the project included staff education on the tool and the management of Emergence Delirium by using Ketamine and Precedex. A …

Developing The Pedis Pediatric Obstructive Sleep Apnea Screening Tool, Steven Sumpter

Doctor of Nursing Practice Projects

Obstructive sleep apnea (OSA) is the most common type of apnea in the pediatric population. Its prevalence is 0.7%-3.0% (Garcia et al., 2016). The dangers of OSA are multiplied in conjunction with anesthesia because anesthesia resembles a state of sleeping, relaxing the airway, and requiring more intense airway monitoring. Childhood OSA includes increased risk for developing neurocognitive impairment, behavioral problems, failure to thrive, hypertension, cardiac dysfunction, systemic inflammation, and increased healthcare costs (Kothare et al., 2015). A perioperative pediatric OSA screening tool is necessary to reduce airway risks. The PEDIS screening tool is a brief, efficient, and evidence-based tool capable …

Implementing A Health Promotion Physical Activity Program For Middle School Youth In A Rural, Faith-Based Organization, Karmin Maher-Hasse

Doctor of Nursing Practice Projects

Problem: Childhood obesity is more prevalent in rural areas, and these areas have fewer resources to address it. Geographic distance to available resources, health care provider shortages, parental obesity, and poverty contribute to higher prevalence of obesity in rural children compared to urban children.

Rationale: Obesity prevention and treatment often requires long-term healthy lifestyle behavior changes including nutrition counseling and physical activity (PA). It is likely an obese pre-adolescent will have obesity as an adult, and the likelihood increases if obesity continues into adolescence. Pre-adolescence provides a window of opportunity to influence healthier PA habits to prevent overweight (OW) and …

A Faith-Based Quality Improvement Project To Increase Awareness, Prevention, And Management Of Coronary Heart Disease In African Immigrants, Temitope S. Okpebho

Doctor of Nursing Practice Projects

Problem Description: Coronary heart disease (CHD) affects people globally, and it is the leading cause of death in the United States. Despite increased CHD awareness, evidence shows the increased prevalence and low CHD awareness among African Immigrants. According to Boateng et al. (2017), African immigrants are more likely to have CHD risk factors and be unaware. This may be due to changes in eating habits, lack of physical activity, increased stress level, and the adaptation of the Western diet.

Rationale: This project included implementing a culture care theory in a faith-based organization to increase awareness, management, and prevention of CHD …

Improving The Process Of Making Preoperative Home-Medication Recommendations, Andrew Standefer

Doctor of Nursing Practice Projects

Improving the Process of Making Preoperative Home-Medication Recommendations

Many patients presenting for surgery have a list of prescribed medications they take daily to treat various comorbidities. Even though prescription drugs may offer patients therapeutic benefits during the perioperative period, they may also cause adverse effects when used in conjunction with anesthesia during surgery (Marley, Calabrese, & Thompson, 2014). Therefore, identification of medications for the preoperative patient to take or withhold is necessary.

Research indicates that clinicians often make inappropriate decisions regarding preoperative medication management in settings where no guideline exists (Renew, Bolton, Alvarado, & De Ruyter, 2015; Symons & McMurry, …

Implementation Of Crisis Checklist For Local Anesthetic Systemic Toxicity (Last) In The Parturient Patient, Annelise Contino

Doctor of Nursing Practice Projects

The chief anesthesiologist at a large hospital in Illinois requested education and a checklist on the treatment of Local Anesthetic Systemic Toxicity for the medical team involved in the care of parturient patients. The implementation of The Stanford Anesthesia Cognitive Aid Group checklist for LAST and an educational session was completed for all staff involved in the care of the parturient patient. A PowerPoint presentation was utilized to educate on the early recognition and treatment of LAST. The presentation was implemented at the obstetrics department staff meetings and the monthly anesthesia department meeting. A pretest was completed prior to education …

Crna To Cvicu Rn: Implementation Of A Standardized Patient Handoff Checklist For Post-Surgical Heart Patients, Ashley Mcgrath

Doctor of Nursing Practice Projects

Patient handoffs occur when the information and responsibility of the patient is transferred from one health professional to another. Ineffective communication during the critical postoperative phase of the transfer of care (TOC) has been associated with extended hospital stays, increased healthcare costs and patient dissatisfaction. In 2007, the Joint Commission National Patient Safety Goals proclaimed the importance of a standardized handoff process for effective handoffs. The purpose of this quality improvement doctoral project was to assess if the utilization of a standardized TOC checklist from the operating room to the cardiac intensive care unit (CVICU) for post-heart patients improved communication …

Dnp Project: Improving No-Show Rates In Primary Care, Mai-Linh T. Nguyen, Sarah M. Kuzara

Doctor of Nursing Practice Projects

Abstract

This paper explores the factors that contribute to no-show rates in the primary care setting and effective interventions to improve no-show rates. The average no-show rate in the primary care setting is 23%, (Dantas, Fleck, Olivaria, & Humacher 2018). In 2018, the no-show rate at the WeCare Clinic was 50-60%. A literature review was conducted to gather information regarding why patients choose to no-show their appointments, the common causes of high no-show rates, and effective interventions found to decrease no-show rates. We investigated the primary causes of a high no-show rate at the WeCare Clinic by interviewing staff and …

Improving Health Insurance Literacy Within Our Community Through The Use Of Local Libraries, Bonnie Gregg, Jenny Lieu

Doctor of Nursing Practice Projects

Low health literacy is associated with a poorer ability to understand medical information leading to disparities among all ages. Communities play a role in supporting efforts to improve health literacy. Libraries are trusted institutes that offer an environment for all members of the community and serve as places of lifelong learning. A needs assessment approach determined a gap in knowledge regarding health literacy and insurance, specifically the Affordable Care Act (ACA). This project was an exploratory, community improvement project. Information was presented in educational sessions at two local libraries. Participants were also given an informative brochure to accompany the presentation. …

Hepatitis C Screening Protocol In A Rural Primary Care Setting, Katie C. Wollerman, Mackenzie M. Bowers

Doctor of Nursing Practice Projects

Current evidence indicates a need for Hepatitis C Virus (HCV) screening, as the virus can lead to complications if not detected early. Screening is determined by population-based risks, behavioral-based risks, and healthcare-based risks. After criteria are met, patients can be screened by a venous laboratory test. A gap existed in a rural primary healthcare clinic, as providers were not following Centers for Disease Control and Prevention (CDC) or U.S. Preventative Services Task Force (USPSTF) recommendations to screen patients. An HCV screening protocol was developed and implemented in this healthcare facility. The providers opted to only implement screening for population-based risk …

Implementation Of Supplemental Oral Anticoagulant Education To Promote Medication Adherence, Blake Cory

Doctor of Nursing Practice Projects

Proper adherence regarding high-risk medications such as oral anticoagulants (OAC) is essential for reducing the incidence of adverse events such as thrombosis or major bleeding when dosages are missed or inappropriately administered.

The goal of this project was to reduce these events by supplementing current educational practices at a metropolitan cardiac electrophysiology office with new medication education protocols, the development of specific medication informational handouts, and provider training. Providers and staff were provided with medication specific education for Vitamin K Antagonists (VKA) such as warfarin and Non-Vitamin K Agonists (NOACs) such as dabigatran, rivaroxaban, and apixaban for those patients initiating …

The Development Of A Pain Medication Management Protocol, Kirstie Mcgrath, Jane M. Brown, Shannon D. Walle

Doctor of Nursing Practice Projects

Implementation of an organization-wide pain management policy incorporates a multifaceted team approach that could lead to improved patient outcomes. The absence of a standardized opioid prescribing policy within a healthcare organization has led to individual departments adopting their own guidelines. Management of an individual patient’s pain medication is often met with reluctance from providers when a patient is transferred from another department leaving the patient with inadequate care.

Creating A Patient Handout For Venting Gastrostomy Catheter: A Quality Improvement Project, Sally A. Mathews

Doctor of Nursing Practice Projects

At the University of Texas MD Anderson Cancer Center (MDACC), approximately 200 patients undergo placement of a venting gastrostomy catheter annually (venting G-catheter). About 10% of these patients are later seen in the emergency room (ER) for complications related to venting G-catheters. These complications include leakage, infection, skin irritation, and dislocation that require interventions ranging from topical management to exchange of the catheter. The purpose of this project was to create an MDACC-designed patient education handout regarding the care of venting G-catheters as a means of improving patient care and reinforcing these concepts for clinical nurses, thus improving their knowledge. …

Reducing Pressure Injuries In The Intensive Care Setting: Nursing Knowledge And Best Practices Approach, Michelle Harvey

Doctor of Nursing Practice Projects

Background: For many health care organizations, pressure injury (PI) prevention strategies have become a priority focus to improve patient outcomes and associated costs.

Problem: A rural community hospital located in the Eastern U.S. experienced an increase in hospital acquired pressure injuries (HAPIs), predominantly in the intensive care unit (ICU). In 2018, 17.4% of HAPIs occurred in the ICU.

Approach: Implementation of a Quality Improvement project in an adult ICU, providing education and on-going learning activities to nursing staff, and applying a standardized plan of care “bundle” for prevention interventions.

Outcomes: The approach resulted in improved documentation of flotation of heels, …

Cultivating Appropriate Prescribing In A Primary Care House Calls Practice: A Quality Improvement Project, Sarah J. Marzolf

Doctor of Nursing Practice Projects

Problem Description: Polypharmacy in the frail elderly can lead to suboptimal management of medical issues. Primary Care Providers (PCPs) often lack knowledge of best practices regarding deprescribing and lack a systematic process for assessing mediation appropriateness. A quality improvement project was developed and executed at Housecall Providers, a home-based primary care practice in Portland, Oregon to facilitate the incorporation of deprescribing into daily practice.

Interventions: Following a literature review, a curriculum was developed and utilized during an educational intervention for PCPs regarding deprescribing best practices. A system for introducing new PCPs to evidence-based deprescribing for the frail elderly. This information …

Pilot Project: Developing A Standardized Evidence-Based Education Process For Nurses To Enhance New Medication Eduction Of Hospitalized Patients With Heart Failure, Michele Ann Crotteau

Doctor of Nursing Practice Projects

Problem Description: Research has shown that health information is difficult for the average adult to understand while clear communication helps patients feel involved and increases adherence to treatment. The Joint Commission recommends Health Literacy (HL) assessment and the use of the Teach Back Method (TBM). Medication errors that occur between the RN and elderly patient are preventable when the RN communicates effectively about the patient’s medications. A paucity of research exists evaluating TBM for nurse-patient communications. This Quality Improvement (QI) Pilot Project (PP) took place over 3-months, aimed to improve new medication education to elderly patients with Heart Failure (HF). …

The Effects Of Diabetes Self-Care Management Education Paired With Behavior Change Support Program Using Mobile Technology In Improving Disease Knowledge, Self-Care Activities, And Health Outcomes In Adult Type Ii Diabetes, Ji Min Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Research has shown that Diabetes Self-care Management Education (DSME) paired with the Behavioral Changes Support Program using Mobile Technology (BCSP-MT) has improved patient outcomes by promoting self-care activities. Yet, not many primary practices provide BCSP-MT to improve diabetes care.

Objectives: The study aimed to assess the effectiveness of DSME paired with BCSP-MT in adult type 2 diabetes patients to improve diabetes knowledge, self-care practices, and diabetes control in a primary care setting.

Methods: In this quality improvement project, a 3-months, one-arm, pre-post pilot study was conducted in a clinic, the Northeastern U.S. A convenient sample of 14 people with …

Educational Session To Improve The Knowledge And Confidence Of State Agency Surveyors In Deficiency Citation Of Immediate Jeopardy Findings In Nursing Homes, Aileen Renolayan, Msn, Ma, Rn, Phn

Doctor of Nursing Practice Projects

Background: The oversight of nursing homes is a shared federal-state responsibility. Under the agreement with Centers for Medicare and Medicaid Services (CMS, 2018), state survey agencies assess nursing homes using standard surveys. Several studies indicate that the type of deficiencies issued to nursing facilities varies significantly by state, suggesting inconsistency in the survey process for issuing deficiencies. For example, variation in Immediate Jeopardy (IJ) citations among state agency surveyors has been the subject of reports from the Government Accountability Office (GAO, 2019) and the Office of the Inspector General (OIG, 2014).

Objective: To determine if a 1-hour educational session about …

Effect Of Care Transition Referral On Readmission Rates Of Geriatric Patients Discharged From The Emergency Department, Kyla Newbould Ms, Rn

Doctor of Nursing Practice Projects

Background: An increasing population of older adults and their need for healthcare resources, pressures hospitals to reduce per capita expenditures and incorporate population health initiatives to reduce readmissions. Multidisciplinary teams such as care transition clinics may reduce readmissions.

Objectives: This quality improvement project was implemented to (a) develop a risk assessment for readmission, (b) identify, assess, and refer geriatric patients to a care transition clinic, and (c) evaluate hospital readmission rates to determine the effectiveness of the model.

Methodology: English-speaking participants 65 years or older, who were treated in the ED and planned for discharge were recruited in a 50-bed …

Using Five Wishes To Improve Advance Care Planning In A Maryland Primary Care Practice, Amanda Bridges, Msn, Acnp-Bc

Doctor of Nursing Practice Projects

Background: Advance Care Planning (ACP) at this primary care practice was minimal and lacked a consistent process to document existing advance directives (AD) or educate patients about ADs.

Objectives: The purpose of this QI project was to improve ACP engagement, documentation of existing ADs and educate patients about Five Wishes.

Methodology: Adults, at each office encounter, were asked three kiosk questions: Do you have an AD, know what ADs are and want to discuss ACP? The responses were uploaded to the EHR to become an evidence backed, visual reminder. Affirmation of existing ADs were descriptively documented. ACP engagement was analyzed …

Using Multi-Faceted Validated Tools To Evaluate The Functional Outcomes And Quality Of Life In Patients Undergoing Elective Spine Surgery And Associated Referral Patterns For Post-Hospital Rehabilitation: A Quality Improvement Project, Mercy Oigbokie, Msn, Agnp-C, Aprn

Doctor of Nursing Practice Projects

Background/Significance: A lack of validated multi-facet assessment tools to assess postoperative patients’ functional ability and quality of life may result in untimely or no referrals to rehabilitation.

Objective: The objective of the DNP project was to introduce the use of validated multi-facet questionnaires in assessing patient-reported outcomes and to assess effect on the time in generating prescriptive rehabilitation therapies and the type of therapies following elective spine surgery evaluated in the outpatient neurosurgery clinics.

Methods: This was a quality improvement (QI) project comprising of 100 patients (50 pre and 50 post the intervention). After the introduction of baseline data, the …

Implementation Of A Provider In Triage Program In A Level Iii Emergency Department, Rachel Parmer Mph, Msn, Fnp- Bc

Doctor of Nursing Practice Projects

Background: This project implemented a Provider in Triage (PIT) system in a small emergency department (ED) in Washington State. The employment of a PIT to decrease patient waiting time and improve ED flow was supported by a literature review. A needs assessment was conducted, which indicated potential benefit from a PIT system, particularly because several ED metrics are worse than national average.

Aims/Objectives: This project aimed to develop, implement, and evaluate a PIT system by employing ED Advanced Practice Clinicians (APCs). The objectives consist of evaluating the impact of a PIT system on the percentage of patients who leave without …

Multidisciplinary Team Approach To Prevent Hf Readmissions In Rural Areas, Naydu Lucas, Rn, Msn, Mba

Doctor of Nursing Practice Projects

Background: Despite the national efforts to decrease 30-days hospital readmissions, readmission remains a challenge for healthcare organizations across the continuum of care. The aim of this quality improve project was to develop and implement a multidisciplinary team approach to provide education to patients hospitalized with congestive heart failure (CHF) to improve 30-day hospital readmissions.

Method: This project was conducted in a critical access hospital in Northeast Washington. Using a pre-post design, we evaluated the 30-day readmission before and after implementing the multidisciplinary education program for patients hospitalized with CHF. The education focused on disease management, discharge education, pharmacy consult and …

Combating Pediatric Obesity With A Community-Based, Family-Centered Pediatric Obesity Prevention Program, Hillary Mayers, Msn, Fnp-C

Doctor of Nursing Practice Projects

Background: Overweight and obesity among children contributes to significant adverse health outcomes that reduce quality of life. Because children are influenced by the behaviors of their parents, there is a need for multicomponent family-based interventions within the community to help overcome these issues.

Objectives: This quality improvement project provided parents and children aged four to six years old with an interactive nutrition and physical activity educational program to increase their knowledge related to healthy lifestyle patterns and alter BMI status.

Methods: A 10-week pre/posttest design was implemented to evaluate outcome measures including BMI percentile, physical activity and nutritional habits, and …