Nursing Commons^™

Implementing An Icu-Specific Pressure Injury Prevention Bundle (Skin Safe)To Reduce The Incidence Of Hospital-Acquired Pressure Injuries In Adult Surgical Intensive Care Unit., Komal Ali

Doctor of Nursing Practice Final Project Abstract

PURPOSE

The purpose of this project was to evaluate the effectiveness of implementing an ICU-specific pressure injury prevention bundle (SKIN SAFE) Sto reduce hospital-acquired pressure injuries (HAPIs) in an adult Surgical ICU.

BACKGROUND

HAPIs remain a major safety concern in critically ill patients. Standardized prevention bundles improve adherence and reduce incidence.

METHODOLOGY

This QI project in a 20-bed Surgical ICU used the PDSA framework to implement the eight-component SKINSAFE bundle. Strategies included staff education, champions, and weekly audits. Data were collected through EMR review, monthly PIP audits for HAPI incidence, and weekly compliance audits.

RESULTS

Pre-intervention data showed two HAPIs …

Standardizing Ascitic Fluid Panel To Improve Outcomes In A Large State Hospital, Yimei Zhang

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement project was to increase provider compliance with evidence-based, hepatology-recommended ascitic fluid studies among inpatient providers from a baseline of 50% to 60% within five months through electronic health record (EHR) standardization.

Background: Delayed or incomplete ascitic fluid analysis can increase the risk of preventable complications. Workflow variability and non-standardized ordering practices contributed to inconsistent adherence to evidence-based recommendations.

Methodology: Using the Institute for Healthcare Improvement (IHI) Model for Improvement with Plan–Do–Study–Act (PDSA) cycles, two paracentesis workflows were redesigned. For the Mobile Procedure Team, a standardized ascitic fluid panel with six defaulted, evidence-based tests …

Evaluating Falls Prevention Processes And Implementation Fidelity In Acute Rehabilitation: A Quality Improvement Project, Bouncy Igweka, Justin Baltazar, Ashley Navas, Clarisse Baligad

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

Abstract

Background: Patient falls remain a significant safety concern in inpatient rehabilitation settings, where patients with neurological and mobility impairments work toward regaining functional independence. Despite established fall-prevention protocols at Stockton Regional Rehabilitation Hospital (SRRH), falls continue to occur, highlighting the need to evaluate existing prevention practices and identify potential implementation gaps.

Purpose: This quality improvement project aimed to evaluate the implementation fidelity of existing fall-prevention practices at SRRH, identify recurring factors associated with patient falls, and develop evidence-based recommendations to strengthen patient safety.

Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, a retrospective review of facility fall reports and patient …

Dnp Final Report: Enhancing Memory Care Staff Knowledge Of Fall Risk In Residents With Alzheimer’S Disease: A Quality Improvement Project, Terese D. Corbin

DNP Final Reports

Background: A 66-bed memory care community in West Texas lacked formalized staff education connecting Alzheimer’s disease progression with fall risk and recorded persistently high monthly fall counts.

Methods: The Johns Hopkins Evidence-Based Practice model and Plan–Do–Study–Act framework guided this quality improvement project. Education included 30-minute sessions, handouts, and posters. Voluntary assessments evaluated foundational knowledge and clinical synthesis. Analysis included five participants with matched assessments; monthly falls were a secondary outcome.

Results: Eleven preintervention and 11 postintervention assessments were completed; five participants had matched assessments. Among matched participants, mean foundational knowledge increased from 88.44% to 92.00%, a 3.56-percentage-point increase that met …

Implementation Of A Standardized Protocol To Improve Provider Documentation And Initiation Of Guideline-Concordant Hypertension Follow-Up Within 14 Days In Primary Care, Stella Williams

Doctor of Nursing Practice Projects

Hypertension is a major modifiable risk factor for cardiovascular morbidity and mortality, yet timely follow-up after elevated blood pressure (BP) readings is not consistently documented in primary care. This Doctor of Nursing Practice (DNP) quality improvement project evaluated whether a standardized hypertension screening follow-up protocol improved provider initiation or documentation of guideline-concordant follow-up within 14 days. The faculty-approved PICOT population was primary care providers in a primary care clinic; we used eligible electronic health record (EHR) encounters as the analytic records to observe provider performance. We used a quantitative pre/post design and retrospectively reviewed 30 eligible EHR encounters: 15 pre-implementation …

Implementing A Fall-Prevention Bundle To Reduce Falls In A Skilled Nursing Facility, Ginette Lubin

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls are a persistent patient-safety concern in skilled nursing facilities (SNFs), contributing to injury, functional decline, reduced quality of life, healthcare utilization, and costs. At the project site, a short-term rehabilitation unit in an urban SNF, 13 resident falls occurred during the baseline period, with 23% resulting in injury, and prevention relied on routine risk assessments, environmental checks, and post-fall reporting rather than proactive strategies.

Aim: To decrease the overall fall rate by 20%, reduce fall-associated injuries from 23% to 15% or less, and raise staff adherence to evidence-based fall-prevention interventions to 90% or higher within 12 weeks.

Evidence: …

Implementing A Risk-Stratified Fall Prevention Bundle To Reduce Inpatient Falls,, Nana A. Tabiri

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: The Step-Down Unit (SDU) had a high fall rate of 4.8 falls/ 1,000 patient days, falling short of the 3.0 falls/1,000 patient days organizational target. Despite the high fall rate, the unit used a one-size-fits-all approach, which was ineffective. Also, nursing practices in the unit were unevenly adopted.

Project Objective: The project aimed to lower the fall rate in SDU by 10% and increase compliance with risk-stratified documentation to at least 90%.

Evidence Review: A huge pool of evidence supported the adoption of a multifactorial, person-centered fall prevention approach as opposed to universal precautions. The AHRQ …

Enhancing Collaboration Through Post-Round Huddles, Kristen Ramirez

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: On a 16-bed medically supervised detoxification unit at a northeast Ohio community hospital, the interprofessional team had no consistent, structured way to communicate after physician rounds, fragmenting coordination and threatening patient safety for a complex, co-occurring population. Organizational HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) communication scores fell below the 80% national benchmark, confirming a modifiable, systems-level concern.

Aim of the Project: The quality improvement (QI) project aimed to enhance care quality and coordination by standardizing a shared plan of care across the interprofessional team.

Review of the Evidence: A systematic search retained 12 …

Improving Abnormal Involuntary Movement Scale Screening Consistency In Outpatient Psychiatric Practice, Jeriece Lovelace

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Tardive dyskinesia (TD) and extrapyramidal symptoms (EPS) are potential adverse effects of long-term antipsychotic use that require ongoing monitoring. At the project site, inconsistent staff education, a lack of a standardized screening process, and the absence of electronic health record (EHR) reminders contributed to missed Abnormal Involuntary Movement Scale (AIMS) screenings. Baseline screening compliance was 54.7% (106/194).

Aim of the Project: The aim of this quality improvement project was to increase AIMS screening compliance among adult patients receiving long-term antipsychotic therapy from a baseline of 54.7% to 90.7% within 12 weeks.

Review of the Evidence: Literature review has shown …

Enhancing Suicide Risk Assessment Using The Columbia-Suicide Severity Rating Scale, Elizabeth Gyang

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Suicide risk assessment is a critical component of mental health care; however, inconsistent use of standardized assessment methods can lead to variability in risk identification and clinical decision-making. At the outpatient mental health project site, standardized use of the Columbia-Suicide Severity Rating Scale (C-SSRS) had not been established, indicating a practice gap.

Aim of the Project: The goal of the 12-week Quality Improvement (QI) project was to improve nursing staff knowledge, skills, competence and organizational readiness for standardized suicide risk assessment through structured C-SSRS education and implementation support.

Review of the Evidence: The C-SSRS is a standardized tool with …

Improving Hospital Throughput Through Early Mobilization And Proactive Case Management, Sadaf Mir

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Prolonged length of stay (LOS) reflected through throughput inefficiency at a Level II trauma center in western United States. Average hospital LOS was 5.3 days, exceeding the organizational benchmark and national average of 4.9 days. Gap analysis identified lack of standardized early mobilization (EM) and inconsistent case management (CM) participation in rounds, contributing to delayed progression, reactive discharge planning, higher costs, reduced bed capacity, and complication risk.

Aim: To reduce hospital LOS by targeting adult trauma patients as a pilot population, aiming to decrease average LOS from 5.3 to 4.9 days over 12 weeks through an early mobility bundle …

Fall Prevention In The Inpatient Oncology Unit Using Fall Boards And Visual Cues, Rachel Miller

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Falls remain a significant patient safety concern in hospitals. In an inpatient oncology unit at a large academic medical center, falls increased from 33 in 2024 to 46 in 2025, while the fall rate increased from 2.86 to 3.95 falls per 1,000 patient days. A gap analysis revealed that only 5% of high fall-risk patients had fall boards and visual cues in place.

Aim of the Project: The aim of this quality improvement (QI) project was to increase the utilization of fall boards and visual cues for high fall-risk patients through implementation of a standardized fall prevention education bundle …

Strengthening Post-Fall Huddle Practices In Long-Term Care, Janette Perry

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: High resident fall rates and repeat falls caused by an unreliable nurse-only post-fall huddle (PFH) process that lacked structure, interdisciplinary participation, and timely root-cause analysis.

Aim of the Project: To reduce falls and fall-related injuries in long-term care units by implementing a standardized, evidence-based PFH workflow that strengthens root-cause analysis, improves interdisciplinary communication, and increases PFH reliability.

Review of the Evidence: Evidence from fourteen high-quality, peer-reviewed studies demonstrates that structured, interdisciplinary post-fall huddles are more effective than informal, nurse-only approaches in improving fall analysis and reducing repeat falls in long-term care settings. Structured PFHs strengthen root-cause analysis; interdisciplinary participation …

The Impact Of Evidence-Based Benzodiazepine Tapering Guidelines In An Outpatient Psychiatric Setting: A Quality Improvement Project, Addeh Tosin

Doctor of Nursing Practice Projects

Long-term benzodiazepine use is associated with dependence, withdrawal, cognitive impairment, falls, and overdose, yet tapering practices remain inconsistent in outpatient psychiatric care. This quality improvement project examined whether evidence-based deprescribing education improved psychiatric mental health nurse practitioners' (PMHNPs) self-efficacy, adherence to benzodiazepine tapering guidelines, and active prescription outcomes. The Plan-Do-Study-Act cycle guided implementation, the ADKAR Model guided change, Bandura’s Self-Efficacy Theory provided the theoretical framework, and the Stetler Model supported evidence translation. The project employed a quantitative, quasi-experimental, single-group pretest-posttest design and involved three PMHNPs from one outpatient psychiatric practice. Participants received one 20-minute educational session based on American Society …

Improving Provider Confidence In Suicide-Risk Screening Through Training On A Safe-T-Guided Pathway At Intake, Shukairo Mack Baker

Doctor of Nursing Practice Projects

Evidence supports structured suicide-prevention education, but inconsistent pathway use at outpatient intake prompted this quality improvement project to evaluate provider confidence. The aim was increased confidence after training on a Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) guided pathway. Donabedian's structure, process, and outcome model and the Awareness, Desire, Knowledge, Ability, and Reinforcement change model guided implementation through one Plan, Do, Study, Act cycle. A single-group pre-test and post-test design involved seven clinicians at one hybrid outpatient behavioral health clinic. All available eligible staff (100%) completed a 2.5-hour training and both surveys. The Suicide Risk Assessment Confidence Scale was administered …

Quality Improvement Project: Telehealth Follow-Up After Psychiatric Hospital Discharge, Ikemi Echeng

Doctor of Nursing Practice Projects

The period following psychiatric hospitalization is a high-risk transition during which inconsistent communication, delayed follow-up, and poorly coordinated referrals can create gaps in continuity of care. This quality improvement project addressed inconsistent post-discharge follow-up processes in a community outpatient mental health clinic. The purpose was to implement staff education and a structured workflow incorporating the Agency for Healthcare Research and Quality Discharge Phone Call Tool to improve staff confidence, telehealth follow-up, and referral coordination over eight weeks. A quantitative, quasi-experimental, one-group pre- and post-intervention design was used. Staff confidence was measured with Grundy’s C-Scale, and telehealth follow-up and referral activities …

Impact Of Cannabis Use Screening And Early Intervention In Outpatient Psychiatric Settings, Theresa Chibuoke

Doctor of Nursing Practice Projects

Cannabis use can complicate psychiatric assessment, treatment planning, and clinical outcomes, yet standardized cannabis-use screening remains inconsistently implemented in behavioral health practice. This quality improvement (QI) project addressed inconsistent cannabis screening and referral practices in an outpatient psychiatric clinic by implementing a standardized workflow to improve screening documentation to at least 80% and timely referral completion to at least 75%. A quantitative, quasi-experimental pretest-posttest design included 10 outpatient psychiatric providers over six weeks. Lewin’s Unfreeze-Change-Refreeze model guided change, the Plan-Do-Study-Act framework supported implementation, and Donabedian’s Structure-Process-Outcome model guided the project. The evidence-based intervention incorporated provider education, the valid and reliable …

Quality Improvement Project: The Impact Of Provider Education On Antipsychotic Medication Side Effects, Anthony Emego

Doctor of Nursing Practice Projects

Weight gain is a frequent and clinically relevant side effect of antipsychotic medication. A needs assessment at the project site found that roughly 55% of patients on an antipsychotic treatment had clinically significant weight gain, and providers had no formal training on how to prevent and manage this. The purpose of this quality improvement project was to determine if a provider-focused educational intervention is effective in increasing provider confidence and decreasing antipsychotic-induced weight gain in adult psychiatric patients. This quantitative, one-group pre-post design utilized Lewin's Change Theory and Bandura's Social Cognitive Theory. It was conducted at an outpatient psychiatric clinic …

Quality Improvement Project: Improve Patient Show Rate For Appointments At The Outpatient Diabetic Clinic, Smitha Mathew

Doctor of Nursing Practice Projects

Missed appointments disrupt diabetes management, delay treatment, and waste healthcare resources. This quality improvement project evaluated whether patient-centered scheduling, staff education, and multimodal communication reduced no-show rates among adults with diabetes. The Plan-Do-Study-Act model provided the theoretical and implementation framework, while Kotter’s Eight-Step Change Model guided practice change. The uncontrolled preintervention-postintervention project occurred from January through July 2026 in a hospital-based outpatient diabetes clinic. The evidence-based intervention included 45-minute staff education, scheduling based on patients’ preferred days and times, verifying contact information and communication preferences, sending telephone and text reminders, and re-engaging patients the same day after missed appointments. Appointment …

Quality Improvement Project: Providing Evidence-Based Practice Education On Administering The Edinburgh Postnatal Depression Screening During Visits Once Per Trimester And Postpartum, Megan Keeney

Doctor of Nursing Practice Projects

Perinatal depression (PND) is prevalent worldwide and frequently remains undetected and untreated due to inconsistent screening. At the project site, the Edinburgh Postnatal Depression Scale (EPDS) was administered postpartum only, without standardization. This quality improvement project implemented evidence-based provider education and a revised EPDS protocol, screening once per trimester and postpartum, to increase PND identification, provider self-confidence, self-efficacy, and behavioral health referral rates. This project was guided by Lewin’s Change Theory and the Donabedian framework. A quantitative pre-post design was used with nine providers in an outpatient women’s health clinic, alongside a retrospective and post-implementation electronic health record (EHR) review. …

Quality Improvement Project: Assessing Healthcare Providers’ Confidence, Familiarity, And Implementation Of The Audit-C Screening Tool For Alcohol Use Disorder In Adults With Depression In Primary Care, Babatunde Thanni Shittu

Doctor of Nursing Practice Projects

In depressed adults, alcohol use disorder (AUD) is a clinically meaningful comorbidity whose existence may go unnoticed unless a systematically introduced practice of conducting standardized alcohol-use screening is implemented. The current quality improvement (QI) project evaluated the use of the Alcohol Use Disorders Identification Test-Consumption (AUDI-C) in order to improve the capacity of healthcare providers to diagnose co-occurring AUD and integrate standardized screening into healthcare. Guided by the Knowledge-to-Action (KTA) framework and Kotter’s Change Model, the project aimed to improve provider familiarity, confidence, self-efficacy, screening, documentation, and referral practices. A pretest–posttest design was implemented with 13 licensed healthcare providers in …

Quality Improvement Project: Early Screening For Kidney Disease In Primary Care Clinics, Binsy Easow

Doctor of Nursing Practice Projects

Chronic kidney disease (CKD) is a common complication of diabetes. Evidence-based guidelines recommend urine albumin-to-creatinine ratio (UACR) screening for early identification of albuminuria in patients with diabetes; however, screening was inconsistently completed in an outpatient primary care clinic. This quality improvement project evaluated the impact of a standardized, provider-focused intervention on UACR screening completion and therapy intensification in patients with microalbuminuria. The Iowa Model served as the evidence-based practice framework, Lewin’s Change Theory provided the theoretical framework for practice change, and the Plan-Do-Study-Act cycle guided implementation and evaluation. A quasi-experimental pre- and post-intervention design was used. The intervention was delivered …

Integration Of The Kidney Failure Risk Equation To Guide Nephrology Referral In Adults With Chronic Hypertension, Shawn A. Siddiqi

Doctor of Nursing Practice Projects

Chronic hypertension is an established risk factor for chronic kidney disease (CKD). Baseline chart review at a Texas family practice clinic showed inconsistent renal risk documentation, and providers did not use a standardized renal risk-stratification tool to guide nephrology referral. The aim of this quality improvement project was to implement a standardized Kidney Failure Risk Equation (KFRE) workflow to improve renal risk documentation, nephrology referral decision-making, and provider self-efficacy for adults with chronic hypertension over eight weeks. Lewin's Change Theory guided practice change, the Donabedian model guided quality evaluation, and the Plan-Do-Study-Act (PDSA) cycle structured implementation. Three providers (one physician, …

Quality Improvement Project: Improving Nurse Discharge Competency Through Standardized Education And Discharge Tools In An Inpatient Behavioral Health Hospital, Valina Williams

Doctor of Nursing Practice Projects

Inconsistent discharge education and variable use of structured discharge tools can affect the consistency of transitions from inpatient behavioral health care. The purpose of this Doctor of Nursing Practice quality improvement project was to improve nurse discharge competency by implementing standardized discharge education and reinforcing use of a structured discharge tool in a rural inpatient behavioral health hospital. A quantitative, quasi-experimental one-group pretest-posttest design was used over 12 weeks with 16 eligible registered and licensed practical nurses. Organizational readiness was assessed at baseline, and nurse self-efficacy was measured before and after implementation. Discharge-tool adherence and 30-day readmissions were also evaluated. …

Enhancing Healthcare Provider Confidence And Accuracy In Performing And Documenting The Abnormal Involuntary Movement Scale, Victoria Okoani-Nneji

Doctor of Nursing Practice Projects

Monitoring for medication-related movement disorders is essential for adults with schizophrenia receiving antipsychotic medications; however, inconsistent Abnormal Involuntary Movement Scale (AIMS) assessment and documentation can limit timely recognition of abnormal movements. This quality improvement project evaluated a six-week structured AIMS education program designed to improve provider confidence and documentation accuracy in an outpatient behavioral health setting in Central Ohio. Guided by Benner’s Novice-to-Expert Model and Kotter’s Eight-Step Change Model, the project used a one-group pretest-posttest design with 15 licensed behavioral health providers. Weekly sessions included instruction, demonstration, guided practice, case-based learning, scoring, interpretation, and electronic health record (EHR) documentation. Descriptive …

Quality Improvement Project: Determining Impact Of Mental Health Screening Provider Training, Sherri Bennett

Doctor of Nursing Practice Projects

Obesity is frequently associated with mental health concerns, yet these conditions may remain under identified when mental health screening is not consistently incorporated into medical weight-loss care. At the project site, fewer than 2% of patients who are overweight or obese were identified as needing mental health services, demonstrating a practice gap in screening and referral. The purpose of this quality improvement project was to evaluate whether targeted mental health screening education improved provider confidence. The aim was to increase confidence in conducting mental health screening among nurse practitioners in a medical weight-loss program. The Stetler Model provided the theoretical …

Standardizing Discharge Communication In Urgent Care: A Teach-Back Quality Improvement Initiative, Pearlean Smith

Doctor of Nursing Practice Projects

Deficits in health literacy and inconsistent discharge education contribute to patient misunderstanding and avoidable return visits. This quality improvement project evaluated a standardized teach-back discharge education process at a community urgent care clinic. Lewin's Change Theory guided the change process, the Iowa Model guided implementation, and Donabedian's Structure-Process-Outcome Framework guided evaluation. A quantitative one-group pretest-posttest design included eight participants: three nurse practitioners, two licensed practical nurses, and three medical assistants. Participants completed a 30-minute teach-back educational session followed by a 12-week implementation period. Measures included the five-item Confidence Scale, discharge audits, and aggregate electronic medical record data on seven-day return …

Quality Improvement Project: Implementing The 2025 Aha Hypertension Guidelines In Rural Primary Care, Johanna M. Alvarez

Doctor of Nursing Practice Projects

Hypertension contributes to cardiovascular morbidity and mortality, and delayed adoption of updated guidelines can increase therapeutic inertia in rural primary care. This Doctor of Nursing Practice quality improvement project addressed an evidence-to-practice gap at a rural Federally Qualified Health Center where clinicians used 2017 American Heart Association/American College of Cardiology hypertension protocols after release of the 2025 guideline. The purpose was to determine whether structured education and point-of-care visual decision aids improved provider knowledge, attitudes, self-reported practices, and selected clinical adherence metrics over 3 months. Guided by the Iowa Model, Lewin’s Change Management Model, and the Plan-Do-Study-Act framework, a quasi-experimental …

Quality Improvement Project: Improving Nurses’ Confidence In Peripheral Intravenous Catheter Assessment Through The I-Decided Framework, Pepe Sanchez

Doctor of Nursing Practice Projects

Peripheral intravenous catheters (PIVCs) remain a patient safety concern because inappropriate management can increase the risk of catheter-related bloodstream infections, prolonged hospitalization, and increased healthcare costs. A vascular access assessment at an acute care hospital identified inconsistent PIVC assessment practices and inadequate documentation, highlighting the need for a standardized approach to vascular access management. This quality improvement project evaluated the impact of education on the I-DECIDED framework on nurses' confidence in PIVC assessment and clinical decision-making. Guided by the Johns Hopkins Nursing Evidence-Based Practice Model and Lewin's Theory of Planned Change, the project used a quantitative, quasi-experimental, one-group pretest-posttest design. …

Integrating Interprofessional Education To Strengthen Team-Based Mental Health Care, Adebisi Tijani

Doctor of Nursing Practice Projects

Fragmented interprofessional collaboration in outpatient mental health settings compromises care coordination and patient engagement. This quality improvement (QI) project implemented a structured interprofessional education (IPE) workshop series to improve team collaboration and reduce patient no-show rates in an outpatient mental health clinic. Guided by Bandura's Social Cognitive Theory and Lewin's Change Management Model, the project used a pre-post, single-group design with 12 licensed mental health professionals. The team measured collaboration with the Assessment of Interprofessional Team Collaboration Scale-II (AITCS-II) and collected aggregate patient no-show rates from the electronic health record. The intervention consisted of four monthly, one-hour workshops covering role …