Nursing Commons^™

Improving Medication Side Effects Documentation And Clinician Understanding In Home Health, Katherine Bales

Master's Projects and Capstones

Abstract

Problem: In home healthcare services, care experience scores are increasingly the strategy for evaluating the continuity of care to patients who require post-hospital follow up and guidance on medication management. Clinician understanding of how to use the available medication education tools impacts how well patients are able to manage their own care.

Context: The organization’s Home Health clinicians have not done well providing medication education on side effects as evidenced by low survey scores. The focus of the project is improving the medication education provided to patients and documentation thereof. The project takes place in a home health microsystem …

Improved Data Communication With Frontline Staff, David Sprecher

Master's Projects and Capstones

Problem: Frequently, communication from the Quality Department (QD) needs to be filtered through several organizational layers without first-hand knowledge of what message was given to frontline staff. Current mechanisms of communication between the QD and front-line microsystem teams have barriers preventing them from being consistent and reliable.

Context: Research has found that collaborating with and supporting frontline staff was key to establishing a culture that supports change and a focus on safety. Establishing open communication and effective teamwork with individuals on the frontline leads to shared values within a team and better collaboration which drives performance improvement.

Interventions: For trended …

Instituting A Preceptor Program In Home Health, Abbi Arnold

Master's Projects and Capstones

Problem: Staff being unfamiliar with the role of being a preceptor impacts their ability to perform the job well. Insufficient understanding of a new role creates stress and uncertainty which can lead to poor employee retention or high job dissatisfaction.

Context: The setting for this project is a large hospital-based home health agency that has an average daily census of 375 patients. The project was a collaboration between home health management and the quality department.

Measures: A measurement strategy was developed to meet the outcome measure, process measure, and balancing measure. The outcome measure was increasing the nurses’ understanding of …

Managing Congestive Heart Failure Through Standardized Symptom Assessment, Shanda M. Joy

Master's Projects and Capstones

Abstract

Problem: Transitional care programs have increased in popularity to focus on optimizing transitions of care from acute hospitalization to home based settings to reduce hospital readmissions. The transitional care model utilized at this urban, integrated health facility is mostly 100% telephonic, short term (30 days) case management. Approximately 30% of the patients referred to the program have a diagnosis of congestive heart failure.

Context: Hospital reimbursement has decreased due to high readmissions rates, especially among congestive heart failure (CHF) patients. This process improvement project was aimed at decreasing CHF related readmissions through educating patient/families on CHF watch symptoms and …

Preventing Hospital-Acquired Pressure Injury In High-Risk Patients, Sahara Thapa

Master's Projects and Capstones

Hospital-Acquired Pressure Injury (HAPI) can be costly for Skilled Nursing Facilities (SNFs) and painful for the patients. Most pressure injuries are considered preventable, but many patients die each year from complications from pressure injuries. Pressure injury treatment costs millions of dollars annually, which could be spent on other treatments. A quality improvement (QI) project was formulated to address pressure-related injuries and improve patient care outcomes in one skilled nursing facility in Northern California. Based on a review of current evidence, HAPI prevention education was implemented for all patient care staff. The education focused on skin assessment, risk factors, staging of …

Improving Outreach With Stroke Patients After Discharge, Marsha Belen

Master's Projects and Capstones

Problem: The 90-day mRS post discharge call project aimed to improve the outreach in stroke patients treated with thrombolytics alone or in combination with mechanical endovascular reperfusion (MER) therapy. An audit of calls was completed and revealed a gap that a number of patients were not reached or did not receive a call attempt. Having a higher outreach provides useful feedback on the patient’s progress within 90-days of being discharged in relation to the effectiveness of the stroke treatment received according to the mRS.

Context: The Neuro Coordinator was responsible for making the 90-day post discharge call and worked in …

Improving The Delivery Of Discharge Instructions On The Postpartum Unit By Increasing The Nurses' Knowledge, Judy Anne Settles

Master's Projects and Capstones

Abstract

The field of nursing prides itself on two critical functions: safety and patient education. One of the mechanisms for both education and safety is the discharge process. Improvements in the discharge process have been shown to increase patient comprehension and safety. This study is grounded in the (Barach & Johnson, 2006) healthcare organizational framework called the 5 Ps microsystems assessment to explore the impacts and improvements in the discharge instruction process on a postpartum unit in a large organization. It was found that HCAHPS scores regarding discharge instructions were 55-60%, which is below what is considered satisfactory. Utilizing the …

No One Should Have To Give Birth Alone: An Analysis Of The Efficacy Of Community-Based Doula Programs Serving Ethnic Minorities In San Francisco, Maria Margaret Nelson

Master's Projects and Capstones

Adverse birth outcomes for both the parent and the child disproportionately affect people of color. Evidence demonstrates that one of the ways to mitigate these negative consequences is through the utilization of a doula, a trained birth companion that is not a medical provider but whose role it is to physically and emotionally support the patient through pregnancy, birth, and postpartum. Community-based doula programs, where the doula is of the same cultural background as the client, are particularly effective in improving birth outcomes in communities of color by providing culturally competent care and helping to navigate a healthcare system that …

Improving Moisture Associated Skin Damage In A Veteran Unit, Beverly Chen

Master's Projects and Capstones

Problem: Moisture-associated skin damage (MASD) has always been a problem, regardless of the setting is an I.C.U., Med-Surg, or long-term care. Evidence suggests prevalence rates can range from 5.2% to 46%, depending on the facility. The highest rates of incontinence-associated damage (IAD) occurred in long-term acute settings (Kayser et al., 2019).

Context: The veterans of the Community Living Center (CLC) have an increased risk for skin breakdown. Currently, of the fifteen residents, six residents (40%) have MASD, two of which have chronic MASD (13%). MASD can be a common occurrence for adults with limited mobility or cognitive diseases. MASD may …

Tepezza: Improving Delays In Treatment, Rebecca D. Page

Master's Projects and Capstones

Problem: There is gap in time from when a Tepezza (teprotumumab) order is placed until the time a patient receives their first infusion.

Context: Delays in the initiation of Tepezza infusions result in worsening symptoms and a decrease in quality of life for patients diagnosed with thyroid eye disease.

Interventions: Interventions included scheduling regular meetings with involved departments, following each patient who has been prescribed Tepezza through the initiation of therapy, and improving staff and patient education.

Measures: Outcome measures include decreasing days from order placement to first infusion from an average of 61 days to 30 days or less …

Utilization Of A Block Excellence Specialty Team Is B.E.S.T, Lauren E. Pittman

Master's Projects and Capstones

Perioperative registered nurses and anesthesiologists that rely on a process for placing regional anesthesia (R.A.) blocks on the correct side for surgical patients consistently provide high-quality, safe care. Infrequently anesthesiologists place the wrong side peripheral nerve blocks (P.N.B.). Due to the sensitive nature of sentinel events, the frequency of its occurrence at this quality improvement (Q.I.) project site is unavailable. Therefore, a report by Harris et al. (2021) was referenced for the incidence of wrong side blocks (W.S.B.), which were recorded in worldwide, national, and multihospital health care system cohorts as 3.63/10,000, 1.6/10,000, and 1.28/10,000 respectively. The PreOp/PACU nursing staff …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Intervention To Increase Home Preparation For Colonoscopies, Joshua Victor Stone

Master's Projects and Capstones

Abstract

Problem: Inpatient colonoscopies are costly to healthcare systems and inconvenient for eligible patients. The cost for a two-night inpatient bed is currently $4800.00 currently. The department manager led a five-month quality improvement project that was initiated in one 180-bed community medical center in Northern California to increase outpatient options, reduce the census and decrease the admission rate.

Context: Overburdened medical facilities often miss the opportunity to utilize ambulatory procedures due to competing operational priorities. In this setting, the Care Without Delay (CWD) department microsystem addresses barriers that impact operational throughput, efficiency, and unnecessary admissions.

Intervention: A …

A "Collaborative" Approach To Improving Nurse Turnover, Tiffany M. Nawabi

Master's Projects and Capstones

Problem: A cardiovascular unit is experiencing an increase in RN turnover and decreased NDNQI RN to RN interaction scores.

Context: Several recent studies demonstrate that a collaborative environment of well-being and enhanced RN communication can improve nurse retention rates (Alsufyani et al., 2021), as well as increase job satisfaction (Ylitörmänen et al., 2019).

Interventions: Nursing-led collaborative sessions were launched, consisting of the unit’s clinical nurses, the management team, and interprofessionals. The collaborative meetings provide a forum for the nurses to express their concerns, collaborate, and develop meaningful solutions.

Measures: The first measure is the Human Resource’s nursing retention report, with …

Optimization Of Postoperative Length Of Stay, Sadia Imran

Master's Projects and Capstones

Abstract

Problem: The increased patient postoperative length of stay (LOS) is impacting the throughput of the operating room and resulting in prolonged wait time for new post-anesthesia care unit (PACU) admissions from the operating room. The baseline data indicated that average LOS of laparoscopic cholecystectomy patients after surgery was 153 minutes, which is longer than the regional 90-minute standard.

Context: To deliver more efficient care, the healthcare team determined that improving LOS for laparoscopic cholecystectomy patients would increase patient care experience, improve department efficiency, and decrease healthcare cost (Health Catalyst, 2018).

Intervention: The microsystem adopted the continuous improvement methodology to …

Improving Compliance With The Sep-1 Sepsis Management Bundle, Allison Uppendahl Mrs.

Master's Projects and Capstones

Abstract

Problem: Providing high quality sepsis care is an organizational priority, however this medical center has only met the target compliance goal for the Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis management bundle 50% of the time over the past year. Root cause analysis has revealed that 40% of the fallouts have been attributed to non-compliance with the intravenous fluid bundle element.

Context: A microsystem analysis was completed on the quality department, a supporting microsystem to the larger mesosystem involved with providing acute sepsis care. A return-on-investment analysis demonstrated that efforts to improve sepsis care and reduce sepsis …

Every Milliliter Matters: Quantitative Blood Loss In Postpartum, Iana Vatsenko

Master's Projects and Capstones

Postpartum hemorrhage remains a leading cause of maternal mortality in the United States. Postpartum hemorrhage occurs when mothers are bleeding excessively, have uterine atony, or the placenta has failed to come out completely. Research has shown that quantitative methods of blood loss estimation revealed a higher incidence of PPH than visual estimation. That is why using quantitative methods on time is essential for diagnosing PPH. Quantification of blood loss should be replaced by estimated blood loss since it is more accurate. The project's main focus was implementing quantification of blood loss and using the Triton Scale, a smart system to …

Addressing Nursing Burnout: Seeking The Need For Mental Health Interventions To Support The Nursing Workforce, Kayla Perry

Master's Projects and Capstones

Problem: Feelings of burnout are rampant in the nursing profession, and can have serious consequences for nurses’ mental health, patient safety, and healthcare facility costs. The COVID-19 pandemic has exacerbated burnout and made it difficult for nurses to cope with constant anxiety, fear, and grief.

Context: At an outpatient clinic in Santa Clara County, nurses on the COVID-19 testing and vaccination unit were observed and communicated feelings of burnout related to the pandemic and other stressors. Based on the mixed-methods data collection performed, a quasi-experimental study was carried out by implementing mental health interventions to support the staff.

Interventions: A …

Implementation Of Aidet And Commit To Sit In Pediatric Outpatient Setting, Shibani Dhir

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET (Acknowledge, Introduce, Duration, Explain, and Thank You), Commit to Sit, and cultural-competent care to improve patient satisfaction and communication between multidisciplinary health care team members and patients in a microsystem of a pediatric outpatient setting. The National Research Company (NRC) scores from the microsystem are below the 85th percentile, and this microsystem strives for excellence in the care provided to patients. The detractors from the patient satisfaction scores include patients scoring low on staff needing to work together, care providers not taking enough time to explain and listen, wanting to trust providers with …

Increasing Patient Satisfaction In A Pediatric Perioperative Outpatient Setting, Ailen Revuelta

Master's Projects and Capstones

Problem: Effective and therapeutic communication in the healthcare setting is multidisciplinary, complex, and has its unique challenges for each microsystem. This quality improvement project implements two communication tools AIDET and Commit to Sit and incorporates cultural competency to improve communication and increase patient satisfaction in a pediatric outpatient perioperative microsystem. A microsystem assessment reflected some challenges that staff were facing when communicating with their patients and family members. A patient satisfaction assessment revealed that the microsystem is scoring below the target goal of the 85th percentile.

Context: The microsystem being addressed by this quality improvement project is an outpatient perioperative …

Implementation Of Aidet, Commit To Sit, And Culturally-Competent Care In Pediatric Outpatient Setting, Melanie T. Wine

Master's Projects and Capstones

Problem: This quality improvement project implements AIDET, Commit to Sit, and culturally-competent care to improve patient satisfaction and communication between providers and patients in a diverse pediatric outpatient surgery microsystem setting. The microsystem’s NRC patient satisfaction scores from September to September is below the 85th percentile, and there is an immense desire to improve the overall scores by the staff. The detractors of the overall performance derived from the patients feeling that the staff needs to work together to meet patients’ needs, care providers not taking enough time to explain and listen, wanting to trust providers with care, procedures …

Improving Quality Of Communication In Pediatric Perioperative Outpatient Setting Using Aidet And Commit To Sit, Hyo Ryung Kim

Master's Projects and Capstones

Abstract

Problem: Effective and therapeutic communication in the health care setting is multidisciplinary,

complex, and has unique challenges for each microsystem. The perioperative setting is an

especially challenging environment for healthcare workers to provide therapeutic

communication, as uniquely high-risk and time-sensitive information must be disseminated in a

language that is understandable for the patient(Osborne-Smith & Kyle Hodgen, 2017). A

microsystem assessment of an outpatient pediatric perioperative setting reflected some of the

challenges the healthcare workers were facing when communicating with their patients and

family members. Upon evaluation of the monthly NRC (National Research Corporation) score

prior to implementation of two …

Utilizing Training And Educational Materials To Increase Hand Hygiene Compliance Of Healthcare Providers Participating In Cesarean Sections, Christopher Natividad

Master's Projects and Capstones

Surgical site infections (SSIs) are one of the most common complications of Cesarean section (C-section) procedures. The incidence of SSIs after C-section procedures at Hospital X has increased in each of the past three years. The Labor and Delivery (L&D) unit at Hospital X performs approximately 4,500 C-sections each year. Observation of these procedures illustrated a lack of adhesion to hand hygiene policies and protocols. This quality improvement project involved informing staff members of the poor hand hygiene compliance rates, and re-educating them regarding proper hand hygiene behavior using flyers, emails, and addressing them at shift change. Data collection focused …

Every Milliliter Matters: A Quality Improvement Initiative For Postpartum Quantified Blood Loss, Amy O. Quinones

Master's Projects and Capstones

Problem: The microsystem for maternal-child healthcare in 2020 had 5.9% of deliveries progress to a postpartum hemorrhage. In 2021, the percentage of deliveries that progressed to a postpartum hemorrhage increased to 12.3%. The nearly two-fold increase in postpartum hemorrhage occurrence led to the creation of the Quality Improvement (QI) initiative to identify postpartum hemorrhage at an earlier stage. The QI initiative aims to extend the quantitative blood loss (QBL) measurement beyond labor and delivery, and support identification of postpartum hemorrhage in the postpartum period.

Context: The microsystem that this quality improvement project occurred on were three postpartum units in a …

Counting Every Drop: Preventing Maternal Mortality With Quantifying Blood Loss Through Triton Scale, Summer Le

Master's Projects and Capstones

Postpartum (PP) hemorrhage is one of the leading causes of maternal mortality (AWHONN, 2021). In each of the past three years, the percentage of PP hemorrhage has increased at Hospital X. The PP unit at Hospital X performs around 4,500 total deliveries each year. While the standard of care for PP blood loss is to specifically measure blood in milliliters as Quantifying Blood Loss (QBL) for Labor and Delivery (L&D), it is not yet the standard of care in the 24 hours postpartum after delivery (ACOG, 2019). This quality improvement project involved educating nurses about measuring blood loss – specifically …

Supporting The Nursing Workforce And Addressing The Phenomena Of Nursing Burnout With Evidence-Based Mental Health Interventions, Kelly Leung

Master's Projects and Capstones

Problem: Burnout within healthcare has been an existing phenomenon, contributing to increased hospital staff turnover rates and the nationwide nursing shortage. The COVID-19 pandemic has exacerbated this issue leading to a decrease in the quality of patient care, nurse satisfaction, and organizational financial security.

Context: At a South Bay Area public healthcare system, staff were displaced throughout the community to support the overflow of COVID-19 patients at ambulatory clinics. Due to the nature of COVID-19, this healthcare system has experienced barriers in maintaining available staff for the demand of work. Studies indicate that signs of increased stress and burnout observed …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Yvonne Oliva

Master's Projects and Capstones

Problem: This quality improvement project aims at Hospital X meeting the new Joint Commission (JC) provisional deadline through the implementation of simulation training and video development as a way of educating emergency department (ED) staff in recognizing and treating preeclampsia (PreE) and postpartum hemorrhage (PPH).

Context: This quality improvement project utilizes evidence-based practice, California Maternal Quality Care Collaborative (CMQCC) toolkits, and JC standards to educate ED staff on worsening cases of maternal morbidity and mortality nationwide. Research shows that early recognition and prevention of maternal hemorrhage and preeclamptic emergencies has the highest probability of decreasing maternal complications in the ED. …

Stop The Bleed And Seize Control: Educating Emergency Department Staff On Maternal Hypertension And Hemorrhage, Mayra A. Portillo-Guerra

Master's Projects and Capstones

Problem: A Not-for-Profit Hospital accredited by the Joint Commission was fined for not having a current policy or procedure set in place for the treatment of obstetric emergencies. This quality improvement project implemented a simulation and a training video to prepare Emergency Department (ED) nurses and clinical staff for the awareness of preeclampsia and postpartum hemorrhage (PPH).

Context: This quality improvement project was implemented in two different Emergency Room locations for this Not-for-Profit Hospital. One of the campuses does not have a Labor and Delivery (L&D) unit while the other one does. The overarching goal is to increase awareness of …

Stop The Bleed And Seize Control: The Use Of Simulation And Video Modules In Educating Emergency Department Staff Regarding Maternal Hypertension And Hemorrhage, Jared Maxwell Talsky

Master's Projects and Capstones

In order to address shortcomings of the health care system within the United States surrounding the early recognition and response to preeclampsia (PreE) and postpartum hemorrhage (PPH) emergencies The Joint Commission (TJC) revised the accreditation requirements regarding implementing yearly maternal hypertension and hemorrhage simulation scenarios in emergency departments. A Quality improvement team of Clinical Nurse Leader (CNL) students at University of San Francisco, working alongside the emergency department and labor and delivery department nurse educators assisted a dual hospital system in the Bay Area of California to develop and implement training materials and simulations for the hospital system’s Emergency Department …

Save Lives And Sanitize: Prevention Of Surgical Site Infections Post-Cesarean Section Through Increased Hand Hygiene Compliance, Lindsay N. Nance

Master's Projects and Capstones

Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the …