Enhancing Medication Storage Protocols For Safety Optimization In Cardiac Care Unit Inpatients, Baothu Nguyen

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project aimed to enhance medication security in the cardiac care unit by implementing a standardized storage protocol to reduce unsecured medications by 20% by December 6, 2024, following a 93-day implementation period. Additionally, the project sought to achieve 100% staff competency in the protocol by September 30, 2024.

Background: Unsecured medications pose significant patient safety risks, including unauthorized access, incorrect administration, and treatment delays. This project aligned with the Patient-Centered Caritas Model and addressed compliance deficiencies identified by the Joint Commission and the hospital’s quality control team.

Methodology: A Plan-Do-Study-Act (PDSA) framework guided the project, integrating …

Implementing A Routine Patient Health Questionnaire-9 (Phq-9) Screening Bundle For Adults (18-65 Years) Scheduled For A Psychiatric Evaluation, Olivier Bertrand Djoumessi

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Depression affects 21 million American adults (8.4%), yet only 28% receive appropriate screening. In Texas, where 20.8% of adults experience depression, systematic screening remains inconsistent. This quality improvement project addressed a critical gap at an outpatient mental health clinic in the Dallas-Fort Worth metroplex, where Patient Health Questionnaire-9 (PHQ-9) screening occurred in only 40% of psychiatric evaluations, resulting in missed diagnoses and inconsistent treatment. Using the Plan-Do-Study-Act framework, the project implemented a comprehensive PHQ-9 screening bundle consisting of staff training, electronic health record integration, and a treatment algorithm based on severity thresholds. The intervention targeted adults, aged 18-65, scheduled for …

Directing Patient Hand Hygiene Before Meals In The Icu: A Quality Improvement Project To Enhance Patient Safety, Nicholas Davini

Master's Theses and Capstones

BACKGROUND:

Hospital-acquired infections (HAIs) are a major problem in healthcare, increasing patient morbidity, mortality, and costs. While staff hand hygiene is a well-established infection control measure, less attention is paid to patient hand hygiene (PHH) despite CDC recommendations.

LOCAL PROBLEM:

An intensive care unit (ICU) in northeastern Massachusetts had no formal policy for patient hand hygiene, and hospital leadership expressed support for enhancing infection control practices.

METHODS:

Using the Plan-Do-Study-Act model, a quality improvement project was implemented to encourage PHH before meals. Baseline PHH rates were collected through observation. The intervention involved registered nurses (RNs) directing patients to use hand …

Optimizing Surgical Count Accuracy And Efficiency Through Enhanced Operating Room Communication To Promote Patient Safety: A Quality Improvement Project, Jessica L. Limbocker

Master's Theses and Capstones

Abstract

Background: Retained surgical items (RSIs) are classified as “never events” because they are preventable and pose significant risks to patient safety. This quality improvement (QI) project aimed to reduce the risk of RSIs, particularly during Cesarean sections by identifying gaps in surgical count practices and implementing targeted interventions.

Local Problem: At the project site, baseline assessments revealed gaps in surgical count practices. These included inconsistent documentation, absence of formal education on count procedures, and communication barriers among the intraoperative team—all contributing to increased risk of RSIs.

Methods: This QI project implemented a multi-faceted intervention to enhance …

Enhancing Patient-Centered Suicide Prevention: A Quality Improvement Project Addressing Educational Gaps In Staff Caring For Veterans, Shayla Craigue

Master's Theses and Capstones

Veterans are at significantly higher risk for suicidal ideation (SI) than the general population and often encounter barriers to care such as stigma, trauma, and distrust in healthcare systems. This quality improvement project, conducted at a Veterans Affairs (VA) Urgent Care Clinic, aimed to enhance trauma-informed care by addressing educational gaps among clinical staff. Using the Plan-Do-Study-Act (PDSA) model, the intervention included a pre-intervention survey to assess baseline knowledge, a targeted educational poster informed by survey findings, and a post-intervention survey to measure changes in staff confidence, resource awareness, and understanding of the role of the mental health response team, …

A Quality Improvement Project: Increasing Pre-Term Infant Safety By Enhancing Skin-To-Skin Time In The Nicu, Maureen A. Cassidy

Master's Theses and Capstones

Background: Skin-to-skin (STS) contact, also known as kangaroo care, is a critical intervention for preterm infants, especially for those in the neonatal intensive care unit (NICU). It promotes neurodevelopmental outcomes, physiological stability, and parental bonding. However, STS often falls below recommended daily levels due to a variety of berries. Exploring aids like belly bands may help address these barriers and promote improved outcomes.

Local Problem: STS time in this NICU microsystem falls significantly below nationally recommended levels, with most preterm infants receiving less than one to two hours daily compared to the World Health Organization’s recommendation of 8-24 hours per …

Does Education On Aseptic Non-Touch Technique Affect Nurse Knowledge On Aseptic Technique When Placing Ultrasound Guided Peripheral Intravenous Lines? A Quality Improvement Initiative, Hannah G. Keyser

Graduate Theses, Dissertations, and Problem Reports (ETD)

This Doctor of Nursing Practice (DNP) project attempted to increase nurse’s knowledge of aseptic technique when placing USG-PIVs in hospitalized adult patients after educational training on the Aseptic Non-Touch Technique Clinical Practice Framework (ANTT CPF). Implementation of the ANTT CPF in the cardiovascular intensive care unit (CVICU) at Ruby Memorial Hospital, as a didactic educational session for nurses already trained to place ultrasound-guided peripheral intravenous lines, was utilized for this DNP project. Pre- and post-surveys were employed to determine changes in knowledge scores as well as feelings of comfort and knowledge related to the CPF. Results remained stable for survey …

Application Of Root Cause Analysis For Fall Prevention: A Quality Improvement Initiative For Older Adults In A Skilled Nursing And Long-Term Care Facility, Terrence Ranjo

Doctoral Projects

Falls in older adults are common and often have severe outcomes. They are the leading cause of fatal and non-fatal injuries among people aged 65 and older and continue to increase. Half of residents in nursing facilities fall annually, and one in every ten falls will lead to a severe injury. Federal regulations like the Centers for Medicare and Medicaid Services require long-term care (LTC) facilities to incorporate quality assurance performance improvement initiatives to address identified quality concerns in LTC facilities. Root cause analysis (RCA) can help clinicians identify several root causes of falls and guide clinicians in developing personalized …

Decreasing Antibiotic Turnaround Time In The Medical Intensive Care Unit: A Quality Improvement Project, Kacie Wright

Doctor of Nursing Practice Final Project Abstract

Purpose: This QI project aimed to increase the percentage of first-dose antibiotics administered within one hour of order placement to 80% in the ICU by 12/31/24.

Background: Antibiotic Turnaround Time (ATT) is the time between antibiotic order placement and administration. Prolonged ATT can cause adverse outcomes by delaying treatment. In 2023, only 54% of first-dose antibiotics were given within the EBP standard of one-hour in our 36-bed Medical ICU.

Methodology: The Six Sigma DMAIC model identified barriers and interventions to achieving target ATT using stakeholder input, process mapping, and root cause analysis. Multidisciplinary Plan-Do-Study-Act (PDSA) cycles were created to evaluate …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Increasing Access To Fresh Fruits And Vegetables At An Urban Clinic: A Quality Improvement Project, Jordan Michael Leahy

Master's Projects and Capstones

The microsystem setting for this quality improvement project is an adult health unit at one of five safety net clinics housed within a macrosystem in a large urban setting in Northern California serving a low-income, predominantly Hispanic population. Professionals involved in the delivery of the food security program include patient support services, medical assistants, case managers, health promoters, registered nurses, and providers. With enrollment in clinic’s food security program significantly lower than program goals, clinical site stakeholders sought to identify and address gaps in delivery. This quality improvement aimed to improve the screening process to increase the percentage of eligible …

Optimizing Fall Prevention: A Quality Improvement Initiative To Enhance Documentation And Intervention Accuracy Using The Hester Davis Scale In Medical-Surgical Units, Kiana Conn, Brooklin Hunter-Johnson, Jashan Kahlon, Adrian Paz

Master's Projects and Capstones

Falls among hospitalized patients remain a critical safety concern, particularly in medical-surgical units caring for geriatric and oncology patients. This quality improvement project aimed to evaluate and address gaps in adherence to fall prevention protocols by utilizing the Hester Davis Scale (HDS) in two medical-surgical units at a large metropolitan hospital in Southern California. The project focused on auditing current practices to identify inconsistencies in documentation and intervention implementation, emphasizing areas such as bed alarm activation, fall risk signage placement, and armband use. Weekly audits were conducted from October 3 to October 29, 2024, to establish baseline data and inform …

Optimizing Laboratory Appointment Adherence Among Patients Prescribed Psychoactive Medications, Tamara N. Blake

Doctor of Nursing Practice Final Project Abstract

PURPOSE

The purpose of this scholarly project was to implement a standardized nurse-driven phone call reminder protocol to improve adherence to scheduled laboratory appointments among patients prescribed psychoactive medications requiring bloodwork. This protocol is aimed to increase appointment adherence and reduce no-show rates within the clinic.

BACKGROUND

The project was implemented within a small outpatient community-based clinic in Round Rock, Texas which provides mental health services. The clinic experienced high no-show rates for scheduled laboratory appointments among patients prescribed psychoactive medications. Monitoring these patients is essential to ensure medication safety and prevent potential adverse effects.

METHODOLOGY

The six-week quality improvement …

Improving Mobility In Acute Care Patients With A Mobility Technician: A Quality Improvement Pilot Project, Oscar A. Acosta, Erin Shea, Madelyn Lliteras, Mary B. Gomes, Tiffany D. Baker, Catherina Chang Martinez

Nursing & Health Sciences Research Journal

Background: Early mobilization during hospitalization remains an important element in the patient’s recovery and is associated with good clinical outcomes. Despite these benefits, nurses and physical therapists experience challenges from time constraints and competing responsibilities. Mobility technicians present an alternative for safe and early patient mobilization during hospitalization. Methods: The purpose of this quality improvement project was to implement a mobility technician program to improve patients’ mobility during their hospital stay. The setting was a medical-surgical nursing unit of a hospital in South Florida. A protocol was implemented in December 2023. Patients who met the criteria for ambulation using the …

Safety Issues Due To Inadequate Utilization Of Policies And Procedures To Identify And Confiscate Dangerous Contraband Found On Patients, Onyinye Uche

MSN Student Capstones

No abstract provided.

Enhancing Pain Management Practices In An Orthopedic Medical-Surgical Unit, Christiana Owusu

MSN Student Capstones

No abstract provided.

Nursing Students’ Evaluation Of Clinical Placement Education Quality: A National Database Analysis, Colleen Ryan, Areum Hyun, Lynda Hughes, Fiona Bogossian, Simon Cooper

Research outputs 2022 to 2026

Aim: To report nursing student ratings of clinical placement education quality. Background: Australian nursing students must complete specified clinical placement hours which must be monitored and evaluated. Design: A quality improvement evaluation design, incorporating survey. Methods: Participating universities used QR codes and weblinks to distribute a survey between January and December 2023. The validated Placement Evaluation Tool (PET – Nursing) incorporates 20 items; Clinical Environment (11 items), Cronbach's alpha =.94 and Learning Support (8 items), Cronbach's alpha =.96 and one item rating satisfaction. Results: Nursing students from 36 universities submitted 17,705 evaluations. The PET – Nursing mean quality rating was …

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Improving Maintenance Of Central Line Dressing To Reduce Risk Of Central Line-Associated Bloodstream Infections In An Acute-Care Setting, Kristi Gaskill, Kerry Wilder, Emily Sneed, Astrid J. Pujals, Kim Newman

HCA Healthcare Journal of Medicine

Background

Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.

The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings. …

Implementation Of Eat Sleep Console For Neonatal Abstinence Syndrome: A Quality Improvement Project, Harley Addison Kennington

Doctor of Nursing Practice Scholarly Projects

Problem Statement: A level III NICU and mother-baby unit within an inpatient hospital in the Southeast United States transitioned from the Finnegan Neonatal Abstinence Scale (FNASS) to the Eat, Sleep, Console (ESC) for treating Neonatal Abstinence Syndrome (NAS). Prior to ESC implementation, there was limited nursing education of ESC practice guidelines or consideration for proper implementation protocol. Purpose: The purpose of this evidence-based quality improvement project was to reintroduce nursing staff to the ESC NAS Care Tool and ESC charting guidelines within the NICU and mother-baby units. Methods: This project followed the PDSA process – Plan, Do, Study, Act, underscored …

Depression In Individuals With Chronic Liver Disease: Improving Screening In The Outpatient Setting, Kayla Corine Wright

Doctor of Nursing Practice Scholarly Projects

Problem Statement: Individuals with chronic conditions such as chronic liver disease experience higher rates of depression, often underdiagnosed and placing high risk demographics in jeopardy of adverse outcomes, including worsening prognosis, decreased quality of life, and increased symptomatology.

Purpose: Evidence advocates for routine depression screening within high-risk patient populations. This paper outlines the implementation of a quality improvement initiative aimed at enhancing depression screening at a selected outpatient liver clinic within an extensive hospital system by implementing the PHQ-9 questionnaire during patient clinic visits, where no standardized screening protocol was previously in place.

Methods: The Plan-Do-Study-Act cycle guided the implementation …

A Nurse-Driven Screening Process To Increase Icu Palliative Care Utilization, Sara L. Stock

Doctor of Nursing Practice Final Project Abstract

Purpose

A scholarly project aimed to increase palliative care by 25% for intensive care unit patients in eight weeks by integrating nurse-driven screening process into multidisciplinary rounds.

Background

Palliative care provides valuable mental, emotional, and spiritual support for patients and families. These benefits are available to any patient with a disease process causing symptoms affecting quality of life. Palliative care is falsely equated with hospice care, leading to further delay. The original referral model relied only on intensivist identification of eligibility The project was implemented in a 20-bed medical and surgical ICU in a community hospital in the Houston area. …

Implementation Of Barcode Medication Administration To Reduce Vaccine Errors, Elizabeth R. Schwarz

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In the project organization, a large ambulatory medical group, there have been high rates of vaccine administration errors, particularly within family practice locations, which have the most variety of vaccines given.

Aim of the Project: This project aimed to improve the safety of vaccine administration by implementing barcode medication administration (BCMA) in two family practice locations.

Review of the Evidence: BCMA is increasingly recommended for outpatient settings by patient safety groups like the Institute for Safe Medication Practices (2022). Studies show BCMA can save time, improve vaccine data capture and can decrease medication errors by up to 74% (Evanson …

Introducing Therapeutic Music As An Alternative Therapy To Reduce Anxiety In The Emergency Department, Azuka Debbie Onyekwe

Doctor of Nursing Practice Final Project Abstract

Purpose: This quality improvement project evaluated the feasibility of implementing therapeutic music in the emergency department (ED) to decrease anxiety levels by 10% over three months at a hospital in West Houston.

Background: Anxiety in the ED can exacerbate patient conditions and lead to increased use of anxiolytic drugs. Prior studies suggest that therapeutic music is effective in lowering anxiety across clinical settings. Anxiety in emergency department settings can negatively impact patient outcomes and increase reliance on pharmacological treatments. Evidence from previous research has demonstrated that therapeutic music interventions can significantly reduce anxiety, making it a promising non-pharmacological approach. However, …

Improving The Diagnosis And Treatment Of Obstetric Sepsis, Edwije Joseph

Master's Projects and Capstones

Problem: Maternal mortality affects women during four phases of obstetrics, including triage, antepartum, labor & delivery, and postpartum. In the U.S., sepsis is the third leading cause of maternal death. Inconsistent screening practices and delays in recognizing symptoms can occur in any phase. These factors were identified as root causes in a northern California community hospital with 600 monthly deliveries.

Context: Two maternal sepsis cases cost $90,000 annually. A standardized pathway was initiated nationally in October 2023 through the California Maternal Quality Care Collaborative (CMQCC). One regional hospital system initiated a quality improvement project over 5 months within a community …

Post Anesthesia Care Unit Comprehension Safety Program Quality Improvement Project On De-Escalation Of Patients, Mary M. Gaukler Giannavola, Basil George Verghese, Deborah Maier

Advances in Clinical Medical Research and Healthcare Delivery

Background:

Violence within the healthcare setting has risen significantly, and has crossed into areas where staff are less prepared to manage and deescalate challenging patient encounters. This lack of preparedness and confidence has led to increased staff stress, burn out, and can potentiate poor patient outcomes.

Methods:

A pre/post-simulation quality improvement project was performed within a tertiary hospital Post-Anesthesia Care Unit in Upstate New York to evaluate the effect of simulation on feelings of confidence and preparedness in patient de-escalation with PACU nurses and patient care technicians. The project evaluation included the Thackrey’s Clinician Confidence in Coping with Patient Aggression …

Improving Hypertension Management In The Family Care Practice Through The Education Of Clinical Staff On Jnc-8 Guidelines, Shiny Michael

Doctor of Nursing Practice Projects

Hypertension is a major public health challenge, contributing significantly to global morbidity and mortality. Despite the availability of JNC-8 guidelines, adherence in clinical practice is often lacking. This project aimed to improve hypertension management in a primary care setting by educating clinical staff on the JNC-8 guidelines to enhance adherence to evidence-based practices. The primary purpose of this project was to address the lack of knowledge and suboptimal hypertension control through targeted educational interventions for clinical staff. The methodological approach involved a pre- and post-intervention design, with educational sessions conducted for medical assistants. Data on blood pressure control and staff …

Implementation Of Home Blood Pressure Monitoring, Sarah Gutzke

Dissertations

Approximately 48.1% of adults in the United States have high blood pressure. Providers may encourage patients to monitor and log their blood pressure at home. Still, patients often fail to bring this information to appointments, leading to reliance on less comprehensive in-office measurements. This quality improvement project aimed to increase adherence to home blood pressure logs using a Blood Pressure Toolkit. A descriptive, observational design was utilized to record patient adherence of taking home blood pressure measurements and increase the number of patients who brought their blood pressure logs to their healthcare provider visits over two months. A convenience sample …

Lgbt Cultural Competence Education For Nurse Leaders In A Large Metropolitan Healthcare System: Quality Improvement, Trevor Mcguffin, Andrew Mitchell

Doctor of Nursing Practice Papers

Background: In the United States, seven percent of adults identify as LGBT. The LGBT population is disproportionately affected by health disparities and barriers to care when compared to the cis-heterosexual population. Due to healthcare providers’ limited LGBT health education and experience, inconsistencies in LGBT culturally competent care perpetuate health disparities and barriers to care for the LGBT population.

Purpose: The purpose of this quality improvement project was to educate nurse leaders on LGBT cultural competency and facilitate nurse leaders’ behavior change.

Methods: This quality improvement project consisted of three LGBT cultural competence modules and two guided behavior change pathways. Outcomes …

Improving Treatment And Follow-Up Care For Patients Who Screen Positive For Depression In Family Practice: A Quality Improvement Project., Jennifer D. Hooper

Doctor of Nursing Practice Papers

Background: Depression is a prevalent condition requiring systematic approaches for effective treatment and follow-up in primary care. This quality improvement project aimed to enhance care for patients screening positive for depression at an academic family practice with a diverse patient population and a comprehensive electronic health record (EHR) system.

Purpose: The primary objective was to assess whether a provider educational session and the implementation of an optional depression treatment and follow-up algorithm could improve timely and appropriate care for patients with positive PHQ-9 screenings.

Setting: The project was conducted at an academic family practice office.

Methods/Procedures: The intervention included a …