An Eicu/Icu Collaborative To Reduce Sepsis Mortality, Laura S. Maples Ms.

Master's Projects and Capstones

Sepsis costs over 20 billion dollars annually to treat making it the most expensive diagnosis for hospitals (Afrefian, et al., 2017) and carries with it an average mortality rate of 45% (SCCM, 2016). The eICU/ICU collaborative project was developed to improve sepsis mortality at Sutter Health’s Solano hospital affiliate from 41.2% to the system-wide goal of 18.8% over the course of a year by implementing two technologies. The first was the onboarding of the non-invasive cardiac output monitoring (NICOM) technology by Sutter Solano to fulfill the 6-hour bundle compliance for septic shock resuscitation. The other technology was the activation and …

Delirium: A Cnl-Led Protocol To Clear Up The Confusion, Shanda N. Whittle

Master's Projects and Capstones

Project objectives: Delirium is a form of organ failure defined as an acute change in cognition, evidenced by altered consciousness and impaired attention that fluctuates over time, and is associated with increased morbidity, mortality, and healthcare services utilization. In the hospital where this evidence-based practice project took place, there was no formal protocol or guideline for assessing or managing delirium. Therefore, this project focused on improving the practice of identifying patients at risk for developing delirium with the AWOL tool and treating patients with signs and symptoms of delirium found using the Short-CAM assessment. Population and setting: This project took …

Pediatric Intensive Care Unit Skin-Care Team, Anna Therianos Konstantin

Master's Projects and Capstones

In the United States, pressure injuries (PIs) cost $9.1–$11.6 billion per year and claim more than 60,000 patient lives. The large Northern California hospital where this CNL project was conducted has had an 8.33% incidence of hospital-acquired PIs at or greater than stage two in the pediatric intensive care unit (PICU). Pressure injury prevention was not a high priority for the nursing staff; nurses were unaware of current PI prevention protocols or the PI prevalence in the PICU. The goals are to reduce PIs by 20% in 3 months, increase PI nursing education, and improve patient outcomes. Nursing skin-care rounds …

Fall Prevention: Responder 5 Bed Connectors, Ani Tatevossian

Master's Projects and Capstones

This paper explores falls, a sentinel event plaguing hospitals in the United States and internationally. Falls are a major contributor to negative patient outcomes and a source of financial strain for hospitals. One particular fall prevention intervention, Responder 5 bed alarms, was explored. A literature review on falls was conducted to study the effectiveness of bed alarms. Capezuti et al. (2009) found bed alarms to be error prone and stress the importance of patient risk factor assessment and using bed alarms as a multifactorial approach to fall prevention. Shorr et al. (2012) came to a similar conclusion after conducting a …

Reducing Operating Room Turnover Times, Marivic Z. Paraz-Lee

Master's Projects and Capstones

Background

The operating room (OR) in an ambulatory surgery center (ASC) is what generates income for an organization, but it can also be costly if it’s improperly managed. The purpose of this project is to decrease OR turnover time (TOT) in order to increase OR efficiency, patient and staff satisfaction, as well as be cost effective. As defined by Gottschalk et al. (2016), OR turnover time is “the duration of time from a patient exiting the OR to the time the succeeding patient enters the OR” (p. 489).

Methods

The method utilized for this project is gathering weekly average TOT …

Improving A Clinic's Process To Increase Preventative Health Screenings, Melissa A. Weathington

Master's Projects and Capstones

Performing health screenings on patients is a potential way to prevent or even identify health issues that may have not otherwise been apparent. In recognition of the importance of this matter, this CNL aims to improve and increase the percentage rate of depression and cervical cancer screenings by addressing barriers that have hindered staff from performing these health screenings. This CNL project took place at a health clinic located in the marginalized community of San Francisco. The health clinic’s primary focus is to foster care to the underserved population—homeless, uninsured, LGBTQ, people of color—and provide them with qualitative patient care. …

Implementation Of Patient Mobility Assessment Tool: A Clinical Nurse Leader Initiative Towards Improved Patient And Nurse Health Outcomes, Janet Lopez

Master's Projects and Capstones

Abstract

Early ambulation during hospitalization has been recognized as a fundamental and logical intervention to reduce patients functional decline and muscle weakness. Recently, our healthcare system is encouraging nurses to become more actively involved in assessing patient’s mobility status and managing their mobilization. However, since the high nursing workload affects the time that a nurse can assign per task, more often than not they have little time to accurately assess patient’s mobility status; Presenting a safety concern for nurses and patients. In an effort to ease this challenge, the Patient Mobility Assessment Tool (PMAT) is introduced as an efficient nurse-driven …

Implementation Of Sbar Reporting In The Ed, William Russel Carpenter

Master's Projects and Capstones

Implementation of SBAR reporting in the ED

Abstract

In our emergency department, reports given to the accepting floor nurse, transfer of care between emergency department nurses and nurses reporting to physicians are given in many different formats with no continuity. It has been reported that 1,744 deaths and $1.7 billion in hospital costs related to miscommunications (CRICO Strategies, 2015). With the implementation of the SBAR reporting tool, we can begin to see a decrease in miscommunications, and improve patient and staff satisfaction. The SBAR framework not only enhances the clarity and efficiency of communication between team members but also assures …

Safe Sleep In The Nicu Environment For Sids Prevention, Renee J. Aumua

Master's Projects and Capstones

Abstract

Sudden Infant Death Syndrome(SIDS) remains a leading cause of death for infants less than one year of age. Historically, Neonatal Intensive Care units have been exempt from following SIDS safe sleep guidelines recommended by the American Academy of Pediatrics(AAP) for SIDS prevention due to patient medical status and environment. However, in 2011 these guidelines were updated by the AAP to include NICU specific recommendations. This is a very important change due to this patient population being at a higher risk for SIDS than the term, well newborn. The Safe Sleep project was conducted in a 35 bed, tertiary care …

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

Improving Quality And Efficient Communication Between Providers And Nursing - A Psychiatric Sbar Tool (Psych), Karen Lee Richards

Master's Projects and Capstones

IMPROVING QUALITY AND EFFICIENT COMMUNICATION BETWEEN

PROVIDERS AND NURSING - A PSYCHIATRIC SBAR TOOL (PSYCH)

Karen Richards

University of San Francisco

Abstract

Effective communication is the cornerstone of providing safety and quality healthcare. However, nursing and providers often share information inequitably, as these disciplines are trained differently regarding communication. Providers are taught to be brief, accurate and focused while nurses are taught to be descriptive and holistic. These differences have led to disparity in the sharing of valuable patient information, subsequently leading to increased frustration, inefficiency, and medical errors. Multiple studies provide evidence that poor communication is a major contributor …

Approach To Safety Improvement: Focusing On Better Care (Fall Prevention In Medical Surgical/Intermediate Care Unit), Jose Fox Caballes Jr

Master's Projects and Capstones

Patient safety is one of the major concern of any healthcare provider during their patient’s hospital stay. This project addressed the steady trend of fall incidences compared to last fiscal years’ data of an average of 4 falls per month. This trend created urgency to envisioned a plan for solutions to prevent this circumstance from happening. This Clinical Nurse Leader led a project in creating a process in identifying all patients that are high risk to fall (HRTF) prior to their admittance or transfer to Medical Surgical/Intermediate Care Unit and throughout their hospital stay until they are discharged. In addition, …

Ihss: Repackaging Consumer Information, Deloras N. Puran

Master's Projects and Capstones

Currently, qualified Californians with disabilities and aging individuals can receive consumer-directed care through the IHSS program. Despite the strong demand for the program, new consumers are still struggling to begin their service after enrollment.

This study assisted San Francisco In Home Supportive Services Public Authority to understand how new consumers can navigate the IHSS program services after enrollment. Focus group and semi-structured in-depth interviews were conducted to gather feedback from consumers regarding what type of information would they need after enrollment, and how would they want to receive the information. Based on the feedback, written and virtual deliverables were designed …

Nonpharmacological Approaches In Dementia Care, Gay Lynn Warren

Master's Projects and Capstones

The 6A acute care unit has been seeing a higher number of patients that are afflicted with dementia. Often times, these patients display challenging dementia-related behaviors. It is commonplace for these patients to be medicated with a psychotropic medication in order to halt the challenging behavior. The global aim of this project is to improve dementia care on the 6A acute care unit. The specific aim, educating staff members about the benefits of nonpharmacological approaches in the management of challenging dementia-related behaviors and to encourage their use, is relative as the education is necessary before improvement can be expected to …

Recovery-Oriented Care And Inpatient Psychiatric Nursing Practice, Julia M. Mclaughlin

Master's Projects and Capstones

For the past 15 years, major organizations such as the World Health Organization (WHO), Substance Abuse and Mental Health Services Administration (SAMHSA), and U.S. federal government have been committed to shifting mental health services from the medical model of care to the recovery-oriented model of care (Moller & McLoughlin, 2013). However, not all identified recovery-oriented practices have been fully implemented throughout mental health services, specifically in acute care settings. In 2015, San Mateo Medical Center’s acute psychiatric nursing staff completed McLoughlin’s (2005) Recovery Self-Assessment- Registered Nurse (RSA-RN). Data showed that 34% of nursing staff did not believe that the nurses …

Lactation Clinic: Improving Patient Lactation Support, Iana Johnson

Master's Projects and Capstones

Despite the numerous health benefits and recommendations that breastfeeding is the optimal method for nourishing infants, many still choose other ways to feed their babies during the first year of life. This project considers the initiation and future implementation of a Lactation Clinic as an additional patient support service provided in the inpatient and outpatient settings. A Failure Modes and Effects Analysis (FMEA) was conducted in an effort to evaluate and eliminate “what could go wrong” before such an establishment becomes operational. The Risk Priority Numbers (RPNs) from the analysis reveal the lack of use (RPN 50) and streamlining (RPN …

Minimizing The Inappropriate Use Of Physical Restraint, Shiela Marie C. Telmo

Master's Projects and Capstones

The aim of this project is to be able to improve patient safety by minimizing the inappropriate use of physical restraints from 45% to about 20% in the acute respiratory unit which caters to patients with acute respiratory issues, such as exacerbation of chronic obstructive pulmonary disease (COPD), patients with new or old tracheostomy, needing bipap, rigorous nebulizer treatment, and other respiratory-related devices, not to mention the multiple comorbidities that oftentimes very difficult to stabilize which makes the hospital stay longer than usual. The Clinical Nurse Leader (CNL) as an educator and an outcome manager is an agent to empower …

Evaluation Of The Nursing Handoff Process From Emergency Department To In-Patient Unit, Yana Marutyan

Master's Projects and Capstones

Handoff, or transition in care, is known to be a danger point in the patient care process for a long time. Ineffective communication during handoff is one of the most common identified cause of catastrophic or sentinel events in hospitals (The Joint Commission, 2015). Emergency department (ED) to in-patient unit handoff is particularly vulnerable to medical errors due to high workload, time constraints, different approaches to patient care, and lack of established relationships between care providers (Ong & Coiera, 2011; Hilligoss & Cohen, 2012).

The purpose of this project was to examine and review a current process of ED to …

Educating Nurses On The Use Of Bedside Mobility Assessment Tool (Bmat) Through E-Learning/Online Education Module, Wei Li Lee

Master's Projects and Capstones

Background Hospital setting is reviewed the most hazardous workplace comparing to other industries. Nursing assistants and orderlies have the high risk of work-related injury. The study found that the top reason that causes the injuries was due to over-exertion or bodily reaction.

Aim State of California requires hospitals to implement a Safe Patient Handling and Mobility (SPHM) policy as part of an injury and illness prevention program (Department of Industrial Regulations, 2016). Bedside Mobility Assessment Tool (BMAT) is the latest evidence based practice, reliable and valid tool, which helps nurses to assess the patients’ current and ongoing mobility and to …

The Effects Orthostatic Hypotension Has On Falls: A Study Done In San Francisco With The Patient Population Of The Veterans Affairs Hospital, Sherry A. Ballard Ms.

Master's Projects and Capstones

The Effects Orthostatic Hypotension has on Falls: A Study Done in San Francisco Represented

Population of the Veterans Affairs Hoapital

The global AIM of this project is to Identify patients that are at risk for Orthostatic Hypotension (OH) with in the first 24 hours of addmission. It was identified that 50% of the falls over the last 4 quarters at the VA were OH related. The patients were not identified as a fall risk and over half of them had fallen multiple times. After performing a nursing survey online, a SWOT analysis, and a Root Cause Analysis using a fishbone …

Increasing Patient Satisfaction And Decreasing Hospital Readmission Due To Deep Venous Thrombosis By Providing Anticoagulation Education For Orthopedic Patients, Margaret Gniewosz

Master's Projects and Capstones

Abstract

Improving Process on Oral Anticoagulant Education for Orthopedic Patients

The aim of this project is to improve anticoagulation education for orthopedic patients to increase patient satisfaction. The microsystem for this project is a medical-surgical (MS), 50-bed unit in a medium size hospital. Because orthopedic patients are at high risk to develop DVT postoperatively, proper anticoagulants and anticoagulation education is an important aspect of patient care. By implementing a well-designed and easy-to-read patient handout on anticoagulants with instructional script for nurses will empower patients to achieve higher level of anticoagulant knowledge and in result, increase patient satisfaction. A preliminary round …

Admission Handoff Between Emergency Department And Inpatient Units, Amanda A. Briones

Master's Projects and Capstones

When admitting a patient from the emergency department (ED) to an inpatient unit, a handoff report is conducted. There are many ways the ED nurse can go about delivering this report to the inpatient or floor nurse. Each ED nurse tends to this task in their own way, providing the information they deem important. Due to the absence of standardization, handoff reports have the ability to lack important information regarding the patient and can even lead to compromising the safety of the patient.

The purpose of this project was to gain a comprehensive understanding of the current handover process of …

Increasing Chlorhexidine (Chg) Daily Bathing Compliance, Jonathan Lee

Master's Projects and Capstones

Chlorhexidine gluconate (CHG) daily bathing in hospitalized patients in the intensive care setting is one of many interventions implemented by institutions to reduce and prevent central line associated bloodstream infections (CLABSIs) and catheter associated urinary tract infections (CAUTIs). These hospital-acquired infections (HAIs) plague and complicate treatments for critically ill patients in the acute care setting. CLABSIs and CAUTIs increase patient morbidity and mortality as well as place a financial burden with increased costs and hospital lengths of stay. The decrease of CHG compliance in our ICU unit can be associated with an elevated CLABSI rates. The focus of this CNL …

Improving Pain Reassessment And Documentation Through Nurse Education, Reina Batto

Master's Projects and Capstones

The aim of the CNL Internship Project is to improve quality of patient care and pain management through improved pain reassessment and documentation. The project is to be implemented in the surgical unit of a community hospital in the California Bay Area. The unit has a maximum capacity of 38 beds and is staffed by 47 RNs and 4 LVNs. A nurse survey was conducted to assess the needs of the staff and the unit, and an education plan was created for the unit. Educational materials, including: highlighted academic articles, posters, handouts, and small posted reminders at nurse computers were …

Nurse Shift Handoff Report At The Patient's Bedside: Improving Nurse-To-Nurse Communication, Francis R. Estrella

Master's Projects and Capstones

The purpose of the CNL project is to develop a standardized approach to communication during nurse shift handoffs through utilization of bedside shift reporting (BSR). Shift handoffs are integral to nursing practice; therefore, this process must be accurate, effective, and consistent in order to ensure the delivery of safe and quality care. The project focuses on the CNL curriculum element of Quality Improvement and Safety, under the role of an Outcomes Manager. Prior to BSR implementation, shift handoffs in the sub-acute unit were being conducted at the nurse’s station or by the medication carts. Nurse shift handoffs were often rushed, …

Standardization Of Body Imaging Huddle In Radiology, Margaret M. Browne Mcmanus

Master's Projects and Capstones

Mag Browne McManus

Clinical Nurse Leader Abstract

University of San Francisco

Abstract

Communication amongst healthcare providers is critical to reducing errors, and in procedural areas, the huddle can be used to standardized communication amongst the team before the beginning of interventional procedures (Goldenhar, Brady, Sutcliffe, Muething, & Anderson, 2013). Prior to the implementation of the revised huddle, a staff survey indicated none of the staff were satisfied with the current process. The objectives of the standardization of the body imaging huddle in the department of radiology were to increase staff satisfaction by 15% and reduce the time from patient arrival …

Chlorhexidine Gluconate Bathing In Hospitalized Patients: Reducing Barriers And Increasing Compliance Rate, Maria R. Dominguez

Master's Projects and Capstones

The organization-wide implementation of Chlorhexidine Gluconate (CHG) bathing protocol is one of many measures used to help reduce hospital-acquired infections (HAI) at the 30-bed, Medical-Surgical Specialties and Palliative Care Unit. CHG bathing compliance rate for the unit for the week of August 14-20 was 82.9%, with a 40.4% refusal rate. This is below the 90% desired performance rate. The purpose of this project is to identify the barriers to CHG compliance and to implement interventions that will aid in reducing these barriers and increase CHG compliance rate. Patient declining was identified as one of the main barriers to CHG bathing. …

Improving Preadmission Testing Nurses' Knowledge Of Aortic Stenosis And Transcatheter Aortic Valve Replacement, Alberta Lynn Canale

Master's Projects and Capstones

Abstract

The purpose of this Clinical Nurse Leader (CNL) project was to reduce gaps in nursing knowledge through staff education. Guided by the CNL theme of educator and information manager, the goals were to increase PreAdmission Testing (PAT) nurses’ knowledge of severe/critical aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) procedure and patient selection, and satisfaction with knowledge by 10%. Rapid growth of the TAVR program has contributed to a gap in nursing knowledge leading to inconsistent patient care and education. An educational program was developed and spread through a series of Plan-Do-Study-Act cycles. Pre- and post- implementation surveys were …

Kinder Ready: Exploring The Role Of Technology In Promoting School Readiness Among Low-Income Parents In A Clinic-Based Setting, Brenda Lu

Master's Projects and Capstones

The Stanford Pediatric Advocacy Program advocates to improve the health status of children in Silicon Valley and the surrounding community. This summer, I worked on a project called Kinder Ready, with the goal of evaluating the feasibility of technology use in promoting school readiness in children ages zero to five. We used a variety of qualitative research methods, including focus groups, one-on-one interviews, and surveys to collect feedback from the community on what their children need to transition into schools. Our local participatory research approach has paved the way for many new partnerships with local organizations, while strengthening existing ones. …

Falls Program On An Acute Psychiatric Unit, Joseph Hunter Rose

Master's Projects and Capstones

In the metropolitan hospital’s acute psychiatric unit there has been an increase in falls incidence as well as need for evaluation of the effectiveness of Schmid Fall Risk Assessment tool in its ability to properly identify those at risk. In the last fiscal year there were 45 falls among 28 patients on the acute psychiatric unit.Falls are harmful to the patients and can cause prolonged hospital stays with non-reimbursable costs to the hospital. Falls amongst psychiatric patients is an even greater challenge to address due to the nature of the mental health disease process. This project addresses general costs of …