Nursing Commons^™

Early Specialty Palliative Care For High Mortality Cancers, Dulce E. Alcantara

Master's Projects and Capstones

Problem: Patients with stage IV cancer have a high mortality rate. Evidence shows that patients have a better quality of life when they receive specialty palliative care (SPC) services. In the microsystem of focus for this project, referrals to SPC are not automatic, and there are no triggers to help the oncologist decide when to refer during a patient’s terminal illness trajectory. Siloes between oncology and SPC exist, which leads to a lack of communication and coordination of care, ultimately affecting patient access to support services from SPC.

Context: A multi-disciplinary SPC clinic and a referring oncologist within the …

Patient Experience As A Metric For Performance In Outpatient Bone Marrow Transplant Patient Populations, Olivia S. Marlinski

Master's Projects and Capstones

Problem: Patient satisfaction and perception of care provided have been linked to the overall quality of healthcare delivery. The Acute Infection Management clinical support department lacks a standardized method to collect information from patients regarding their satisfaction with care provided therefore impeding the units’ ability to capture performance results related to satisfaction, and improve care delivery processes accordingly.

Context: The Acute Infection Management unit is an outpatient clinical support department located within a large university-affiliated hospital that has been recently designated as the unit to operate the facility’s new outpatient bone marrow transplant program.

Intervention: The proposed project seeks to …

Maximizing Mobility In The Icu, Stephen Kupiec

Master's Projects and Capstones

Problem: In a large tertiary medical center in Northern California, the patients in the 20-bed ICU achieved averaged maximum mobility (AMM) scores well below the regional target. These patients had longer lengths of stay in the ICU and spent more days on ventilators, as compared to patients in other ICUs in the region. Barriers to mobilization included patient diagnosis, sedation practices, staff burnout, insufficient staffing, a knowledge deficit around the safety and benefits of mobility, lack of standard workflows, and lack of interdisciplinary collaboration.

Context: A microsystem assessment focused on metrics-that-matter to determine the focus of this quality improvement project. …

The Impact Of Nurse-Led Initiative Interventions On Cauti, Dalveer Kaur

Master's Projects and Capstones

Problem: National Healthcare Safety Network (NHSN) has reported U.S. hospitals having 0.2 to 4.8 per 1000 catheter-days for adult inpatient units. The insertion of a catheter and delay in removal have a significant impact on morbidity, mortality, length of stay, and reimbursement.

Context: Post-Acute Care Unit (PACU) is a microsystem that provides rehabilitation services for a patient with various post-surgical procedures. The staff of this unit was well aware of policies of catheterizations that led to prolonged use of urinary catheters and an increased rate of CAUTIs in the last quarter of this year. This project aims to increase staff …

Communication Strategies To Promote Infection Control Compliance: My Health Is In Your Hands, Ezra Macabio

Master's Projects and Capstones

Abstract

Problem: The facility has less than 70% adherence to handwashing hygiene every week. Moreover, staff does not comply with the required PPE, affecting their infection-control performance and compliance to circumvent COVID-19. Furthermore, the microsystem lacks information flow and communication systems focusing on hand hygiene, and PPE usage significantly affects the healthcare staff's ability to perform such vital practices.

Context: Herman Health Care Center provides multiple services to its residents depending on medical needs after patient hospitalizations, such as short-term rehabilitation and long-term skilled nursing services. The COVID-19 pandemic had a remarkably negative impact on the skilled nursing facility. The …

Social Determinants Of Health Assessment For Skilled Nursing Patients, Heather Welch

Master's Projects and Capstones

Section I: Abstract

Problem: Skilled nursing facility (SNF) patients are vulnerable, aging, and have complex medical histories. Readmissions from an SNF impact healthcare costs and hospital resources and indicate poorly coordinated transitions home. Patients discharging from SNFs are at risk for higher social determinants of health (SDOH) disparities, such as limited caregiver support, transportation, housing insecurity, and food access. These SDOH risks can significantly increase an SNF patient's risk for hospital readmissions. Assessing and addressing SNF patients' social needs to reduce 30-day post-SNF readmissions can improve health outcomes and positively impact healthcare costs and a patient's financial liabilities.

Context: Frailty, …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Addressing Critical Care Nurse Burnout, Julie Suarez

Master's Projects and Capstones

Problem: Critical care nurses are at higher risk for developing burnout than nurses from other areas of clinical practice. If not addressed promptly, the problem of burnout can worsen, negatively affecting the healthcare provider, organization, and patient outcomes.

Context: Increased stress and burnout observed in the microsystem with the onset of the COVID-19 pandemic prompted consideration of ways to address the well-being of critical care nursing staff with targeted interventions that could be implemented quickly with readily available resources.

Interventions: The project aim was to reduce critical care nurse burnout scores through implementation of evidence-based strategies addressing participative management, camaraderie …

Columbia-Suicide Severity Rating Scale (C-Ssrs) Inpatient Perinatal Clinical Pathway, Kristin M. Schoen

Master's Projects and Capstones

Problem: The potential harm to women and infants due to untreated perinatal anxiety and mood disorders is both a patient safety and a public health concern. Studies show that mental health decline during the postpartum period is associated with increased morbidity and mortality for both the mother and infant. The project aim was to utilize the initial screening of perinatal patients using the Columbia-Suicide Severity Rating Scale (C-SSRS) as the baseline screening tool. The tool will help implement a standardized workflow for patients who screen low, moderate, or high, as this workflow had yet to be developed.

Context: In July …

Closing Communication Gaps For Unplanned Surgical Patients: One Pre-Op Checklist At A Time, Seda L. Vash

Master's Projects and Capstones

Problem: Unplanned, inpatient surgical patients were experiencing poor outcomes and dissatisfaction with their overall care. This surgical patient population also lacked communication from their healthcare teams with regard to plans of care throughout their hospital stays.

Context: This was a quality improvement project for the unplanned, inpatient surgical patient population in the Central Valley of California. Approximately 13% of this hospital’s surgical patients required post-surgical care in the inpatient units. These patients, according to unfavorable HCAHPS scores, experienced unsatisfying care and insufficient communication from their healthcare teams, including physicians and nurses.

Intervention: This project implemented an Add-On Communication Tool for …

Improving Patient Knowledge On Medication Communication, Deborah Cha

Master's Projects and Capstones

Abstract

Problem: Effective medication communication, including potential side effects, is a key determinant of safe patient care and better health outcomes. 3SA scores a 1-2 out of 5-stars for medication communication with the HCAHPS survey from October 2020-March 2021.

Context: As one of the medical-surgical units at this California hospital, it serves the purpose of providing medical and/or surgical management to acutely ill patients. The unit is a 24-bed, 1:5 nursing ratio with medical-telemetry and Covid-19 overflow.

Intervention: The interventions include a structured, evidence-based multi-component program in improving patient knowledge about new medications they receive, the possible side effects of …

Discharge From Hospital To Home: Implementation And Use Of The Ahrq Ideal Chf Discharge Planning And Aha Chf Discharge Checklist, Eric Jason Byrd

Master's Projects and Capstones

Section I: Abstract

Problem: Hospital readmission rates in the congestive heart failure (CHF) population is a quality concern. As excessive readmissions tend to indicate low quality of care, government and private healthcare payers are increasing their focus on 30-day readmission rates as a new quality measure for hospitals.

Context: This was a quality improvement project for a telemetry unit at a medical center in the Central Valley of California. There are 56,551 members in the Central Valley enrolled in the healthcare provider system and 2,567 patients with a primary or secondary diagnosis of CHF. Within the healthcare system, CHF was …

Enhanced Recovery After Surgery Ambulation Project, Jennifer M. Rose

Master's Projects and Capstones

Abstract

Problem: The enhanced recovery after surgery (ERAS) Ambulation Project aims to increase early ambulation of cesarean section patients in the maternal child inpatient unit. The current data has shown inconsistency with the application of the ERAS program with the maternal population. Instituting standardization of care and documentation, along with increasing patient centered care, has the potential to decrease the hospital length of stay (LOS).

Context: This quality improvement project standardizes the education provided to staff nurses and patients; allotting more time for staff to create meaningful relationships with their patients. A microsystem culture utilizing patient centered care …

Testing A New Workflow To Integrate The Voice-Of-The-Customer In Readmission Analysis For Skilled Nursing Facility Readmissions From Home, Stephanie Edurese Bilbao

Master's Projects and Capstones

Abstract

There are multiple layers of oversight across the healthcare delivery system. Measuring acute hospital readmissions has been identified as an important outcome measure of quality care. Our patients are one of the major stakeholders in the healthcare system. One role of a clinical nurse leader is to integrate evidence-based leadership practices that identify and assess outcomes, mitigate risk, enhance health promotion, deliver highly effective patient care, and ensure transparent relationships with stakeholders. Rationales for examining and re-designing the readmission analysis workflow based on the customer’s experience are discussed in this paper. The global aim of the project is to …

Decreasing Floor Morphine Equivalents Per Day Rates In The Mother/Baby Department, Jessica Welsh

Master's Projects and Capstones

Problem: Cesarean sections (C/S) are among the most common operations in the United States and result in moderate visceral and somatic pain. Historically, C/S pain has been treated with opioid pain relievers. The U.S. Department of Health and Human Services declared the misuse of opioids an epidemic in 2017, leading healthcare providers and organizations to look inward at how opioids are prescribed and used at all levels of patient care.

Context: A microsystem assessment on a 60-bed mother/baby unit indicated one of the highest average opioid administration rates per day for postoperative C/S patients in the organization’s region for the …

The Use Of Isbared/Ishaped And Elimination Of Reviewing Patients’ Chart Before Handoff To Decrease Incremental Overtime, Sheila Bucao

Master's Projects and Capstones

Problem: Incremental overtime was found to majorly impact the financial well-being of a stroke unit. From an allocated budget of 22 hours per pay period, the unit’s incremental overtime averaged 40 hours. The stroke unit had skilled-mix competencies, further complicating handoffs. The absence of a standard reporting method means that reviewing patients’ charts takes approximately 10 to 15 minutes, extending what should be a quick, but thorough nurse knowledge exchange.

Context: The body of evidence reviewed indicated that pertinent information to patient care is not left out or missed when a standardized tool is used during handoff. Based on Lean …

Peer-To-Peer Emotional Support For Second Victims Of Hospital Adverse Events, Jessica L. Van Leuven

Master's Projects and Capstones

Abstract

Problem: Psychological impact of trauma on healthcare workers is profound, and if left unaddressed can debilitate its victims, depress morale, and undermine safety culture. When adverse events occur and focus is placed on providing care and support to patients and their families, the emotional support needs of healthcare workers must also be acknowledged.

Context: Frontline workers in the oncology unit of the medical center that is the setting for this project experience emotional distress as “second victims” of adverse patient events. Close relationships develop between providers and patients during long-term treatments. When unanticipated or adverse patient events there can …

Optimizing Pediatric Preoperative Experiences In The Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one …

Standardized Outreach: Increasing Vaccine Uptake In The Latinx Community Through A Standardized Phone Call Process, Vanesa Vazquez

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in several minority communities since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines (Increased risk, 2020). The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake, particularly in the Latinx community. Patients at a community clinic in Oakland, California have made apparent their distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. Most of these patients are Latinx-identifying and are considered more at risk for development of COVID-19 in …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Vanessa M. Arteaga

Master's Projects and Capstones

Vaccine hesitancy during the COVID-19 pandemic has been an issue in the Latinx and Black community since the initial discussions of the emergency use of the experimental Moderna and Pfizer vaccines. The aim of this project is to standardize the patient outreach process to increase COVID-19 vaccine uptake. Patients at a community clinic in Oakland have expressed hesitance of the COVID-19 vaccine. They also exhibited increased frustration with the staff who are contacting them to schedule vaccine appointments and provide information. This resulted in refusal of the vaccine and less than desirable number of vaccine appointments. The objective of this …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Stephanie Ramirez

Master's Projects and Capstones

In the United States, Latinx communities have experienced a disproportionately high burden of COVID-19 infections and hospitalizations throughout the pandemic. The focus of this quality improvement project is to standardize the patient outreach process and education to increase COVID-19 vaccine uptake. The ambulatory community clinic in the city of Oakland, California serves a majority of underserved Latinx patients that have demonstrated distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. The high burden of COVID-19 infections among the Latinx community has led to misinformation and fear. In order to overcome this issue, Clinical …

Preventing Central Line Associated Bloodstream Infections In An Adult Intensive Care Unit, Monica Shaw

Master's Projects and Capstones

Central line associated blood stream infections (CLABSI) are considered preventable healthcare acquired infections, and are associated with significantly increased morbidity, mortality, and length of hospital stay. The CLABSI rate in an inpatient unit is a meaningful metric in relation to the safety and quality of care in that microsystem. This quality improvement project examines the efficacy of a CLABSI prevention bundle in reducing CLABSI events and improving adherence to central line care policy within a medical surgical adult intensive care unit. The target areas the bundle aimed to improve were unit processes, awareness of CLABSI and central line policies, and …

Improving Patient Experience And Staff Workflow During Ed To Inpatient Interfacility Transfers, Jonathan Nakagawa

Master's Projects and Capstones

ED overcrowding has been an issue for Facility X pre-COVID19 and has been exacerbated following the first shelter in place mandate around March 2020. Facility X had proposed to increase the amount of interfacility transfers (IFT) to mitigate overcrowding and, hopefully, improve patient outcomes. 2020 Census data had shown that patient satisfaction scores and Nurse Daily Engagement scores were down; leading Facility X to believe that there can be improvements made to the IFT workflow and communication. Patient interviews also revealed that not all patients were satisfied with how they were treated during the IFT process. This quality improvement project …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …

Code Blue: Do You Know What To Do? Increasing Nurse Confidence And Readiness Through In-Situ Mock Code Simulation, Katelyn Nusser

Master's Projects and Capstones

An underprepared nurse is the most dangerous threat to patient survival in the intense and frightening environment of a code blue situation. With basic life support certification required on merely a biannual basis, it cannot be expected that nurses maintain the skills and knowledge without routine application. This quality improvement project proposed the following PICOT question: for medical-surgical nurses, how does in-situ mock code blue training between BLS recertification periods affect nurse readiness and confidence in a code blue situation? Mock code simulations were conducted over a three-week period with an emphasis on hands-on practice as well as teamwork and …

Implementing In-Situ Mini Mock Code Trainings For Medical-Surgical Nurses To Improve Nurse Readiness And Self-Confidence During A Code Blue, Allison Haley Jeong

Master's Projects and Capstones

Immediate, high-quality cardiopulmonary resuscitation (CPR) and early defibrillation are important in increasing survival rates during a cardiac arrest. At the Medical Center, which is part of an integrated healthcare system in a metropolitan area of the San Francisco Bay Area, a quality improvement project was implemented to increase readiness and self-confidence of medical-surgical nurses during a code blue situation. Nurse participants completed a pre- and post-intervention survey containing questions about their self-confidence in performing different skills relevant to a code blue, scored on a 5-point Likert scale from Strongly Disagree (1) to Strongly Agree (5). The intervention included an in-service …

Standardizing And Documenting Decision-To-Incision Intervals For Unscheduled Cesarean-Section Deliveries, Molly Bloom

Master's Projects and Capstones

The term decision-to-incision interval (DII) refers to the interval between when a laboring patient and their healthcare provider agree to an unscheduled surgical cesarean section (C/S) delivery and when the first incision is made in the operating room. The ideal length for this interval varies with the urgency of each case, and there is no international consensus regarding the timing. In an urban labor and delivery unit in a private hospital, examination of this interval revealed inconsistent documentation of the decision, as well as unclear guidelines on the DII for two of the three unscheduled C/S urgency levels. This quality …

Improving Surface Cleaning And Hand Hygiene Using Fluorescent Markers, Taryn Whitman

Master's Projects and Capstones

Problem: Compared to inpatient units, ambulatory care clinics have differences in staffing available and frequency to perform room turnover (RTO). Pre-intervention data revealed poor Hand hygiene (HH) and high-touch surface cleaning (HTSC) knowledge and low RTO compliance reliability. Currently, there is no process for objectively monitoring RTO compliance and staff self-evaluation of HH, HTSC, and RTO performance is incongruent with observations.

Context: HH and HTSC are a crucial component of preventing healthcare-associated infections (HAIs). Estimated loss of revenue for one northern California tertiary university hospital system (HCO) campus was nearly $1.8 million dollars in Medicare penalties for 2018.

Intervention: …

Optimizing Pediatric Experiences In Mri, Ryan Jann

Master's Projects and Capstones

Problem: Over the past decade, the prevalence of children with sensory processing disorders has had a steep upward trend. Youth with hyposensitivity and hypersensitivity conditions often develop enhanced stress and anxiety during the pre-operative admission process in preparation for MRI procedures.

Context: Specialized interventions and accommodations are a necessity for this population however, no preventative measures have been utilized within the outpatient surgical center.

Interventions: Resources were created to better prepare patients and guardians for their MRI visits including: a Social Story Video, Picture & Activity Book, as well as an MRI Toolkit. In addition, a one hour staff inservice …

Standardizing Thoracic Aortic Aneurysm Education, Marjorie Anne Gisslow

Master's Projects and Capstones

Problem: Patients receive information about a new thoracic aortic aneurysm (TAA) diagnosis from their primary care providers (PCPs). As TAA is a relatively rare conditions, many PCPs have rudimentary knowledge of TAA, and need information and support from cardiac specialists to address their patients’ concerns and guide their care.

Context: In the Regional TAA Surveillance Program the TAA nurses offer educational content for patients through the information they provide to the PCPs. Currently the educational material available to PCPs is not comprehensive or easily accessible.

Intervention: Uniform, comprehensive educational content provided through recommendations in the patient’s electronic medical record at …