Doctor of Nursing Practice Projects

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https://ir.ua.edu/handle/123456789/7250

The DNP is a practice doctorate in nursing which prepares graduates to function at the highest level of nursing practice. The DNP curriculum includes development of a clinical practice project. This “DNP project” is designed to synthesize scholarship in an advanced nursing practice specialty or an area of health care leadership. Practice immersion experiences provide the context within which the project is completed. Students develop the project under the direction of a team, including program faculty, the student, the clinical advisor, the faculty advisor, and alumni mentors.

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Provider Adherence to a Point-of-Care Reminder for H. pylori Patient Education
Wheeler, Carl; Wilson, Kimberly; Velamati, Praveena
Helicobacter pylori (H. pylori) is a bacterium that causes Gastroesophageal Reflux Disease (GERD) and gastric cancer. It has a treatment failure rate higher than 20%. Patient education materials (PEMs) positively affect H. pylori eradication rates and treatment compliance. Purpose: The purpose of this quality improvement project was to provide PEMs for patients diagnosed with H. pylori at the point of care. Methods: Fifteen providers in an urban gastroenterology practice were instructed on the use, access, and importance of PEMs for patients diagnosed with H. pylori at the point of care. An in-service provided the instruction and PEMs were added to the electronic health record (EHR) with a point-of-care reminder for provider access. A 14-day pre-intervention and post-intervention chart review was completed to record providers' use of PEMs for patients diagnosed with H. pylori at the point of care. Results: A paired t-test was conducted with the pre-and post-intervention groups. A statistically significant improvement (p < .001) indicated the number of PEMs post-intervention was significant. Providers' adherence to the point of care reminder for utilization of PEMs was measured at 79.6%. Discussion: Provider use of PEMs increases in clinical practice when training programs and a point of care reminder are utilized. Additional research is recommended to explore clinical implications. Conclusion: Adding PEMs to the EHR with a point of care reminder for staff improves provider use of PEMs and can improve the quality of care.
Standardized Approach to the Golden Hour: A Program Evaluation
Trawinski, Kristin; Simmons, Staci; Patchett, Michelle
Premature, low birthweight infants are at increased risk of complications. Hypothermia upon admission to the Neonatal Intensive Care Unit (NICU) after delivery increases morbidity and mortality in this population. The Golden Hour is defined as the first 60 minutes of life, during which interventions and staff behaviors impact neonatal outcomes. This program evaluation assessed the effectiveness of a standardized Golden Hour process program change in a level III NICU. Methods: The gap analysis performed by the multidisciplinary team identified a need to address role clarification to improve hypothermia. A job instruction breakdown tool (JIBT) was created to guide the multidisciplinary team to provide a standardized approach. The admission body temperatures of low birth weight (LBW) infants were measured before and after a program change. Participants were organized into three groups: infants born in the seven-month period before the program change, infants born in the first six months after the program change, and infants born during months 7-12 after the program change. Data was analyzed using ANOVA repeated measures test. Results: 90 infants were included in the retrospective chart reviewed. Results showed an improvement of euthermia upon NICU admission from a baseline of 63% (n=35) during the 7 months prior to the program change to 82% (n=33) during months 1-6 months after the change and 77% (n=22) during months 7-12. While results were not statistically significant, there was an improvement towards euthermia in the post-program change group, a clinically significant finding. Discussion: Hypothermia in the Golden Hour among infants weighing ≤1500 grams places them at greater risk for morbidity and mortality as compared to euthermic counterparts. Utilizing an evidenced-based process improvement measure to clarify standardized roles improves admission temperatures from delivery to the NICU. Stakeholder buy-in was a key step in garnering staff engagement.
Decreasing Hospital Readmissions with Advanced Care Planning
Shadoan, Beth; Welch, Teresa; Duke, Jennifer; Haamankuli, Hiboombe
Patients with progressive and terminal disease processes such as chronic kidney disease (CKD), congestive heart failure (CHF), and chronic obstructive pulmonary diseases (COPD), acute myocardial infarction (AMI), and coronary artery bypass graft surgery (CABG), are at a higher risk for hospital readmissions due to the progressive nature of the disease processes and the continuation of symptoms that worsen over time. Regardless of recent hospitalizations, once symptoms escalate, the common response for patients and families is to return to the hospital. To reduce readmissions health care providers should address goals of care and advanced care planning prior to discharge. The palliative care patient navigator is typically the initial person on the interdisciplinary health care team to initiate this conversation. Patients who receive palliative care consults for patient-centered goals of care and advanced care planning conversations early in the disease process will have an increased understanding of symptomology and symptom management allowing them to utilize community-based resources and have more autonomy in the management of their care. As a result, return visits to the hospital are decreased, patients can remain at home to manage episodes of symptom exacerbation and improve the quality of life. Methods: As a collaborative project between the quality and case management departments, this evidence-based process improvement project was designed to reduce 30-day readmission rates for high- risk patient populations. The Gunderson Lutheran Health system Advanced Disease Coordination Respecting Choices model was used to frame the development, implementation, and evaluation of the project. All inpatients readmitted to the hospital within 30-days of discharge were screened using the BOOST tool method within the electronic medical record (EMR). Patients with BOOST scores >15 demonstrate the highest risk for readmission. Those with a score >15 and who met inclusion criteria were triaged and seen by the Palliative Care team for appropriateness of the Respecting Choices Advance Care Planning education and assistance completing health care goals and advanced directives. All patients who received goals of care and advance care plan conversations, were also referred to interdisciplinary teams for follow up and identified discharge needs. The goal of the program was to discharge patients with a specific plan for treatment with the necessary resources for symptom management at home to prevent frequent hospital readmissions. Results: The evidence-based project was implemented over 30 days during the month of August 2023 with aggregate 30-day readmission data collected for September 2023 on October 1. Data collection and analysis began immediately with a comparative analysis of baseline data collected June 2023 and post implementation data from September 2023. The goal of the project was to reduce the hospital readmission rates by 10% within 30 days of implementation. And to increase the amount of advanced care plans/advanced directives by 20%. The goal was surpassed by 15% reduction in hospital readmission rates within 30-days post project completion. The amount of advanced care plans/advanced directives was 9%. Discussion: Comparative analysis pre and post implementation data revealed a 15% decrease in 30-day hospital readmissions. This information has been presented to stake holders proposing continuation of the process to address 30-day readmissions with advanced care planning.
Dexmedetomidine for Cardiac Surgery Education Intervention
Sellers, Nathaniel; Hines, Cheryl B.; Brown, Howard
Cardiac surgery is the definitive treatment for many cardiac defects. Cardiac surgery is a high risk surgery that is associated with a systemic inflammatory response that can lead to increased morbidity and mortality postoperatively. Dexmedetomidine is a presynaptic alpha-2 agonist that reduces sympathetic outflow via negative feedback and has been shown to reduce this systemic inflammatory response. This is associated with improved postoperative outcomes. There was a knowledge gap on the benefits of dexmedetomidine in cardiac surgery amongst anesthesia providers. Methods: An educational intervention was provided to the anesthesia staff on the current literature for the uses of dexmedetomidine in cardiac surgery. The retrospective chart review was completed five weeks prior to the intervention and five weeks after the intervention. Statistical analysis was carried out and results were presented to the anesthesia staff. Results: This has led to increased usage of dexmedetomidine in cardiac surgery. Dexmedetomidine was used during cardiac surgery in 88% of cases prior to the intervention vs. 98.6% in the postintervention group. Discussion: Dexmedetomidine has shown promising results in improving patient outcomes when used in cardiac surgery. By educating the cardiac anesthesia staff, the cardiac anesthetists have gained a better understanding of dexmedetomidine in cardiac surgery. This led to increased usage.
Examining Obstructive Sleep Apnea Risk and Changes in Oxygen Saturation in an Outpatient Endoscopy Center
Parrish, Joseph; Cody, Shameka; Matthews, Joanne
The significant increase in obesity, which is classified as a body mass index (BMI) greater than 30 kg/m² presents potential challenges in the field of office-based anesthesia. As obesity has become more prevalent in our society, the incidence of undiagnosed or untreated obstructive sleep apnea (OSA) and the associated comorbidities have increased. Purpose: The purpose of this project was to examine the changes between pre-procedural and post-procedural oxygen saturations among patients with moderate to high OSA risk. Methods: Participants (N=316) in the pre-procedural area were screened using the STOP-BANG questionnaire prior to receiving anesthesia. The participant’s STOP-BANG score (SBS) and pre-post procedural oxygen saturations were obtained and documented. Final data was obtained using a retrospective chart review. Results: More than half of the participants’ (59.8%; n=189) were identified as having a moderate to severe risk of OSA (Mean SBS=4, SD=1.05). There was a statistically significant reduction in mean oxygen saturations for participants with moderate to severe OSA risk from pre-procedural (M=97.2%, SD=1.76%) to post-procedural (M=94.2%, SD=3.48%); t (4) = 10.45, p < .001. Discussion: The clinical significance of the findings of this study reinforces the importance of screening all patients in the pre-procedural area to identify those at increased risk of OSA. This will allow referral to sleep specialists and provide evidence-based data that can be utilized by the anesthesia providers to update exclusion criteria identifying patients that are not appropriate for office-based procedures, with the goal of limiting potential adverse events.
Nursing Education for Heart Failure to Improve Patient Outcomes: A Quality Improvement Project
Mays, Tamera; Parker, Kimberly; McGrue, Vandalyn
Heart failure (HF) is a complex chronic illness that requires extensive self-care management. For patients to effectively manage home self-care, nurses must provide adequate education based on patient specific needs and knowledge deficits. The objective of this project is to improve patient outcomes and home self-care abilities by improving the nursing staff’s HF knowledge and increase the frequency of patient education provided by the nursing staff. Methods: This quality improvement project was guided by the Iowa Model for Evidence Based Practice with identification of a problem, research solutions, and implement change. The project followed a pre- and post-implementation design. The nurse’s HF knowledge and confidence was assessed prior to and following a specialized HF education session. Additionally, chart information was viewed pre- and post-intervention to obtain quantitative data regarding the HF education provided by the nursing staff. Results: By providing specialized HF education, the nursing staff’s knowledge and confidence in providing discharge education to HF patients significantly improved. Unfortunately, this had no significant impact on the quantity of discharge teaching provided to HF patients throughout their hospitalization. Discussion: Based on the concept that improved knowledge has the potential to allow the nurses to better prepare patients for the transition to home self-care, the expected outcome of this project was to demonstrate that increased knowledge of HF principles would increase the amount of HF education provided by the nursing staff. It was found that more than 30-days is necessary to effect a significant behavior change that can improve the education provided to patients.
Assessing Provider Adherence to Music Therapy in Parturients Undergoing Awake Cesarean Section: A Quality Improvement Project
Matson, Nikola
Low patient satisfaction with cesarean section (C/S) birth is a widely documented phenomenon which carries substantial risk for compromised health. Music therapy is a technique that can reduce stress and improve satisfaction when applied intraoperatively. Methods: The Kosucu et al. (2017) survey instrument was adapted for the research. The survey was administered pre- and post- intervention of an educational offering. Data was collected on the presumed impact of music therapy on patient mood, stress, anxiety, and pain and on practitioner implementation of music therapy. Results: A paired sample t test showed a statistically significant increase in the practitioner’s presumption of positive impact on mood, stress, anxiety, and pain between the pre and post survey scores. The paired sample t test showed no statistically significant increase in the practitioner’s adherence to music therapy between the pre and post survey scores. Discussion: The results of this study indicate a clear statistical correlation between music therapy education and presumptive positive impact of music therapy on mood, stress, anxiety, and pain. The study also cites reasons for not implementing music therapy. These include lack of time; concerns about increased workload; and lack of institutional support. Music therapy represents a low cost, low risk method of improving patient outcomes. Therefore, additional study is warranted with respect to effective educational techniques, institutional attitudes, and removing obstacles to implementation in the operating environment.
Attitudes Toward Suicide and Self-Harm in the Detention Environment: An Educational Intervention for Nursing
Krüg, Michael Stephen
Suicide is a significant public health threat and a leading cause of death in U.S. detention facilities. Detention suicide rates are estimated to be three times greater than in the general population, and suicide is ranked as the number one cause of preventable death among all persons in custody. Nurses are routinely challenged with assessing suicidal detainees, and the attitudes toward suicide and self-harm can positively or negatively influence the outcomes of detention suicide prevention programs. Methods: The Attitudes Toward Prisoners Who Self-Harm (APSH) Scale was administered to nurses (n=21) working in a large U.S. Immigration and Customs Enforcement detention facility to determine current attitudes toward detained non-citizens related to self-harm and suicide. A 30-minute instructional education intervention regarding suicide risk evaluation was provided, followed by a communicative shared experience intervention between the nurses. A secondary survey was obtained 30 days after the training intervention to evaluate any change in nurses' attitudes, pre-intervention versus post-intervention. Results: A repeated measures design was utilized, and paired t-tests were used to evaluate the results from the two 5-point Likert surveys that were collected. The measures were processed with Intellectus Statistics software (Intellectus Statistics [Online computer software], 2023) to evaluate and determine any change in the nurses' attitudes.
Hypothermia Prevention Protocol in Cesarean Sections with a Spinal Anesthetic
Johnston, David Jr.
One of the most common side effects patients encounter when having a procedure that requires anesthesia is hypothermia, and patients presenting for a scheduled cesarean section are no exception. Body temperature changes directly related to the anesthetic type and other external factors place the mother at an increased risk for hypothermia. Hypothermia is associated with adverse outcomes, therefore increasing the risk for complications after cesarean section. The clinical facility where the DNP project was completed did not previously have a specific hypothermia prevention protocol in place. Methods: Maintaining normothermia throughout the perioperative period can help alleviate the risks associated with hypothermia. Certified Registered Nurse Anesthetists (CRNAs) play a pivotal role in direct patient care for women who present to the hospital for cesarean section and are crucial in implementing strategies to prevent the patient from becoming hypothermic. An evidence-based checklist was created by the DNP student for staff to implement evidence-based interventions to decrease the incidence of hypothermia. Results: Maternal PACU temperatures were higher in the post-implementation group when compared to the parturients’ temperatures from the month before protocol implementation, although not statistically significant between pre-implementation temperatures. Conclusion: Utilizing an evidence-based hypothermia prevention protocol is effective at preventing hypothermia in cesarean sections with a spinal anesthetic. The combination of warmed IV fluids and forced-air warming was effective and resulted in higher patient temperatures.
Reducing Distress and Emergency Room Visits with and an Evidence-Based Aroma Therapy Palliative Care Program for Breast Oncology Patients
Horton, Priscilla; Welch, Teresa D.; Augustyniak, Heather
Implementing an evidence-based nurse-led palliative care program that incorporates aromatherapy can significantly enhance the quality of life for cancer patients. This approach aims to minimize emergency department visits and reduce the necessity for additional full-time advanced practice Nurse Practitioners (APRNs). The presence of unaddressed symptoms such as nausea, vomiting, anxiety, and pain can contribute to the challenges in patient care, chronic side effects, compromised treatment tolerance, and an overall decrease in the quality of life. These uncontrolled symptoms directly contribute to the rising utilization of emergency department services. Integrating essential oils into a palliative care program can effectively mitigate the need for emergency department visits. Methods: Implementation of an evidence-based nurse-led palliative symptom management program in an outpatient comprehensive cancer care center using essential oils for symptom management for breast cancer patients undergoing active treatment. Results: Key findings from this process improvement project were statistically significant in decreasing ED visits with 100% reduction in Emergency Department visits by breast cancer patients, with a p-value below 0.0001. Conversely, when examining productivity, a reduction of 1.4 hours in weekly time, approximately 10%, was observed, but this reduction was not statistically significant, as indicated by a p-value of 0.3151. Implication: An evidenced based process improvement project integrating essential oils as palliative care option effectively addressed symptom-related challenges. This program successfully created a holistic therapeutic environment that significantly improved the quality of life for cancer patients, bridging the gap between symptom management and patient care
Improving Acute Care Readmission Rates Through Multimodal Education Plans in the Elderly Congestive Heart Failure Patient
Hodge, Tanya; Hobbs, Jill R.
Congestive heart failure (CHF) has a high hospitalization readmission (RTH) rate leading to increased economic burden and decreased quality of life. This scholarly project implemented an educational intervention to promote health literacy and wellness to reduce re-hospitalization and improve quality of life. Methods: Participant inclusion was age 60 and older with recent CHF hospitalization discharged to a skilled nursing facility (SNF). The American Heart Association (AHA) SMART-HF heart failure management tool and the symptom tracker diary (STD-HF) tool were implemented. Primary care provider (PCP) follow-up appointments were facilitated. The Brief Interview for Mental Status (BIMS) was utilized to determine baseline cognitive status. Over four weeks, a weekly follow-up nursing visit gathered weight, vital signs, and disease-specific symptom analysis, facilitating an early plan of care adjustment and wellness teaching to prevent rehospitalization. Results: The project revealed the subject's cognitive capacity is a primary factor in successfully utilizing multimodal education tools. Those with a BIMS 13 or higher produced positive outcomes within the project with reduced rehospitalizations. Attempts for appointment scheduling with the PCP proved to be time-prohibitive and unsuccessful. The data showed no subjects could get a PCP appointment before being discharged home. Discussion: This study supported the evidence-based research showing CHF education and self-care initiatives facilitate wellness ownership, and early interventions do improve quality of life with decreased hospital readmissions in those who can participate effectively in the program.
Integrating Oncology Nurse Navigation to Improve Care Transition
Collins, Coretta; Acker, Kristi
Oncology nurse navigation is recognized as a beneficial service in managing and caring for oncology patients. However, this service is not readily available in all settings including complex and high-risk units. This DNP Project aimed to integrate an Oncology Nurse Navigation program to measure the clinical outcomes related to the transition of care timeliness, improving hospital readmission rates and improving emergency department visits. Methods: Using a quality improvement process model, the advanced practice nurse led the integration of an oncology navigation service as part of an established oncology consulting service within a single site setting over six weeks. Patients newly diagnosed with cancer were provided purposeful care coordination and follow up. The coordination included the integration of an oncology nurse navigation tool and telecommunications as part of the program implementation process. Results: Pre and post-data were compared, and inferential statistics were reported. Descriptive statistics provided an optic of the patient population that benefited from the navigation services. The main practice outcomes were evaluated which showed interventional improvements in all three clinical outcome measures. Discussion: The project was well received by the institution and the stakeholders. The stakeholders recognized the benefit of integrating oncology nurse navigation to the team. The oncology consult team also recognized the benefit and found that it made the team function more efficiently. Based on the program's initial success, plans to keep the navigation program in place are expected. The value of intentional care coordination, including telecommunications, can improve transition of care delays and reduce overutilization of health care resources.
Improving Metabolic Screening in Pediatric Patients on Antipsychotics
Ajayi, Taiye; Lee, Amy; Finn, Edgar
Introduction: Psychiatric pediatric patients treated with second generation antipsychotic medications are at an elevated risk for developing metabolic syndrome (MS), dyslipidemia and rapid weight gain. Childhood obesity and MS are major issues in the prescribing of second-generation antipsychotics (SGA) due to significant weight gain which carry health consequences both in childhood and into adulthood. Early intervention leads to improved outcomes. This project's overall goal was to increase the metabolic screening rates among pediatric populations prescribed antipsychotics. Methods: In this quality improvement project, metabolic monitoring and screening tool in paper format was provided to all mental health providers at a mental health Federal Qualified Health Center (FQHC) clinic during patients’ medication management visits over a six-week period. The Primary Investigator (PI) conducted a retrospective chart review, using pre and post intervention data in determining compliance with the recommended clinical guidelines for monitoring and screening for metabolic risk factors in patients receiving antipsychotic medications. Results: Metabolic screening rate was calculated using the number of patients that were screened post intervention of the screening tool. The pre-intervention rates and post-intervention rates were compared through a Chi Square analysis. Pediatric patients between the ages of 4-18 that were prescribed antipsychotic drugs were included in the project. MS screening rates did increase significantly post implementation of the intervention, x2(1, N=87) = 13.3481, p =.000259, and the rate of metabolic monitoring increased from 29% to 69% for the primary outcome measures (weight, height, BMI, blood pressure, HbA1C and lipid panel). Discussion: Failure to screen patients prior to initiating antipsychotic drugs and during antipsychotic treatment can lead to omission of key components in screening and monitoring for MS among psychiatric ill patients. This omission leads to a lack of early identification of those at high risk for MS. The project showed clinical and statistical significance, in pediatric patients prescribed antipsychotic medications. Provider education and implementation of a screening tool demonstrated an effective strategy in improving the screening rates of these patients in the pediatric practice. Timely identification and screening for MS is key to preventing cardiovascular morbidity and mortality among patients with severe psychiatric illnesses.
Implementation of a Provider Mentor Program to Support Nurse Practitioner Retention
Barnes, Caulita Payne; Lee, Amy; Smith, NaChasity
The retention of health care providers is a growing issue since recruitment and training of replacements can be costly for health care organizations. New graduate nurse practitioners (NPs) entering the workforce after graduation can experience numerous challenges and overwhelming tasks which can lead to unhappiness and decreased job satisfaction. These factors have been correlated with an increased intent to leave and high turnover rate. In a study assessing strategies to promote successful transition, NPs reported that having engaged mentors and allotted time to spend with their mentors, was essential to their competency and confidence development in clinical knowledge. This project's overall goal is to implement a provider mentor program that increases provider confidence in mentoring. The primary investigator (PI) implemented a provider mentor program to increase provider confidence in mentoring new graduate nurse practitioners in the urgent care setting. Quantitative data was collected and analyzed by the PI in this project. The measure was used to analyze the effect of the mentor program on the providers' confidence in mentoring new graduate NPs. The mean scores showed improvement, increasing from 113.8 pre-intervention (n=5) to 125.5 post-intervention (n=2). Discussion Mentor programs have been proven to help transit the novice NP into practice. Increasing a provider’s confidence to mentor new graduate NPs can be beneficial for facilities in combating the direct cost of a NPs turnover because of decreased job satisfaction and intent to stay. Research indicates that providing support for new graduate NPs has numerous benefits, including enhanced job satisfaction, decreased turnover, and improved retention rates. The literature consistently emphasizes the importance of mentorship programs for novice NPs, particularly in urgent care settings where they may face various challenges and self-doubt. Implementing mentor programs has been shown to facilitate the transition of new graduate NPs into practice. Moreover, increasing the confidence of providers to serve as mentors can be advantageous for healthcare facilities, as it addresses the costs associated with NP turnover due to decreased job satisfaction and intention to stay.
Telemedicine Interventions to Increase Postpartum Depression Screening Rates in Postnatal Patients: A Focus on a Vulnerable Patient Population
Loveless-Yates, Brooke D.; Lee, Amy; Friend, Louanne
Postpartum depression (PPD) is one of the mothers' most common health problems following childbirth. The diagnosis of PPD is on the rise, especially in Alabama. Research shows this vulnerable population of postpartum patients frequently do not come for their postpartum exam and, therefore, get lost in follow-up after delivery. Many effective therapies have been broadly concluded to prevent or treat PPD. However, despite available treatments for PPD, numerous barriers hinder access to care, including stigma, time, financial constraints, and childcare concerns. This quality improvement project aimed to increase the postpartum screening rates for PPD. A telemedicine visit with postnatal patients was conducted at three weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS) tool. Education was also performed via this telemedicine visit regarding other postpartum and infant care topics, as well as support provided, and questions answered for these new mothers. This telemedicine intervention at three weeks increased PPD screening to the postnatal patients who participated in the visit to 100%. Close to 75% of patients (n=87) attended these telemedicine visits. National statistics demonstrate a 60% show rate for scheduled face-to-face postpartum visits. Three-week telemedicine visits led to earlier awareness of PPD symptoms and earlier diagnosis of PPD, as well as increased referrals and treatment for these patients versus patients who are not screened until the traditional face-to-face visit at six to eight weeks. PPD is a debilitating illness that affects both mother and infant. It can also inhibit the bonding between a mother and her child. This condition is on the rise and contributes to poor health outcomes for both mother and child. The project rate of 75% visit attendance with 100% of those screened for PPD demonstrates a clinically significant increase compared to the national benchmark. Increased screening for PPD can lead to earlier recognition of symptoms and diagnosis as well as increased referrals and treatment for these patients.
Prevention of Arteriovenous Access Clot Formation in Individuals with Hemodialysis Treatment
Uribe, Jonathan Luis
Introduction/Purpose: End Stage Renal Disease (ESRD) has been an uprising over the past decades. To sustain life, patients with ESRD need Renal Replacement Therapy, also known as dialysis. For hemodialysis, arteriovenous accesses (AV Access) are preferred over permcath for vascular access; unfortunately, AV access is not free of complications such as infection, steal syndrome, aneurysms, stenosis, or thrombosis. In addition, morbidity related to AV access is the leading cause of frequent hospitalization among patients with ESRD. This project aimed to create a comprehensive training program to help guide dialysis facilities and increase the dialysis staff's knowledge and confidence in detecting AV access flow dysfunction and complications by incorporating AV access physical examinations with current evidence-based practice. Methods: This study has developed a training program for dialysis staff to monitor AV access of individuals receiving hemodialysis and catch the signs and symptoms of any complications early on, if any. The intervention consisted of two in-person learning sessions and two weeks of supervised independent practice on the individuals receiving hemodialysis. Before and after the intervention, the dialysis staff was asked to complete a pre and post-survey that evaluated and compared their knowledge and confidence score in performing AV access physical examinations to monitor AV access flow dysfunction and complications. Results: The confidence level mean pre-survey showed a slight increase in confidence score from (M=19.66, SD=4.07) to post-survey mean scores intervention (M=21.39, SD=3.92); Also, the knowledge level pre-survey mean scores remained relatively the same (M=57.09, SD=3.50) compared to post-survey knowledge mean scores (M=56.00, SD=4.90). Of all the participants' surveys, only 2 had missing values in their post-test scores of knowledge and confidence assessments. In addition, around 66% (n=15) of participants were able to perform a complete AV access evaluation during independent skills under supervision. Based on the total census of 169 patients between both clinic sites of High Desert Hemodialysis and East Palmdale Dialysis, only 111 patients had AV accesses, of which we calculated that 18.01% (n=20) of the patients who had AV accesses had a confirmed stenosis after their examination. Discussion: The study showed improvements in participants' confidence in evaluating AV access after receiving or training program of AV access monitoring. Our participants were able to identify the AV access dysfunctions with AV access examinations, and these identified cases were also identified as AV access dysfunctions, thereby validating the results by the interventional radiologists. Therefore, our study supports implementing the evidence-based training program for dialysis staff to enable them with a high confidence level in performing AV access examinations, thereby identifying AV access dysfunction cases early on. Hence, our evidence-based training program must be implemented to monitor AV access daily with each cannulation opportunity and identify and treat AV access dysfunctions early on to avoid further complications.
Evaluating the Effectiveness of Staff Education on the use of PowerGlide ProTM Ultrasound Guided Intravenous Insertion on First Attempt Success Rate and Confidence with Technique
Baron, Marc; Carter, Patricia; McLuckie, Andrew
Introduction/Purpose: Ultrasound guided peripheral IV (UGPIV) placement is a practice that isempirically supported. The PowerGlide ProTM is one ultrasound technology and has the potentialto decrease the number of attempts providers use to obtain peripheral access. However,standardized provider education on the use of this device is not universal and may impactprovider confidence and success rates. The purpose of this project was to evaluate the impact ofstandardized education provided by the vendor for the PowerGlide ProTM technology on firstattempt success rates and provider confidence.Methods: A pre- and post-educational confidence survey was completed by providers whoattended the standardized education offered by the Vendor. A procedure log was maintained totrack usage of the PowerGlide ProTM and provider success rate with peripheral IV placement.Results: Using a significance level of p <.05, a statistically significant difference in the pre- andpost-education surveys between the pre (M = 11.6, SD = 4.42) and post implementation (M =14.9, SD = 3.64) survey values [t (N =20) = -2.57, p = .007].Discussion: Provider confidence with use of the PowerGlide ProTM improved significantlyfollowing implementation of the standardized education. There was a mean increase of 3.3points from pre to post-test scores. The overall effect was large (d=.82). There was also aclinically significant decrease in the number of PIV attempts when using the PowerGlide ProTMtechnology.
Enhanced Recovery After Surgery (ERAS) for Cesarean Section
Bennett, Keiston; Lee, Amy; Cornelius, Brian
Introduction/Purpose: Enhanced recovery after surgery (ERAS) was first utilized in the field of colorectal surgery. Among anesthesia providers it was considered “goal directed fluid therapy”. Combining already proven ERAS protocols, anesthesia considerations, and the obstetric population, protocols for ERAS for cesarean sections have benefited the parturient patients. The purpose of this project was to assess the local anesthesia providers current utilization of ERAS, to implement ERAS of education for the providers, and assess to ERAS understanding after an educational initiative. Methods: This was a quality improvement project with pre and posttest to the anesthesia group in obstetrics to evaluate the current utilization level before and after introduction of ERAS protocols/interventions. The survey used with permission was from Pujic’s A Survey of Enhanced Recovery After Surgery Protocols for Cesarean Delivery in Serbia to evaluate ERAS utilization. Results: An unpaired t-test was used to determine pre and post utilization of ERAS interventions for cesarean sections after an educational intervention. The data was not significantly different (p = 0.2488) but survey score averages increased 3.92 points from the pre (n=42) to post (n=16) surveys indicating an improvement in ERAS utilization overall. Discussion: This project sought to increase utilization of ERAS for cesarean sections amongst anesthesia providers. Ultimately, utilization of ERAS for cesarean sections holds the potential to change the practice of current providers at the local facility.
The Pressure Is On: A Quality Improvement Project on the Effects of Culturally TailoredHealth Literacy on Medication Compliance and Hypertension Health Literacy
Jarrett, Charolette; Johnson, Paige; Golaub, Pauline
Introduction/Purpose: Limited health education regarding hypertension can lead to poor medication compliance and secondary complications such as cardiovascular disease. By improving hypertension-specific health literacy education in an Afro-American population with Afro-Caribbean influences, we sought to improve patient medication compliance and hypertension health literacy. Methods: Patients were recruited using inclusion criteria of native English speakers over 50 years of age, diagnosed with hypertension, blood pressure >140/90 within the previous 6 months, self-identified as Afro-American descent, and smartphone access with the capability of WhatsApp download. Consented patients participated in three weekly hypertension-specific health literacy WhatsApp sessions. Pre- and post-Intervention High Blood Pressure-Health Literacy Survey(HBP-HLS) and medication adherence questionnaires were administered. Patients’ perceived measurement of the project’s impact on their hypertension health literacy was evaluated post-intervention using a Likert scale: ranging from “0” (strongly disagree) to “10” (strongly agree) with the project’s impact on health literacy.Results: The average pre-intervention HBP-HLS was 34.4 with medication adherence averaging 9.6. The average post-intervention HBP-HLS was 36.75 with medication adherence averaging 10. The post-intervention health literacy assessment averaged 10, which showed an improvement in hypertension knowledge. Discussion: The increase in improvement of HBP-HLS from 34.4 to 36.75 was impactful, but limited by small sample size. Utilizing WhatsApp as a platform for individual educational sessions was an effective method of delivery. Sharing recorded sessions along with AmericanThe Pressure Is On Heart Association-approved infographics, allowed patients to replay and distribute infinitely.This dissemination of accurate targeted information can help combat future misinformation.
Pain Assessment in Advanced Dementia (PAINAD) use with hospice patients
Gardner, Sophia; Carter, Patricia; El Hachem, Pierre
Introduction: Hospitalized hospice patients continue to struggle with comfort at the end of life. This project provided nurses education on use of the Pain Assessment in Dementia scale (PAINAD) for better identification of non-verbal pain symptoms in hospice patients. This project also elicited feedback on ease of basic understanding of the PAINAD scale, use with the PAINAD scale, any perceivable time constraints associated with using this tool. One of the other goals was to determine if the PAINAD scale was a feasible option as a standardized observational tool in this patient population. By providing proper education on the PAINAD scale to the nurses, hospice patients can achieve greater comfort at death.Methods: This was a quality improvement project. An educational in-service was provided to registered nurses in the hospital setting to elicit feedback on basic understanding of the PAINAD scale, ease of use, anytime constraints, and their opinion on whether using the PAINAD scale as a standardized observational tool was a feasible option for hospice patients. This was conducted at UH Hospital, Parma, Ohio over a five-day period. After the implementation phase, a post-intervention survey containing eight questions was sent via UH RedCap, secure data site. Results: Of the 20 nurses who participated, 48% reported never receiving education on how to assess for non-verbal signs of pain in hospice patients. Following the educational in-service, 90% of participants reported increased knowledge on how to use the PAINAD scale and 81% recommended use with hospice patients.Only 10% of nurses perceived use of the PAINAD scale would increase assessment burden. Discussion: Hospice patients are frequently under-medicated at the end-of-life. By providing proper education on the PAINAD scale to nurses that routinely provide hospice care, they may be better equipped to identify non-verbal signs of pain in this patient population. This gap in care has not been specifically addressed in the literature in relation to hospice patients. This project focused on education and feedback from the nurses on ease of use, any time constraints when using the PAINAD scale, and the feasibility of use of the PAINAD scale with hospice patients. Findings support implementation of the PAINAD scale for hospice patients as a standardized observational tool to improve pain management in dying patients.

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