Critical Care Nursing Commons^™

Dnp Final Report: Sedation Protocol Compliance For Improved Outcomes In Intensive Care, Sonya M. Grigsby

DNP Final Reports

Background: Current evidence-based practice guidelines show that lighter sedation reduces mechanical ventilator days (MVD) and intensive care (ICU) length of stay (LOS). Guidelines (2018) for the management of pain, agitation, delirium, immobility, and sleep were released to direct appropriate high-quality care to achieve positive outcomes. However, studies demonstrated there were barriers to compliance of these guidelines.

Objective: To improve compliance with an existing evidence-based sedation protocol in an intensive care, and, thereby, improve patient outcomes (MVD and ICU LOS).

Methods: The three-month quality improvement (QI) project evaluated processes leading to compliance with the guideline. First, nurses were surveyed to determine …

Oral Care And Ventilator Associated Pneumonia Prevention, Rachel Baber

MSN Capstone Projects

With rising healthcare costs and increasing demands placed on healthcare workers, it is no wonder that decreasing hospital length of stay for patients is high priority for hospitals today. Hospital acquired infections are one of the culprits keeping so many patients hospitalized. Specifically, in intensive care units (ICU) and intermediate care (IMC) units that care for mechanically ventilated patients, ventilator associated pneumonia secondary to intubation is a complication and cost that is being sought to be avoided. Hospitals have been pro-active to prevent ventilator associated pneumonia from occurring by placing oral care bundles or protocols in place to care for …

Dying Well: Improving End-Of-Life For Those Affected By Life-Limiting Illness, Fawna R. Allen

MSN Capstone Projects

Healthcare at End-of-life (EoL) in the older adult with a life-limiting illness is often crisis-driven, incongruent with patient and family preferences, and futile. Advance care planning (ACP) is an effective means of aligning EoL goals of care to values and preferences. ACP near EoL in the United States healthcare system is frequently under-utilized and fragmented. Without timely communication and education regarding EoL care options patients and their families are susceptible to spending their last days consumed by ineffective and potentially painful treatments. Alignment of goals of care with patient and family preferences has been shown to reduce crisis-driven care and …

Qt Monitoring In The Icu: A Benchmark Project, Jeffrey S. Woodward

MSN Capstone Projects

In adult Intensive Care Unit (ICU) patients, does QT/QTc monitoring compared to no QT/QTc monitoring affect mortality or ventricular tachyarrhythmia rates during their ICU stay? Not monitoring changes in the QT interval can lead to poor outcomes since mortality rates are higher in patients with arrhythmias (Uvelin, Pejakovic, & Mijatovic, 2017). Approximately 300,000 sudden cardiac deaths occur in the United States each year with an estimated 15,000 because of a lethal ventricular tachyarrhythmia rhythm called Torsades de Pointes (TdP) that occurs when a QT interval is prolonged (Dave, Bessette, & Setnik, 2017). Some risk factors for developing prolonged QT intervals …

Controlled Donation After Circulatory Death: Benchmark Study, Marilyn R. Strait

MSN Capstone Projects

Abstract

In potential organ donors after circulatory death (P), does the utilization of an evidence-based critical pathway from identification of potential donor to organ donation (I) versus no utilization of an evidence-based critical pathway (C) increase the rate of organ procurement and the satisfaction of donor families with the donation process (O)? A benchmark study was conducted to answer this question, and in short, yes, it does. The utilization of a critical pathway, when individualized to a local population and hospital’s organization increases the organ procurement rate, the donor family satisfaction with the process, and increases staff satisfaction with the …

Early Extubation After Cardiac Surgery: An Evidenced-Based, Nurse-Driven Protocol, Emily Brooks

DNP Final Reports

Prolonged mechanical ventilation in cardiac surgery patients has been associated with increased hospital stay, increased intensive care unit (ICU) length of stay, higher health care costs, and higher morbidity from atelectasis, intrapulmonary shunting and pneumonia. Early extubation of post-operative cardiac surgery patients has been associated with shorter ICU and overall hospital stays, reduced mortality, decreased resource use, and is safe and effective in elderly patients with no increased risk of reintubation. As such, the question arises in intubated post-operative cardiac surgery patients, how does a nurse-driven extubation protocol compared to no standardized protocol affect extubation rates within six hours post-operative? …

Meta-Regression: Prognostic Models As Objective Predictors Of Mortality Among Icu Cancer Patients, Sheila Donnell

Nursing Theses and Dissertations

Cancer patients admitted to the intensive care unit (ICU) may be experiencing complications of disease or treatment-related effects. While acute complications related to disease and/or its therapeutic management vary in severity, the approach to ICU-centered care is complicated by actual versus perceived risks of poor outcomes. Prognostic models that inform clinical judgment of nurses and physicians may prove helpful in this population. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment (SOFA) are ICU-based models predicting 30-day mortality among the general ICU population. Although studies have been …