Critical Care Nursing Commons^™

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 …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

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 …

Quality Improvement (Qi) Project Aimed At Reducing 30-Day Hospital Readmissions For Patients With Congestive Heart Failure (Chf) Through Checklist Implementation, Gary Gutierrez

Seton Hall University Dissertations and Theses (ETDs)

Abstract

Congestive Heart Failure (CHF) remains a leading cause of preventable 30-day hospital readmissions,

especially in outpatient and transitional care settings. This quality improvement (QI) initiative was

launched within a private internal medicine practice in Essex County, New Jersey, to address this issue

by implementing a standardized CHF management checklist. The checklist focused on four key

components: (a) comprehensive medication reconciliation, (b) tailored patient education, (c) timely

follow-up appointments, and (d) improved interdisciplinary communication. By integrating evidence-

based practices into a structured workflow, the QI project aimed to improve care coordination,

empower patients to manage their condition, and reduce preventable …

Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative, Haley Lynne Johnson

Graduate Theses, Dissertations, and Problem Reports (ETD)

ABSTRACT

Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative

Haley Lynne Johnson, BSN, RN

Background: Stroke and brain injuries remain among the leading causes of mortality in the United States, accounting for 162,890 deaths in 2021 (Centers for Disease Control and Prevention [CDC], 2021). Although frequent neurological assessments are essential for monitoring patient status, limited evidence supports the prolonged use of hourly neuro-checks (LaBuzetta et al., 2022). Excessive neuro-check frequency has been linked to sleep deprivation, an increased risk of delirium, and inefficient resource utilization (Kishore et al., 2021).

Purpose: This project aimed to assess the impact of …

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 …

Evaluating The Impact Of Epic Integration And Dual Registered Nurse Check-Off On Pressure Injury Prevention Workflow Compliance, Darlene Y. Olowu

Doctor of Nursing Practice Final Project Abstract

Background

Hospital-acquired pressure injuries (HAPIs), particularly sacral and heel injuries, remain a persistent challenge in critical care settings, leading to increased morbidity, mortality, and healthcare costs.

Purpose

This quality improvement project aimed to improve compliance with a pressure injury prevention (PIP) workflow by integrating a dual RN check-off system within EPIC, thereby reducing sacral and heel pressure injuries. The project sought to enhance accountability, standardize documentation, and optimize compliance with evidence-based PIP measures.

Methodology

A Plan-Do-Study-Act (PDSA) framework guided the project implementation in an oncologic intensive care unit (ICU). Key interventions included: (1) EPIC integration of a dual RN check-off …

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, 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 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 …

Icu Liberation Bundle: A Multidisciplinary Approach, Julie Anne Snyder Amoroso

Student Scholarly Projects

Practice Problem: Patients with increased ventilator days see dramatic increases in their chances of developing healthcare-related conditions (HAC). Extended ICU stays increase the potential for problematic issues in patients' physical, mental and spiritual health with short-and-long-term consequences.

PICOT: The PICOT question that guided this project was looking at adult ventilated patients in a medical ICU (P) and what is the effect of initiating interdisciplinary ABCDEF-ICU liberation bundle rounding as (I) compared to no ICU liberation bundle rounding (C) has on the length of ventilator days (O) over eight weeks (T).

Evidence: Evidence from quality studies and backing from the …

Implementation Of An Evidence-Based Bundle To Reduce Hospital Acquired Pressure Injury Harm Rates In The Intensive Care Unit: A Quality Improvement Project, Jessica Tripp

Doctor of Nursing Practice Scholarly Projects

A pressure injury (PI) is a condition in which prolonged pressure or shear causes localized damage to the soft tissue and skin and is usually over a bony prominence (National Pressure Ulcer Advisory Panel (NPUAP), 2016). PIs can increase morbidity and mortality, increase length of stay, increase infection rates, increase healthcare costs and decrease quality of life (Agency for Healthcare Research and Quality (AHRQ), n.d.; Coyer et al., 2017). PIs are largely preventable yet continue to occur, despite the growing number of high-quality research articles that focus on this problem. Quality improvement initiatives are an effective way to translate evidence-based …

Improving Multidisciplinary Adherence To A Daily Goals Checklist In The Icu: A Quality Improvement Initiative, Chelsea Mccarty

DNP Projects

Abstract

Background: In November 2019, the University of Louisville Hospital merged and assumed operations of all KentuckyOne facilities. During the transition, a spike in hospital acquired infection rates ensued at Jewish Hospital, notably amongst the critical care units. In January 2020, a daily checklist was introduced to the critical care department. A Daily Checklist is a tailored communication tool designed to reduce communication error and improve adherence to patient safety measures. There continues to be a gap in adherence to the U of L daily checklist from both nurses and providers. Purpose: The purpose of this project was to improve …

What Are The Nurse’S Perception Of The Effectiveness Of The Electronic Go-Jo Monitoring System On Hand Hygiene Compliance And Hospital Acquired Infection’S?, Patricia James

Seton Hall University DNP Final Projects

Background: The importance of hand hygiene compliance in preventing hospital acquired infections is well known. Yet national averages for compliance rates with hand hygiene among healthcare workers remains unsatisfactory. Noncompliance with hand hygiene practices can contribute to increased patient mortality, prolonged length of hospitalization, increase healthcare costs and decreased reimbursement for hospitals from the Centers for Medicare and Medicaid. Project Aim: The purpose of this quality improvement project was to explore the nurses’ perceptions of the effectiveness of the electronic Go-Jo monitoring system on hand hygiene compliance and hospital acquired infections. Methods: This was a performance …