Other Nursing Commons^™

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Intervention To Increase Home Preparation For Colonoscopies, Joshua Victor Stone

Master's Projects and Capstones

Abstract

Problem: Inpatient colonoscopies are costly to healthcare systems and inconvenient for eligible patients. The cost for a two-night inpatient bed is currently $4800.00 currently. The department manager led a five-month quality improvement project that was initiated in one 180-bed community medical center in Northern California to increase outpatient options, reduce the census and decrease the admission rate.

Context: Overburdened medical facilities often miss the opportunity to utilize ambulatory procedures due to competing operational priorities. In this setting, the Care Without Delay (CWD) department microsystem addresses barriers that impact operational throughput, efficiency, and unnecessary admissions.

Intervention: A …

A "Collaborative" Approach To Improving Nurse Turnover, Tiffany M. Nawabi

Master's Projects and Capstones

Problem: A cardiovascular unit is experiencing an increase in RN turnover and decreased NDNQI RN to RN interaction scores.

Context: Several recent studies demonstrate that a collaborative environment of well-being and enhanced RN communication can improve nurse retention rates (Alsufyani et al., 2021), as well as increase job satisfaction (Ylitörmänen et al., 2019).

Interventions: Nursing-led collaborative sessions were launched, consisting of the unit’s clinical nurses, the management team, and interprofessionals. The collaborative meetings provide a forum for the nurses to express their concerns, collaborate, and develop meaningful solutions.

Measures: The first measure is the Human Resource’s nursing retention report, with …

Supporting The Nursing Workforce And Addressing The Phenomena Of Nursing Burnout With Evidence-Based Mental Health Interventions, Kelly Leung

Master's Projects and Capstones

Problem: Burnout within healthcare has been an existing phenomenon, contributing to increased hospital staff turnover rates and the nationwide nursing shortage. The COVID-19 pandemic has exacerbated this issue leading to a decrease in the quality of patient care, nurse satisfaction, and organizational financial security.

Context: At a South Bay Area public healthcare system, staff were displaced throughout the community to support the overflow of COVID-19 patients at ambulatory clinics. Due to the nature of COVID-19, this healthcare system has experienced barriers in maintaining available staff for the demand of work. Studies indicate that signs of increased stress and burnout observed …

The Resilience Vaccine, Sara Horton-Deutch T. Duffy

Master's Projects and Capstones

Healthcare workers have been working in unprecedented circumstances since the declaration of the COVID-19 pandemic. Caregivers have been taxed with burnout. A large healthcare organization’s 26-bed, medical-surgical, telemetry, COVID-19 overflow unit was significantly impacted. Many healthcare organizations have adopted advocacy for attaining joy in work as an extra dimension of the Institute for Health Improvement’s Triple Aim. Adding this fourth aim supports averting caregiver burnout (CBO) while promoting joy in work.

This quality improvement project examined nurse leaders’ interventions that address CBO, promote healthy work environments, and promote joy in work. From June through August 2021, an 8-week resilience program …

Targeting Nstemi Readmissions: Education To Protect The Hearts Of Our Patients, Gisha Gireesan

Master's Projects and Capstones

Section I: Abstract

Problem: January and February 2021 data showed a rise in readmissions for the NSTEMI population. This is significant as 2020 had a readmission rate of 5.6% and 7.3% in 2019. This sudden increase in readmissions within the first two months of the year is a cause for concern and immediate action is needed.

Context: 2020 had a reduction in cardiac catheterizations due to the multiple canceled cases during the COVID 19 pandemic. As the cases were being rescheduled along with new cases in 2021, the institution experienced an uptake in readmissions.

Interventions: The staff of department 220 …

Decreasing Patient Fall Rates In The Microsystem, Kevin Dwayne Sanchez Camaya

Master's Projects and Capstones

Abstract

Problem: Falls are considered never events, yet continuously occur in the inpatient setting. Falls,

especially falls with injuries, impact the patients, the staff, and the hospital. Falls cause extended lengths of stay, affect the morale of the patients and the staff, and are non-reimbursable events.

Context: There have been an increased rate of falls within a medical/surgical/telemetry unit

microsystem at a Northern California hospital despite standardized screening and prevention tools. The unit can house up to 52 patients and is the designated Covid unit of the hospital at the time of this project.

Interventions: The interventions include optimizing the …

Patient Experience As A Metric For Performance In Outpatient Bone Marrow Transplant Patient Populations, Olivia S. Marlinski

Master's Projects and Capstones

Problem: Patient satisfaction and perception of care provided have been linked to the overall quality of healthcare delivery. The Acute Infection Management clinical support department lacks a standardized method to collect information from patients regarding their satisfaction with care provided therefore impeding the units’ ability to capture performance results related to satisfaction, and improve care delivery processes accordingly.

Context: The Acute Infection Management unit is an outpatient clinical support department located within a large university-affiliated hospital that has been recently designated as the unit to operate the facility’s new outpatient bone marrow transplant program.

Intervention: The proposed project seeks to …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Communication Strategies To Promote Infection Control Compliance: My Health Is In Your Hands, Ezra Macabio

Master's Projects and Capstones

Abstract

Problem: The facility has less than 70% adherence to handwashing hygiene every week. Moreover, staff does not comply with the required PPE, affecting their infection-control performance and compliance to circumvent COVID-19. Furthermore, the microsystem lacks information flow and communication systems focusing on hand hygiene, and PPE usage significantly affects the healthcare staff's ability to perform such vital practices.

Context: Herman Health Care Center provides multiple services to its residents depending on medical needs after patient hospitalizations, such as short-term rehabilitation and long-term skilled nursing services. The COVID-19 pandemic had a remarkably negative impact on the skilled nursing facility. The …

The Impact Of Nurse-Led Initiative Interventions On Cauti, Dalveer Kaur

Master's Projects and Capstones

Problem: National Healthcare Safety Network (NHSN) has reported U.S. hospitals having 0.2 to 4.8 per 1000 catheter-days for adult inpatient units. The insertion of a catheter and delay in removal have a significant impact on morbidity, mortality, length of stay, and reimbursement.

Context: Post-Acute Care Unit (PACU) is a microsystem that provides rehabilitation services for a patient with various post-surgical procedures. The staff of this unit was well aware of policies of catheterizations that led to prolonged use of urinary catheters and an increased rate of CAUTIs in the last quarter of this year. This project aims to increase staff …

Improving Patient Knowledge On Medication Communication, Deborah Cha

Master's Projects and Capstones

Abstract

Problem: Effective medication communication, including potential side effects, is a key determinant of safe patient care and better health outcomes. 3SA scores a 1-2 out of 5-stars for medication communication with the HCAHPS survey from October 2020-March 2021.

Context: As one of the medical-surgical units at this California hospital, it serves the purpose of providing medical and/or surgical management to acutely ill patients. The unit is a 24-bed, 1:5 nursing ratio with medical-telemetry and Covid-19 overflow.

Intervention: The interventions include a structured, evidence-based multi-component program in improving patient knowledge about new medications they receive, the possible side effects of …

Testing A New Workflow To Integrate The Voice-Of-The-Customer In Readmission Analysis For Skilled Nursing Facility Readmissions From Home, Stephanie Edurese Bilbao

Master's Projects and Capstones

Abstract

There are multiple layers of oversight across the healthcare delivery system. Measuring acute hospital readmissions has been identified as an important outcome measure of quality care. Our patients are one of the major stakeholders in the healthcare system. One role of a clinical nurse leader is to integrate evidence-based leadership practices that identify and assess outcomes, mitigate risk, enhance health promotion, deliver highly effective patient care, and ensure transparent relationships with stakeholders. Rationales for examining and re-designing the readmission analysis workflow based on the customer’s experience are discussed in this paper. The global aim of the project is to …

Improving Vaccination Uptake In The Latinx Community Through Standardized Outreach, Stephanie Ramirez

Master's Projects and Capstones

In the United States, Latinx communities have experienced a disproportionately high burden of COVID-19 infections and hospitalizations throughout the pandemic. The focus of this quality improvement project is to standardize the patient outreach process and education to increase COVID-19 vaccine uptake. The ambulatory community clinic in the city of Oakland, California serves a majority of underserved Latinx patients that have demonstrated distrust of the healthcare system and their disbelief in the positive outcomes of the COVID-19 vaccine. The high burden of COVID-19 infections among the Latinx community has led to misinformation and fear. In order to overcome this issue, Clinical …

Improving Patient Experience And Staff Workflow During Ed To Inpatient Interfacility Transfers, Jonathan Nakagawa

Master's Projects and Capstones

ED overcrowding has been an issue for Facility X pre-COVID19 and has been exacerbated following the first shelter in place mandate around March 2020. Facility X had proposed to increase the amount of interfacility transfers (IFT) to mitigate overcrowding and, hopefully, improve patient outcomes. 2020 Census data had shown that patient satisfaction scores and Nurse Daily Engagement scores were down; leading Facility X to believe that there can be improvements made to the IFT workflow and communication. Patient interviews also revealed that not all patients were satisfied with how they were treated during the IFT process. This quality improvement project …

Preventing Central Line Associated Bloodstream Infections In An Adult Intensive Care Unit, Monica Shaw

Master's Projects and Capstones

Central line associated blood stream infections (CLABSI) are considered preventable healthcare acquired infections, and are associated with significantly increased morbidity, mortality, and length of hospital stay. The CLABSI rate in an inpatient unit is a meaningful metric in relation to the safety and quality of care in that microsystem. This quality improvement project examines the efficacy of a CLABSI prevention bundle in reducing CLABSI events and improving adherence to central line care policy within a medical surgical adult intensive care unit. The target areas the bundle aimed to improve were unit processes, awareness of CLABSI and central line policies, and …

Standardizing Thoracic Aortic Aneurysm Education, Marjorie Anne Gisslow

Master's Projects and Capstones

Problem: Patients receive information about a new thoracic aortic aneurysm (TAA) diagnosis from their primary care providers (PCPs). As TAA is a relatively rare conditions, many PCPs have rudimentary knowledge of TAA, and need information and support from cardiac specialists to address their patients’ concerns and guide their care.

Context: In the Regional TAA Surveillance Program the TAA nurses offer educational content for patients through the information they provide to the PCPs. Currently the educational material available to PCPs is not comprehensive or easily accessible.

Intervention: Uniform, comprehensive educational content provided through recommendations in the patient’s electronic medical record at …

Standardizing Patient Handoffs In The Icu – Implementing The “I Put Patients First” Tool., Wislande Joseph

Master's Projects and Capstones

Abstract

Background. Ineffective patient handoff can result in poor nurse communication, increasing the likelihood of adverse events including medication and documentation errors.

Context/Problem. In one 20-bed ICU unit in a northern California community hospital, 48 patient handoffs were observed over 2 weeks. Only 29% occurred at the patient’s bedside; 39.5% used a standardized handoff tool; and 54% included the patient and/or family. These findings indicate significant quality gaps in the unit’s ICU patient handoff processes.

Intervention. The educational intervention consisted of one introductory and two follow-up teaching sessions related to best practices for handoff processes followed by implementation …

An Innovative Contest: A Team Approach To Improving Patient Satisfaction Scores For Medication Side Effects, Jennifer Natsch-Jensen

Master's Projects and Capstones

Problem The Home Healthcare Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey question 14 regarding providers discussing possible side effects is below the organizational goal of 74.1 linear mean in this home health microsystem.

Context According to the Agency for Healthcare Research and Quality (AHRQ), nearly 20% of patients discharged home from the hospital had an adverse event within the first few weeks of discharge and most are related to medications (AHRQ, 2019).

Interventions An innovative contest was introduced to promote engagement and to use teach-back best practices, including planned discussions with the patient and caregivers regarding name of …

Introducing A New 12 Week Education & Simulation Program To Optimize Financial Performance Of Nurse Managers, Melissa Hathcoat

Master's Projects and Capstones

Problem: Several nurse executives (Waxman 2018; Massarweh, 2017; Hunt, 2018) agree that in today's increasingly complex health care environment, the reality of decreasing reimbursements and increasing focus on value-based metrics reflects a crucial knowledge base for nurse managers. Therefore, it is imperative for unit-based nurse leaders to receive education and support to attain and maintain the requisite business competencies to achieve both fiscal and quality targets in their microsystem (McFarlan, 2020). In an integrated managed care delivery system in northern California, no education curriculum exists for nurse managers and assistant nurse managers that addresses gaps in financial knowledge, skills, and …

Nurse Interrupted: Educating Nurses To Reduce Work Interruptions In The Intensive Care Unit, Lelayitu Shiferaw

Master's Projects and Capstones

Background: Interruptions occur in high frequency in the critical care hospital setting.

The purpose of this study is to understand the impact of work interruption for the critical care nurse and to examine ways to mitigate predominant, non-urgent interruptions.

Methods: The nurse interrupted project followed the Lean methodology framework to identify which high-frequency interrupters to address. Baseline assessment of the intensive care unit (ICU) nurses identified alarms and patient family member calls as predominant causes of interruption. A literature review was conducted to understand work interruption for nurses and to identify available solutions.

Intervention: To address the …

Aiming For Zero: Creating A Culture Of Safety And Improving Cauti Outcomes In The Microsystem, Shiela Escobar

Master's Projects and Capstones

Abstract

Problem: Catheter-associated urinary tract infection (CAUTI) remains the leading cause of hospital-acquired infection (HAI) despite being preventable. CAUTI increases the length of stay, morbidity, mortality, readmissions, and costs. There is also increasing antimicrobial resistance in pathogens causing CAUTI. Thus, reducing HAIs such as CAUTI should be a priority for every institution.

Context: The microsystem for this CAUTI quality improvement project is a 24-bed adult medical-telemetry unit in an acute care teaching hospital with excessive CAUTI. This project aims to improve the unit’s CAUTI standardized infection ratio (SIR) from a baseline of 2.54 to 1.75 by October 2020. A SIR …

From Team Huddle To Team Cuddle: Rekindling Caring, Self-Compassion, And Joy In Work!, Amerizza Quemada

Master's Projects and Capstones

Problem: The healthcare industry suffers from a high level of burnout and unhealthy work environments, which has been heightened by the COVID-19 pandemic. The consequences of burnout may be expressed in both individuals and teams as a lack of caring, disengagement, incivility, and staff turnover.

Context: One department in an integrated healthcare organization displayed a pattern of annual low employee engagement scores and alleged workplace bullying. Team members also observed that employees failed to speak up when experiencing incivility. The Clinical Nurse Leader (CNL) student determined that an improvement initiative was needed to create a culture of caring to improve …

In-Basket Teamwork: Divide The Work And Multiply The Success The Registered Nurse Role In Ambulatory Clinic Ehr In-Basket Management, James Smoot

Master's Projects and Capstones

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the …

Nurse Leader Rounding: A Stellar Strategy To Improve The Patient Experience Of Care In The Emergency Department, Polina Shishkina

Master's Projects and Capstones

Abstract

Many clinical outcomes that occur in the emergency room determine the patient’s continued care and experience in the hospital and beyond as well as influence the organizational reputation in the community. Mack and Fill emphasize that “an ED visit is a significant encounter between a patient and a hospital and one that affects ‘repurchase’ decisions for future health care” (as cited in Welch, 2010, p. 65). Thus, patient experience in the emergency department necessitates continued quality improvement efforts. The emergency room, or “the front door to the hospital”, provides equitable and affordable care to patients who need urgent medical …

Pressure Injury Documentation And Reporting: A Quality Gap, Mary Ann Laslo

Master's Projects and Capstones

Abstract

Problem: Inaccurate and incomplete pressure injury (PrI) assessment and documentation leads to inaccurate reporting of PrI quality reporting measures to the Centers for Medicare and Medicaid Services. Inaccurate, incomplete documentation of pressure injuries and wounds adversely affects the quality of care, financial reimbursement, and hospital reputation as well as increasing the risk of litigation to medical providers. Barriers to accurate and complete documentation by the nurses were inaccuracy in identification of PrIs Stage 1 or greater and knowing what and where to document the information in the electronic medical record.

Context: This quality improvement project attempted to improve nurse …

Implementing A Fall Prevention Program: A Quality Improvement Project To Promote Patient Mobility On The Medical-Surgical Unit, Alba Araiza

Master's Projects and Capstones

Implementing a fall prevention program is imperative in acute healthcare settings. Falls are one of the top reported events that occur in hospitals and it is a patient safety concern that requires the implementation of evidence-based practices to reduce falls. This quality improvement project will be developed by a master’s prepared clinical nurse leader (CNL) on a medical-surgical unit to improve patient safety.

Problem

Maintaining patient safety is the most important priority in health care. Health care organizations implement protocols, policies and procedures to ensure that care is provided in a safe manner to minimize preventable harms. However, falls are …

Implementing A Fall Prevention Program: A Quality Improvement Project To Promote Patient Mobility On The Medical-Surgical Unit, Alba Araiza

Master's Projects and Capstones

Abstract

Implementing a fall prevention program is imperative in acute healthcare settings. Falls are one of the top reported events that occur in hospitals and it is a patient safety concern that requires the implementation of evidence-based practices to reduce falls. This quality improvement project will be developed by a master’s prepared clinical nurse leader (CNL) on a medical-surgical unit to improve patient safety.

Problem

Maintaining patient safety is the most important priority in health care. Health care organizations implement protocols, policies and procedures to ensure that care is provided in a safe manner to minimize preventable harms. However, falls …

Compounding Effects Of Reducing Nurse Burnout And How It Can Produce An Increase In Patient Safety And Satisfaction, Alexander Mua

Master's Projects and Capstones

The reduction of nurse burnout has shown to have an increase in patient satisfaction and quality of care. It also has shown a decrease in patient-related or sentinel events. Accordingly, with the reduction of nurse burnout, there has also been a reduction of compassion fatigue. This project has illuminated the benefits of acuity-based caseload at the micro-level, including the cost-effective nature of overtime pay, including HCHAPS benefit score. The method of obtaining, planning, and implementing was based on the Plan, Do, Study, Act (PDSA), which required collaboration amongst multiple disciplines, groups, departments, and executives. The process and goals concluded to …

Nurse-Driven Protocol To Reduce Urinary Catheter Infections: A Quality Improvement Project, Sara Burrington

Master's Projects and Capstones

Costs of healthcare are astronomical, not only in the financial sense, but in many aspects of life for both patients and healthcare providers. Costs include those accompanying healthcare associated infections (HAI), where as a result of environmental factors, a patient acquires an infection during their admission. Since 2008, Medicare and Medicaid no longer reimburse hospitals for infections deemed ‘reasonably preventable.’ The biggest offender of this type of HAI is overwhelmingly, catheter associated urinary tract infections (CAUTI) (Kennedy, Greene & Saint, 2013). With approximately 31% of the inpatient population requiring an indwelling catheter at some point throughout their stay, risk of …