Critical Care Nursing Commons^™

Feasibility Of An Emergency Department Fall Screening Tool And Intervention Bundle Checklist On Nursing Fall Prevention Documentation: A Quality Improvement Project., Bailee Pope, Bailee E. Pope

Doctor of Nursing Practice Papers

Background: The World Health Organization (2018) and The Joint Commission (2015) define falling as a sudden, unplanned involuntarily advancement toward the ground, that may or may not result in injury. Fall rates are directly related to a facility’s mortality and morbidity rates, delayed patient care, additional diagnostic testing, and increased length-of-stay. Evaluating the practices of a local emergency department (ED), it was noted that ED nurses are not documenting their acknowledgment of a patient’s risk for falls, and also failed to chart interventions aimed at preventing falls. Failing to implement these practices into regular patient care can lead to negative …

The Utilization Of Stress Management In Critical Care Nurses To Decrease Nursing Burnout, Danny Atkins

Student Scholarly Projects

Practice Problem: Since COVID-19, nurses have felt the pressure from the pandemic on their shoulders. The practice problem has helped nurses manage stressors to decrease the symptoms of burnout.

PICOT: In critical care nurses (P), how does the implementation of HeartMath techniques for stress management (I) compared to standard practice (C) affect rates of absenteeism, request for assignment transfer, and resignations (O) over 8-weeks (T)?

Evidence: The evidence that guided this project change is based on the Johns Hopkins nursing evidenced-based-practice model.

Intervention: The intervention assisted critical care nurses in dealing with stress and fatigue by …

Improving Compliance With The Sep-1 Sepsis Management Bundle, Allison Uppendahl Mrs.

Master's Projects and Capstones

Abstract

Problem: Providing high quality sepsis care is an organizational priority, however this medical center has only met the target compliance goal for the Centers for Medicare & Medicaid Service (CMS) SEP-1 sepsis management bundle 50% of the time over the past year. Root cause analysis has revealed that 40% of the fallouts have been attributed to non-compliance with the intravenous fluid bundle element.

Context: A microsystem analysis was completed on the quality department, a supporting microsystem to the larger mesosystem involved with providing acute sepsis care. A return-on-investment analysis demonstrated that efforts to improve sepsis care and reduce sepsis …

Myasthenia Gravis, Rebecca Wheeler

Nursing Student Class Projects (Formerly MSN)

Myasthenia gravis (MG), a neuromuscular and autoimmune disorder, is not completely understood by clinicians and scientists. The primary cause is thought to be anti-Acetylcholine receptor antibodies that attack the neuromuscular junction, causing destruction of post-synaptic junctional folds and blockade of the receptor. This causes frequent weakness and fatigability of voluntary muscles, making activities of daily living difficult for those living with MG. Although it is not an incredibly prevalent disease, the incidence is increasing in the United States due to better testing and diagnosis. Treatments are available, including cholinesterase inhibitors that raise the concentration of Acetylcholine at the neuromuscular junction …

Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone

Journal of Patient-Centered Research and Reviews

Delirium, a common and serious disorder in older hospitalized patients, remains underrecognized. While several delirium predictive models have been developed, only a handful have focused on electronic health record (EHR) data. This prospective cohort study of older inpatients (≥ 65 years old) aimed to determine if variables within our health system’s EHR could be used to identify delirium among hospitalized patients at the bedside. Trained researchers screened daily for delirium using the 3-minute diagnostic Confusion Assessment Method (3D-CAM). Patient demographic and clinical variables were extracted from the EHR. Among 408 participants, mean age was 75 years, 60.8% were female, and …

Asking The Question ‘What Matters To You?’ In A London Intensive Care Unit, Harriet Pittaway, Laura White, Karen Turner, Angelique Mcgillivary

Journal of Patient-Centered Research and Reviews

Purpose: At the heart of the paradigm shift in approach to patient care from paternalism toward shared decision-making lies the international “What Matters To You?” (WMTY) movement. However, WMTY principles are not frequently applied to the critical care setting. The aim of this quality improvement project work was to design and integrate a tool for all patients admitted to the intensive care unit (ICU) that helped answer WMTY.

Methods: Using Plan-Do-Study-Act (PDSA) methodology across 8 cycles, a multidisciplinary team designed and integrated a bedside poster into the ICU. Quantitative and qualitative data were collected via a bedside audit process on …

Reducing The Incidence Of Clabsi Through Hand Hygiene, Bindu Paudel

Student Scholarly Projects

Practice Problem: Central line-associated bloodstream infections (CLABSI) account for most hospital-associated preventable infections in the United States and globally. Implementation of effective hand hygiene practices is considered to be highly effective in preventing CLABSIs if performed during insertion and every handling instance.

PICOT: The PICOT question guiding this project is as follows: Among intensive care unit employees (P), implementation of hand hygiene awareness program and practice (I) compared to current practices (C) in reducing CLABSI incidences (O) among adult inpatients in 10 weeks (T)?

Evidence: The evidence from a rigorous literature review showed that the appropriate education …

Nurse-Led Intervention: Implementing Early Mobilization Of Patients In The Intensive Care Unit, Lou A. Hill

Student Scholarly Projects

Practice Problem: Immobility of patients in the hospital intensive care unit can cause longer stays in the intensive care unit and the hospital. Evidence-based early mobilization of patients helps to reduce length of stay (LOS) and avoid many detrimental sequelae, leading to short and long-term debilitation.

PICOT: The PICOT question that guided this project was: In the adult medical and surgical intensive care units (P), how does implementation of a nurse-driven protocol for early mobility (I), affect the LOS in the intensive care units and the LOS in the hospital (O), as opposed to not using a protocol for early …

What About Anosmia From Covid-19 ?, Sharanya S E Santhi, Sara Elnour, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Implementation Of A Critical Event Debriefing Tool In The Pediatric Intensive Care Unit, Tara Fiala

Dissertations

Problem: Working in the Pediatric Intensive Care Unit (PICU), staff encounter critical patient events without warning. Debriefing after adverse patient events has been shown to give staff the opportunity to process these events in an open, honest, and judgement-free environment. Debriefing has been recognized as a tool for detecting medical errors, improving team communication, providing emotional support, and analyzing team performance.

Methods: A descriptive, observational pilot study was used to implement the DISCERN tool into a large, midwestern, urban PICU. The aim of the quality improvement project was to achieve a debriefing tool completion rate of 20% over a one-month …

Reducing Catheter-Associated Urinary Tract Infections In The Pediatric Intensive Care Unit, Maria Smith

Dissertations

Problem: CAUTIs (catheter-associated urinary tract infections) are a common hospital-acquired condition (HAC) that increase length of hospital stays, hospital costs, and risk for patient mortality. CAUTI rates in a PICU increased in 2021 from the year 2020. A rapid cycle PDSA revealed nurses were not using soap and water for foley catheter care, which is the recommended cleanser by the Centers for Disease Control and Prevention (CDC).

Methods: An observational descriptive design was used to evaluate foley catheter cleaning and CAUTI rates. PICU nurses completed behavior surveys regarding foley catheter cleaning practices. An education intervention occurred when nurses answered anything …

Implementation Of A Protocol Nurse In The Emergency Department, Marissa Kramer

Dissertations

Abstract

Problem: Increased wait times and extended length of stay (LOS) of patients in the Emergency Department (ED) are contributing to overcrowding, burdening EDs worldwide. A nurse can initiate patient care using protocol order sets while a patient is in the waiting room; however, triage nurses are often too busy to complete these orders. Scheduling a nurse to complete these protocol order sets could reduce ED overcrowding and patient LOS.

Method: A convenience sample was used to retrospectively chart review and collect data utilizing an excel spreadsheet with patients 40 years of age and older with a chief complaint of …

Healthcare-Associated Pressure Injury Prevention In The Intensive Care Unit, Ross Quinton

Dissertations

Problem: Healthcare-associated pressure injuries (HAPIs) occur when prolonged pressure is on the sacrum, coccyx, elbows, and heels, during a hospital stay. HAPIs can result in increased morbidity and mortality, and prolonged hospital stays, which consequently requires excess expenditure on treatment. Early specialty mattress placement can prevent HAPI acquirement.

Methods: This quality improvement (QI) pilot project aimed to increase specialty prevention mattress usage in the intensive care unit (ICU). A sleep surface decision tree was implemented into the admission process in a 30-bed ICU. A retrospective record review was used to examine demographics, comorbidities, HAPI risk, length of stay, and when …

Implementing A Standardized Nursing Communication Tool To Improve Inpatient Nursing Communication, Ashley D. Nator

Dissertations

Implementing a Standardized Nursing Communication Tool to Improve Inpatient Nursing Communication

Ashley D. Nator

B.S. Nursing, University of Missouri-St. Louis, 2018

A Dissertation Submitted to The Graduate School at the University of Missouri-St. Louis in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice with an emphasis in Family Nurse Practitioner

August 2022

Advisory Committee

Cathy Koetting, PhD, DNP, APRN, CPNP, PMHS, FNP-C

Chairperson

Sarah Jackson, DNP, APRN, FNP-C

Amy Terbrock, MSN, PCCN, SCRN, RN

Copyright, Ashley D. Nator, 2021

Original: 08/2021 Revised: 09/2021, 10/2021, 04/2022

Abstract

Problem: Patient handovers occur among nurses more than 4,000 times …

Initiation Of Procalcitonin Screening As A Marker In Antibiotic Therapy De-Escalation, Briana Kile

Dissertations

Problem: The overuse of antibiotics has created antimicrobial resistance (AMR)

resulting in treatment failure for bacterial infections. To combat AMR, clinicians should

only prescribe antibiotic therapy when clinically warranted. It is easy to misdiagnose a

viral infection. However, any delay in the initiation of antibiotic therapy in a bacterial

infection may lead to increased morbidity and mortality. These patients with non-specific

clinical symptoms may be misdiagnosed without a rapid and definitive diagnostic test.

Methods: This quality improvement (QI) initiative utilized an evidence-based clinical

guideline for procalcitonin (PCT) levels for antibiotic therapy de-escalation. WBC counts

were collected two-days and one-day before …

Evaluation Of A Process Change Using An Updated Sedation Protocol, Rachel Allen

Dissertations

Problem: Pediatric delirium is continuing to increase intensive care environments and for patients who require mechanical ventilation and continuous sedative medications. Delirium is harmful to the patient creating lasting neurologic and mental health issues along with prolonged hospitalization and increased healthcare cost

Method: For this quality improvement (QI) project, a descriptive observational study was used to evaluate the implementation of a sedation protocol for patients who are mechanically ventilated and on continuous sedative medications. This was completed with the use of retrospective chart reviews three months prior to implementation and three months after the new protocol was implemented. Nurses were …

Evaluating The Rass And Cap-D In A Pediatric Cardiac Intensive Care Unit, Sarah Anderson

Dissertations

Abstract

Problem: Pediatric delirium is highly prevalent in the intensive care setting, as much as seventy to eighty-seven percent. Kalvas & Harrison (2020) found that sixty-six percent of critically ill children in a pediatric intensive care unit suffered from a diagnosis of delirium. Delirium has been widely linked with increased costs, mortality, and length of stay.

Methods: The quality improvement (QI) project used a descriptive design to collect retrospective and prospective data before and after an individualized bedside education session was completed. The QI project used a purposive convenience sampling to assess the ability to accurately identify the presence of …

Eye Care Protocol In Critically Ill Pediatric Patients On Neuromuscular Blockage, Jinnie Tkach

Dissertations

Abstract

Problem: Patients admitted to the pediatric intensive care unit (PICU) are at increased risk for the development of ocular surface disease (OSD) due to impaired ocular mechanisms while intubated, sedated, and on continuous neuromuscular blockade. The purpose of this project is to prevent OSD and vision impairments by increasing the frequency of eye care in accordance with a PICU eye care protocol.

Methods: An observational descriptive study was conducted utilizing retrospective and prospective chart review. Comparisons were drawn between the 2021 pre intervention group and the 2022 post intervention group regarding the impact of linking lubricating eye ointment orders …

Left Ventricular Assist Device (Lvad) Driveline Infection Rates Between Two Different Dressing Methods, Gretchen Compton

Dissertations

Problem: Heart failure has a growing impact on Americans, and this contributes to an increased number of patients requiring treatment for advanced heart failure. Typical treatment options may include cardiac transplant or the implantation of a left ventricular assist device (LVAD). The use of an LVAD requires sterile management of an external driveline site. Driveline infections are a common complication in this patient population and can lead to chronic complications. There are no published guidelines on the management of the driveline site. This project aimed to provide evidence that can be used in the establishment of standardized guidelines for driveline …

Clabsi’S: Reducing The Rates In An Urban Intensive Care Unit By Consistent Use Of The Central Line Maintenance Evaluation Tool (Clmet), Bridget Smith

Doctor of Nursing Practice Projects

Background: Quality improvement efforts from an urban facility have observed a need for staff education on the central line maintenance bundle and consistent surveillance with the Central Line Maintenance Evaluation Tool (CLMET).

Purpose: To address the practice gap of central line maintenance bundle usage at the bedside by utilizing the CLMET consistently.

Methods: A voluntary didactic program offered to staff and encouraging daily utilization of the CLMET that included real-time feedback by the supervisors.

Results: Pretest grade for the unit (n=13, 82.06) and the post-test grade (n=13, 86.33), which is + 4.27 points after education. Pre-implementation, January 1st through 31st, …