Improving Nurse Confidence And Patient Safety Through Timely Nonpharmacologic Delirium Prevention Interventions: A Quality Improvement Project, Claire E. Mccabe

Master's Theses and Capstones

Abstract

Background

Delirium prevention is an ongoing patient safety priority within a Medical Intensive Care Unit (MICU) because delirium contributes to preventable patient harm, including unplanned device removal, prolonged mechanical ventilation, falls, increased mortality, and long-term cognitive impairment. Key signs of delirium include fluctuating awareness, severe confusion, disorganized thinking, and difficulty focusing. Although the ABCDEF bundle is established within the local MICU, an implementation gap remained in consistently integrating nonpharmacologic prevention strategies into routine nursing workflows.

Methods

The purpose of this quality improvement project was to improve nurse confidence, awareness of workflow opportunities, and implementation of evidence-based delirium prevention interventions …

Improving Staff Knowledge And Consistency In Sat And Sbt Practices In The Critical Care Unit: A Quality Improvement Initiative, Morgan Crapo

Master's Theses and Capstones

Abstract

Background: Spontaneous Awakening Trails (SATs) and Spontaneous Breathing Trials (SBTs) are key components of the ICU Liberation Bundle and have been associated with shorter durations of mechanical ventilation, reduced intensive care unit (ICU) length of stay (LOS), and improvement in patient outcomes. Despite having strong evidence supporting their use, implementation remains inconsistent due to knowledge gaps, workflow barriers and interdisciplinary communication challenges.

Local Problem: This quality improvement (QI) project aimed to improve critical care nurses’ knowledge and confidence regarding the implementation of SATs and SBTs through an evidence-based educational intervention.

Methods: Guided by the Plan-Do-Study-Act (PDSA) framework, this QI …

Improving Efficiency In The Intensive Care Unit Through Reduction Of Nurse Burnout: A Quality Improvement Initiative, Johanna Grace Koroma

Master's Theses and Capstones

Abstract

Background: Intensive care unit (ICU) nursing is prone to high levels of burnout, which poses concern for staff wellbeing, patient safety, and microsystem strain (Kerlin et al., 2020). Educational interventions may serve as a means of increasing awareness on the issue and reducing the effects of burnout, through promotion of evidence-based management strategies.

Local Problem: One ICU microsystem identified several key contributing factors to nurse burnout, including staffing shortages, limited resources, competing responsibilities within the macrosystem, and insufficient organizational support (Zhang et al., 2025). Baseline survey data of the population observed a prevalence of 50% “high” burnout profiles among …

Introducing A Paper Communication Alternative For Emergency Department Nurse-Technician Delegation To Promote Workflow Efficiency: A Quality Improvement Project, Grant Quinn

Master's Theses and Capstones

Background: Efficient and high quality communication is paramount in the emergency department setting, especially between registered nurses (RNs) and emergency department technicians. In a fluid and high-octane microsystem, poor communication can lead to missed or delayed delegated tasks, which harm teamwork and patient safety and outcomes.

Purpose: By introducing a low-cost, paper-based communication alternative to this microsystem into the workflow it is expected that perceived ease of use and communication quality will both increase when surveying department staff. This intervention offers an alternative means of communicating with the goal of improving communication overall in the microsystem.

Methods: Through use of …

Improving Intensive Care Unit Nurses' Knowledge And Confidence In Performing Effective Spontaneous Awakening Trials: A Quality Improvement Project, Sophia T. Merry-Carreiro

Master's Theses and Capstones

Abstract

BACKGROUND

Mechanically ventilated ICU patents often require sedation for comfort and ventilator compliance. However, oversedation is linked to negative outcomes such as delirium, prolonged ventilation, and increased duration of ICU stay. Current best practices now support the use of daily sedation interruptions such as Spontaneous Awakening Trials (SATs). Despite these recommendations, implementation of SATs remain inconsistent and suboptimal.

LOCAL PROBLEM:

Within the ICU in a northern new England hospital, there was a need to improve nurse confidence and knowledge in SATs practices through staff education.

METHODS:

Using the Plan-Do-Study-Act (PDSA) model, a quality improvement project was developed to improve …

Reinforcing Nursing Staff Knowledge For Accurate Cam-Icu Assessment And Documentation In A Medical Icu: A Quality Improvement Project, Tiffany Rzepka

Master's Theses and Capstones

Background: Delirium is an acute state of confusion that can lead to increased morbidity and longer hospital stays. Patients in the ICU are at high risk for developing delirium due to additional risk factors such as mechanical ventilation and sedation. The Confused Assessment Method for the Intensive Care Unit (CAM-ICU) is a tool used by nursing staff to document and assess for delirium.

Local Problem: The microsystem in this project is a 16-bed medical ICU in central New Hampshire. In the microsystem, CAM-ICU documentation compliance is tracked monthly, but the accuracy of the documentation is not routinely assessed. Stakeholders have …

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 …

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) …

Using Education To Confidently Identify And Report Concerns Of Child Abuse And Neglect: A Qualitative Improvement Initiative Through Staff Development, Sarah E. Neilson

Master's Theses and Capstones

BACKGROUND: Pre-licensure education on child abuse and neglect is crucial for nurses in the healthcare field. It helps to equip them with the knowledge and skills necessary to effectively identify, report, and intervene in cases of child abuse and neglect. Having this education available and understanding the signs and effects of child abuse and neglect, empowers nurses to take quick and decisive action in early intervention and prevention. Within the microsystem of a local Operating Room (OR), this quality improvement (QI) project will determine the muchneeded addition to the healthcare curriculum.

METHODS: The Plan, Do, Study, Act (PDSA) framework was …

Improving Patient Handoff In The Emergency Department Microsystem, Alahna V. Kinney-Sandefur

Master's Theses and Capstones

Abstract

Background: Gaps in communication in the patient handoff process have been directly linked to patient safety errors and unwanted patient outcomes. The reviewed literature highlights multiple factors impacting the handoff process and unanimously conclude that a standardized handoff process is necessary in maintaining a high standard of patient safety and a minimization of safety errors.

Methods: This intervention took place in an 86-bed, acute care facility, a level III trauma center macrosystem with implementation of this project taking place in the emergency department and medical/surgical microsystems. Utilizing the Plan, Do, Study, Act framework over a total of eight weeks, …

Using The Stop5 Debriefing Model To Increase Utilization Of Debriefing Practice In The Emergency Department: A Quality Improvement Project, Hallie Chancey

Master's Theses and Capstones

Abstract Background: The practice of debriefing has been an important process in critical care settings to promote team unity as well as best care practices. Literature has shown that debriefing can not only influence quality care and improved operations, but the process can also influence the emotional support staff receive. These implications are particularly important for nurses that work in critical care settings as the job can often be stressful and lead to moral distress as well as the need for evidence-based care practices is crucial when a patient’s life is on the line. Literature supports that any form of …

Implementing A Nurse-Driven Protocol To Reduce Routine Gastric Residual Monitoring: A Quality Improvement Project, Alondra N. Abreu Carlo

Master's Theses and Capstones

The American Society for Enteral and Parenteral Nutrition (ASPEN) and the Society for Critical Care Medicine (SCCM) updated the Adult Patient Enteral Nutrition Guidelines in 2016. These updates included discontinuing routine gastric residual monitoring due to its contribution to poor patient outcomes and mentioning the lack of evidence proving its relevance to gastric motility. Per ASPEN and SCCM, best practice suggests monitoring patients for intolerance symptoms and then checking gastric residual volume (GRV) if symptoms are present. If the GRV is greater than 500ml and intolerance symptoms are present, the recommendation is to perform further assessment, potentially leading to stopping …

Educational Interventions To Improve Icu Nurses’ Knowledge And Confidence Related To Pressure Injuries: A Quality Improvement Initiative, Benjamin R. Maltais

Master's Theses and Capstones

Background: The prevalence of pressure injuries (PI) in critical care is highest amongst inpatient units, and are associated with significant complications, decreased quality of life, increased cost of hospitalization, and poor patient care (Agency for Healthcare Research and Quality, 2019; Cox et al., 2022; Gorecki et al., 2014; Mervis & Phillips, 2019). Similarly, many PI are considered to be avoidable (Pittman et al., 2019). Despite an increase in focus on PI awareness and prevention, there still remains a challenge for patients in critical care units. In addition, research has indicated that nurses’ lack of basic knowledge of PI (risk assessment, …

Improving Initial Pain Assessments Upon Arrival To The Post Anesthesia Care Unit By Implementing The Critical Care Pain Observation Tool, Molly Jacques Ms, Rn

Master's Theses and Capstones

Abstract

Background

Pain assessments in the post-anesthesia care unit (PACU) are crucial to recovery, the discharge process, patient outcomes, length of stay, and readmission rates. It is one of the main responsibilities of PACU nurses to adequately assess and treat pain when patients are in phase one and two of recovery after surgery. A thorough and accurate pain assessment tool is needed for these critically ill patients because not all of them are able to verbally express discomfort.

Local Problem

The problem that was identified during this quality improvement project was inconsistent initial pain assessments in the PACU. Patients arrive …

Implementing Change: The Use Of Minocycline-Rifampin Impregnated Central Venous Catheters In Central Line Associated Blood Stream Infection Prevention In Critically Ill Patients, Shawn B. Murray

Master's Theses and Capstones

Introduction: At a large academic healthcare facility in the northeast a Gap Analysis was conducted finding quality improvement opportunities for central line associated blood stream (CLABSI) prevention in critically ill patients. Review of literature reveals the use of minocycline-rifampin impregnated (MNRI) central venous catheters (CVCs) as being an effective intervention in CLABSI prevention.

Methods: Several assessments were conducted regarding the implications of updating the facilities practice to reflect this evidence including AHRQ Gap Analysis Tool, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Stakeholder Feedback, and Resource Allocation.

Results: Facilitators and barriers were identified in implementing this …

Reducing Clabsi Rates Through Education On Maintaining Cvc Dressing Integrity: A Quality Improvement Initiative, Hanna I. Lentine

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units.

LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma …

Improving Communication Between The Emergency Department And Prehospital Emergency Medical Services Through The Use Of A Secure Messaging Application: A Quality Improvement Project, Jacob G. Petlon

Master's Theses and Capstones

Background: Communication between emergency medical services (EMS) and the emergency department (ED) is a key part of treating patients being transported by ambulance. This communication is moving away from traditional radio and cell phone calls to the use of secure text-based apps. These apps can generate metrics and provide real time location information that is not available using traditional methods. Increased use of these apps can improve communication between EMS and receiving EDs.

Local Problem: Wildcat hospital introduced the EMS communication app Twiage in May of 2023. There is low utilization of the app and some EMS and ED …

Establishing A Protocol To Address Workplace Violence And Increase The Perceptions Of Safety Among Emergency Department Nurses: A Quality Improvement Initiative, Devan M. Robidoux

Master's Theses and Capstones

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse's job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally …

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 …

Improving Disinfectant Cap Use On Central Lines In The Icu To Reduce Patient Risk For Clabsi: A Quality Improvement Project, Tali Cherim

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common type of preventable healthcare-associated bloodstream infection, and may increase length of stay (LOS), facility treatment costs, and patient mortality rates. Intensive Care Unit (ICU) patients are especially vulnerable to CLABSI due to their critical health conditions and other comorbid factors. A literature review provided evidence supporting the use of alcohol-impregnated disinfectant caps, such as SwabCap®, on central line (CL) ports to significantly reduce patients’ risk for CLABSI. This quality improvement project took place within an adult ICU of a Level II trauma facility in New England, where the Infection Prevention …

Reducing Patient Handoff Inadequacies Using An Electronic Medical Record Based Standardized Handoff Tool In The Critical Care Unit, Mariah E. Needham

Master's Theses and Capstones

INTRODUCTION: Inadequate handoff communication is a contributing factor in sentinel events and adverse patient outcomes. Research has shown that the use of a standardized handoff tool can improve quality of handoff communication. This quality improvement (QI) project sought to standardize handoff and reduce the risk of adverse patient outcomes by utilizing the I-PASS handoff tool available in the electronic medical record (EMR).

AIM: The aim of this quality improvement project was to improve the accuracy of nurse-to-nurse patient handoffs.

METHODS: The outcomes measured by the post-intervention survey were the number of reported handoffs received with omissions, the percentage of staff …

Reduction Of Order-To-Scan Times To Increase Patient Throughput And Improve Patient Outcomes: A Quality Improvement Project, Jason Harrington

Master's Theses and Capstones

Background: Throughput is a key metric for both the emergency department and the hospital system. Diagnostic tests, such as CT scans, can lead to a large delay in patient throughput which can negatively impact patient satisfaction and patient outcomes. Finding ways to reduce delays in CT scan acquisition can positively impact patient satisfaction and patient outcomes.

Aim: The specific aim of this quality improvement project was to decrease the amount of time it takes to complete abdominal CT scans with IV contrast once ordered from 61 minutes to below 35 minutes by July 1^st, 2022

Methods: Plan was …