Quality Improvement Commons^™

Patient-Centered Preimplant Education Session And Bi-Weekly Text Message Adherence Reminders In Patients With A Newly Implanted Cardiomems® Device: A Quality Improvement Study, Elizabeth M. Miller, Alicia Abboud, Audrey Cooper

Doctor of Nursing Practice Projects: College of Nursing

Rationale

Heart failure is a deadly disease, affecting over 6.2 million individuals and costing the United States an estimated 30.7 billion dollars (Virani et al., 2020). By 2023, heart failure costs in the United States are estimated to grow to 70 billion dollars with 75-80% of these costs attributed to inpatient hospitalizations (Heidereich et al., 2022). The CardioMEMs® is a small device placed in the patient’s pulmonary artery via a minimally invasive procedure by an interventional cardiologist. The use of remote patient data from the CardioMEMs® device has been shown to reduce hospital re-admissions, facilitate tailored medication management, detect increased …

Implementing A Standardized Protocol For Early Detection Of Undiagnosed Hypertension Patients, Jenscena Hansen, Chris Bell

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Hypertension is a preventable disease that frequently goes unrecognized and undertreated. Early diagnosis can prevent further comorbidities such as heart disease, stroke, and chronic kidney disease. Implementation of this protocol aims to decrease the number of patients with undiagnosed hypertension and increase the identification of patients with elevated blood pressure who did not have a pre-existing diagnosis of hypertension. The goal of implementing a standardized protocol would help eliminate the number of patients who go undiagnosed.

Methods: This quality improvement design had clinical staff flag patients with elevated blood pressure. Identified patients without a diagnosis of hypertension were educated …

Effects Of A Compassion Fatigue Workshop On Psychiatric Mental Health Nurses, Johnnie Elizabeth Bower Bsn, Mary Johnson Dnp

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Compassion fatigue (CF) is a collection of symptoms associated with exposure to traumas experienced by other people. Nursing is one of the professions that experiences CF from recurrent exposure to patient and family distress and from potential acts of abuse at work. Nurses working in behavioral health are one of the highest at risk for CF. Of newly graduated behavioral health nurses, 17.5% leave the field after one year and 33.5% leave after two. Signs of CF include hopelessness, feelings of inadequacy, anxiety, depression, fatigue, and increased absenteeism. Training in self-care techniques and mindfulness builds nurse resilience and …

Implementation Of A Standardized Suicide Screening Process In A University Student Health Clinic: A Quality Improvement Project, Addie Grace Strong, Kathryn Dambrino, R. David Phillippi, Linda Wofford

DNP Scholarly Projects

Background: Suicide is a leading cause of death among college age students, prompting the need for evidence-based screening tools like the Columbia Suicide Severity Rating Scale (C-SSRS) to enable early detection and timely intervention. Inconsistencies in suicide screening may pose a risk of missed intervention opportunities. This Doctor of Nursing Practice project specifically aimed to improve the quality and consistency of suicide screening in a university student health clinic by implementing the C-SSRS tool into the clinic workflow during mental health appointments. Methods: Employing a quality improvement framework, this scholarly project followed the Institute for Healthcare Improvement Model for Improvement …

Improving Outcomes For Persons With Opioid Use Disorder By Introducing Buprenorphine In The Emergency Department, Emily Caroline Wegenka, Mary Johnson, Thomas Vajen

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Opioid related death is the leading cause of accidental death in adults younger than 50 years old in the United States (US) with approximately 130 opioid related deaths daily. Emergency department (ED) visits for a non-fatal overdose, the one-year mortality is 4.7-5.5%. Studies show increased access to medications for opioid use disorder (MOUD) decrease morbidity and mortality related to OUD. Additionally, there is evidence that initiating MOUD in the ED increases engagement in outpatient follow up, also reducing morbidity and mortality associated with OUD.

LOCAL PROBLEM: The setting for this practice improvement project was a non-profit, rural …

Optimizing A Clostridium Difficile Screen For Intensive Care Unit Admissions, Mary Katherine V. Natour, Jennifer Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Clostridium difficile infection is one of the most common healthcare-associated infections. Careful screening upon hospital admission enables clinicians to mitigate the spread and sequelae of this illness through early intervention and isolation but this screening must be accurate and highly sensitive to maximize benefit.

Local problem: The site for this project, an ICU in Tennessee, currently employs a highly sensitive but nonspecific tool to detect CDI. This has resulted in low accuracy, low staff compliance, low patient morale, and unnecessarily high personal protective equipment (PPE) costs.

Methods: Levin’s evidence-based practice improvement model was chosen to guide this project from …

Antibiotic Stewardship In Patients With Viral Upper Respiratory Illness: Improving Quality Measures In Retail Health, Meredith A. Nolan, Robin Harris, Clay Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Millions of people will die from antibiotic-resistant bacterial infections in the next 30 years. Retail health providers are pivotal in this global epidemiological problem.

LOCAL PROBLEM: Setting included 15 retail health clinics operated by Vanderbilt University Medical Center in Middle Tennessee. Project examined provider education, patient engagement, and commitment to antibiotic stewardship, components of the CDC's Core Elements of Outpatient Antibiotic Stewardship framework. Specific aims were that providers would have a significant reduction in the percentage of antibiotics prescribed for viral illness over the study period.

METHODS: Using the Evidence-Based Practice Improvement Model, a Quality Improvement …

Reducing Copd Readmissions Through The Implementation Of A Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project, Hannah F. Hall, Allyson Neal, Samantha Bauer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm …

Effect Of Certified Diabetes Clinical Education Specialists On Adults With Type 2 Diabetes, Rachel Faller, Tracy Gregory, Michelle Jones, Peyton Barnett, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Purpose/Background

Type 2 diabetes mellitus affects 13.1% of adults living in Shelby County and over 30 million adults in the United States. This chronic disease creates a higher risk of macrovascular and microvascular complications for this population resulting in poor outcomes if not properly managed. Improving glycemic control can help to improve the quality of life for people living with diabetes and reduce healthcare costs. Currently 20% of funds spent in the United States on healthcare is utilized for diabetic care. Certified Diabetes Care and Education Specialists (CDCES) primarily educate patients about managing their diabetes, including health promotion that can …

Police Versus Non-Police Response To 988 Crisis Calls, Miriam A. Maloney-Mattheisen Bsn, Rn, Latrina N. Blakemore Msn, Fnp-Bc, Janelle M. Scullark Msn, Fnp-C, Jacqueline Sharp Dnp, Pmhnp-Bc, Sharon Little Dnp, Fnp-Bc, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn

Doctor of Nursing Practice Projects

Purpose/Background

The 988 Suicide & Crisis Lifeline is a mental health-specific emergency line that became nationally available in July of 2022. This resource allows callers in crisis to connect with trained mental health professionals. Despite the initiation of this new dispatching service, there is still a significant shortage of trained mental health professionals to respond to these calls when they require emergency intervention. The present scoping review aims to determine whether non-police crisis responses correlate to improved outcomes when compared to police response as evidenced by reduced inpatient admissions, reduced arrests, and decreased presence of intrusive traumatic symptoms following intervention. …

The Financial Impact Of Correct Status Within Health Systems, Davin Evanson, Arveen Asghar, Eugene York, Michael S. Weingarten, Walter Bohnenblust

Tower Health Research Day

No abstract provided.

How Soon Is Too Soon? A Quality Improvement Approach To Postoperative Length Of Stay Following Transcatheter Aortic Valve Replacement, David Brian Jones, Robin Harris, Paul N. Fiorilli Md, Allyson Neal

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Heart valve disease prevalence is expected to rapidly increase over the next twenty years. Aortic stenosis, the most common valvular disorder, is a significant cause of heart failure hospital admissions and high mortality if left untreated. Treatment options include surgical aortic valve replacement (SAVR) and the more popular transcatheter aortic valve replacement (TAVR). The rapid increase of TAVR procedures generates hospital bed capacity issues, and there is no recommendation defining the minimum length of stay (LOS) following TAVR.

LOCAL PROBLEM: The setting was a 1,100-bed academic medical center in southeastern Pennsylvania with an average annual TAVR volume …

Agents Of Change: Which One Are You?, Michelle C. Dziurgot Dds

The Journal of the Michigan Dental Association

In her editorial, Michelle C. Dziurgot, DDS, explores various roles dentists play as agents of change, including catalysts for urgency, collaborators with specialists, diligent workers for accuracy, risk-taking entrepreneurs, charismatic leaders, and peacemakers who resolve conflicts within their practices.

The Impact Of Covid-19 On The Utilization Of Early Magnetic Resonance Imaging (Emri) In The Assessment Of Acute Uncomplicated Low Back Pain (Lbp) And The Subsequent Effect On Health Care Service Utilization And Patient Outcomes, Kimberly Radcliffe

MUSC Theses and Dissertations

OBJECTIVES: To examine changes in MRI rates between Pre-COVID-19 period (Feb-April 2019) and COVID-19 period (Feb-April 2020) among commercially insured patients aged 18-60 with a diagnosis of acute LBP, and to analyze differences in patient characteristics and outcomes between the time periods. Additionally, to examine the impact of eMRI on patient outcomes and health care costs for patients in the COVID-19 period.

DESIGN/METHODS: Using IBM® MarketScan® Commercial Database (MarketScan) we performed a quantitative pre-post comparative retrospective observational study of 117,150 total patients to examine adjusted differences in patient characteristics and rates of MRIs between time periods. We analyzed 49,020 patients …

Quality Improvement In Healthcare: A Practical Guide For Providers (Part 3), Jeremy Ellis

Transformative Medicine (T-Med)

No abstract provided.

Use Of A Primary Care Dataset To Describe ‘The Real Picture’ Of Diabetes In Kimberley Aboriginal Communities, Caitlyn S. White, Kimberley Seear, Lorraine Anderson, Emma Griffiths

Journal of the Australian Indigenous HealthInfoNet

Objective
Aboriginal communities are impacted by high rates of diabetes, however these are currently underestimated by national data sources used by policy and decision makers to inform allocation of health resources. We aimed to estimate diabetes prevalence and screening coverage using primary care electronic medical record data.

Methods
A cross-sectional audit was conducted using primary care data from Aboriginal regular Aboriginal Community Controlled Health Service (ACCHS) clinic attendees aged 15 years and over (n=1763) in five remote communities in the Kimberley region. Main outcome measures were overall diabetes prevalence; age-specific diabetes prevalence; prevalence of pre-diabetes; and screening rates among patients …

Quality Improvement Protocol: Improving The Use Of Nonpharmacological Pain Management Strategies Within The Inpatient Hospital Setting, Katherine Salamon, Christina Russell, Dara Devinney, Catherine M Soprano

Department of Medicine Faculty Papers

Background: There are many nonpharmacological pain management services available to hospitalized youth; however, not all youth are offered these services. Lack of knowledge about resources, difficulty with the referral process, and lack of understanding about nonpharmacological pain management services and when to refer patients are among the main reasons for lack of utilization. Quality improvement (QI) initiatives have grown within hospital settings and can serve to create change in fast-paced environments. Methods: The current QI project aimed to pilot an educational program to increase the use of nonpharmacological pain management interventions. Staff located on one floor of a pediatric hospital …

Quality Improvement In Public-Private Partnerships In Low- And Middle-Income Countries: A Systematic Review, Cassandra Iroz, Rohit Ramaswamy, Zulfiqar Bhutta, Paul Barach

College of Population Health Faculty Papers

BACKGROUND: Public-private partnerships (PPP) are often how health improvement programs are implemented in low-and-middle-income countries (LMICs). We therefore aimed to systematically review the literature about the aim and impacts of quality improvement (QI) approaches in PPP in LMICs.

METHODS: We searched SCOPUS and grey literature for studies published before March 2022. One reviewer screened abstracts and full-text studies for inclusion. The study characteristics, setting, design, outcomes, and lessons learned were abstracted using a standard tool and reviewed in detail by a second author.

RESULTS: We identified 9,457 citations, of which 144 met the inclusion criteria and underwent full-text abstraction. We …

An Educational Intervention Differentiating Pressure Injuries From End-Of-Life Wounds, Alicia Perez Varela, Annette Callis

Providence Nursing Research Conference 2023 – Present

Background

End-of-life (EOL) wounds are identified in the literature as Kennedy Terminal Ulcers (KTU), Skin Failure (SF), Trombley-Brennan Terminal Tissue Injury (TB-TTI), and SCALE (Skin Changes at Life’s End). EOL wounds have a similar appearance to pressure injuries (PIs) with a fundamentally different etiology. The misclassification of EOL wounds as PIs results in increased Hospital Acquired Pressure Injuries (HAPI), hospital fines, and less-than-optimal EOL wound management.

Purpose

To examine the effectiveness of an educational intervention on EOL wounds in increasing nurse confidence in providing End-of-Life Care (EOLC) and differentiating PIs from EOL wounds.

Methods

This quasi-experimental study used the 28-item …

Fall Prevention Quality Initiative: Implementation Of Fall Ambassador Safety Team (Fast), Jerome Codilla, Joanna Arraiza

Providence Nursing Research Conference 2023 – Present

Background

Patient falls are the most common adverse events reported in hospitals and represent a persistent patient safety issue. Annually, roughly 700,000 to 1 million patient falls occur in United States hospitals, resulting in around 250,000 injuries and up to 11,000 deaths (LeLaurin et al., 2019). Nurses are responsible for the identification of high fall risk patients and development of a plan of care to minimize risk. Multifactorial strategies have been shown to reduce falls, but evidence of a sustainability team (fall champions) is lacking. Review of the National Database of Nursing Quality Indicators (NDNQI) data on a 33-bed progressive …