Critical Care Nursing Commons^™

The Comfort Cart Initiative: A Quality Improvement Intervention To Improve Patient Satisfaction In The Emergency Department, Heidy Cladimir Ayala

Doctor of Nursing Practice Final Project Abstract

The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Purpose

The Comfort Cart QI project aimed to improve Emergency Department patient, parent, and guardian satisfaction by 10% over an 8-week implementation period.

Background

In healthcare, patient satisfaction is an important indicator of the quality of care provided, and many literature reviews suggest it is closely associated with patient-centered care.

 Methodology

The Comfort Cart intervention is an evidence-based quality improvement project employing a pre- and post-intervention design, conducted over an 8-week period, in the Emergency Department. The project was guided by Kolcaba's Comfort Theory …

Improving Patient Satisfaction In The Emergency Department Waiting Room Through Enhanced Communication Strategies: A Quality Improvement Initiative, Wael P. Karaki

Doctor of Nursing Practice Final Project Abstract

Purpose: This QI project aimed to improve ED waiting room experience by standardizing communication to increase transparency and expectation management, targeting an increase in Net Promoter Score (NPS) from 33.5 to ≥35.4 within three months.

Background: ED waiting room dissatisfaction is driven by uncertainty (unclear wait times, inconsistent updates, and limited understanding of triage and ED flow), supporting structured communication over individual clinician delivery.

Methodology: A 3-month, single-site QI project in an urban ED used iterative PDSA cycles and included all ED encounters (n=17,444). The bilingual intervention included orientation pamphlets (print/QR-based), standardized triage verbalization of …

Standardizing Care: Strengthening Dka Protocol Implementation Among Emergency Department Nurses, Toni Joy Angelique Biliran Miculob

Master's Projects and Capstones

Objective: The objective of this project was to address the inconsistent understanding and utilization of the Diabetic Ketoacidosis (DKA) protocol in a high-acuity emergency department within a large hospital system, where baseline survey results showed that 84% of nurses found the DKA order set confusing and only 15% felt “very comfortable” applying it.

Aim: The aim was to improve nurse clarity, confidence, and consistency in using the DKA protocol to support timely, evidence-based management of this high-risk, time-sensitive condition.

Methods: The intervention consisted of brief, targeted education delivered during pre-shift huddles across day and night shifts, focusing …

Palliative Care Beyond Cancer: The Use Of The P-Cares Tool, Breslin E. Meyer

Dissertations

Emergency Departments (EDs) often lack the necessary resources and protocols to provide comprehensive palliative care, resulting in inadequate pain and symptom management (Stoltenberg et al., 2022). This study investigates the potential transformative impact of a palliative care consultation on patients with advanced disease who screen positive using the validated P-CaRES tool. The PICOT questions: Will patients with end-stage COPD, CHF, and or other chronic conditions benefit from P-CaRES screening in the emergency department over nine weeks and receive more palliative care consultations from their primary care providers?

This project was conducted over 9 weeks, utilizing convenience sampling to select 20 …

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 …

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 …

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.

Bundle For Left Ventricular Assist Device (Lvad) In The Ed, Tina Morris

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Purpose

Left Ventricular Assist Device (LVAD) is a high-risk, low-volume patient population with admission rates of up to 72%. The purpose of this study was to provide a care bundle to increase the knowledge of the emergency department (ED) staff and decrease the door to consult times to the advanced heart failure (AHF) team for LVAD patients presenting to the ED at a level I trauma center in Texas.

Methods

In collaboration with emergency clinical staff, the project team implemented a bundle that included a pathway for the LVAD patients upon presentation to the ED, targeted education for clinical staff …

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 …

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) …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Oscar J. Castillo

Master's Projects and Capstones

Problem: The Quality Improvement (QI) Project focused on improving early sepsis management and sepsis bundle adherence among Emergency Department (ED) nurses to decrease sepsis mortality rates and avoidable length of hospital stays (LOS).

Context: A group of Clinical Nurse Leaders (CNL) students evaluated sepsis protocol compliance at Hospital A's ED, which provides critical care for patients with various medical conditions. The CNL students concentrated on patients identified with sepsis for the QI Project.

Interventions: Limitations and time did not allow for the implementation of interventions. Recommendations offered to management included increasing sepsis training biannually and intravenous placement skills, offering sepsis …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Monica P. Rabago Moreno

Master's Projects and Capstones

Problem: This quality improvement project aims to enhance early sepsis management and sepsis bundle compliance among Emergency Department nurses to reduce the risk of sepsis-related deaths as well as hospital length of stays.

Context: A microsystem assessment, in the emergency department (ED) unit, was performed in Hospital A located in the Greater San Francisco Bay area by Clinical Nurse Leader (CNL) students. This ED unit cares for a variety of critical care patients ranging from urgent to life-threatening conditions.

Intervention: An intervention was not implemented in the ED unit due to time constraints and limitations; however, CNL students provided recommendations …

Improving Safety In The Emergency Department: Utilizing Metal Detectors To Mitigate Weapon Possession, Jonathan Garcia

MSN Capstone Projects

Today’s high risk-healthcare environment has prioritized patient safety with great initiatives and, unfortunately, placed staff safety second. However, safety for both groups should be equal priorities. Evidence suggests that Emergency Departments (ED) often care for patients with a history of crime and mental health diagnoses, creating an environment where the threat of violence and weapons is increasingly prevalent compared to other clinical settings. (Erlyana, 2019) Risk mitigation is possible if we consider studies by Malka et al. (2015) and Laidlaw et al. (2017) that indicate the efficacy of metal detectors in accurately identifying concealed weapons. To improve clinician and patient …

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 …

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 …

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 …

Increasing New Orienting Emergency Department Nurses' Awareness Of Mass Casualty Incident Emergency Preparedness And Disaster Response Core Competencies To Improve Mass Casualty Incident Response, Christopher C. Deramo Ii

Doctoral Dissertations and Projects

Mass casualty incidents (MCI) impose a substantial threat to healthcare. Despite the increasing frequency of MCIs many healthcare organizations and nursing programs do not adequately prepare nurses to be effective responders during an MCI. This evidence-based practice pilot project was purposed to increase new orienting emergency department nurses’ confidence and ability to effectively respond to an MCI. This project involved implementing an MCI educational program consisting of a disaster nursing framework to educate new orienting emergency department nurses on emergency preparedness and disaster response core competencies. The project leader utilized a quasi-experimental design to collect data pre- and post-intervention utilizing …

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 …

Health Priorities, Current Lifestyle Behaviors, And Barriers To A Healthy Lifestyle Among Emergency Department Nurses, Shannon C. White

Theses and Dissertations--Kinesiology and Health Promotion

Background: Emergency nurses are tasked with managing the hectic, unpredictable, and constantly changing environment of an ED. In addition, emergency nurses have been shown to have high levels of stress, irregular meal schedules, rotating shift work, long hours, and a lack of physical activity. Furthermore, research has suggested that nurses are at an increased risk for non-communicable diseases, such as diabetes, hypertension, and coronary heart disease (Phiri, et al., 2014), in addition to a high prevalence of obesity (Kyle, et al., 2016).

Methodology: In this study, 23 emergency nurses completed a 43-item survey regarding current behaviors and constructs of …

Measuring Nurse Competence In The Emergency Department, Matthew Lojo

University of the Pacific Theses and Dissertations

Background: “Nurses provide essential care to the millions of people who are hospitalized each year as a result of illness or injury” (Smith, 2012, p. 172). The Institute of Medicine reported approximately 44,000-98,000 patients die annually resulting from a medical error, and health care errors ranked among the top 10 for the leading causes of death in the United States (Smith, 2012).

Problem: Nurse competence impacts safe and quality nursing, and several research studies investigated the measurement of nurse competence among nurses in various nursing settings (Flinkman et al., 2016). However, a review of the research revealed limited studies in …

Improving Handoff To Decrease Sepsis Mortality: A Quality Improvement Project, Macdana Selecon, Macdana Selecon

Master's Projects and Capstones

A sepsis handoff tool utilized between Emergency Department nurses and unit nurses at a 554-bed acute care hospital were investigated. A survey assessing general knowledge of the facilities sepsis protocol was given to ED nurses, and unit nurses. The electronic health records (EHR) were evaluated for feasibility to transfer the facilities current paper format sepsis handoff tool into the EHR with time sensitive alerts. Three literature reviews supported utilization of standardized handoff tools for improved patient outcomes.

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …

Cnl As Educator In The Emergency Department: Improving Hand Hygiene Outcomes, Michelle Batz

Master's Projects and Capstones

Prevention of hospital acquired infections (HAI) is a National Patient Safety Goal. Proper and frequent hand hygiene (HH) prevents HAI and various cross-infections in any setting. Audits of visual adherence for HH generates low compliance scores. During a yearlong improvement project, low monthly compliance scores of 52% in the Emergency Department (ED) of a community hospital, were reported by hospital auditors and found to be inaccurate by ED staff due to lack of visibility of HH actions because they occurred behind curtains or closed doors. Low scores and challenges were associated with behavioral change among ED team members, requiring multiple …

Implementation Of Sbar Reporting In The Ed, William Russel Carpenter

Master's Projects and Capstones

Implementation of SBAR reporting in the ED

Abstract

In our emergency department, reports given to the accepting floor nurse, transfer of care between emergency department nurses and nurses reporting to physicians are given in many different formats with no continuity. It has been reported that 1,744 deaths and $1.7 billion in hospital costs related to miscommunications (CRICO Strategies, 2015). With the implementation of the SBAR reporting tool, we can begin to see a decrease in miscommunications, and improve patient and staff satisfaction. The SBAR framework not only enhances the clarity and efficiency of communication between team members but also assures …

An Exploratory Inquiry And Creation Of Emergency Room Discharge Education Materials, Ivory Catalano

Honors Undergraduate Theses

Background

Each Emergency Room (ER) across the USA provides every patient with paperwork upon discharge, which commonly includes information about the patient’s diagnosis. This information will briefly describe the condition, provide information on treatment outside the ER, and possibly more, depending on the document and source. These documents are not made by hospital staff, but are generally purchased from outside providers who mass market such documents as resources for hospitals to use to educate patients. One issue with these documents lies in their mass usage, which is not necessarily designed to target the general population’s reading and educational levels.

Purpose …

Sepsis Bundle Completion, Jenna Churnock

Dissertations

Background: Sepsis is a serious condition resulting in end organ damage and ultimately, death. Communication techniques for nurses and physicians on septic patients admitted to the hospital from the emergency department was evaluated. Paper communication was used in 2020 to facilitate serum diagnostic acquisition and antibiotic administration (i.e., sepsis bundle), but an electronic communication form was utilized in 2021.

Method: An observational, descriptive design utilizing a medical record review was completed to compare the same time-period in 2020 and 2021. Communication methods for sepsis bundle completion were compared.

Results: A total of 100 medical records were reviewed (N …