Resocialization Of An Inpatient Handoff Sepsis Bundle Checklist On A Medical-Surgical Unit, Sophia Kawada

Master's Projects and Capstones

Problem: In September 2023, it was found that only 25% of nurses were familiar with an inpatient handoff sepsis bundle checklist (IHSBC) on a Medical-Surgical Unit in Hospital A. This evidence-based project aimed to improve resocialization of the IHSBC such that compliance to the bundle continues to be maintained well above the benchmark of 75%. Context: Clinical Nurse Leader (CNL) students at the University of San Francisco conducted a microsystem assessment of the Medical-Surgical Unit at Hospital A. This hospital aimed to maintain high rates of compliance with the IHSBC. Interventions: Resocialization of the IHSBC was completed in October, and …

Enhancing Diabetic Patient Continuous Glucose Monitoring Access, Colleen Ildefonso

Master's Projects and Capstones

Problem: Diabetic patients utilize treatments that require frequent monitoring and medication changes based on their blood sugar results. Continuous Glucose Monitoring (CGM) is more commonly used for diabetes management as time in range is becoming more prevalent to measure diabetes outcomes. Many diabetic patients find CGM use more accessible than finger sticks and glucometers. In contrast, others utilize the technology to closely monitor their blood sugars for interventions throughout the day. However, older adults have difficulty facilitating new CGM technology and may require further reinforcement using additional education methods such as teach-back.

Context: The endocrinology clinic serves a patient population, …

Reducing Care Companion Utilization In Medical-Surgical And Telemetry Units, Mary Jane B. Sagabaen

Master's Projects and Capstones

Abstract

Problem: The facility highly utilized sitters or care companions, negatively impacting the staffing plan, budget, and productivity. An average of 56 hours of care companions were used daily. This greatly exceeded the budget of 33 hours a day. Reassigning Patient Care Technicians (PCT) as care companions resulted in inadequate nurse support for patient care and increased cost for additional staffing needs. Despite this, the fall rate remained higher than the target.

Context: The patient population is mainly 65 years old and above, sometimes with confusion, dementia, delirium, and at high risk for falls and elopement. The culture included promptly …

Optimizing Sepsis Management Through Enhanced Protocol Compliance In The Emergency Department, Teela Sade Miller-Buford

Master's Projects and Capstones

Abstract

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 and hospital length of stays.

Context: A group of students studying to become Clinical Nurse Leaders (CNLs) evaluated Hospital A's Emergency Department (a clinical microsystem) located in the greater Bay Area. This microsystem provides diverse emergency care for patients with various medical conditions and diagnoses. The CNL students concentrated on patients diagnosed with sepsis for their quality improvement project.

Interventions: Although time constraints prevented the implementation of interventions, the CNL students proposed recommendations …

Purposeful Rounding For Fall Reduction, Deborah Grant Rn

Master's Projects and Capstones

Objective. The quality improvement project aimed to study the effects of purposeful rounding on falls in a long-term care unit. The focus was on CNAs who provided care for 6 residents each, with a current census of 36 residents in the long-term care setting. Problem. Many of the residents are at risk for falls due to immobility, medication, and environmental hazards (Centers for Disease Control and Prevention, 2022). Context. Research has found that the key reasons residents call for staff include needing to use the bathroom, to address pain, to address positioning, and to address IV pumps and alarms (Studer …

An Implementation Of Combined Fecal/Gastric Occult Blood Testing In The Emergency Department, Desiree Long

Master's Projects and Capstones

Problem: The gastrointestinal occult blood test is a point-of-care (POC) test used to detect the presence of occult (hidden) gastrointestinal bleeding via stool or gastric contents. Existing fecal and gastric occult blood point-of-care (POC) testing requires separate and unique sampling cards and developer, respectively. Separate fecal/gastric tests are less definitive and take longer than a combined test. Fecal/gastric testing can be improved and more effective using a combined testing mechanism.

Context: This project includes the microsystem of the emergency department, which involves groups of medical professionals, such as groups of clinicians and staff working together with a shared clinical goal …

Prevention And Reduction Of Catheter-Associated Urinary Tract Infection, Lea F. Garin

Master's Projects and Capstones

Abstract

Problem: Fifteen to twenty-five percent of hospitalized patients receive indwelling urinary catheters (IUCs) during their hospital stay and are at high risk for catheter-associated urinary tract infections, according to the Centers for Disease Control and Prevention (CDC, 2015).

Context: A CAUTI Prevention program was implemented in a community hospital surgical unit to address concerns of high rates of CAUTI.

Interventions: Staff training/education, pre-CAUTI and post-CAUTI prevention survey, hand hygiene, bundle care audit, and staff competency for indwelling urinary catheter insertion were implemented to prevent and reduce CAUTI cases in the surgical unit.

Measures: The Standardized Infection Ratio …

Reducing Hospital-Acquired Clostridium Difficile, Tracy Esposo

Master's Projects and Capstones

Background: This project focused on implementation of clostridium difficile (C. diff) education sessions at Hospital A, a not-for-profit, short-term, acute care hospital serving the Greater Sacramento community. It comprises of 241 staffed beds in the medical-surgical, telemetry, and intensive care units.

Problem: My Clinical Nurse Leader project focused on preventing hospital-acquired C. diff. At Hospital A, there were 19 hospital-acquired C. diff cases for the 2022 performance year. Of the 19 clostridium difficile cases, 12 were related to C. diff testing criteria fall-outs.

Despite huddling with staff on opportunities and providing education through health stream modules, Hospital A continues to …

Analyzing Reporting Of Hospital Acquired Pressure Injuries In The Acute Care Setting, Trineca R-N Godfrey, Gabriella Garcia, Ameerah Tolentino, Gisselle Chairez, Jane Kwak

Master's Projects and Capstones

This project was conducted at a level one trauma center, acute care hospital consisting of 459 beds. With more patients than wound care nurses, hospital-acquired pressure injuries (HAPIs) have become a significant problem for this hospital. A gap between reporting in the Safety and Quality Information System (SQIS) and the reporting that takes place in electronic health record (EHR) with wound care consults has been observed. A root cause analysis (RCA) was used to identify discrepancies. The accurate collection of data was identified as paramount providing information necessary to create improvements and lower the occurrence of HAPIs. The conceptual framework …

Implementation Of A Wellness Program For Nurse Leaders, Ericson A. Fernando

Master's Projects and Capstones

Background: The setting for this study is the implementation of a wellness program for nurse leaders at Hospital A, a healthcare organization servicing the South Sacramento area in California. Healthcare is a challenging and high-demand profession, and the COVID-19 pandemic has exacerbated an issue of burnout and unwavering job-related stress for physicians and employees. This remains true for nurse leader professionals who take on the responsibility to ensure safety and quality always remains at ideal measures for any facility.

Problem: During the past several years of the pandemic, the nurse leader role has had to endure several unknowns, placing significant …

Hapi Prevention On A Medical Surgical Telemetry Covid Unit, Maria G. Gonzalez

Master's Projects and Capstones

Abstract

Problem: Hospital acquired pressure injures (HAPI) are potentially preventable but frequently occurring events in hospitalized patients. Pressure injuries can occur because of prolonged pressure and in combination with shear and friction forces. HAPI negatively impacts a patient’s quality of life. HAPI also increases the hospital’s financial burden and increases the patient’s length of stay.

Context: The 52-bed medical surgical, telemetry, COVID, unit is one of several unis within a hospital setting. The unit is challenged with the management of HAPIs. The staff are challenged with documenting and escalating the findings, and with finding a second nurse to assist with …

Reduce Extended Length Of Stay By Reducing In-Hospital Falls, Norberto Benitez

Master's Projects and Capstones

Abstract

Problem: Every year, there are many in-hospital falls (IHFs). Nationally there are between 700,000 to 1 million falls recorded each year. Hospital falls financially burden our healthcare industry, costing approximately 34 billion annually. Context: In a local hospital in Northern California, Marin County, the microsystem has had an extraordinary number of in-hospital falls (IHFs). To date (June 2023), 13 falls have been recorded thus far; the microsystem is on track to beat the previous year's record number of 21 falls in a calendar year. Interventions: The MSN–CNL student proposed re-educating staff, resetting expectations, and reestablishing workflow. We also sought …

Improving Outcomes In Persons Who Inject Drugs: A Multidisciplinary Healthcare Initiative, Carla S. Martin

Doctor of Nursing Practice (DNP) Projects

Background: Outpatient parenteral antimicrobial therapy is the standard of care for patients who require long-term antimicrobial therapy but is not considered a safe discharge option for persons who inject drugs (PWID). Many PWID leave against medical advice before completing therapy, resulting in high emergency department utilization and frequent readmissions.

Local Problem: A 646-bed academic and Level I trauma center where opioid overdoses are 6.5 times higher than the state average experiences disproportionately high PWID admissions. Prolonged hospitalization for the duration of antimicrobial therapy increases costs and reduces access for other acute care patients.

Methods: A prospective cohort of PWID discharged …

Implicit Bias In Nursing: Raising Awareness, Fostering Change, Jeanette C. Sandoval

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Extensive research evidence demonstrates that implicit bias can lead to differential treatment of patients based on race, gender, weight, age, income, language, and insurance status. Evidence-based interventions that couple implicit bias mitigation with therapeutic communication skills can contribute to the delivery of equitable care.

Local Problem: Implicit bias in healthcare occurs when unconscious behavior that is not favorable to the patient population served perpetuates unequal treatment and contributes to poor healthcare outcomes.

Methods: Knowledge of implicit bias in the nursing staff was assessed through a validated and reliable survey tool before and after participation in an online LMS …

Therapeutic Gardening For Addiction Recovery, Hayley Milleson

Master's Projects and Capstones

The following study examines the potential benefits of implementing therapeutic gardening and outdoor activities as a supplemental resource for adult males with a history of substance abuse issues who have been affected by the criminal justice system and are seeking sobriety while in a residential treatment program. The goal is to investigate how therapeutic gardening can add to traditional addiction treatment methods. Through a review of current evidence-based practice, this study focuses on how alternative interventions such as therapeutic gardening and outdoor activity can improve overall mental health and well-being, promote a sense of community, improve social connections, alleviate stress …

Therapeutic Gardening For Mental Health In Substance Use Recovery, Stephanie E. Schafer

Master's Projects and Capstones

Abstract

As the clinical nurse leader (CNL) in this project, I used the “[CNL]

Essential 1: Background for Practice from Sciences and Humanities” (Competencies and Curricular Expectations for Clinical Nurse Leader Education and Practice, 2013) and its competencies to focus on designing nursing care for a clinical or community-focused population based on biopsychosocial, public health, nursing, and organizational sciences and to synthesize evidence for practice to determine appropriate application of interventions across diverse populations. With the help of the CNL competencies and collaboration with the healthcare team, we created and implemented a therapeutic garden for residents in a substance use …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Christopher N. Guinto

Master's Projects and Capstones

Problem: Results from a voluntarily anonymous pre-survey about sepsis revealed that a majority of the seventeen nurses assessed themselves below an "expert knowledge '' level. The survey results present an opportunity to improve the nurses’ knowledge and confidence in nursing response and improve patient outcomes with sepsis.

Context: The quality improvement (QI) project was conducted on a medical-surgical unit in a large Northern California hospital.

Intervention: A QI team initiated evidenced-based practice research and created an educational sepsis handout for nurses to increase sepsis knowledge and confidence.

Measures: The self-assessment pre-survey would be compared to the responses from the post-survey. …

Bridging The Gap: Educating Medical-Surgical Unit Nurses In A Large Hospital Organization On Sepsis Bundle Elements, Meara J. Matthews

Master's Projects and Capstones

Problem: Sepsis is a life-threatening response to infection that remains one of the leading causes of death worldwide. Based off results obtained from a pre-education survey of nurses on a medical-surgical unit in a large hospital organization, there is an opportunity to increase knowledge and confidence level regarding sepsis and care of septic patients so that nurses are prepared to detect sepsis early and intervention can begin.

Context: The project is being conducted in a medical-surgical unit at a large hospital organization in Northern California. The data from the survey includes 17 nurses on the unit who completed the pre-education …

Improving Timely Sepsis Care Through Staff Education Within The Emergency Department, Jillian J. Abinader

Master's Projects and Capstones

Problem: A sepsis protocol and bundle has been implemented in an urban Emergency Department to help screen patients and treat sepsis efficiently and effectively. The benchmarks from the bundle are not being met consistently every month and are below the targeted 90%.

Context: A microsystem assessment and a gap survey sent out to nurses, helped determine that there is room to improve nurses’ knowledge and confidence about sepsis and the sepsis bundle workflow. Sepsis is one of the most expensive and burdensome conditions in U.S. hospitals. Literature supports staff education to improve sepsis bundle compliance.

Intervention: A video was created …

Educating Medical-Surgical Nurses In A Large Hospital Organization On Sepsis: Bundle Elements, Grace Jenks

Master's Projects and Capstones

Problem: Based on the findings of a pre-survey conducted, it was observed that around 6% of the Medical-Surgical nurses who participated from Hospital A possessed "expert knowledge" of the "inpatient handoff sepsis bundle checklist." The results highlight the potential for educating and boosting the confidence of nurses working in a healthcare organization located in Northern California, enabling them to provide better care for patients afflicted with sepsis.

Context: The microsystem is a Medical-surgical unit situated within Hospital A, which is one of the 21 hospitals located in Northern California. Dr. Theresa Mostasisa conducted a survey on February 15, 2023, …

Decreasing Hospital Acquired Pneumonia In Adult Patients By Patient Care Technicians: Education With A Focus On Oral Care And Tooth Brushing, Amanda Nicole Lee

Master's Projects and Capstones

Hospital acquired pneumonia’s (HAPs) are unfortunate and preventable events quality improvement efforts should focus on. At a Northern California Hospital, there was an unmet HAP rate goal of 2.3 (20 out of 8795 patients) against a target goal of 2. This increase in HAP rates, both non-ventilated and ventilated was a call to action to reduce HAP to the target goal. The quality improvement project specifically aimed to reduce HAP rates on medical-surgical units through an ultra-brief refresher on the hospital validated and endorsed ROUTE bundle. The education focused on oral care completed by the patient care technicians (PCT’s). The …

The Effect Of Standardized Patient Education On 30-Day Hospital Readmissions For Heart Failure Patients In The Outpatient Setting, Lurie Dimalanta

Master's Projects and Capstones

Problem: Heart failure (HF) is the second leading condition of hospital readmissions. Evidence shows that patient education on self-care and disease management can help reduce and prevent 30-day hospital readmissions. Registered nurse case managers (RN CMs) can help improve patients' ability to self-manage their condition and prevent 30-day hospital readmissions by applying a standard approach to patient education.

Context: The Integrated Care Management (ICM) is an outpatient department that provides post-discharge patient calls. The ICM RN CMs utilized various HF patient education tools for patient teaching. The organization’s HF task force developed health-literate patient resources to be used …

Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura

Master's Projects and Capstones

Increasing Colorectal Cancer Screening Rates in the Psychiatric Inpatient Unit

Abstract

Problem: Colorectal cancer is one of the leading cancer deaths in the United States. The Psychiatric Inpatient Unit has a colorectal cancer screening compliance rate of 40% compared to the statewide average of 80%.

Context: The Psychiatric Inpatient Unit is a 58-bed inpatient intermediate care facility mental health program in Northern California. Upon review of the EMR, most PIU nurses give verbal instructions and patient education on colorectal cancer screenings when due. Still, no printed handout was provided to the patients upon review of the EMR.

Intervention: Review of …

Delirium And Staff Injury, John Olague Jr

Master's Projects and Capstones

Abstract

Problem: From April 2021 to January 2022 there were 17 cases of reported patient aggression and staff injury due to patients in the hyperactive state of delirium. In a stroke/tele unit, diagnosis of delirium was delayed due to subjective assessment from the confusion assessment method (CAM) tool. This delay allowed patients to reach the hyperactive state of delirium which poses a threat to patient and staff safety. An objective form of assessment for delirium was needed on this stroke/tele unit.

Context: Through a microsystem assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis, stakeholders in this performance improvement plan …

Standardizing Handoff Report In A Medsurg Telemetry Floor, Brandon Tyler Thompson

Master's Projects and Capstones

Problem: Hospital A’s 9^th floor telemetry units lacked a standardized method of handoff and required investigation. Current practices were evaluated, and an intervention was designed based on weak communication areas. Context: Using a 5 P’s assessment the key stakeholders included unit nurses, the nursing director, nurse educators, and unit nurse managers, and the patients were medsurg telemetry patients. The process included handoff in care and the pattern evaluated was methods of reporting with the purpose of providing high quality evidence-based patient centered care. A SWOT analysis revealed strong teamwork, interdisciplinary collaboration, and proficiency in health record technologies as strengths …

Reducing Hospital-Acquired Pneumonia By Educating Patient Care Technicians On Route Bundle Care Measures, Munroop K. Thiara

Master's Projects and Capstones

Hospital-acquired pneumonia (HAP) is an infection of the lungs that can lead to severe and sometimes fatal outcomes. HAP can be prevented by oral care interventions, but without proper patient care, treatment can be very expensive. Evidence-proven HAP preventative measures such as the ROUTE bundle and increased patient mobility can significantly lower the risk of pneumonia as well as prevent additional hospital costs. Hospital X is a private nonprofit health care organization in the urban suburbs of a large Northern California city with a current HAP rate of 2.3 and with targeted goals of 2.0. By creating a project that …

Improving Safe Handling And Administration Of Usp<800> Hazardous Drugs Within The Medical-Surgical Unit, Pavlo Karaputa

Master's Projects and Capstones

Nurses comprise the largest proportion of healthcare providers who make contact with Hazardous Drugs (HDs) during multiple types of clinical activities and have a risk of exposure. Hazardous drugs (HDs) are a class of pharmaceuticals that pose serious health risks to individuals who handle them, including organ toxicity, reproductive and developmental defects, infertility, miscarriage, genetic toxicity, cancer, and even death. This project was implemented in a hospital system within Northern California, on two units that serve medical-surgical, oncology, geriatric, and transplant patients. The Medical Surgical microsystem at this hospital comprises a small group of professionals such as registered nurses (RNs), …

Impact Of Pcts In The Prevention Of Hap Through A Route Bundle With An Emphasis On Oral Care And Positioning The Patient Out Of Bed And In A Chair, Melissa Ray

Master's Projects and Capstones

Background: Hospital Acquired Pneumonia (HAP) is a leading cause of most hospital-acquired infections among surgery patients who are hospitalized and bed-bound for more than 48hrs. The occurrence of HAP is associated with increased hospital stays and cost of care. However, its occurrence can be reduced by oral care. In this regard, this project aimed to decrease the incidence of HAP on the 3^rd, 4^th, 6^th, and 7^th floors on the Medical Surgical and ICU units of the Northern California Hospital.

Methods: To achieve the aim above, the project utilized methods namely …

Improving Nursing Shift Handoff Reports: A Quality Improvement Project, Nathan Mm Secrest

Master's Projects and Capstones

Nursing shift-to-shift handoff report can greatly impact a patient’s quality of care. According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off” (Inadequate handoff communication, 2017). In total, this quality improvement (QI) project worked with three hospital inpatient units on three different floors in an urban California (CA) city. Each unit and even shifts within each unit varied, leading to the conclusion that interventions should be trialed by units with the most buy-in, then adjusted to the unique needs of each unit. For our main intervention we …

Mentoring Infection Preventionists: An Infection Prevention Practice Fellowship Program, Sejal Naik

DNP Qualifying Manuscripts

Background: The COVID-19 pandemic created enormous demands on infection preventionists (IPs). It seriously taxed IPs and required hiring new IPs to support these demands. It is highly competitive to hire experienced IPs, and it can take up to two years for new IPs to demonstrate proficiency before pursuing their certification. A gap analysis revealed that current infection prevention (IP) programs did not provide formal training or mentoring.

Methods: The fellowship program will use the Association for Professionals in Infection Control and Epidemiology (APIC) competency model to train and build IP competency. The APIC accelerated training program will provide training to …