Critical Care Nursing Commons^™

Improving Intravenous Catheter Insertion Success In Difficult Access Patients, Heidi Berry

Doctor of Nursing Practice Projects

Around one in every nine Emergency Department (ED) patients have Difficult Intravenous Access (DIVA) and 25% of ED patients will require more than one attempt (Fields et al., 2014a). Failed insertion attempts contribute to decreased patient satisfaction, care delays, and financial losses. The freestanding ED affiliated with a multi-state, not-for-profit healthcare system in an urban community had difficulty with first-attempt Peripheral IV (PIV) insertion success in identified patients. The target population was the clinical staff of the freestanding ED which included Registered Nurses and Paramedics. The objective outcome was to enhance personal knowledge of PIV catheter insertion in difficult-access patients …

Implementing Change: The Use Of Minocycline-Rifampin Impregnated Central Venous Catheters In Central Line Associated Blood Stream Infection Prevention In Critically Ill Patients, Shawn B. Murray

Master's Theses and Capstones

Introduction: At a large academic healthcare facility in the northeast a Gap Analysis was conducted finding quality improvement opportunities for central line associated blood stream (CLABSI) prevention in critically ill patients. Review of literature reveals the use of minocycline-rifampin impregnated (MNRI) central venous catheters (CVCs) as being an effective intervention in CLABSI prevention.

Methods: Several assessments were conducted regarding the implications of updating the facilities practice to reflect this evidence including AHRQ Gap Analysis Tool, a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis, Stakeholder Feedback, and Resource Allocation.

Results: Facilitators and barriers were identified in implementing this …

Reducing Clabsi Rates Through Education On Maintaining Cvc Dressing Integrity: A Quality Improvement Initiative, Hanna I. Lentine

Master's Theses and Capstones

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units.

LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma …

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 …

Improving Communication Between The Emergency Department And Prehospital Emergency Medical Services Through The Use Of A Secure Messaging Application: A Quality Improvement Project, Jacob G. Petlon

Master's Theses and Capstones

Background: Communication between emergency medical services (EMS) and the emergency department (ED) is a key part of treating patients being transported by ambulance. This communication is moving away from traditional radio and cell phone calls to the use of secure text-based apps. These apps can generate metrics and provide real time location information that is not available using traditional methods. Increased use of these apps can improve communication between EMS and receiving EDs.

Local Problem: Wildcat hospital introduced the EMS communication app Twiage in May of 2023. There is low utilization of the app and some EMS and ED …

Establishing A Protocol To Address Workplace Violence And Increase The Perceptions Of Safety Among Emergency Department Nurses: A Quality Improvement Initiative, Devan M. Robidoux

Master's Theses and Capstones

Background: Violence against emergency department nurses has become a widespread phenomenon that can greatly impact a nurse's job satisfaction and performance. Research has been scarce in examining the relationship between workplace violence and its underlying consequences. There remains a disconnect between precursors of violence against nurses perpetrated by patients and the cultural expectation that violence is a part of the nurses job and, subsequently, what they signed up for when going into the field. Nurses learn that having a greater understanding of the value in the lived experience of their patients leads to better quality delivery of care. However, culturally …

Support Their Sleep: Enhancing Nurses' Knowledge And Implementation Of Non-Pharmacological Sleep Protocols To Improve Patient Rest, Recovery, And Reduce Cognitive Impairment., David C. Barry

Master's Theses and Capstones

Background: Sleep and rest play an influential role in promoting recovery and healing in humans. Hospitalized patients are at risk for altered sleep from hospitalization, illness, and stimulation from a hospital environment. Non-pharmacologic interventions preformed by nurses can help to improve sleep and sleep environment for patients.

Local problem: There was no protocol or available information regarding patient sleep promotion for nurses to references when caring for patients.

Methods: Nurses in the microsystem (n=8) were administered a pre/post questionnaire containing Likert scales and a short quiz containing knowledge-based questions. Questionnaires were distributed to nurses prior to and after …

An Interprofessional Collaboration To Increase Total Enteral Nutrition In Critically Ill Patients On Vasopressor Agents In Cvicu, Priyanka Shah

DNP Projects

Background: Delayed enteral nutrition (EN) in critically ill patients increases the risk of complications and poor outcomes. The 2016 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and Society of Critical Care Medicine (S.C.C.M.) evidence-based guideline recommends initiating EN within 24-48 hours of Intensive Care Unit (ICU) admission once resuscitation and hemodynamically stability have been achieved. The evidence-based guideline notes that critically ill patients on low-dose vasopressors can be started on EN with close monitoring.

Purpose: This interprofessional project aims to increase the amount of EN delivered to all qualifying Cardiovascular Intensive Care Unit (CVICU) patients who are at risk …

The Effect Of Mentorship And Social Events On Job Embeddedness And Intent To Stay In Emergency Department Nurses, Kacie L. Albertsen

DNP Projects

Background and Purpose: The COVID-19 pandemic has drastically impacted nurse retention. According to the Kentucky Nurses Association, 57% of surveyed Kentucky nurses are considering leaving their jobs. Best retention strategies are unclear. Job embeddedness (JE) and Intent to stay (ITS) are factors that influence retention. The purpose of this project is to increase JE and ITS at a level one emergency department (ED) by implementing evidence-based mentorship and social event interventions.

Methods: This study utilized a mixed-methods, one group pretest-posttest design. Mentorship pairs were matched by personality type using the Big Five Personality Test. Four mentorship discussion meetings and two …

Improving Nursing Comfort In Relation To Difficult Conversations, Sarah Clifton

DNP Projects

Abstract

Background/Purpose

Conversations between care providers and patients are integral to medicine and are the most performed “procedure” (Luff et al., 2016). In Pediatric Intensive Care Units (PICUs) and Pediatric Cardiac Intensive Care Units (PCICUs), children of all ages with diverse diagnoses and needs are treated for critical illnesses and traumatic events. Therefore, providers frequently have difficult conversations with patients and their families. Pediatric critical care nurses are often invited to participate in these discussions. However, their role during, and after, these conversations is not always clear. The goal of this project was to evaluate the impact of an educational …

Effectiveness Of A Multimodal Educational Program In Increasing Understanding And Utilization Of Tele-Icu Resources By Critical Care Nurses: A Pilot Study, Olga Vulakh

DNP Projects

Background. Integration of tele-intensive care units (tele-ICUs) into healthcare systems is associated with improved patient outcomes and organizational performance. Inadequate bedside nurses’ knowledge about tele-ICU is associated with poor communication and lack of trust between bedside and tele-ICU teams. These problems might diminish tele-ICU’s ability to maximally impact patient outcomes.

Purpose. The purpose of this project was to create a multimodal educational program with the goal of improving knowledge, attitudes, and skills related to tele-ICU among critical care nurses and to assess the effect of the educational intervention on tele-ICU utilization among bedside nurses as evidenced by the number of …

Relationship Between Number Of Mechanical Ventilation Days Prior To Ecmo Initiation And Outcomes In Covid-19 Patients, Brittany Bergman

DNP Projects

Background: Since the start of the pandemic, there has been over 16,000 COVID-19 positive patients placed on Extracorporeal Membrane Oxygenation (ECMO). Little is known about the effect of long mechanical ventilation prior to ECMO initiation. Purpose: The first purpose of this project is to evaluate whether a longer mechanical ventilator time (ten or more days) prior to ECMO initiation is associated with increased mortality and longer total lengths of time on ECMO in patients with COVID-19, as opposed to being on a ventilator for under ten days prior to being placed on ECMO. The second purpose is to increase provider …

Utilizing Podcast Education To Improve Nurse Knowledge, Confidence, And Behaviors Related To Palliative Care Conversations In The Intensive Care Unit, Brittany Estridge

DNP Projects

Background: The personal connection that Registered Nurses (RNs) build with patients and their families puts them at the forefront of many conversations during the patient’s stay in the intensive care unit (ICU). Some of the most difficult conversations are related to palliative care (PC). It can be challenging to know how to respond to the complex questions posed in palliative care conversations (PCC) when patients and their caregivers are making decisions that will alter the course of the patient’s treatment, as well as affect the quality and length of their life.

Purpose: Nurses receive inadequate training in PCC. The purpose …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Implementing Universal Suicidality Screening In A Critical-Access Emergency Department, Delaney M. Kjendal, Kerry Nolte, Sara Robinson, Kimberly Force

Honors Theses and Capstones

Background: Implementation of a universal suicidality screening is considered best practice as it is associated with improved the detection of occult, or latent, suicide risk and can reduce subsequent risk. This quality improvement (QI) project evaluates the implementation of the Columbia-Suicide Severity Rating Scale (C-SSRS) to screen patients over the age of twelve at a regional healthcare system.

Methods: The QI project was conducted at Littleton Regional Healthcare (LRH) emergency department, a critical-access hospital in Littleton, New Hampshire that serves about 206 patients per week. Implementation of suicidality screening was of interest to LRH to promote mental health in the …

The Implementation Of A Palliative Needs Screening Intervention In A Neuro Critical Care Unit:, Marcus Goodfellow

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Purpose: Palliative care (PC) is an important and yet underutilized discipline in neuro critical care units (NCCUs). The purpose of this project was to integrate and improve PC in a NCCU by implementing a Palliative Needs Screening Intervention (PNSI). A PNSI consists of a list of criteria used to screen patients to identify family and patient PC needs.
Methods: A quality improvement project using a PNSI was implemented in a NCCU. Nurses completed 2 hours of pre-implementation PC education and a palliative perceived self-efficacy scale pre/post-implementation. A PNSI was developed and integrated into the NCCU’s daily rounding process.
Results: PNSI …

Clinical Care Protocol For Enhanced Nurse Competency In Caring For The Patient With An External Ventricular Drainage (Evd) Device, Lauren Orson

Doctor of Nursing Practice (DNP) Practice Innovation Projects

Background: The focus of this Doctor of Nursing Practice Project surrounds the need for an evidence-based clinical nursing protocol to augment nurse competency and therefore streamline care to patients with an external ventricular drain (EVD).
Methods: A clinical protocol alongside tailored education was used to promote nurse competency for EVD management. A pre-implementation survey was completed evaluating the nurses’ baseline competency when managing an EVD. The nursing protocol was then implemented for bedside use. After 2 months, the survey was completed once again and paired for statistical analysis.
Results: Statistical analysis using the Wilcoxon signed-rank nonparametric test with dependent matched …

Decreasing Post-Operative Ventilator Time In The Cardiovascular Surgical Patient: A Nursing Education Quality Initiative, Amanda J. Bruno Roberts

DNP Scholarly Projects

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation …

Dnp Final Report: Vascular Access In Burn Patients: An Evidence-Based Practice Project, Amanda Venable

DNP Final Reports

Vascular access in burn patients is a challenging aspect of care that affects the healthcare team and patients daily. The goal in this evidence-based practice project at a southern United States burn center was to improve the quality of the vascular access process by reducing the use of Central Venous Lines (CVL) and unsuccessful venipuncture attempts. The following practice question was formed: In hospitalized burn patients (P), how does a vascular access team with ultrasound-guided peripheral IV capability (I) compared with no vascular access team and standard IV insertion (C) affect central line days (O1) or patient experience (O2) during …

Reducing Blood Culture Contamination Rates Through Staff Education: A Quality Improvement Initiative, Kirsten M. Mutuberria

Honors Theses and Capstones

BACKGROUND: Blood cultures are a widely utilized tool that aids in diagnosis and treatment plans. Contaminated cultures are incredibly costly, resulting in increased length of stay, opportunistic infections, pharmacy costs, repeated laboratory tests, and decreased reimbursements. Evidence suggests higher incidence rates of blood culture contaminations (BCCs) are seen in emergency departments (ED) compared to any other unit within a hospital system. The internationally accepted threshold of 3% is not often met, although recent studies suggest a lower rate is possible, even in critical care environments. A literature review resulted in data showing that educational-based interventions focusing on adherence to facility …