Pregnancy Loss In The Emergency Department, Gudrun Reiterhiltebrand

Master's Projects and Capstones

Abstract

The aim of this project is to improve the care for patients experiencing pregnancy loss in the emergency department (ED). Objectives are to enhance understanding of staff about the patients’ experience and their knowledge on how to best care for emotional needs, thus improving quality of patient care, work satisfaction, knowledge, confidence and comfort levels, while decreasing experienced stress. The project was implemented in a midsized community hospital with 117 beds, which discharged 74 patients with “interrupted pregnancies” over the previous year from the ED. The project was directed toward nurses, doctors, care partners, chaplains, and social workers. The …

Reducing The Risk Of Hypothermia In Neonatal Infants, Monika Klett-Dunbar

Master's Projects and Capstones

Abstract

Global Aim: To improve infant thermoregulation within the first 24 hours of life of the high risk preterm and very low birth weight (VLBW) infant population in the NICU, thereby reducing rates of morbidity and mortality due to complications influenced by infant hypothermia. Project Aim: To reduce the rate of hypothermia at one hour and the first 24 hours of life in the target population of preterm neonates weighing less than 1500 grams with a gestational age less than 32 weeks from 9.5% to < 5% through the consistent use of a specific bundle of interventions applied in the labor and delivery setting, by December 2017. The aim of the current initiative is also to build on the success of the pilot program launched in 2015 by adding to the preliminary bundle of initiatives, and sustaining hard-won achievements by reinforcing education measures to the nursing and medical teams involved in the infant delivery and NICU admission process. Background: Hypothermia is a major factor in morbidity and mortality of low-birth-weight premature infants, …

Midline Catheter Usage In The Neonatal Population, Kelly Freeland

Master's Projects and Capstones

Neonatal sepsis is associated with increased mortality and morbidities including lengthy hospital stays. Neonate’s immature immune system and susceptibility to sepsis make them prone to antibiotic treatment. Lack of recommendations points to the need for evidence-based practices when selecting a vascular access device (VAD). Literature reviewed demonstrated that a midline catheter (MC) was an option for a VAD with neonatal populations requiring antibiotic therapy more than 48 hours. MCs offer fewer complications compared to the peripheral intravenous (PIV) device. The objective of this project is to reduce the amount of pain experienced by neonates by reducing the number of PIV …

The Need Of Lactation Consultant For Night Shift, Joyce Fung

Master's Projects and Capstones

Abstract

Breastfeeding can provide many health benefits for both mother and baby. To increase the health benefits for patients, a change project will be implemented to increase the rates of exclusive breastfeeding for postpartum patients. The project will be focusing on teaching and be providing information on health benefits of exclusive breastfeeding. Our project is aiming to increase the rates of exclusive breastfeeding by providing lactation consultants during night shift.

Surveys and interviews were conducted pre-program and found most patients are unaware of the health benefits of breastfeeding and the lactation consultant services provided by the hospital. The method used …

Newborn Kangaroo Care Immediately After Cesarean Birth, Sarah Abdolcader

Master's Projects and Capstones

Newborn Kangaroo Care Immediately after Cesarean Birth

Sarah Abdolcader

Global Aim: Improve exclusive breastfeeding rates from 76% to 80% in the Perinatal Unit during the newborn’s hospital admission by February 2018.

Project Aim: Improve the percentage of mother/baby skin-to-skin (kangaroo holding) from a baseline of 55% to 65% by August 2017.

Setting: Perinatal Units

Participants: Newborns birthed via cesarean section

Evidence: According to the World Health Organization (2003), hospitals should have a goal of >80% exclusive breastfeeding rates for all newborns during their acute hospital stay and it begins with skin-to-skin contact (SSC), newborn’s bare chest placed on mom’s bare …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Gavage Program For The Preterm Infant, Amanda K. Guina

Master's Projects and Capstones

Preterm infants in the Neonatal Intensive Care unit, are susceptible to hospital acquired infections due to their immature immune systems. To mitigate this occurrence a change project will be implemented to decrease the incidence of nosocomial infection in this population. The project will be focusing on preterm infants working on full nipple feeds. Our project is aiming to discharge this population home with a nasogastric tube to work on feedings, rather than remaining in the hospital. Chart Audits were conducted pre-program and found approximately 18 patients acquired blood stream infections and 2 acquired MRSA. The method used to assist in …

Infection Control: Reducing Hospital Acquired Central Line Bloodstream Infections, Bobbie Joy Hollins

Master's Projects and Capstones

Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (Ceballos, Waterman, Hulett, & Makic, 2013). It’s estimated that each neonatal bloodstream infection costs about $35,000 and adds about two weeks to a baby’s hospital stay (Akron's Children Hospital, 2015). This project was formulated to reduce the incidence of central line blood stream infections in the neonatal population. The setting used for this project was a 40 bed Level III Neonatal ICU. The methods executed include: conducting a root-cause analysis and formulating a unit survey. Kurt Lewin’s Three-Step Change Model was also used to complete …

Improving Breastfeeding Rates By Using Glucose Gel To Treat Newborn Hypoglycemia, Madena Barak

Master's Projects and Capstones

Newborn hypoglycemia occurs in 5-15% of newborns during the postnatal period (Weston et al., 2016). Typical treatment for hypoglycemia includes supplementing with formula, which causes a decrease in breastfeeding rates, decreasing patient satisfaction, and interfering with maternal-infant bonding. To combat this issue, a large community hospital in Southern California used Lewin’s Theory of Planned Change to implement an alternative intervention for the treatment of newborn hypoglycemia. Evidence based articles as well as collaboration with surrounding hospitals was used to support the use of oral dextrose gel instead of supplemental formula to treat newborn hypoglycemia. The hospital’s revised treatment protocol on …

Safe Sleep In The Nicu Environment For Sids Prevention, Renee J. Aumua

Master's Projects and Capstones

Abstract

Sudden Infant Death Syndrome(SIDS) remains a leading cause of death for infants less than one year of age. Historically, Neonatal Intensive Care units have been exempt from following SIDS safe sleep guidelines recommended by the American Academy of Pediatrics(AAP) for SIDS prevention due to patient medical status and environment. However, in 2011 these guidelines were updated by the AAP to include NICU specific recommendations. This is a very important change due to this patient population being at a higher risk for SIDS than the term, well newborn. The Safe Sleep project was conducted in a 35 bed, tertiary care …

Lactation Clinic: Improving Patient Lactation Support, Iana Johnson

Master's Projects and Capstones

Despite the numerous health benefits and recommendations that breastfeeding is the optimal method for nourishing infants, many still choose other ways to feed their babies during the first year of life. This project considers the initiation and future implementation of a Lactation Clinic as an additional patient support service provided in the inpatient and outpatient settings. A Failure Modes and Effects Analysis (FMEA) was conducted in an effort to evaluate and eliminate “what could go wrong” before such an establishment becomes operational. The Risk Priority Numbers (RPNs) from the analysis reveal the lack of use (RPN 50) and streamlining (RPN …

Reducing Annual Emergency Department Visits Through Improved Asthma Discharge Teaching, Alvin R. Walters

Master's Projects and Capstones

Asthma is the most common pediatric condition in the United States, and a child's home environment plays an impactful role in the triggering of asthma exacerbations (Harper et al., 2015). Current emergency department (ED) ideology focuses on symptoms management, with little time spent on education, and virtually no attention paid to the home environment. Evidence shows that programs which incorporate home environmental assessments into asthma patient education produce a reduction in annual ED visits, fewer missed school days, decreased use of rescue medications, and improvements in quality of life (Gruber K.J., et al, 2016, Hollenbach J.P. & Cloutier M.M., 2015, …

Development Of A Breastfeeding Class Specifically For Working Moms, Maryleah S. Needels

Master's Projects and Capstones

Successfully breastfeeding mothers who are planning to return to work and remain exclusively breastfeeding their infants have a knowledge deficit as to the federal law protecting their rights along with the basic skills for pumping, storing, and bottle-feeding of breast milk. There is a significant drop in breastfeeding rates at both the 3 and 6-month marker, which coincides with maternal return to employment. After attending the Working Moms Breastfeeding Class, 100% of mothers reported an increase in knowledge surrounding the law and the CDC’s basic skills for handling pumped breast milk based on a pre/post questionnaire. Bandura’s theory of self-efficacy …

A Quality Improvement Project On Diagnosis And Management Of Asthma In A Private Pediatric Setting., Sosamma Ashley

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Although national guidelines exist for the diagnosis and management of asthma, general practice differs significantly from recommendations. Quality improvement methodology when implemented can narrow quality gaps.

Objective: The objective of the project was to create and implement a plan of action to address identified gaps in key clinical activities of asthma care among pediatric population in a private pediatric setting in Northern California

Methods: The project was centered on the use of Education in Quality Improvement for Pediatric Practice (EQIPP), a program of the American Academy of the Pediatrics. Both the pediatrician and the DNP student took this …

Reducing Iv Infiltrates In The Neonatal Population, Stephanie L. Miller

Master's Projects and Capstones

Abstract

The objective of the CNL project is to improve the quality of care provided to our patients. The project focuses efforts to reduce IV infiltrates by auditing all running IV lines, IV management monitoring and auditing infiltrate grading and documentation to find commonalities that could be causing infiltrates.

The project is focusing on the neonatal population at a children’s hospital in the Neonatal Intensive Care Unit (NICU). This NICU is an 80 bed unit that houses both critical care patients and intermediate care neonates.

Auditing was a major component to the project and helped with identifying common causes so …

Obstetric Triage Improvement, Whitney Depaoli

Master's Projects and Capstones

The objective of the obstetric triage improvement project is to decrease the average length of stay for perinatal patients presenting to the obstetric triage. The setting is a university hospital in a large urban city. The population includes pregnant patients with obstetric complaints presenting to triage for further evaluation. Methods used include a root cause analysis, process mapping, lean transformation methodology, and standardization of workflow. The results of the project include reducing the average length of stay in obstetric triage from a baseline of 152 minutes to 120.58 minutes, which represents a 21% decrease. The creation of standard workflows, the …

Improved Satisfaction On Postpartum Unit By Implementing A Discharge Nurse Role, Nicole Ware Rn, Msn

Master's Projects and Capstones

A three-month time period was used to develop a postpartum education program change by designing a discharge nurse role on the postpartum unit at University of North Carolina Women’s Hospital. The goal of the education change is to increase patient satisfaction scores of discharged post-natal mothers on the postpartum unit by having HCAPS and Press Ganey to improve up to10% over the next 6 months.

An observational assessment revealed a fragmented and antiquated discharge process. This process was paper based and difficult to complete in light of the short stay and high volume patient population. Informal nurse feedback as well …

Implementing Emergency Bedside Backpacks In The Nicu To Improve Patient Outcomes, Melissa M. Garcia

Master's Projects and Capstones

Abstract

Planning for a disaster, by implementing a unit specific disaster plan, has become an essential recommendation for Neonatal Intensive Care Units. Emergent situations have resulted from past natural disasters proving the need for additional planning when it comes to units with fragile populations. Research has shown instituting a specialized disaster plan, increases patient safety resulting in improved patient outcomes. This prospectus aims to implement emergency bedside backpacks as the first step in the development of a NICU specific disaster plan. These backpacks are meant to be an addition to the current hospital emergency plan, with the goal being to …

Implementation Of A Debrief “Takeaway” Board, Carly A. Skeath

Master's Projects and Capstones

Abstract

My original focus of my project was to implement Team STEPPS, to help improve the communication and teamwork within our entire perinatal service department. However, as I started I ran into barriers with time and with other projects put out by our management that needed to take president. It is then that I decided to narrow my focus on one aspect of Team STEPPS which we are already implementing, and that is debriefs. As a member of the Perinatal Patient Safety Program (PPSP), I was able to learn about all the takeaway’s we received from debriefs that had occurred, …

Quantify Blood Loss To Prevent Escalation Of Blood Loss, Manprit Virk

Master's Projects and Capstones

Abstract

The CNL project’s aim is to implement quantifying blood loss (QBL) after each delivery to prevent the escalation of postpartum hemorrhage (PPH), and decrease maternal mortality and morbidity related to PPH in Maternal Child Health (MCH). This project is initiated in a Northern California acute-care facility’s MCH department, which consists of: childbearing women pregnant at gestation age of more than thirty-four weeks, and women post delivery. According to CMQCC (2014), 1-3% of pregnancies are affected by postpartum hemorrhage, and the acute-care facility has a current postpartum hemorrhage rate of 2.7%. There is lack of standardized method of measuring blood …

Prospectus Summary Brief: Nicu Communication Improvement, Joy E. Lawley

Master's Projects and Capstones

Joy Lawley RNC, NICU Communication Improvement: A prospectus summary brief. Effective communication in the neonatal intensive care unit (NICU) not only reduces errors and adverse patient outcomes but also create an environment that promotes staff satisfaction. The purpose of this prospectus is that of improving the process of communication between the perinatal departments. The specific aim was to improve communication to the NICU through standardize communication tools (SBAR) from patient delivery to discharge starting April 1, 2015. With 100% participation of all staff members within a three month period and a 95% staff satisfaction related to improved communication from staff …

Perinatal Patient Management, Natalie Whitten

Master's Projects and Capstones

The medical center has lacked the bed capacity and nursing staff to accommodate the needs of maternity patients. Patients are redirected to other network and non-network medical centers due to lack of bed availability, inadequate nurse staffing, and poorly managed patient movement. This project aims to improve patient management in the perinatal departments, including the discharge process. We will have 100% staff participation to facilitate bed management. The patient management project was conducted in a 200-bed hospital serving the residents of an urban area. The perinatal areas of labor & delivery (L&D), antepartum, and postpartum (OB) are highly productive units …

Recommendations For Enhancing Psychosocial Support Of Nicu Parents Through Staff Education And Support, S L. Hall, J Cross, Nancy Selix, C Patterson, L Segre, R Chuffo-Siewert, P A. Geller, M L. Martin

Nursing and Health Professions Faculty Research and Publications

Providing psychosocial support to parents whose infants are hospitalized in the neonatal intensive care unit (NICU) can improve parents’ functioning as well as their relationships with their babies. Yet, few NICUs offer staff education that teaches optimal methods of communication with parents in distress. Limited staff education in how to best provide psychosocial support to families is one factor that may render those who work in the NICU at risk for burnout, compassion fatigue and secondary traumatic stress syndrome. Staff who develop burnout may have further reduced ability to provide effective support to parents and babies. Recommendations for providing NICU …

Relocation Of Orc To Or2, Svetlana N. Schopp

Master's Projects and Capstones

The goal of this Clinical Nurse Leader (CNL) internship project was to maintain safety and quality of care of obstetric (OB) patients undergoing Cesarean Sections (C/S) after operating room for cesarean sections (ORC) is relocated from obstetric unit to the main operating room (OR). The microsystem will accomplish this through effective teamwork, clear interdisciplinary communication, collaboration, and standardization of processes involved. The institution is a not for profit rural health care facility and is a designated Critical Access Hospital; it is located in Northern California. A general obligation bond was passed in 2007 to fund seismic upgrades. Old OB unit …

Lean Management Principles To The Creation Of Postpartum Hemorrhage Care Bundles, Bethan Faulkner

Doctor of Nursing Practice (DNP) Projects

Postpartum hemorrhage (PPH) is the number one cause of pregnancy-related death in the US. The Maternity local improvement team (LIT), co-led by an Obstetrician and Board Certified Clinical Nurse Specialist found that each month the maternity unit averages 40 PPHs with 1-2 resulting in an emergency. Over a 6-month period, the LIT decreased response time for emergencies significantly. Supply retrieval time decreased by 99.9%, MD response time decreased by 81%, and Family Centered Care increased by 100%. They recently turned their attention to prevention. Given the lack of literature on preventing PPH in postpartum units, the team developed a PPH …

Interprofessional Roles Shoulder Dystocia: Maximizing Safety In Community Hospitals, Elizabeth Yznaga

Doctor of Nursing Practice (DNP) Projects

Prompted by evidence that clinical simulations improve patient safety, team simulations are emerging in hospital settings. Accrediting organizations such as the U.S. Joint Commission on Accreditation of Healthcare Organizations and the American College of Obstetricians and Gynecologists (Joint Commission, 2004, American College of Obstetricians and Gynecologists, 2002) have recommend simulation of obstetrical emergencies, including shoulder dystocia for hospital teams. National patient safety mandates for simulation training of critical events have not been available to small, rural hospitals because of lack of talent and equipment, creating a gap in resources. Other than demonstrations by manikin companies, this author has currently been …

Newborn Umbilical Cord Care: An Evidence Based Quality Improvement Project, Janeen Marie Whitmore

Doctor of Nursing Practice (DNP) Projects

No Abstract Available

Exploring The Value Of Group And Traditional Obstetrical Appointments To Reduce Health Disparity, Helene M. Holbrook

Doctor of Nursing Practice (DNP) Projects

Disparity in health outcomes is influenced by socioeconomic factors that may include access to important healthcare information in a culturally sensitive way. Can a group appointment model like the CenteringPregnancy model provide a more effective means for engaging Spanish-speaking pregnant women? Research studies using the group prenatal appointment model show increased pregnancy knowledge, readiness for labor and higher satisfaction compared with individual prenatal appointments. This paper discusses the importance of reducing disparities in birth outcomes using a group appointment model conducted in partial fulfillment for the Doctor of Nursing Practice degree.