Nursing Commons^™

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 …

Promoting Adherence To Best Practice Related To Urine Reflex To Culture Testing, Maykel Verdecia Alonso Ba,Rn-Cphn

Nursing and Health Professions Faculty Research and Publications

Over a two week period, the infection control nurse, from a trauma designated facility located in norther California, planned a practice improvement project in collaboration with the laboratory microsystem to educate referring physicians and increase adherence to the Centers for Disease Control (CDC) protocol, which delineates recommended best practices related to urine reflex to culture testing. Urinalysis (UA) is a test that triggers a reflex urine culture when pyuria is present. Frequent urine culturing without the presence of pyuria can cause unnecessary treatment with antimicrobials. From January 2017 to December 2017, 10% of UAs from 200 urine samples from asymptomatic …

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 …

Medication Exposure Patterns In Primary Care Patients Prescribed Pharmacogenetically Actionable Opioids, Mitchell R. Knisely, Janet S. Carpenter, Marion E. Broome, Ann M. Holmes, Diane Von Ah, Todd Skaar, Claire Burke Draucker

The Qualitative Report

Current approaches to assessing medication exposure fail to capture the complexity of the phenomenon and the context in which it occurs. This study’s purpose was to develop a typology of subgroups of patients who share common patterns of medication exposure. To create the typology, we used an exemplar sample of 30 patients in a large public healthcare system who had been prescribed the pharmacogenetically actionable opioids codeine or tramadol. Data related to medication exposure were drawn from large data repositories. Using a person-oriented qualitative approach, eight subgroups of patients who shared common patterns of medication exposure were identified. The subgroups …

Blood Pressure And Job Domains Among Hotel Housekeepers, Marie-Anne Sanon Rosemberg Phd, Mn, Rn, Bidisha Ghosh Ms., John Shaver Bsn, Maria Militzer Ma, Julia Seng Phd, Cnm, Faan, Marjorie C. Mccullagh Phd, Rn, Aphn-Bc, Cohn-S, Faaohn, Faan

Journal of Health Disparities Research and Practice

Hotel housekeepers have challenging working conditions, putting them at risk for poor health such as hypertension. Despite their risks, few studies have measured their blood pressure (BP). The purpose of this study was to explore hotel housekeepers’ blood pressure and the associations between work and BP. Methods: A community engagement approach was used to recruit study participants. Data sources included questionnaires, and BP measurement. Results: Over 25% of the 39 hotel housekeepers reported hypertension diagnosis and/or antihypertensive medication used. Across the job domains, job satisfaction was correlated with diastolic BP, and workload was correlated with systolic BP. There were difference …

Health In Surroundings: Application Of The Theory Of Environment In Nursing Practice, Nasreen Rafiq

School of Nursing & Midwifery

Nursing practices are guided by theoretical frameworks which provide functional basis to nursing care. This paper discusses the application of Nightingale’s theory of environment in nursing practices. The theory highlights and explains 13 environmental cannons which include ventilation, cleanliness of walls/rooms, light, noise, personal cleanliness, bed and bedding, and taking food. Florence exquisitely explains the influence of environmental health on patients wellbeing. The application of the theory in nursing practices will help to understand and reflect the direct relation of environment on patients health.

Retinitis Pigmentosa, Amanda Moore

Nursing Student Class Projects (Formerly MSN)

This poster contains information on the pathophysiology of Retinitis Pigmentosa (RP). Main points of the poster include a description of the disease, the pathophysiology of RP, diagnostics, signs and symptoms, nursing implications, and the resources used to obtain the information. This topic was chosen based on my father in law, who is currently living with retinitis pigmentosa. The purpose of this was to educate myself about RP, and to recognize any signs and symptoms in the case that my husband and/or son develop the genetic disease

Implementation Of A Screening Protocol To Improve Provider Assessment Of Depression In Patients With Psoriasis, Marlee Bryant

Doctoral Dissertations and Scholarly Projects

Patients with psoriasis are at an increased risk for depression. Despite this risk, many dermatology care providers do not screen for depression in practice, including providers at the target practice for this project. This evidence-based practice pilot project was purposed to increase dermatology providers’ assessment of depression in patients with psoriasis. This project involved implementing a depression screening protocol at one private dermatology practice and educating providers on the use of the protocol including the embedded depression screening tool, the Patient Health Questionnaire-9. The project leader used a quasi-experimental design and collected data utilizing retrospective chart reviews completed pre- and …

Increasing Advance Care Planning In The Primary Care Setting, Nicole Marie Coffey

Doctoral Dissertations and Scholarly Projects

Evidence shows the many benefits of advance care planning (ACP) discussions, including; giving patients peace of mind, decreasing healthcare costs, increasing quality of care, and decreasing distress at the end of life. Due to the many proven benefits of ACP, the United States Department of Health and Human Services as well as many leading national health organizations are promoting ACP, even tying it to reimbursement. The best setting and time to initiate ACP is in the primary care setting as early as possible, before patients have any cognitive decline. In this context, patients have an established relationship with their provider, …

Antibiotic Stewardship Among Primary Care Providers In Mississippi, Foley D. Graham, Hayden S. Kilgore, Kali D. Rogers, Sierra G. Cain, Brittany D. Dickerson, Kayla L. Warner

MSN Research Projects

The World Health Organization states antimicrobial resistance is the ability of a microorganism to stop an antimicrobial from working which results in ineffective treatment and persistent infections. The Center for Disease Control and Prevention (CDC, 2017) reported that in the year 2015, 269.4 million antibiotic prescriptions were written in the outpatient setting, and approximately 30% of antibiotics written are unwarranted. Of those cases, most patients receive an antibiotic related to acute uncomplicated bronchitis, pharyngitis, or rhinosinusitis. The CDC reported that Americans spend nearly $11 billion yearly on antibiotics alone. However, up to 50% of all antibiotics prescribed are not indicated …

A Retrospective Study To Assess The Prevalence, Determinants And Outcome Of Sepsis In A Tertiary Care Hospital, Udupi District., Drago Melba Bazel

Manipal College of Nursing, Manipal Theses and Dissertations

ABSTRACT A retrospective study to assess the prevalence, determinants and outcome of sepsis among ICU patients in a selected tertiary care hospital, Udupi District was conducted in partial fulfilment of the requirement for the award of Master of Science in Nursing at Manipal College of Nursing Manipal, Manipal Academy of Higher Education Manipal.

The study objectives were to measure the prevalence, determinants and outcome of sepsis and to find the association between determinants and outcome of sepsis among ICU patients. The research variables were prevalence, determinants and outcome of sepsis. The demographic variables were age, gender, diagnosis, history of smoking …