Critical Care Nursing Commons^™

Nurse-Driven Infusion Protocols In Diabetic Ketoacidosis: A Scoping Review, Nicholas Morrell Pierce Msn, Rn, Cen, Ccrn, Mary Cassandra Scott Bsn, Rn, Ccrn, Cen, Alvertis Demetreis Warren Bsn, Rn, Ccrn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Diabetic ketoacidosis (DKA) is a high-risk acute emergency requiring timely insulin titration, intensive monitoring, and coordinated interdisciplinary care. Traditionally, management relies on provider-driven insulin infusion adjustments, which may introduce delays and workflow inefficiencies. Emerging nurse-driven insulin infusion protocols aim to standardize care, improve safety, and enhance clinical efficiency. The purpose of this scoping review was to evaluate existing evidence comparing nurse-driven versus provider-driven insulin infusion protocols in the management of adult patients with DKA.

Methods

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From August 2023 through November 2025, …

Combating Pressure Injuries In Critical Care: A Dnp Project On Nursing Education And Prevention Strategies In The Icu, Tijuana M. Johnson

Doctor of Nursing Practice Projects

Hospital-acquired pressure injuries (HAPIs) are preventable complications that significantly increase patient morbidity, mortality, length of stay, and healthcare costs, particularly in intensive care units (ICUs). At a rural 146-bed hospital, the ICU pressure injury rate of 1.17 per 1,000 discharges exceeded the national benchmark of 0.58 per 1.000 discharges, identifying a critical gap in prevention practices. This Doctor of Nursing Practice (DNP) project aimed to improve ICU nurses' knowledge of pressure injury prevention and reduce unit-based educational intervention grounded in Patricia Benner’s Novice to Expert Theory and implemented using the Plan-Do-Study-Act (PDSA) quality improvement framework.

A pre-and post-intervention design was …

Assessing The Efficacy Of The Cam-Icu Scale In Reducing Length Of Stay In The Icu: A Scoping Review, James Ray Davis Mph, Bsn, Rn, Donna Lynch-Smith Dnp, Aprn, Acnp-Bc, Ne-Bc, Cnl

Doctor of Nursing Practice Projects

No abstract provided.

Pulmonary Embolism Response Team In Acute Care Settings: A Scoping Review Of The Evidence, Tia Glover Bsn, Rn, Leslie Asplund Bsn, Rn, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C

Doctor of Nursing Practice Projects

Purpose/Background

Pulmonary embolism (PE) is a critical cardiovascular emergency associated with high morbidity and mortality. Despite its prevalence, traditional PE management often lacks cohesion, leading to suboptimal outcomes. Pulmonary Embolism Response Teams (PERTs) offer a multidisciplinary approach aimed at improving patient outcomes by streamlining diagnosis, facilitating timely interventions, and promoting evidence-based treatment. This scoping review evaluates the evidence supporting PERT efficacy across various clinical and resource-related outcomes with the aim to decrease mortality rates, shorten inpatient length of stay, improve cost efficacy, and minimize adverse events from treatment modalities.

Methods

A comprehensive literature search was conducted using PRISMA guidelines across …

Decreasing Extubation Times Using Adaptive Support Ventilation: A Scoping Review, Daphne Thomas, Cole Vest, Luke Wilson, Shannon Witcher, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background:This scoping review explores the effectiveness of adaptive support ventilation (ASV) compared to conventional ventilation modes in reducing postoperative extubation times in adults undergoing general anesthesia with ventilatory support. Ventilator weaning is a critical determinant of recovery and outcomes in intensive care settings. ASV, a closed-loop ventilation mode, automatically adjusts ventilator parameters based on patient-specific respiratory mechanics and demand to optimize the weaning process. Although promising, evidence regarding ASV’s effectiveness remains inconsistent across different patient populations and surgical contexts.

Methods: A systematic literature search was conducted from August 2023 to December 2024 across PubMed, CINAHL, Medline, JAMA, and Google …

Central-Line Dressing Protocols: The Effectiveness Of A Standardized Dressing Change Protocol In Reducing Central-Line Associated Bloodstream Infections (Clabsi) In Critically Ill Patients Requiring Central Lines, Cody Jones, Melissa Marino, Ryan Mcfarland, Asia White, Tracy Mcclinton Dnp, Aprn, Agacnp-Bc, Hget-C, Ebp-C, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Fhrs

Doctor of Nursing Practice Projects

Purpose/Background

In the Intensive Care Units (ICU), central lines are an essential way of life. However, central lines have risks such as central line-associated bloodstream infections (CLABSI), which increase hospital stays and mortality. CLABSI significantly impacts patient outcomes in critical care, increases mortality and morbidity, increases medical costs, increases hospital-acquired infections, and reduces hospital reimbursements. Typically, antimicrobial dressing has been associated with decreased mortality and improved CLABSI rates. The scoping review will evaluate the literature and examine the effectiveness of various antimicrobial dressing strategies on CLABSI rates. This study aims to synthesize these findings to develop improved CLABSI prevention protocols …

Nutric: Enhancing Surgical Intensive Care Unit Patient Nutrition Consultations, Misty Armstrong

Doctor of Nursing Practice Projects

Background: Daily nutritional screenings in the critical care population can identify patients in need of nutritional modifications during hospital admission. Inadequate nutritional assessments of critically ill patients lead to poor outcomes. Daily nutritional assessments result in the early identification of patients at risk for nutritional compromise compared to weekly assessments.

Purpose: The purpose of this project was to incorporate a daily nutritional assessment using the Nutrition Risk in the Critically Ill (NUTRIC) scores for patients in a surgical intensive care unit to identify patients in need of a referral to a registered dietician.

Methods: The method for this project used …

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 …

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Promoting The Incorporation Of Regional Anesthesia To Improve Pain Management For Lower Extremity Surgeries, Kendra Knaga

Doctor of Nursing Practice Projects

Opioid addiction in the United States is a healthcare crisis and continues to increase yearly. Multimodal pain management is a priority intervention that needs to be implemented to manage pain with less intra and postoperative opioid use. Peripheral nerve blocks are one alternative that can be used to decrease opioid use and assist in controlling pain for foot and ankle surgeries. This project aims to educate, develop, and create a protocol for popliteal nerve blocks at Hillsboro Area Hospital in Hillsboro, Illinois. As a result, the long-term goal is to reduce opioid administration and improve pain control. An educational PowerPoint …

Using The Confusion Assessment Method For The Intensive Care Unit (Cam-Icu) To Decrease Length Of Stay: A Scoping Review, Brooke D. Ward Bsn, Rn, Dnp Agacnp Student, Martina Little Bsn, Rn, Dnp Agacnp Student, Tracy Mcclinton Dnp, Agacnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background

Delirium is a prevalent challenge among ICU patients, impacting approximately 30% of admissions (Brennan et al., 2023). If left untreated, delirium can increase use of restraints, hospital length of stay, intensive care unit length of stay, and ultimately, morbidity and mortality. This scoping review assesses the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) to gauge its efficacy in reducing the length of stay in the ICU for adult patients with delirium.

Methods

A literature review from 2018 and 2023, using PubMed, CINAHL, and Medline were utilized for the search along with key words such as: length of …

Sepsis Criteria On Triage (Scot): Sepsis Alert, Kristie Givens

Doctor of Nursing Practice Projects

Sepsis is a serious life-threatening condition that kills hundreds of thousands of patients every year and is a major leading cause of death. Sepsis is a medical emergency where early identification and prompt treatment are crucial for survival. Despite assessment tools for early recognition, a delay in antibiotic therapy remains. A sepsis alert (Code Sepsis) in the emergency department could improve sepsis care, spare countless lives, and save billions of dollars nationwide, annually. The implementation of a Code Sepsis will trigger a team to deliver immediate treatment and ensure one hour antibiotic administration times. The John Hopkins Nursing Evidence-Based Practice …

Implementation Of A Patient Care Specialist Role To Enhance The Patient Experience In A Pediatric Emergency Department, Jillian Brodeur

Doctor of Nursing Practice Projects

Background: Patient-centered care (PCC) has been an emerging trend in healthcare for the past two decades (Walsh et al., 2022). PCC and the patient experience have become essential measures of the quality of care provided and are linked to reimbursement dollars and improved patient outcomes (Rapport et al., 2019).

Purpose: The purpose of the Doctor of Nursing Practice (DNP) project was to improve the patient experience in the Emergency Department (ED) of a metropolitan hospital. The DNP project focused on the benefit of a patient advocate in the ED to improve the patient experience. The project sought to improve …

Implementing An Emergency Severity Index (Esi) Triage Refresher Training To Decrease The Under-Triage Rate In The Emergency Department (Ed), Monique Wallace

Doctor of Nursing Practice Projects

Background: The Emergency Severity Index (ESI) is a triage tool used in most emergency departments in the United States (U.S.) that assesses acuity and resource allocation for emergency care patients. Registered nurses (RNs) must assign the appropriate triage category to ensure patients are seen in a proper time frame, have ideal patient outcomes, and have efficient patient throughput.

Purpose: This quality improvement project aims to decrease the under-triage rate of patients in the emergency department (ED) by implementing an Emergency Severity Index (ESI) triage refresher training.

Methods: This project used an A3 methodology. The triage specialist completed retrospective chart reviews …

Amniotic Fluid Embolism Diagnosis & Treatment Pathway, Jeremy May

Doctor of Nursing Practice Projects

Access to care in rural areas can prove difficult for any patient, but especially for the expecting mother. Healthcare providers in these rural settings often lack the staffing and experience to effectively recognize and treat rare obstetric emergencies. Amniotic fluid embolism (AFE) is a rare medical emergency that requires healthcare providers to rapidly diagnose, monitor, and treat the sequela of resulting symptoms in the obstetric patient. After a literature review, a teaching session was developed and implemented as part of the annual training for 20 nursing staff at a small 50-bed rural hospital in central California. An 8-question pre-test was …

Improving Traumatic Brain Injury Outcomes: Early Identification And Management Of Paroxysmal Sympathetic Hyperactivity, Randi Rockwell

Doctor of Nursing Practice Projects

Abstract

Background: Paroxysmal sympathetic hyperactivity (PSH) can occur in patients with acutely acquired brain injury and is associated with mortality, poor clinical outcomes, prolonged hospitalizations, physical disability, and increased healthcare costs. The most common cause of PSH syndrome is traumatic brain injury (TBI). Symptoms consist of hyperthermia, diaphoresis, arterial hypertension, tachycardia, tachypnea, and extremity motor dystonic posturing, often in response to evoked stimuli and occurs in 8% to 33% of TBI patients. Critical care nurses are at the forefront of providing direct patient care to TBI patients and are often the first to identify PSH.

Purpose: The objective of this …

Improved Bonding & Maternal Self-Efficacy In The Nicu: A Scoping Review​, Alexandria Sneed Nauert Bsn, Rnc-Nic, Mckenleigh N. Hill Bsn, Rnc-Nic, Bobby Bellflower Dnsc, Nnp-Bc, Faanp

Doctor of Nursing Practice Projects

Purpose/Background

Mothers of infants admitted into the neonatal intensive care unit (NICU) are at risk for developing anxiety, depression, and post traumatic stress disorder (PTSD) related to their child’s hospitalization which impedes the mother-infant bonding and attachment process. Research shows that children of mothers suffering from these issues are more likely to develop their own behavioral, emotional and cognitive problems later in life. The purpose of this scoping review is to analyze the literature regarding methods to improve bonding and attachment between NICU patients and their mothers to improve long-term outcomes for the whole family.

Methods

The authors conducted a …

Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Education Regarding Advance Directives Improves The End-Of-Life Choices Documentation In Heart Failure Patients, Phebe Hagins Wright

Doctor of Nursing Practice Projects

Background: Heart failure affects the lives of more than 6 million people in the United States and outpatient heart failure clinics offer an opportunity to educate patients while providing evidence-based care. A needs analysis revealed that many heart failure patients do not have an advance directive (AD) on file.

Purpose: The DNP project aims to implement an educational program that provides the tools and knowledge to heart failure patients to assist patients in determining their end-of-life care goals and allow them to document these goals in the Five Wishes document.

Methods: This quality improvement project consisted of a didactic educational …

Clabsi’S: Reducing The Rates In An Urban Intensive Care Unit By Consistent Use Of The Central Line Maintenance Evaluation Tool (Clmet), Bridget Smith

Doctor of Nursing Practice Projects

Background: Quality improvement efforts from an urban facility have observed a need for staff education on the central line maintenance bundle and consistent surveillance with the Central Line Maintenance Evaluation Tool (CLMET).

Purpose: To address the practice gap of central line maintenance bundle usage at the bedside by utilizing the CLMET consistently.

Methods: A voluntary didactic program offered to staff and encouraging daily utilization of the CLMET that included real-time feedback by the supervisors.

Results: Pretest grade for the unit (n=13, 82.06) and the post-test grade (n=13, 86.33), which is + 4.27 points after education. Pre-implementation, January 1st through 31st, …

Transferring Patients To A Higher Level Of Care, Chiquita Rockiemore Rn, Msn, Olubunmi Osinloye Bsn, Rn, Angela Uta Bsn, Rn, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

The purpose of this study is to determine whether the transfer of critically ill patients, who require a higher level of care, to another facility impacts morbidity and mortality within 24-72 hours post transfer

Central Line Associated Blood Stream Infection Prevention With Use Of Disinfection Caps: A Scoping Review, Marianne E. Person, Jessica Biggs, Elizabeth Ross, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background Central lines provide lifesaving uses, but they also place the patient at risk for central line associated blood stream infections (CLABSI). Catheter location, length of stay, handwashing, dressing changes, and disinfection of ports before use are all factors to prevent CLABSIs, yet sometimes these measures are not enough. Disinfecting caps are another way to decrease central line infection, however not all hospitals use this method. This scoping review aims to compare CLABSI rates with and without the use of disinfecting caps for the duration of central line use in intensive care patients.

Methods From August 2019 to September 2021, …

Impact Of Spontaneous Breathing Trials On Reducing Ventilator-Associated Pneumonia In Adult Intubated Patients: A Scoping Review, Jireh R. Johnson Bsn, Rn, Hamzha Aysheh Bsn, Rn, Keianna Luckett Bsn, Rn, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background For ventilated patients in the intensive care unit, ventilator-associated pneumonia (VAP) is a major source of morbidity. It is difficult to diagnose due to many of the diagnostic criteria being subjective, its clinical signs that are broad, and its association with various respiratory disorders. Hospitals have developed varying ventilator bundles in expectation to prevent the incidence of Ventilator-associate pneumonia. We performed scoping review to determine the impact of spontaneous breathing trials (SBT) on reducing VAP.

Methods From August to November of 2021, using the MEDLINE, ScienceDirect, and Scopus databases and MeSH search terms, we identified over 20,000 articles containing …

Increasing Knowledge And Comfort Levels Of Icu Nurses In Goals Of Care Discussions Through Palliative Care Education, Stephanie Harrison

Doctor of Nursing Practice Projects

Critical care nurses are tasked with treating patients during the most complex times, typically beginning with aggressive treatment measures and in many cases, transitioning to end-of-life care. According to the literature review, critical care nurses report they frequently provide care that they feel is futile and palliative care resources are underutilized in the intensive care unit. They also report limited education/training and comfort in understanding their role in goals of care conversations and end-of-life care despite their vital role in providing direct patient care. The goal of this project was to implement an education program using the IMPACT-ICU toolkit to …

Impact Of Central Line Bundle Care On Reduction Of Central Line Associated-Infections: A Scoping Review, Alisha James-Scott Msn, Fnp-C, Rachel Savoy Msn, Fnp-Bc, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Apn

Doctor of Nursing Practice Projects

Purpose/Background Central venous catheters (CVC) are typical for critically ill patients in the intensive care unit (ICU). Due to the invasiveness of this procedure, there is a high risk for central line-associated bloodstream infection (CLABSI). These infections have been known to increase mortality and morbidity, medical costs, and reduce hospital reimbursements. Evidenced-based interventions were grouped to assemble a central line bundle to decrease the number of CLABSIs and improve patient outcomes. This scoping review will evaluate the literature and examine the association between reduced CLABSI rates and central line bundle care implementation or current use.

Methods A literature review was …

Sepsis Initiative: Champion Series, Ashlie Barnes

Doctor of Nursing Practice Projects

Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays …

Using Infographics To Improve Completion Rates Of The Sepsis Protocol Bundle, Stephen Newbern

Doctor of Nursing Practice Projects

Hospitals have sepsis protocols that must be implemented when a patient shows positive signs and symptoms of a septic infection. Nurses learn about sepsis in nursing school and rarely further their education beyond this basic understanding of the disease. So, when nurses fail to comply with organizational instructions outlined within a defined sepsis protocol bundle, this often leads to a progression of severe sepsis in a patient and, most likely, increased cost for the healthcare facility. Multiple sepsis protocol bundle failures negatively impact organizational ratings established by The Joint Commission for patient care and are highly associated with increased sepsis …

Efficacy Of Handoff Education For Icu Nurses When Transferring Patients To The Operating Room, Sandra Ruth Horace

Doctor of Nursing Practice Projects

Background: The transition of care from the Surgical Intensive Care Unit (SICU) to the Anesthesia team in the Operating Room (OR) is a vulnerable time for patients. There is currently no formal process for the patient transitioning from the Surgical ICU to the OR. The disarray of this transition can lead to serious omissions in communication and be harmful to the patient.

Purpose: Currently, there is no formalized or universal process for handoff communication between the SICU team and the Anesthesia team. This project aimed to provide handoff education for SICU nurses when sending a patient from the OR. This …

Improving The Nurse Patient Assignment Process On A Medical Surgical Unit, Kevin K. Mcewan

Doctor of Nursing Practice Projects

Background: Nurse patient assignments on an adult medical surgical unit at a community hospital are often accomplished with inconsistent processes and rationales. Each charge nurse utilizes individualized processes to determine which patients will be best teamed-up and assigned to the available nurses. There are frequently no acuity measurements system or set criteria by which the number or types of patients can or should be assigned to any given nurse, nor are staff skill or competency considered in the assignment process.

Project Design: A pilot project was conducted on a medical/surgical unit. The project utilized the American Association of Critical Care …

Improving Emergency Department Quality Of Care, Carmen Smith

Doctor of Nursing Practice Projects

Emergency department (ED) crowding can cause an extended length of stay (LOS) and high rates of patients who leave without being seen (LWBS). This quality improvement ED project sought to reduce LOS and LWBS by implementing a triage (PIT) team. The design included an outcomes evaluation with available data and a staff pre and posttest. Length of stay and LWBS rates were compared before and after implementation. Results indicated a reduction in the average LOS and LWBS rates for the 30 days of project implementation compared to the 30 days before the project initiation. The overall goal of the PIT …