Nursing Commons^™

It's Time To Break Old Habits: Admitting Stemis To The Telemetry Unit, Teresa Jahn, Tanya Glenz

Nursing Posters

Beginning December 2020 uncomplicated ST-Elevated MI patients will be admitted directly to Telemetry following intervention instead of CICU.

June 2020: Review and develop evidence- based exclusion criteria for admission to Telemetry

June 2020: Create a process for communication between the nursing supervisor, cath lab, Telemetry Unit and CICU for patient placement

Fall 2020: Meeting with Telemetry and CICU charge nurse, nursing supervisor and cath lab RN to discuss communication process

Dec 2020: Begin tracking STEMI patients

• Unit admitted to (Telemetry or CICU/ICU)
• Requiring transfer to CICU/ICU from Telemetry

A Multidisciplinary Approach To Reduce Complications From Blind Small Bore Feeding Tube (Sbft) Insertion, Teresa Jahn, Jennifer Burris, Peggy Lange, Elizabeth Plante, Mithun Suresh Md

Nursing Posters

Between 2019 and 2021, six lung perforations related to blind placement of SBFTs.

A multidisciplinary team reviewed current methods of placing SBFTs and the feasibility of each:

• Fluoroscopy
• 2 Step X-Ray
• Capnography
• Electromagnetic visualization

Capnography was selected as a safe and cost-effective way to attempt to identify insertion location in real time.

• Four team members were selected and trained to insert SBFT using capnography
• Each placement attempt and outcome of placement was tracked
• Outcomes were identified as successful or unsuccessful
• Any adverse events were to be tracked

Open All Hours!: Bariatric Surgery Patients Love Csc, Naomi Schneider, Mallory Mondloch

Nursing Posters

During the fall and winter of 2020, St. Cloud Hospital saw a dramatic increase in the number of COVID-19 patients. Additionally, elective surgeries in Minnesota were on hold during the early months of the pandemic, and later in 2020 there was a significant backlog of these patients, waiting for their procedure. To serve patients and their families, St. Cloud Hospital teams planned for a way to safely and professionally offer surgical care needs to Central Minnesota.

Early Detection Of Sepsis, Holly Kockler, Evalyn Michira

Nursing Posters

The aim for this project was to improve early identification and intervention for sepsis to lower mortality rates and increase sepsis order set usage.

Key Drivers:

• Sepsis mortality rate is higher than compare groups
• Sepsis Order Set utilization is low
• Sepsis core measure performance is below benchmark

Centracare Launch Of Covid Antiviral Therapy, Jessica Miller, Todd Lemke Pharmd, Dennis Heinen Rph

Nursing Posters

• Efficiently monitor the limited available stock of oral antiviral COVID therapies during surge states
• Prescribe safely and appropriately
• Dispense to patients close to home.

Icu Liberation: Early Mobility And Exercise, Leann Volkers, Holly Kockler, Kristi Patterson

Nursing Posters

The aim of this project was to streamline and standardize the delivery of the follow up Important Message from Medicare (IMM) for IP admissions across CC and Carris-RWF in compliance with regulatory standards of care.

Key drivers identified:

• Site specific variation
• Underutilization of Epic functionality
• Use of data to understand performance

Promoting Patient Outcomes: Clabsi Prevention, Woon Paek

Nursing Posters

What is a CLABSI?

“A central line-associated bloodstream infection (CLABSI) is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line” (CDC, 2021)

Best practices for preventing CLABSIs:

• Perform hand hygiene
• Don proper PPE
• Sterile/aseptic technique during insertion
• Prioritize for cares related to central line first
• Daily assessment for need of central line
• Daily chlorhexidine gluconate bathing
• Remove catheters that are unnecessary
• "Scrub the hub" BEFORE EVERY access
• Change dressings every 7 days or as needed
• Assessment of site/dressing condition
• Change purple Ultrasite caps with dressings
• Tubing changes per CentraCare policy
• Discard …

Innovative Use Of Ehr To Support Admission Screening For Emerging Pathogens, Patricia Dumonceaux Msn, Rn, Cic, Phn, Carolyn Harlander-Zimny, Elizabeth Kiffmeyer, Ellen Simonson, Tamara Welle

Nursing Posters

• CentraCare hospitals were the first in Minnesota to identify a patient with Candida auris (C. auris), an emerging pathogen.
• 2018 Centers for Disease Control and Prevention (CDC) and state health department recommended adoption of enhanced admission screening process to allow for early identification of patients at risk of being colonized with C. auris/Carbapenem-Resistant Organisms (CROs).
• C. auris, a fungus, and CROs, comprised of organisms from the Enterobacteriaceae family resistant to carbapenems, are emerging multidrug resistant pathogens. Emphasis on identification and early isolation of at-risk patients decreases risk of transmission.

Improving The Management Of Tardive Dyskinesia On An Inpatient Mental Health Unit, Jennifer Krebsbach

Nursing Posters

Implement a practice change on the adult mental health unit to improve the accuracy and increase the rate of completion of the abnormal involuntary movement scale (AIMS) for tardive dyskinesia (TD).

Perioperative Glucose Monitoring Protocol, Nicole Helgeson

Nursing Posters

Currently, there is no established glucose management protocol for our surgical patients. Poor outcomes related to hyperglycemia may include increased morbidity/mortality, surgical site infection (SSI), sepsis, renal, and cardiac concerns. The purpose of this protocol is to improve the care and outcomes for surgical patients through a consistent standardization of glucose management.

Purewick External Female Catheter, Elizabeth Kiffmeyer, Mallory Mondloch

Nursing Posters

Catheter-Associated Urinary Tract Infection (CAUTI) rates increased in FY21 compared to FY20, and many units continue to not meet their National Database of Nursing Quality Indicators (NDNQI) target goal even through FY22.

A group of CentraCare stakeholders gathered, including bedside nursing staff, urology techs and nursing leadership, to discuss barriers and areas for opportunity. Representatives from BARD®, our urinary catheter supply company, were invited to conduct an analysis on our urinary catheter/ CAUTI reduction practices. Findings from the analysis included an opportunity to implement an external female catheter.

Icu Liberation: Early Mobility And Exercise, Vanessa Fuller, Andrea Nyquist

Nursing Posters

ICU Liberation:

The Society of Critical Care Medicine’s (SCCM) Intensive Care Unit (ICU) Liberation Bundle was created to reduce the harmful effects of events that occur in the ICU setting. Early mobility and exercise is part “E” of the ICU Liberation Bundle; goals are to reduce ICU and hospital length of stay (LOS), prevent readmissions, reduce discharges to long term care facilities, reduce delirium and coma days, and reduce likelihood of hospital mortality (SCCM, 2021)

Preoperative Weight Loss For Patients Undergoing Lumbar Spine Surgery Utilizing Motivational Interviewing To Decrease Postoperative Complications: A Quality Improvement Project, Amanda Welle

Nursing Posters

Do patients who are obese, based on BMI>30 and are offered lumbar spine surgery, who undergo preoperative MI via telehealth to lose weight, compared to those who don’t undergo MI have decreased postoperative complications at 30 days postoperatively?

Conclusions/Implications:

• Results from this QI project suggest a higher BMI class is associated with postoperative complications-wound infection.
• However, given the small sample size no conclusions could be drawn
• This QI project should be replicated on a larger scale
• The process for recruitment and intervention is established. The Neurosurgical providers are supportive of the continued study.

Very Important Discharge Appointment (Vida), Jennifer Burris, Holly Kockler, Gail Olson, Kristi Patterson, Natasha Pflueger, Jennifer Salzer, Leann Volkers

Nursing Posters

To improve patient flow, access, and decrease strain on resources by enhancing the current process of Discharge and Loop Back Huddle by identifying two patients for early discharge the next day.

Current Practices:

• Discharge huddle and Loopback (Discuss care progression for all pts)
• Discharge planning using the IDEAL Model (Patient and Family Engagement with Discharge)
• Electronic Discharge Readiness Tools (Exp Discharge Date, Discharge milestones, etc.)

Next piece of the puzzle:

• VIDA: a framework to identify 2 patients to be discharged before 11 am – so the bulk of our discharges do not occur between Noon and 4:00 pm.
• Decreasing the …

Neurointerventional Post-Procedure Assessment And Documentation Compliance, Chandra Brower

Nursing Posters

Per stroke best practice guidelines, pulse and groin checks need to be completed post-neurointerventional procedure per orders. Our plan is to improve assessment and documentation of post-procedure pulse and groin checks by improving the flow of the Electronic Medical Record (EMR). By enhancing clinical documentation and improving the documentation process, nursing practice can be supported, and best patient care delivered.

Comparing Intravenous And Inhalation Anesthetics For Intraoperative Anesthesia In Adult Patients With An Acute Traumatic Brain Injury, Natasha K. Moody

Nurse Anesthesia Student Capstones

As research and science has progressed to further analyze the effects of anesthetics on cerebral physiology, the margin of safety for each anesthetic is reassessed to enhance patient outcomes and recovery. The purpose of this review is to strategically examine and provide updated information on the impact of specific anesthetics administered during the intraoperative period as it applies to patients with acute traumatic brain injury (TBI). In efforts to preserve the cerebral physiology of the patient, current research has identified benefits of administering intravenous over inhalation anesthetics to reduce secondary injuries that have been linked to chronic TBI, morbidity, and …

The Impact Of Dexmedetomidine Use In Patients Over The Age Of 60 Undergoing General Anesthesia On Postoperative Delirium Incidence, Elaina Branco

Nurse Anesthesia Student Capstones

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are of concern in the elderly population undergoing an anesthetic due to increased mortality and decreased quality of life that can ensue. Sui et al. (2021) reported a 15-50% incidence of POD in elderly surgical patients. Dexmedetomidine is a highly selective, alpha-2 agonist with sedative, analgesic, and anxiolytic properties that mimics a sleep-like state and causes bradycardia and hypotension but not respiratory depression. Dexmedetomidine has neuroprotective properties, including anti-apoptosis and anti-inflammation (Wu et al., 2019). A current review of the literature revealed that dexmedetomidine use can decrease POD incidence in the aged …

The Effect Of Clonidine On Hyperbaric Bupivacaine And Opioid In Cesarean Section Women Under Spinal Anesthesia, Novisi Abba

Nurse Anesthesia Student Capstones

Pain is undoubtedly one of the most undesirable outcomes associated with cesarean section in parturients. The most effective post-cesarean section pain relief option should prioritize maternal, fetal, and neonatal safety, with minimal to no medication transfer to the fetus and neonate. In obstetric anesthesia, neuraxial approaches, with the inclusion of adjuncts like clonidine for pain management may provide some additional benefits. Consequently, obstetric anesthesia practitioners have increasingly used intrathecal clonidine to alleviate post-cesarean section pain. This manuscript examines whether intrathecal clonidine, when combined with hyperbaric bupivacaine and/or opioids (fentanyl and/or preservative-free morphine), has a sustained analgesic effect in parturients following …

Do The Benefits Of Sugammadex Outweigh Its Higher Cost Compared To Neostigmine?, Ashley Mcdonald

Nurse Anesthesia Student Capstones

Neuromuscular blocking agents (NMBAs) are frequently utilized in anesthetic practice to relax the vocal cords in preparation for endotracheal intubation and to facilitate optimal operating conditions for various surgical procedures. Residual muscle paralysis in the postoperative period is a serious consequence of NMBAs that can lead to severe consequences including airway obstruction, hypoxia, reintubation, aspiration, and pneumonia. Neuromuscular blockade (NMB) is overcome either by spontaneous recovery or, in most cases, with the use of a reversal agent. Two of the most common reversal agents are neostigmine, a cholinesterase inhibitor, and sugammadex, a modified gamma-cyclodextrin. Of the two medications, sugammadex is …

Maura O'Neill's Portfolio, Maura O'Neill

Honors College Portfolios

This portfolio consists of works that I have completed during my time in the School of Nursing at Duquesne University. The portfolio consists of blogs, brochures, posters, reflections, and more that encapsulate not only my nursing curriculum but my public and global health minor. Each element of this portfolio demonstrates my knowledge, passion, and interest in nursing with a focus in public/global health. A Bachelor of Science in Nursing curriculum consists of science-based courses and clinical experience. Aside from the tedious and rigorous nursing courses, public health courses can be added to further educate nursing students. Being able to understand …

Climate Change And Mental Health: What Can We Do?, Ann N. Welch

VCU Health Nursing

Climate change has been described as the defining health issue of this century. Many aspects of mental health are affected by the events related to the earth's warming climate. This poster presentation will identify ways in which climate change affects mental health and suggest concrete actions that can be taken to help to mitigate these effects.

Using Silicone Mesh To Mitigate Risk Of Forehead Pulse Ox Pressure Injuries, Patrick Alridge

VCU Health Nursing

Introduction

In the intensive care unit (ICU) setting, patients may require the use of a pulse ox probe on the forehead to obtain an appropriate oxygenation saturation reading. The pulse ox probe has two clear plastic sensors, through which the infrared light travels to measure oxygenation. Despite applying the sensor per manufacturer’s instructions and rotating the device location on the forehead more frequently than manufacturer recommendations, the sensor can still cause a medical device-related pressure injury.

Methods

Silicone mesh dressing is commonly used under wet to dry dressings or under negative pressure wound therapy dressings to prevent adherence of the …

Proposal For A Formal Pediatric Abuse Screening Tool For The Emergency Department, Christina Bolin

Master of Science in Nursing Theses and Projects

Implementation of a quick, reliable pediatric child abuse assessment tool for use in the emergency department is of great importance. A thorough assessment of all pediatric patients presenting to the emergency department (ED), regardless of complaint, should become second nature in order to recognize the signs of child abuse. Because a tool of this nature is lacking in many ED's, the Escape Instrument is needed. This instrument is a successful, efficient screening tool that can be applied to all pediatric patients during triage in the emergency department. This tool will allow the emergency department staff to quickly identify children under …

Case Manager Discharge Planning For Safe Discharge Of Homeless Patients, Melody Jenkins

Master of Science in Nursing Theses and Projects

Acute care case managers are continually challenged with the task of identifying discharge barriers and preparing a discharge plan that facilitates successful recovery and healing. Planning a discharge for a patient that is homeless can be extremely challenging. This MSN Nursing project addresses the complex discharge barriers involved in planning a safe discharge for homeless patients. The project goal was to create a Case Management Resource Algorithm that will organize available community resources to meet the social determinants of health deficits to prevent the progression of disease processes, prevent repeat visits to the emergency room, decrease inpatient admissions, as well …

Bedside Reporting, Morgan Sanford

Master of Science in Nursing Theses and Projects

Bedside reporting can directly correlate with preventing errors in the healthcare setting. The three main errors that occur are falls, medication errors, and sentinel events. These errors have a vast number of different outcomes, even resulting in death in some cases. Despite The Joint Commission directly stating that bedside reporting is best practice, this is not always what is conducted in many hospital organizations. Literature has suggested the problem that exists with implementation is the longevity of the implementation from staff. Identifying a feasible and conducive way to implement bedside reporting that is both favorable for the patient and staff …

Reducing The Number Of Patients Leaving Before Evaluation From The Emergency Department, Myranda Dills

Master of Science in Nursing Theses and Projects

Boarding patients in the emergency department (ED) can lead to several adverse events and errors that can prolong the patient’s hospitalization and delay discharges from the inpatient floors. These excessively long hospital stays decrease the number of bed available to patients being admitted from the ED, creating a bottleneck effect of patients backflowing in the ED. When this occurs, there are less available beds and resources for new ED patients, creating long wait times, and eventually an increase in the number of patients leaving before provider evaluation. This MSN project serves to create a new job role in the ED …

Virtual Visits In Prenatal Care: An Integrative Review, Katrina Wu, Christina Lopez, Michelle Nichols

Graduate School Faculty Publications

Introduction: Addressing gaps in access to prenatal care is an important step to reversing rising rates of maternal and neonatal morbidity and mortality and invites the exploration of innovative care models. This integrative review of published literature explores the patient, health care provider, and organizational experience of integrating virtual visits in prenatal care.

Methods: A literature search to identify original studies and quality improvement projects published between 2010 and 2020 was conducted in PubMed, Scopus, CINAHL, and Google Scholar using keywords associated with both telemedicine and prenatal care. Inclusion criteria specified articles pertaining to synchronous virtual visits between pregnant patients …

The Implementation Of A Validated Csec Screening Tool For Youth Age 11 - 17 In A Pediatric Emergency Room, Julie Clark, Josie Doss, Krystal E. Canady, Yameika Head Md

Graduate Research Showcase

Abuse of children is a public health issue covering a range of inflicted harm from neglect to physical to sexual abuse. A severe form of child sexual abuse is the Commercial Sexual Exploitation of Children (CSEC). This phenomenon involves sexual crimes against children, including exploitation for gain. High-risk indicators are noted throughout the literature to aid in identification, but some children are vulnerable because of their young age. Perpetrators can be family, friends, or acquaintances and choose their potential victims by recognizing a child’s vulnerabilities. Inevitable physical and mental health consequences are associated with CSEC involvement; hence these youth seek …

Addressing Tobacco Use With Improved Utilization Of 5as Framework In Primary Care, Binta Bojang

Doctor of Nursing Practice Projects

Abstract

Identifying and treating tobacco use disorder through screening and evidence-based intervention is necessary to assist all tobacco users to quit and or to decrease typical tobacco-linked health risks. The findings from the literature review suggested that the implementation of the technology-enhanced 5As model (asking, advising, assessing, assisting and arranging for follow up) approach might serve as a reminder to clinicians to assess tobacco use, and improve patient outcomes in tobacco cessation care. The purpose of this DNP project was to improve the treatment of tobacco use disorder among adults in a primary care. The objective of this project was …

Bridging The Gap In Education For Patients On Oral Chemotherapy: A Qi Project, Lindsay Rodriguez

Doctor of Nursing Practice Projects

Abstract

Oral chemotherapy and intravenous (IV) chemotherapy share many of the same side effects. However, at community General Hospital Medical Center oral chemotherapy patients were not receiving equitable monitoring and education like their IV chemotherapy counterparts. To bridge the gap, a quality improvement (QI) initiative to improve education, documentation and follow-up between visits was proposed to increase compliance and understanding. The QI project consisted of patients taking oral chemotherapy within the first 12 weeks of starting treatment. Patients were contacted weekly via nurse lead follow up calls and the Oral Chemotherapy Template was discussed with the patient to identify concerns …