Nursing Commons^™

Improving Surgical Patient Outcomes Through A Cross-Training Program For The Hybrid Operating Room, Ana Chozet-Griggs

Master's Projects and Capstones

Abstract

Innovations in the treatment of abdominal aortic aneurysms have resulted in the reduction of open surgical procedures and the increased use of minimally invasive procedures known as endovascular aortic artery repairs (EVAR) and thoracic endovascular artery repairs (EVAR). These hybrid procedures integrate the technical skills and resources used in surgical procedures with the technology used for radiological interventions. (Odle, 2011). These procedures are performed in a Hybrid Operating Room (HOR) within the Catheterization Laboratory (Cath Lab) microsystem. A HOR is a surgical operating room that is equipped with interventional radiology imaging and equipment (Taylor, 2017). These high-risk procedures demand …

Enhance Nurse-Physician Communication, Samira Samimi

Master's Projects and Capstones

Abstract

Communication is the soul of healthcare, without it, the microsystem cannot survive. There are many disciplines in healthcare, in order for safe and effective care to be delivered strong communication is key. With initiatives taken, there is always room for improvement where gaps can be identified. In particular, a gap in communication between night shift nurses and primary care physicians. According to the CRICO Strategies (2015) there has been a $1.7 billion-dollar loss and 2,000 deaths in healthcare nationally as a result of miscommunication. Poor communication has serious devastating effects if it is not corrected promptly. The duty of …

Educational Prevention Program Of Surgical Site Infections (Ssi), Carena Leung

Master's Projects and Capstones

Surgical site infections (SSI) cause negative health care effects to patients and hospitals. SSI is one of the most common types of healthcare-associated infections (HAI) accounting for 31% among hospitalized patients (Centers for Disease Control and Prevention [CDC], 2012). It is associated with prolonged length of stays (LOS), higher morbidity and mortality, and increased healthcare costs. The purpose of this quality improvement project is to decrease SSI rates by enhancing patient education and engagement in preoperative care and hygiene before surgery. In a metropolitan pediatric hospital, a microsystem analysis of the preoperative unit was conducted before generating the SSI Prevention …

Implementation Of A Transcutaneous Bilirubinometer On A Postpartum Unit At A Magnet Community Hospital, Riley O'Connell

Master's Projects and Capstones

A common clinical concern for all newborns in the first few days of life is the risk of hyperbilirubinemia. Hyperbilirubinemia if left untreated can lead to permanent hearing loss, neurological dysfunction, and even irreversible brain damage called kernicterus. Bilirubin monitoring and early intervention can prevent these adverse events from occurring. Best practice recommends the use of transcutaneous bilirubin (TcB) monitoring on all term, low-risk newborns (>38 weeks gestation at birth) at 24-hours of life. Replacing total serum bilirubin (TSB) draws through a heel stick, with TcB assessments leads to utilization of evidence-based practice. The transcutaneous bilirubinometer is a non-invasive, …

Advance Alert Monitor, Liesel Buchner

Master's Projects and Capstones

Problem: The acute deterioration of patients outside the Intensive Care Unit (ICU) are safety and quality concerns. Studies have shown that these deteriorations are associated with increased morbidity and mortality. This study aims to standardize the Rapid Response Team (RRT) nurse documentation in response to an Advanced Alert Monitor (AAM) alert, as at baseline no such alert nor standardized response and documentation exist.

Context: Hospitals are continually challenged to innovate and create systems that can track multiple parameters and identify at-risk patients earlier on. An Early Warning System (EWS) in combination with a RRT significantly reduces patients’ potential for clinical …

Amiodarone-Induced Peripheral Phlebitis:Implementation Of Practice Guideline To Decrease Incidence, Elaine Mindo

Master's Projects and Capstones

Abstract

Amiodarone is used in the management of ventricular and atrial arrhythmias, and the drug of choice among many cardiothoracic surgeons to manage post-operative arrhythmias. Atrial fibrillation with rapid ventricular response, is the most common arrhythmia treated with amiodarone in a telemetry unit in one medical center located in northern California. Nurses have noted a high incidence rate of phlebitis related to amiodarone infusion even when the current hospital guidelines are being followed. Data were collected over six months and included 35 patients, each infusion via a different intravenous site was considered another occurrence, for a total of 40 infusions. …

Standardizing The Palliative Care Referral Process, Ronaviv M. Garcia

Master's Projects and Capstones

Standardizing the Palliative Care Referral Process

Problem: Heart failure (HF) is one of the most common causes of hospital admissions and emergency department visits in the United States. HF patients are at high risk for hospital readmission: 25% of HF patients discharged from the hospital are readmitted within 30 days of discharge, and 50% are readmitted within 6 months (Vedel & Khanossov, 2015).

Context: Palliative Care (PC) has been shown to be an effective way of managing distressing HF symptoms and thus of reducing hospital readmissions, yet patients are infrequently referred to PC services during their transition from hospital to …

Reducing Patient Harm From Catheter Associated Urinary Tract Infections: A Quality Improvement Project, Grace Cooper

Master's Projects and Capstones

Abstract

Problem: The Institute of Medicine’s seminal report on patient safety, To Err Is Human led to widespread effort to improve the safety of patients. Healthcare-associated safety problems, which include healthcare-associated infection (HAI), account for far more considerable morbidity and mortality than “never events”. The first harm to be addressed as part of the “No Preventable Harms” campaign was catheter-associated urinary tract infection (CAUTI).

Context: The microsystem is a 20-bed mixed medical surgical intensive care unit. Unit assessment at the beginning of the quality project indicated that there were 2 CAUTIs attributed to the unit in a span of 6 …

Improving The Care For Acute Ischemic Stroke Patients, Hermelinda Gonzalez Rivero

Master's Projects and Capstones

Abstract

Problem: Decreasing the time to assess acute ischemic stroke patients impacts the patients’ well-being. The clinical benefit of intravenous Alteplase for ischemic stroke patients results in better outcomes. Intravenous thrombolysis success is dependent on narrowing time to treat (Fonarow et al., 2014). Decreasing the time to intravenous thrombolysis for acute ischemic stroke patients augments the ability of patients to improve the quality of life by minimizing disability and improving health outcomes (Speirs & Mitchell, 2015).

Context: The microsystem chosen for this evidence-based change of practice project change takes place in the Northern California emergency department (ED). The ED provides …

Quality Improvement In Reducing Falls In A Medical-Surgical-Telemetry Unit, Joseph Mojares

Master's Projects and Capstones

Problem: Inpatient falls are the top quality measure for patient safety in hospitals. In the United States, falls affect approximate one million people per year leading to increased health care utilization and cost. A Northern California Hospital 24-bed Medical-Surgical-Telemetry (MST) Unit has experienced high rates of patient falls in 2016 to 2017. Therefore, it is imperative that this hospital MST unit develop an effective fall prevention program.

Context: The MST is a 24-bed inpatient telemetry unit serving a population at risk for cardiovascular disease with patients primarily 65 years and older. The MST unit has also experienced a high turnover …

Postpartum Hemorrhage: A Change Strategy, Alison Landis

Master's Projects and Capstones

Problem: Postpartum hemorrhage (PPH) is one of the leading causes of severe maternal morbidity and mortality. It is unpredictable and can occur with or without identified risk factors. A postpartum hemorrhage can happen rapidly, therefore it is important for the team to be trained and prepared to recognize and respond quickly to the situation, by quantifying blood loss at deliveries.

Context:The California Maternal Quality Care Collaborative (CMQCC) has created a toolkit to better prepare maternal child health teams for readiness, recognition, response, and reporting when a hemorrhage occurs. This program was rolled out on the unit in 2015 resulting …

Improving The Timing Of Antibiotic Administration In High-Risk Neonates, Jed Comuelo

Master's Projects and Capstones

Improving the Timing of Antibiotic Administration in High-Risk Neonates

Abstract

Problem: The rapid nurse turnover and improper use of the golden hour flowsheet are some of the factors that affect the timing of antibiotic administration. A review of 38 patient charts was done and only shows 20% received antibiotics within 1 hour.

Context: This microsystem is a 22-bed neonatal intensive care unit with an average of 900 admissions per year. The team is composed of doctors, nurses, respiratory therapist, and pharmacists. The budget needed for this project consists of the overtime pay needed to compensate nurses for attending additional staff …

Improve Effectiveness In Trauma Teamwork, Ginger Miramontes

Master's Projects and Capstones

On average, each Ventilator-Associated Event (VAE) is anticipated to increase the length of stay in the Intensive Care Unit (ICU), resulting in potential adverse events and cost to the organization. The Center for Disease Control (CDC) defines VAE as the increase of daily minimum positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2) values, after a baseline period of patient stability or improvement on the ventilator (CDC, 2018). Standard endotracheal tube designs have led to the incidence of VAE because of the accumulation of subglottic secretions in the trachea. Untreated VAE can later result in Ventilator Associated Pneumonia (VAP). …

Clinical Nurse Leader As Educator: Creating Standardized Orientation Materials For Patient Care Coordinators, Sylvia Su

Master's Projects and Capstones

The purpose of this quality improvement project is to create standardized orientation materials for patient care coordinators (PCC) in a medium-sized community hospital. The problem of not providing standardized orientation materials to newly-hired PCCs presents a risk of PCCs being unable to render the same level of quality of care to patients. Standardized orientation materials can help the newly-hired PCCs to access needed resources in a timely manner and provide patients with consistent quality of care. In order to create the orientation materials, a pre-intervention qualitative interview was conducted to determine the need for developing such tools. Through several PDSA …

The Interactive Patient Careboard: A Technological Innovation To Improve Patient Safety, Perla Q. Baldugo

Master's Projects and Capstones

Problem: An innovative method to communicate with the patient and between interdisciplinary team members is the use of the interactive patient careboard (IPC) which has declined since its implementation. Concurrently, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for the med surg unit need improvement. The low HCAHPS scores in communication suggested to nursing leadership that revitalizing use of the IPC could lead to improvements in the scores. The ideal shift handoff includes IPC as a focal point of communication. The RN is expected to display the careboard during handoff and identify for the patient the healthcare …

Improving Intermediate Lactate Sepsis Bundle Performance, Jocelyn Alimboyoguen

Master's Projects and Capstones

Problem: The aim of this project is to improve intermediate sepsis bundle performance with a primary focus on repeat lactate within 6 hours of arrival in the ED. One of the most significant problems we are facing today in healthcare, with an incidence of 300 to more than 1,000 cases per 100,000 persons annually in the United States, is severe sepsis (Gaieski, Edwards, Kalian, & Carr, 2013).

Context: Multiple studies have shown a strong correlation in reducing hospital and 30-day mortality by implementing process-oriented bundle for patients with sepsis and intermediate lactate values in accordance with the Surviving Sepsis Campaign …

Implementing A Telephone Triage System, Joanyett Mays-Scott

Master's Projects and Capstones

Implementing a Telephone Triage System

Abstract

Introducing a telephone triage system requires conscientious regard to the organizational configuration and culture, staff abilities and experience, observed need and expected outcomes, staffing issues, and the physical location in which the system will be introduced (Murdoch et al., 2015). For this microsystem A SWOT analysis and microsystem assessment were performed. This community health center’s goal was to have standardized, evidence-based triage protocols followed by the nursing staff and the contracted nursing staff. The workflow was introduced in a series of lunch and learns provided by clinical nurse managers. Once workflows were established a …

Decreasing Falls In A Medical Surgical Unit: A Quality Improvement Project, Ann Chetty

Master's Projects and Capstones

Abstract

The purpose of the project was to decrease the number of falls occurring in the 48-bed medical-surgical unit by building standard work for hourly rounding and communication. Falls are a patient safety issue and are preventable. Since the Institute of Medicine has published “To Err is Human” in 1999, there have been a multitude of studies on falls, yet falls continue to be prevalent in health care organizations. The increase in patient falls adversely impact the patient’s length of stay, discharges to nursing homes and the facility’s reputation for providing safe care. The staff in this microsystem used the …

Improving Communication In A Virtual Team: A Quality Improvement Project, Deepali Addagarla

Master's Projects and Capstones

Problem: Data analysis based on two surveys revealed team communication, interdependence, technology interfaces, and integration as the quality gaps in the Virtual Surveillance Team. When compared with traditional in-person teams, a virtual working team faces different types of communication challenges.

Context: The virtual surveillance team in the regional quality department at Oakland monitors both Advance Alert Monitor (AAM), a statistical model developed by the Kaiser Permanente (KP) Division of Research (DOR) that is used to predict an individual’s likelihood of deterioration, and eHospital care gaps for Kaiser Foundation Hospitals in Northern California (KFH, NCAL). The latest evaluation from DOR of …

Optimizing Icu Throughput To Neurology Unit, Mina B. Mai

Master's Projects and Capstones

Due to competition for resources in the hospital setting, efficient processes are essential to functioning. One of the critical factors that influence efficient healthcare delivery is throughput, the movement of the patient through the system. Hospitals, therefore, strive to provide the right care to the right patient at the right time both to meet the individualized needs of the patient and to ensure economic viability. The intensive care unit (ICU) in this project specializes in neurological services. When these ICU patients stabilize, they are typically transferred to the neurology unit for continued specialty care. The neurology unit is regularly at …

Prospectus For Improving Measure Ii Scores Of Hospice Visits When Death Is Imminent In The Hospice Item Set, David Ainsworth

Master's Projects and Capstones

Abstract

Problem: Center for Medicare Services (CMS) created a new quality measure pair to collect data on hospice visit patterns by a registered nurse in the last three days of life (Measure I), and at least two visits by a social worker, home health aide, licensed vocational nurse or spiritual counselor in the last seven days of life (Measure II). A hospital-based hospice organization created a quality improvement project to address this problem and improve both parts of the measure pair, but special emphasis was placed on improving Measure II, as initial data revealed the …

Preventing Hospital Acquired Pneumonia: A Quality Improvement Project, Calyn Pascual

Master's Projects and Capstones

Abstract

Problem: From October 2016 to September 2017, the 5^th floor medical surgical telemetry unit has had 9 incidences of hospital-acquired pneumonia (HAP). Among the facility, this is the floor with the highest HAP incidences.

Context: HAP is associated with $40,000 to $65,000 to each patient care cost; an additional 7-9 days of stay in the hospital, increases the chances of discharging a patient to a skilled nursing facility instead of home, and has an attributable mortality rate (Quinn, et al., 2014).

Interventions: Daily oral brushing self-audits are given to patient care technicians (PCT) for both day and evening …

Reducing Workplace Injuries Among Advice Registered Nurses, Mey Saephanh

Master's Projects and Capstones

An area of concern for clinical nurse leaders (CNLs) is the increasing incidence of workplace injuries in integrated healthcare systems with call centers where repetitive stress injury (RSI) is among the leading causes of workplace injuries. Recurring pain and discomfort that call center Advice Registered Nurses (ARNs) experience hurts them and their teams, influences the operation of the call center, and decreases the quality of care provided to the healthcare system members. Due to high call volumes ARNs do not adequately use breaks or other measures to reduce physical strain. There is an opportunity to reduce RSIs through deployment of …

Quiet At Night: A Quality Improvement Project, Maria Novales-Fiel

Master's Projects and Capstones

Abstract

Problem: Providing a quiet environment is essential in patient’s healing and recovery. Last year, the October 15 through May 17 survey period resulted at a 2 Star Rating for the hospital, which is below the top 25th percentile. This result along with the patient population, telemetry designation, and unit size prompted the selection of the inpatient telemetry unit in Northern California for the change strategy plan.

Context: The microsystem is a 24-bed adult inpatient telemetry unit in Northern California. Assessment of the unit shows that inconsistencies exist when it comes to bundling care at night. Doors are …

Introduction Of Communication Strategies To Decrease Patient Falls In An Acute Rehabilitation Setting, Alicia Joachim

Master's Projects and Capstones

Background: Due to the lack of appropriate fall prevention measures in an acute rehabilitation unit, there has been a notable increase of patient fall occurrences within a 6 month period. The purpose of this practice improvement project was to reduce patient falls within a 36-bed unit, using visual aids and effective communication among nursing staff. The multi-disciplinary members involved licensed nurses, nursing assistants, nursing supervisors, director of nursing, and executive administrator. Methods: The method used to implement this project included a literature search, informational interviews and staff surveys, and prioritization of interventions by the team. Project implementation was guided by …

Leadership Rounding In The Intensive Care Unit To Improve Satisfaction, Stephanie Laborde

Master's Projects and Capstones

A mid-sized hospital in Alameda County would like to increase its Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) scores by improving the patient care experience. The specific aim for this project is that by August 2018, the implementation of daily leadership rounding in the ICU will result in an increase of patient satisfaction HCAHPS scores by 5%. The project team used the Plan-Do-Study-Act cycle to guide the implementation of leadership rounding. Leadership rounding was conducted daily over a 10-week period by the project team, which consisted of the floor manager and clinical nurse leader (CNL) student. The project …

Simulation Course Redesign, Hsuan Ho

Master's Projects and Capstones

The purpose of this project is to enhance the clinical nurse leader (CNL) nursing students’ learning experiences through simulation education, ensure that their learning outcomes meet course objectives, and increase students’ recognition of educational best practices in simulation.

This summer semester, the number of students in the obstetric course doubled and the course was changed from four scenarios held over two simulation days for four pre-licensure students each class to five simulation days with eight to ten students in attendance each class period. While the old student-to-instructor ratio was three to four to one, the new ratio is nine to …

Hospital Acquired Pressure Injury Prevention On An Inpatient Unit, Cherilyn Schumacher

Master's Projects and Capstones

Abstract

The aim of the project is to improve the process and delivery of care with established and accepted standards by implementing evidence-based change. The plan is to create a HAPI prevention plan with the main expected outcome to reduce the HAPI occurrences on the unit to zero by July 30, 2018. This will be accomplished by increasing awareness among nursing staff members through education and diligent monitoring of prevention practices and treatments.

The education portion of the plan will include reviewing basic pressure injury education and HAPI prevention and management in the form of visual aids provided by the …

Musculoskeletal Disorders In Healthcare Workers, Josephine Lauer

Master's Projects and Capstones

Musculoskeletal Disorders (MSD) are one of the leading causes of disability in hospital nurses and nursing aids and is a high cost problem in the healthcare industry. Working in a complex environment of an acute medical floor where repetitive nature of patient handling, can lead to musculoskeletal injuries for healthcare workers. This is evidenced by work-related injuries in hospitals nearly doubling compared to private industry and hospitals are one of the most hazardous work environments in the country. Musculoskeletal injuries of healthcare workers are an ongoing problem which requires investigation due to high risk of reoccurrence. This is especially true …

Improvements On Fall Risk Assessment To Promote Patient And Employee Safety, Christopher Haupt

Master's Projects and Capstones

Cohort 22 of the University of San Francisco’s MSN, Clinical Nurse Leader (CNL) program conducted a study focusing on the implementation of the Hendrich II Fall Risk Model and the Patient Mobility Assessment Tool (PMAT) at an urban California Bay Area hospital. Assessments were performed on 74 patients (n = 74) between January 2018 and April 2018. Cohort 22 determined that the Hendrich II test with introductions took an average of 01:49 minutes to conduct. It was also determined that it took and average of 03:12 minutes to conduct the PMAT. 88.19% (66/74) patients correctly estimated their level of mobility. …