Critical Care Nursing Commons^™

Reducing Rates Of Blood Culture Contamination In The Emergency Room, Erika Goldberg

Student Scholarly Projects

Practice Problem: In one emergency room (ER) blood cultures (BC) drawn by nurses had a high contamination rate due to lack of collection standards, which lead to poor patient outcomes.

PICOT: The PICOT question that guided this project was; In adult emergency room patients where blood cultures are drawn (P), how does implementation of an evidence-based practice method (I), compared to the standard method of obtaining blood cultures (C), affect blood culture contamination rates (O), within ten weeks. (T)?

Evidence: Based on multiple sources within the literature; best evidence for lowering blood culture contamination rates (BCC) is done using EBP …

Ekg Is Key: A Quality Improvement Project To Decrease Door-To-Ekg Time In A Rural Emergency Department, Amanda Southwell

Doctor of Nursing Practice Projects

Background: Electrocardiograms (EKGs) are the priority when evaluating patients with chest pain who present to the Emergency Department (ED). The American Heart Association and other governing bodies suggest a 10-minute door-to-EKG (DTE) time. The target facility displayed a delay in DTE times.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement (QI) project aimed to decrease the average DTE time for patients over 18 years old with chest pain who presented to the ED registration area.

Methods: The DNP project consisted of an EKG suite to perform EKGs near the ED registration/triage area. Registration and ED staff were educated on …

A Quality Improvement Project To Reduce Facility-Acquired Pressure Injuries, Carolina Rosario

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Facility-acquired pressure injuries (FAPIs) pose significant risks to patient outcomes and healthcare costs ($500 to $70,000 per PI) in subacute rehabilitation (SAR) facilities. An assessment in a SAR identified a concerning pressure injury (PI) rate of 15.3%, exceeding the national benchmark of 10% for such facilities. This prompted an evidence-based quality improvement (QI) initiative.

Aim of the Project: This project aimed to reduce FAPI rates by 30% or greater among patients 65 and older using a PI prevention bundle called SSKINS (Skin, Surface, Keep moving, Incontinence/moisture, Nutrition/hydration, Self-management).

Review of the Evidence: A comprehensive literature review indicated that PIs …

Ultrasound Guided Piv Insertion Implementation, Blake Hotchkiss, Beth O'Donnell, Miles Merwin, Billie Jo Senecal, Ronica Smith, Eric Alan, Bryan Tavary, Chelsea Harkins, Taylor Archard, Leslie Geissinger, Lauren Remington

Operations Transformation

Observed high number of unsuccessful peripheral IV insertion attempts. This increases waste (cost and time) and decreases patient satisfaction.

Approach To Pivie In Pediatrics: Standardization For Early Detection, Jamie Green, Jill Gregory, Elizabeth Murphy, Jessica Miller, Nicole Manchester, Frank Harris, Meaghan Wildes, Cecilia Inman, Jenn Paradis, Faye Weir

Operations Transformation

PIVIE (Peripheral Intravenous Infiltration & Extravasation) can have devastating effects, especially in the pediatric population. The condition may disrupt vasculature severe enough for permanent skin and tissue loss that can lead to impaired limb function due to severe scarring. Problem: No standardized process existed either to prevent or review these events at Barbara Bush Children’s Hospital at Maine Medical Center prior to the study. PIVIEs were measured through the event reporting platform and only severe PIVIEs were being documented in this report. All infiltrations (1-4 on the infiltration scale) should be measured for accurate benchmarking. Occurrences in the electronic medical …

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Educating Nurses On Frequent Oral Care For Mechanically Ventilated Patients: An Evidence-Based Practice Project Proposal, Grace Alford, Susan Butz, Ruth Chavez, Joy Shoemaker

Doctor of Nursing Practice Scholarly Projects

The final scholarly project proposal is to implement oral care education for nurses in an intensive care unit (ICU). The proposal aims to create a guideline for an investigator to implement oral care recommendations for mechanically ventilated patients in order to reduce ventilator-associated pneumonia (VAP). The proposal consists of obtaining VAP data and oral care charting data for the unit studied, steps for providing oral care education, and analysis recommendations. Oral care involves swabbing the patient’s mouth every two hours with a swab and mouthwash. Oral care education would include handouts and direct teaching. The proposal aims to increase oral …

Enhancing The Safety Of Medication Administration: The Synergistic Role Of Closed Loop Electronic Medication Management And Iv Medication Administration, Kelly Goetz, Angela Schoenung, Lauren Daugherty, Kaitlyn Hornsby

Posters-at-the-Capitol

The high acuity of patients in the ICU results in numerous medications being administered, increasing the risk of medication errors. The purpose of this project is to investigate the impact of integrating consistent closed loop electronic medication management (CLEMM) to decrease medication errors in the ICU for bedside nurses who use electronic health records (EHRs). The project type is a comprehensive literature review, with studies that included a single prospective cohort study, case report, single non-randomized trial, quasi experimental study, single cross-sectional studies, and systematic reviews. The importance of this project is to address the break in the loop of …

Understanding The Importance Of Administrative Mental Health Support For Frontline Nurses Post Covid-19, Sarah Mah

Nursing | Senior Theses

During the peak of the COVID-19 pandemic, intensive care units and critical care units were overwhelmed with the number of patients that were on the floors. It was during this time that nurses were experiencing the most mental health decline.

Several factors can be associated with the rapid decline of nurses’ mental health. However, these issues could ultimately stem from the lack of action taken by healthcare administration. This includes increased workload and the lack of PPE, resources institutional support. Because these units played such a vital role during the pandemic, it is imperative that healthcare administrators do what they …

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Senior Theses

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care-based training, with the …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Senior Theses

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Optimizing Ventilator-Associated Pneumonia Prevention And Education: In Adult Icu Settings, Danielle Gonzalez

Nursing | Student Research Posters

Background: Ventilator associated pneumonia (VAP) in adult intensive care patient units (ICU) is one of the most common and deadly nosocomial infections today. Studies have identified a gap in intensive care nurse ventilator education and compliance with hospital protocols. Overall increasing the rates of VAP and morbidity. Hospitals worldwide have shown a decrease in VAP rates after inheriting "VAP-bundles''. This includes nurse specific interventions and assessments as a preventative measure. However, studies failed to demonstrate which bundle interventions directly correspond to the prevention of VAP. Purpose: Address all components of education, a nurse’s ability to properly identify and understand the …

Creation Of A Structured Rapid Response Team And Early Rrt Activation, Elizabeth Amaka Azie

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Cardiac arrest, unanticipated admissions to the intensive care unit (ICU), and mortality account for about 50% of serious inpatient adverse events (Ko et al., 2020). Efforts to prevent in-hospital cardiopulmonary resuscitation (CPR) require a system to identify deteriorating patients and include an appropriate interventional response, such as a rapid response team (Andersen et al., 2019). A well-structured rapid response team (RRT) has five categories that include team structure, organizational culture, expertise, communication, and teamwork (Jackson, 2017). A community hospital in Texas has been challenged in its attempts to have a well-structured RRT and had an increase in cardiac arrest. A …

Promoting Inpatient Mobility To Improve Patient Outcomes: A Quality Improvement Project In A Rural Critical Access Hospital, Chantal Laplante

Master's Theses and Capstones

Background: Although beneficial to patient outcomes, inpatient ambulation is not a prioritized care intervention, and a task often deferred to physical therapy. Patient immobility is a complex problem that requires a multifaceted approach.

Local Problem: In a rural, critical access hospital, on an 18-bed medical surgical unit, nursing staff lacked ownership of patient mobility. There was no standardized process to document ambulation and mobility tasks were not scheduled, falling to the end of the nursing work list. Many patients did not have activity orders upon admission and nurses lacked resources for ambulation assessment and daily goal setting. There was no …

Enhancing Chest Pain And Oxygen Supplementation Protocol Adherence Through Nurse Education In The Emergency Department For Patients With Acute Coronary Syndrome And Unspecified Chest Pain: A Quality Improvement Project, Leah Gamble

Master's Theses and Capstones

Abstract Background: Acute Coronary Syndrome (ACS) and unspecified chest pain are common presentations in the Emergency Department (ED). Proper management, including appropriate oxygen supplementation, is crucial for optimal patient outcomes. However, discrepancies between current practice and evidence-based guidelines have been identified, highlighting a need for targeted educational interventions.

Local Problem: In the ED, knowledge gaps among nurses regarding the correct administration of supplemental oxygen for patients with ACS and unspecified chest pain have been observed. This inconsistency with the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines may lead to poor patient outcomes.

Methods: The Plan-Do-Study-Act (PDSA) …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience: Master of Public Health

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Sustaining Care Team Engagement Using A Hierarchy Of Needs Framework, Katherine Skroski, Sam Canonico, Hailey Frager, Mary Beeaker, Natalia Johnson, Rebecca A. Brookes

Operations Transformation

Cardiology Intensive Care & Cardiovascular Interventional (CICU & R9 West) teams provide superb care to critically ill cardiac patients at Maine Medical Center. Covid Pandemic revealed the importance of physical and mental health wellbeing, as well as care team engagement in order to continue to provide outstanding care to patients. CICU/R9 West Leadership looked for ways to improve team engagement and ensure that care team members’ needs are met and sustained.

Improving Timeliness Of Palliative Care Referrals Within The Intensive Care Unit: A Quality Improvement Project, Stephanie Fiore

DNP Projects

Significance and Background: Palliative care (PC) services are often underutilized in the ICU. There is a lack of understanding of PC by providers, staff, patients, and families which then leads to difficulty obtaining appropriate and adequate referrals to the PC team. In the ICU practice setting, the current process for palliative care referrals (PCRs) has the attending physician as the only individual to initiate a PCR referral. Another element missing from the current process is a criteria trigger tool that other disciplines, including nursing, can use to assess the patient’s need for PCR in the first 48 hours of admission. …

Increasing Repeat Lactate Collection For Sepsis Bundle Management Of Care, Rahwa Teklehaimanot

Master's Projects and Capstones

Abstract

Problem: In 2020, sepsis was the leading cause of mortality in this Northern California Hospital Organization. This QI project aimed to reduce the number of fallouts for collecting repeat lactate levels to less than two per month, from a baseline of five per month, within three months.

Context: This Northern California Emergency Department serves a broad range of patients, from pediatrics to geriatric patients, with an average daily census of 80-90 patients. In this 20-bed Emergency Department, approximately 650 patients were diagnosed with sepsis in 2022.

Intervention: The hospital sepsis committee collaboratively developed a new standardized workflow for sepsis …

Extubation Readiness Test In A Pediatric Cardiac Intensive Care Unit, Mary K. Holyoke

Dissertations

Extubation Readiness Test in a Pediatric Cardiac Intensive Care Unit

Abstract

Problem: The lack of standard extubation readiness tests (ERTs), that are practiced in pediatric ICUs to monitor extubation readiness, clinicians have the difficult task of weighing the risk versus benefit of extubation. ERTs can aid clinicians in deciphering patients ready to be successfully extubated and have shown to decrease length of mechanical ventilation and decrease extubation failures.

Methods: The quality improvement (QI) project utilized a descriptive observational design to assess the effects of the implementation of an ERT in a pediatric cardiac ICU. This project used a convenience sample …

Effect Of Confusion Assessment Scores On Identifying Delirium In Intensive Care Patients, Kayla Jacobs

Dissertations

Delirium in intensive care unit (ICU) patients can lead to increased length of stay in the hospital, increased risk of complications, increased polypharmacy, family distress and increased rate of mortality (Vasilevskis et al., 2018). Research has shown that addressing modifiable risk factors can improve survival rate by up to 15%, and routine screening for delirium in ICU patients leads to decreased patient anxiety, reduced in-hospital mortality, early recognition, and treatment of delirium (Krewulak et al., 2021 ; Vasilevskis et al., 2018). This quality improvement project used evidence-based intervention to increase accurate documentation of the confusion assessment method in the ICU …

Reducing Urinary Catheter Usage In The Intensive Care Unit Setting And Education Related To Preventing Cautis: A Qi Project, Kristina Diurno

DNP Projects

Significance and Background: Catheter-associated urinary tract infections (CAUTIs) are common but preventable hospital-associated infections. The inappropriate and prolonged use of indwelling urinary catheters can pose a significant risk for patients and healthcare organizations. The Centers for Disease Control and Prevention identified that the most important factor related to an increased risk of CAUTI is the length of time an indwelling catheter remains in place. This DNP (Doctor of Nursing Practice) project assessed the barriers to removing indwelling catheters in the intensive care unit (ICU) while providing encouragement of prompt removal.

Purpose: Three aims were developed for this quality improvement project: …

Use Of An Alarm Bundle To Reduce Alarm Fatigue In The Icu: A Quality Improvement Project, Blerina Petitti

DNP Projects

Significance and Background: In the critical care setting, frequent false alarms can lead to sensory overload and delayed reactions to alarms (aka, alarm fatigue). Patients are at risk because overtime staff may ignore or become desensitized to all alarm sounds, even true ones.

Purpose: The purpose of this QI project is to establish alarm management protocol in a 14-bed ICU. The goals were to reduce alarm fatigue and create a safe environment for patients and clinical staff.

Methods: The Model of Improvement (IHI, 2023) with cycles of the Plan-Do-Study-Act (PDSA) was used to implement an alarm bundle checklist that …

Medical Device-Related Pressure Injury (Mdrpi) Prevention In The Intensive Care Unit (Icu): An Evidence Based Practice Quality Improvement Project, Sana Shah

DNP Projects

Introduction: All intensive care unit (ICU) patients utilize various medical devices for care and treatment, placing them at high-risk for medical device-related pressure injuries (MDRPIs), which can lead to life-threatening infections, wounds/scars, and consumption of additional time and products to rectify these issues. Lack of appropriate decompression measures and improper bedside handoff report was recognized in the ICU at a hospital in Connecticut (CT).

Method: A literature search using CINAHL, MEDLINE, and the Cochrane Database of Systematic Reviews was conducted, restricting the search to the period between 2018-2022. The keywords searched were: “pressure injuries,” “adult patients,” “intensive care …

Understanding Language Barriers And Its Implications On Patient Outcomes In The Urgent Care Situation, Nicolo Co

Nursing | Senior Theses

Background

A common goal for healthcare is healthcare for all, through which can be achieved when communication between the client and healthcare team is established. There are millions of immigrants worldwide who are not granted the healthcare that they deserve simply because of a lack of understanding in a country’s dominant language.

Patients with a limited language proficiency in a new country can have difficulty in understanding the care that they receive, which leads them to toil with understanding their healthcare options, let alone establishing expectations. This issue also stretches onto the risks of patient safety, in which urgent needs …

Improving Spiritual Care Competency Among Intensive Care Unit Nurses: Promoting Holistic Patient Care Towards End-Of-Life, Joanne Nguyen, Dana Bagis

Nursing | Student Research Posters

Intensive care unit (ICU) nurses play a crucial role in providing physiological stabilizing care in a dynamic and fast-paced environment, often marked by constant changes and variability in complex patients. Despite their specialization, the aspect of spiritual care tends to be overlooked, particularly in the context of end-of-life care. This is significant because previous studies have shown that a lack of spiritual care leads to poorer health outcomes, decreased coping, increased depression, and diminished quality of life for patients. This research proposal aims to investigate the spiritual care competency among ICU nurses who partake in spiritual care based training, with …

Support Their Sleep: Enhancing Nurses' Knowledge And Implementation Of Non-Pharmacological Sleep Protocols To Improve Patient Rest, Recovery, And Reduce Cognitive Impairment., David C. Barry

Master's Theses and Capstones

Background: Sleep and rest play an influential role in promoting recovery and healing in humans. Hospitalized patients are at risk for altered sleep from hospitalization, illness, and stimulation from a hospital environment. Non-pharmacologic interventions preformed by nurses can help to improve sleep and sleep environment for patients.

Local problem: There was no protocol or available information regarding patient sleep promotion for nurses to references when caring for patients.

Methods: Nurses in the microsystem (n=8) were administered a pre/post questionnaire containing Likert scales and a short quiz containing knowledge-based questions. Questionnaires were distributed to nurses prior to and after …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …