Nursing Administration Commons^™

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

Dnp Project: Improving No-Show Rates In Primary Care, Mai-Linh T. Nguyen, Sarah M. Kuzara

Doctor of Nursing Practice Projects

Abstract

This paper explores the factors that contribute to no-show rates in the primary care setting and effective interventions to improve no-show rates. The average no-show rate in the primary care setting is 23%, (Dantas, Fleck, Olivaria, & Humacher 2018). In 2018, the no-show rate at the WeCare Clinic was 50-60%. A literature review was conducted to gather information regarding why patients choose to no-show their appointments, the common causes of high no-show rates, and effective interventions found to decrease no-show rates. We investigated the primary causes of a high no-show rate at the WeCare Clinic by interviewing staff and …

Preventing Readmissions Through Community Health Nursing, Stephanie Dawson

MSN Capstone Projects

Incorporating community health nurses to follow patients with a moderate to high risk of readmission post-discharge could improve the risk of readmission for these patients. When a patient is discharged from the hospital, they can become overwhelmed and not be adequately prepared to go home despite the discharge education given (Kenney-Lueptow, 2020). Telephone follow up is a low-cost way to decrease readmissions and provide continued education to the patients (Heitkam, 2019). Utilizing the bedside nurses that have been caring for the patients in the hospital can create a greater sense of community for the hospital and its population. By connecting …

Reducing Readmissions In The Heart Failure Population, Yvette Castellanos

MSN Capstone Projects

This paper will explore the importance of preventing acute hospital readmissions in the heart failure adult population. Prevention of re-hospitalization is aimed at improving patient care and outcomes as well as reducing the financial stress caused by readmissions. Recurrent hospitalizations are expensive and unnecessarily overutilize resources (Donzé, Lipsitz, Bates, & Schnipper, 2013). Research shows that improving transitions of care during hospitalization and developing specific heart failure interventions healthcare providers can assist in reducing readmissions. For this project the Plan Do Check Act (PDCA) tool combined with the lean methodology. The PDCA cycle consist of planning, to identify the problems, do …

Bedside Shift Report Improves Patient Safety, Scott Meyers

MSN Capstone Projects

In the inpatient setting, Parkland Health & Hospital System has continued to have patient falls with injury above its target goal. This occurred every month throughout 2019. Additionally, multiple egregious IV medication administration errors occurred over the last year related to nurses bypassing established safety practices.

An evaluation of evidence-based literature reveals that the practice of bedside shift report (BSR) leads to a reduction in both patient falls and medication administration errors. Indeed, BSR is evidence-based practice (EBP) that promotes an overall environment of safety, quality care, and improved communication between nurses and patients. Additionally, there is virtually no risk …

Benchmark Nurse Leader Mentorship Program, Ijeoma Anyanwu

MSN Capstone Projects

“Historically, promotion to management positions has been a key pathway by which hospital staff nurses advance their careers, and these promotions typically occur before the nurse has acquired any formal management training” (Weisman, Minnick, Dienemann & Cassard, 1995, p. 296). Nurse managers are often driven to their roles due to sudden vacancies as a result of promotions, resignations, transfers or layoffs. Though willing to take on these challenges, these nurses are nevertheless inadequately prepared. “Nurse leaders are ill-equipped in terms of knowledge and may lack support and guidance to manage the challenges inherent in the role, such as productivity, job …

Official Mentor Program Benchmark Project, Gabriela O'Hara

MSN Capstone Projects

Nursing shortage, turnover, and low job satisfaction are constant issues that often trouble healthcare organizations. These issues have led organizations to implement programs, such as externship, internship, and preceptor programs to strengthen new nurses’ professional practice and skills. However, these issues continue to be organizational challenges. Considering the need for new nurses to have a supportive foundation for their career and to further encourage workplace satisfaction and retention, the following PICOT question was developed: In a healthcare organization, how does an official mentor program, compared with not having a mentor program, influence nursing retention and nursing job satisfaction over 2 …

Dnp Final Report: Changing Admission Criteria In A Vocational Nursing Program To Decrease Attrition, Gabrielle O. Davis

DNP Final Reports

By the year 2030 Texas will have a shortage of 33,500 Licensed Vocational Nurses (LVN). The LVN is responsible for providing safe, compassionate and focused nursing care to assigned patients with predictable health care needs. Most LVNS work in settings caring for our ever increasing and aged population. To combat the coming shortage VN programs need to graduate safe, competent, and compassionate nurses, but programs across the state are experiencing high student attrition rates. Admission criteria is a common method to determine student success in nursing programs. This evidence-based practice improvement project synthesized evidence and integrated best practices along with …

High-Risk Pregnant Patients In The Third Trimester: Comparing Mental And Physical Health, Megan Maxwell

MSN Capstone Projects

The purpose of the paper is to compare physical and mental health in high-risk pregnant patients in their third trimester who are managed in an inpatient setting compared to an outpatient setting. This paper looks at specific high-risk pregnancy diagnoses.

Controlled Donation After Circulatory Death: Benchmark Study, Marilyn R. Strait

MSN Capstone Projects

Abstract

In potential organ donors after circulatory death (P), does the utilization of an evidence-based critical pathway from identification of potential donor to organ donation (I) versus no utilization of an evidence-based critical pathway (C) increase the rate of organ procurement and the satisfaction of donor families with the donation process (O)? A benchmark study was conducted to answer this question, and in short, yes, it does. The utilization of a critical pathway, when individualized to a local population and hospital’s organization increases the organ procurement rate, the donor family satisfaction with the process, and increases staff satisfaction with the …

Emergency Department Homeless And At Risk Homeless Screening Benchmark Study, Emily Mulder

MSN Capstone Projects

Individuals experiencing homelessness drastically overutilize emergency department (ED) services compared to non-homeless individuals (Ku et al., 2014). Many unhoused individuals have serious medical and psychosocial needs, which are chronic in nature, and become exacerbated due to poor management while living on the streets (Ku et al., 2014). The health needs of such individuals would be best managed through primary care continuity. However, care coordination becomes complex when a patient does not have a physical address or knowledge of available community resources (Mitchell, León, Byrne, Lin, & Bharel, 2017). By understanding the unique barriers that homeless and at risk homeless patients …

Implementation Of A Patient Acuity Tool And The Impact On Nurse Satisfaction, Amber M. Denson

MSN Capstone Projects

Increased workloads contribute to nurse stress, affect nurse-patient relationships, and can ultimately lead to nurse turnover (O’Connell, Nettleton, Bunting, & Eichar, 2020). Nurse satisfaction can also be influenced by nurse-patient assignments (Allen, 2019). Implementation of a patient acuity tool (PAT) to balance workload and evenly distribute patient acuity in nurse-patient assignments can improve nurse job satisfaction, quality of care, and nurse retention (Firestone-Howard, Gonzalez, Dudjak, & Rader, 2017; Al-Dweik & Ahmad, 2019).

Discussions were held on a 20-bed medical-surgical unit in an acute care hospital with stakeholders that included the nurse manager, charge nurses and bedside nurses at staff meetings …

Evaluation Of An Advanced Quality Improvement Program, Arjun M. Dangre Bds Mph, Angelo P. Giardino Md, Phd

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Texas Children’s Hospital implemented the Advanced Quality Improvement and Patient Safety Program (AQI) in 2009, designed to train clinicians and staff to develop leaders in quality improvement to improve patient care, lower costs, change culture, and lead improvement initiatives at the organization. Evaluations of the AQI programs measured the program’s effectiveness in achieving its goals and objectives. This paper describes the Texas Children’s Hospital’s Advanced Quality Improvement and Patient Safety program (AQI,) the program’s evaluation processes, and show the results of the evaluation of the AQI programs using evaluation surveys completed by QI participants over the span of 13 successful …

Utilization Of Patient Toolkit And Discharge Algorithm For Providers To Reduce Readmission Due To Repeat Ground Level Fall, Sara Karl

Doctoral Projects

Introduction. Falls are the leading cause of injury and injury death in adults over the age of 65. A retrospective examination at Level 1 trauma center in the Midwest found that 19.4% (118/605) of older adults admitted with a ground level fall were readmitted with a subsequent fall and injury. The aim of this quality improvement initiative is to determine if the implementation of an evidenced based patient toolkit and a discharge algorithm for providers will reduce outpatient falls. The objective was to reduce hospital readmission due to repeat fall.

Methods: The design of this project was mixed methods, observational, …

Implementation Strategies To Reduce Hospital Readmission Rates In Adults With Sepsis: A Quality Improvement Project, Erin Kucharek

Doctoral Projects

Background: Sepsis is a concern in healthcare, as patients are 2 to 3 times more likely to be readmitted to the hospital than those with other illnesses. Readmitted patient with sepsis costs the healthcare system $3.5 billion dollars per year. Effective care coordination is a tool that decreases readmission rates in other illnesses and is likely applicable to those with sepsis. The purpose of this quality improvement project was to determine if primary care provider follow-up appointments, increased home care utilization, and patient education would reduce sepsis readmissions.

Methods: The Transitional Care Model guided project design and The Kotter Model …

Increasing Annual Retinal Exams Among Patients With Type 2 Diabetes, Afokoghene H. Odhu

Doctoral Projects

The Center for Disease Control and Prevention (CDC, 2017) reports that approximately 30 million people in the United States (US) have diabetes. Approximately 8 million have diabetes retinopathy (DR) (CDC, 2018). DR is the leading cause of vision impairment in type 2 diabetes patients. Left untreated, DR can result in loss of vision and blindness (Hernández, Simó-Servat, Bogdanov, & Simó, 2017). The US spends approximately $500 million dollars annually in the treatment of diabetes-related blindness (CDC, n.d.). Early detection and management of DR through tight glycemic control, aggressive blood pressure and lipid management is essential to preventing complications of the …

A Quality Improvement Project To Improve Financial Sustainability Of Home-Based Palliative Care Program, Andrea L. Giffel

Doctoral Projects

Background and Objectives: Home palliative care services are challenging to bill due to the complexity of services and competing time demands. Objectives and protocol were developed to guide coding and billing to increase Relative Value Unit generation and improve financial sustainability.

Design: A quality improvement project.

Setting: A home-based palliative care program in one health system in the Midwest.

Participants: Participants included 7 nurse practitioners.

Intervention: Coding protocol were developed, providers were educated, electronic health record audits were conducted to collect data on improvement, and feedback provided to prompt improvement.

Measurement and Analysis: Documentation of advanced care planning and billing, …

Learning Lean To Lead, Krystle Irene Guenther

Doctoral Projects

This project sought to see if training frontline nurses and physicians together in Lean methodology improved collaboration between the two disciplines while giving them the tools they need to lead change at the bedside and in their practice. A quasi-experimental pre- and post-intervention methodology was used. The intervention was six, four-hour in-person modules on performance improvement (PI). Respondents completed two surveys, the performance improvement instrument and the Professional Practice Environment Assessment Scale (PPEAS). Surveys were paired for analysis. There was a statistically significant median increase in participants confidence for all questions on the PI instrument post-intervention. Results for the PPEAS …

Pulmonary Rehabilitation Initial Education, Allison Vititoe

Scholars Week

Abstract

Pulmonary rehabilitation has been proven successful among those with chronic pulmonary diseases. However, there is a low rate of involvement and a lower rate of completion for these patients.

One of the major underlying factors contributing to this problem is patients’ lack of motivation. If the patients can be given information on the benefits of this program that align with what they hold as important there will be increased level of motivation and subsequently completion of pulmonary rehabilitation.

How Do Nurse-To-Patient Ratios In The Emergency Department Impact Patient Experience?, Jessica L. Marcoux

Electronic Theses and Dissertations

There is a lack of consensus about the staffing matrix across nursing and especially in emergency

nursing, where variations in arrival patterns, acuity, social determinants of health, and length of stay all impact the workload of emergency nurses. The objective of this paper was to determine if government-mandated staffing ratios had a greater impact on patient experience at hospitals in California than staffing based on hours per patient visit at hospitals in Massachusetts. Seven hospitals from the state of California with government-mandated nurse-to-patient ratios were compared to 7 hospitals from Massachusetts that did not have mandated staffing ratios to determine …