Critical Care Nursing Commons^™

Clabsi Prevention Through Prevention Huddles And Clabsi Risk Assessment And Prevention Form In Electronic Medical Record, Tara Benton, Barb Haney, Lacey Bergerhofer, Yolanda Ballam, Kaitlyn Hoch

Posters

Our aim is to increase the awareness of high risks for central line associated bloodstream infection (CLABSI) and decrease the CLABSI rate with the implementation of CLABSI prevention huddles and an electronic medical record (EMR) "CLABSI Risk Assessment and Prevention" form.

The Kanga-Croo: Nurse Resident Champions Creating Momentum For Improvement, Brett Butler, Jacob Burden, Carly Creekmore, Blair Griffin, Taylor Godemann, Taylor Hagen, Theresa Koelling, Mary Anne Kucera, Halle Magid, Makenna Miller, Monica Page, Mary Riffel, Madison Stebbins, Sarah Stokes, Skylar Suppes

Posters

Topic Summary:

Kangaroo Care (skin to skin care) is a parent-led, evidence-based intervention which improves outcomes in neonatal patients including: decreased apnea, increased weight gain, increased parent satisfaction and decreased length of stay.

Results:

Nurse resident team interventions to support parent engagement and remove barriers to Kangaroo Care (KC) through iterative PDSA cycles from January 2018 to July 2019 yielded positive results within a subset of ICN patients.

Development Of Mechanical Ventilator Educational Brochure For Patients/Families, Cathy Palleschi, Wendy Osgood, Mark Parker

Operations Transformation

Patients on mechanical ventilation often have no memory of events while being ventilated. In addition, families during this time, are often overwhelmed and unable to retain information provided to them by caregivers.

In attempt to address these issues, a team of care providers in an tertiary academic hospital established a goal to create a mechanical educational brochure with the goal to reduce associated anxiety and improve overall understanding of information provided.

As part of a clinical transformation project, a root cause analysis was conducted and a number of countermeasures were initiated. Some of these included a survey to capture feedback …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Implementation Of Trauma Service Guideline For The Use Of Phenobarbital In The Management Of The Non-Icu Trauma Patient At Risk Or Experiencing Severe Alcohol Withdrawal, Joseph Rappold, Julianne Ontengco, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

The trauma service in a large academic tertiary medical center admits a large proportion of patients with the secondary diagnosis of alcohol use disorder. Given the successful use of phenobarbital in the critical care unit for withdrawal prophylaxis and treatment of acute withdrawal, a quality improvement project was established to create and implement guidelines for the non ICU patient.

A root cause analysis demonstrated several issues to include inconsistent clinical decision documentation. As a result, several countermeasures were initiated to address the various issues.

Post implementation of countermeasures, a decrease in the amount of severe alcohol withdrawal as well as …

Evidence Based Practice Implementation Of The Delirium Portion Of The Abcdef Bundle, Jessica Sumner

Graduate Theses, Dissertations, and Capstones

Background: Delirium is a common complication in the ICU setting and has serious long-term consequences. Increased mortality and long-term cognitive issues are associated with under-recognition and lack of treatment for delirium. Nursing staff must identify delirium and manage the event, in addition to providing care to other assigned patients.

Purpose: The purpose of this evidence-based project was twofold. First, the project set out to determine if implementation of the delirium portion of the ABCDEF bundle promoted delirium recognition and decreased ICU length of stay and ventilator days. Second, the project examined if the use of a structured delirium education program …

Enhancing Discharge Communication For Timely Patient Discharge: A Quality Improvement Project, Maricel Hiponia

Master's Projects and Capstones

A delay in discharge is a delay in patient care. The complexity of hospital discharge can be challenging and time-consuming in poorly coordinated discharge planning. Generally, older adults and those patients with chronic medical conditions are often met with challenges for after-care services and require more attention to discharge. Variations in discharge practice often resulted in hours, sometimes days in discharge delays with implications to cost, reduced patient satisfaction and outcomes. A well-structured team communication during rounding and bedside shift handoff has the potential to decrease discharge delays advertently increasing patient satisfaction and quality outcomes of care.

Aortic Stenosis Poster, Katonya Lawson

Nursing Student Class Projects (Formerly MSN)

Aortic stenosis is the narrowing of the aortic valve secondary to calcification and fibrosis. It is the most common valve disorder and the second most frequent reason for cardiac surgery. As the elderly population increases, the number of patients presenting with aortic stenosis will increase. RNs and APRNs need to be aware of the pathophysiology and clinical manifestations of aortic stenosis because the disease can progress quickly and be fatal if mismanaged. Patients with aortic stenosis have an increased risk of morbidity and mortality during the peri-operative period during non-cardiac surgery. Therefore, CRNAs must remain vigilant when caring for this …

Ischemic Stroke, Rachele Gualtieri

Nursing Student Class Projects (Formerly MSN)

Stroke is one of the leading causes of death in the United States, and a very large percentage of those who suffer a stroke experience an ischemic stroke. It is detrimental that the healthcare providers caring for these patients are proficient in understanding the pathophysiology and treatment of a stroke to preserve maximal function of the brain and promote a full recovery. It is also crucial that providers are aware of risk factors for stroke, events leading up to an ischemic injury, and the events that follow an ischemic injury. This poster discusses the underlying pathophysiology, signs and symptoms, risk …

Intensive Care To Intermediate Care Bridge Program, Natasha Bartlett, Sally Langerak, Lindsey Lucas, Jonathan Archibald, Tayla Robbins, Miranda Thompson, Patrice Tetu, Calla Hastings, Megan Garland, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operations Transformation

To deliver the highest quality of care across the continuum, a large academic tertiary medical center envisioned a project that would provide an internal source of cross trained nurses for their medical intensive care unit (SCU2) and their medical intermediate care unit (R4/IMC/AVU). The hope for this program was to improve communication and collaboration between nurses and enhance the care that they provide to patients and their families.

A highly qualified team of nurses was established to create a performance improvement project. The overall goal of this endeavor was to build a more collaborative relationship between the units and ultimately …

Increasing Nursing Competence And Confidence During Obstetric Emergencies Through Simulation: A Quality Improvement Project, Tram Wallen

Dissertations

Problem: This quality improvement project aimed to improve the knowledge and confidence of the mother/baby nursing staff during postpartum hemorrhages through in situ simulation. PPH is a leading cause of maternal death. Hospitals across the U.S. lack a standard approach to managing obstetric emergencies; the complications of childbirth are often identified too late. Multidisciplinary simulation-based team training has been associated with improved outcomes in obstetrics.

Methods: A convenience sample of 26 registered nurses (RNs) that care for postpartum patients attended a one-hour instructor-led presentation followed by in situ simulations of postpartum hemorrhage. A knowledge assessment and confidence survey were administered …

Reducing Cautis In A Neurological Icu, Claire Mckee

Dissertations

Catheter-associated urinary tract infections (CAUTIs) are the primary source of infection in patients with urinary catheters and are the fourth leading cause of healthcare-associated infection. Because indwelling urinary catheters are not completely avoidable in hospitalized patients, it is crucial to utilize evidence-based research to prevent CAUTIs. A urinary catheter maintenance bundle is one way to reduce CAUTI rates in hospitalized patients. This quality improvement project utilizes a catheter maintenance bundle with seven elements with the aim of reducing CAUTI rates. The project takes place in a 20-bed neurological intensive care unit (ICU) in a larger tertiary care medical center. Prior …

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …

Pre-Discharge Bnp: A Policy Change To Reduce Hospital Readmission, Melissa Duckett

Doctor of Nursing Practice Projects

Heart Failure (HF) is the leading cause of hospital readmission for patients 65 years of age and older. A pre-discharge B-type natriuretic peptide is a strong predictor of hospital readmission and mortality. The annual cost for admission of patients with HF is greater than $17 billion. Diagnosed heart failure patients continue to be discharged without the physician knowing their current BNP levels. The Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) requiring the Center for Medicare and Medicaid Services (CMS) to reduce reimbursement to hospitals with high readmission rates. A change in policy should be initiated to include …

Improving Sepsis Bundle Compliance Through Comprehensive Education, Stacy Mikel

Doctor of Nursing Practice Projects

Purpose: The purpose of this project was to improve emergency department compliance with sepsis bundles by educating registered nurses and licensed practical nurses on the proper use of sepsis screening tools, make changes to screening tools identified through chart reviews, and finally to evaluate the impact of these changes once initiated. This project sought to increase staff knowledge using an educational module.

Methods: This project began with the delivery of a pre-test questionnaire. The facility's target audience was asked to complete this to determine their current knowledge level regarding sepsis. Once these questionnaires were completed, they were reviewed, and information …

Safe Care For Seizure Patients On An Epilepsy Monitoring Unit, Deborah Bachand, Lauri Wilson, Rachel Caiola, Lynne Keller, Megan Selvitelli, Mary Jo Farley, Jennifer O'Neill, Sara Shrock, Hannah Plummer, Sally Prokey, Amy Sparks, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Operations Transformation

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients.

The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Nurse Family Member Perceptions Of Patient Death And Nursing Care After Withdrawal Of Life-Sustaining Treatment, Deena Drake

Dissertations

Purpose/Aims: This pilot study explored nurse family member perceptions of nursing care and patient quality of death and dying during and after withdrawal of life-sustaining treatment within Intensive Care Units (ICU).

Rationale: Past research that examined physician, nurse, and family member experiences of End-of-Life (EOL) care within the ICU found significant differences between the three groups.

Background: Approximately 500,000 people die within an ICU each year in the United States. End-of-Life and Palliative Care programs focused primarily on physician interventions to improve quality of EOL care have had little impact on family member perceptions of quality of care or patient …

An Investigation Of The Relationships Between And Among Disaster Preparedness Knowledge, Perceived Use Of Intuition, And Triage Decision Making Of Emergency Department Registered Nurses In Acute Care Hospitals Using Benner’S Novice To Expert Theory, Brian Charles Schneider

Seton Hall University Dissertations and Theses (ETDs)

Background: Disasters are man-made or natural events that challenge resources and support in an environment lacking rules and regulations. Nurses represent the largest resource in healthcare and are among the first to encounter victims of disaster, thus having knowledge of disaster preparedness is essential to disaster response. However, there is a lack of empirical evidence concerning the relationships between everyday elements of nursing practice such as intuition and triage decision-making and disaster preparedness knowledge.

Purpose: The purpose of this study is to examine the relationships between and among disaster preparedness knowledge, perceived use of intuition, and triage decision-making in emergency …

Implementation Of Crisis Checklists In The Operating Room, Gregory S. Feilner

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …