Doctor of Nursing Practice Projects

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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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    Reducing Readmission using the Re-Engineered Discharge: A Quality Improvement Project—Evaluation and Analysis
    Zeller, Nicole; Barron, Keri; Jennings, Ryan
    Introduction/Purpose: One out of every five patients hospitalized for heart failure (HF)- related complications are readmitted within 30 days of previous admission. Readmission, as a healthcare quality index, provides a metric to investigate strategies to improve HF outcomes. The Re-Engineered Discharge (RED) protocol is a comprehensive transitional care tool created to improve overall patient outcomes and self-efficacy. The purpose of this quality improvement project was to evaluate the RED protocol’s effect on readmission rates in patients admitted with HF at a small, Midwestern hospital. Methods: This project used a convenience sample of adult patients, ages 18 years or older admitted to the hospital with HF during a 60-day period. All patients (N = 7) who met the sample criteria received the RED transitional care protocol delivered by a trained cardiac care nurse. Following the implementation, the researcher performed a chart audit over 30 days to identify readmission status, collect data, and verify the integrity of RED implementation. Results: The readmission rate was 28.6% among the study group, which was above the hospital’s baseline rate of 25.42% in August. The readmission index was 0.91 in the study group versus the hospital’s overall index (1.07). The findings regarding the secondary data was consistent with the literature results that demonstrated increased HF incidence among older adults (age range, 58 - 91), females (four females versus three males), and increased occurrence in higher socio-economic status persons. The most common secondary diagnoses were hypertension (N = 7), osteoarthritis (N = 4), hyperlipidemia (N = 4), atrial fibrillation (N = 3), and diabetes mellitus (N = 3). The protocol fidelity was 100% for all steps, except for the follow up phone call (78%), validated through self-report and chart audit. Discussion: The project does not statistically support use of the RED protocol as a means of reducing readmission; however, the literature continues to support the individual steps of the protocol. Further study is necessary to validate the protocol. This project sought to inform transitional care guidelines in acute care institutions to improve patient outcomes and reduce readmission.
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    An Antibiotic Stewardship Program for Sinusitis in an Urgent Care Setting: A Quality Improvement Project for Advanced Practice Providers
    Slattery, Meagan; Simmons, Staci; Gosnell, Jason
    Introduction: Sinusitis is commonly diagnosed in the urgent care setting. According to evidence-based practice guidelines, most cases do not require antibiotics. Current clinical practice guidelines support a target antibiotic prescribing rate of less than 12% for upper respiratory infections, such as sinusitis. Inappropriate antibiotic usage can cause adverse effects, ranging from mild rashes and gastrointestinal distress to life threatening antibiotic resistance and colitis. In the chosen network for this project, 56.9% of patients received antibiotics when diagnosed with sinusitis between April and September 2023. Methods: All non-physician advanced practice providers (APPs) within the urgent care network were invited to view an educational PowerPoint presentation regarding current evidence-based practice guidelines for sinusitis. Participation in the intervention was voluntary and anonymous. Post-intervention prescribing patterns were evaluated to determine the efficacy of the intervention. Results: The results of the intervention demonstrated a statistically significant reduction in antibiotics prescribed by APPs for the diagnosis of sinusitis. The antibiotic prescribing rate improved to 46.3% during the six-week period following the educational intervention, a reduction of 10.6%. Conclusion: While this quality improvement project did not achieve the desired antibiotic prescribing rate of 12%, the educational intervention was effective at lowering the overall rate of antibiotics prescribed for sinusitis. Limitations include a short follow-up period and the voluntary nature of participation in the educational intervention.
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    Improving Health through Knowledge and Intervention: Promoting Hypertension Management with Early Screening, Self-Care, and Hypertension Literacy in an Occupational Setting
    Robinson, Kira; Scott, Letisha; Bryan, George
    Introduction/Purpose: Hypertension (HTN) is one of the leading causes of cardiovascular events. This project aims to increase blood pressure (BP) management, hypertension health literacy, and self-care awareness by providing early awareness in an occupational setting. Methods: 33 consented participants’ BP was measured and were given the Hypertension Knowledge Literacy survey (HK-LS), Brief Illness Perception questionnaire, and Hypertension self-care activity level effect (H-SCALE) questionnaire. They were seen in an occupational clinic from October 31, 2023-December 31, 2023. Each participant’s BP and survey/questionnaires were scored and reviewed. Participants with elevated systolic >130 mm Hg and/or diastolic >85 mm Hg BP received education from the American Heart Association (AHA) and required follow-up. During follow-up, each questionnaire and survey was redistributed, scored, and reviewed with repeated BP measurements, which was completed within two weeks after initial visit. Results: Out of 33 participants, sixteen required follow-ups. Of those requiring follow up eleven were African American (AA). Concerning effect size, systolic and diastolic BP showed a positive significance related to Brief Illness scores (systolic 41 (.023)b. and diastolic 37 (.039)b). In returning follow-up patients (n=11), post-education HK-LS scores (M = 20.82, SD = 1.25) were significantly higher than pre-education (M = 19.64, SD = 1.43), t(10) = 3.99, p = .003, d = 1.20, and this effect was very large. Pre-education systolic BP (M = 150.73, SD = 16.38) had significantly lower post education systolic BP (M = 145.09, SD = 22.10), t(10) = -2.47, p = .033, d = -.74, and a large effect. There was no significant significance in BP in relation to the H-SCALE survey. Discussion: Based on data analysis, the presence of an OH clinic supported preventive health promotion and early BP management. In the clinic, there was a significant decrease in BP and increase in hypertension (HTN) literacy in those that required follow-up post-education. Early screening for hypertension, assessing hypertension literacy, and providing interventions in Occupational Health (OH) helps to bridge gaps in care.
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    Nurse Perspectives about Screening Patients with Opioid Use Disorder, an Educational Intervention
    Mazzocco, Lisa; Andrabi, Mudasir; Myers, Leonece; Velazquez, Denise
    Introduction/Purpose: The consequences of drug overdoses are devastating, with opioids being a major contributor to preventable deaths. Those with cardiovascular disease are particularly vulnerable to the effects of opioid use, making the need for effective Opioid Use Disorder (OUD) screening even more pronounced. This scholarly project aims to assess the impact of an educational intervention on nurses’ confidence and perceived benefits of opioid use disorder screening among cardiovascular patients. Methods: Staff nurses completed an anonymous, online Qualtrics pre-survey consisting of questions pertaining to nurse’s attitudes, perceptions, and preparedness regarding screening for OUD. Following the pre-survey, education regarding OUD screening and risks associated with OUD and cardiovascular disease was completed. Within two weeks of completing the education, staff nurses then completed the identical post-education survey. Results: The percentage of nurses who answered “strongly agree” (seventeen percent, n=4) and “agree” (forty-two percent, n=10) to the statement “I feel prepared to screen my patients for OUD/opioid use” decreased on the post-survey after they participated in the educational intervention. On the post-survey, twelve percent (n=3) answered “strongly agree” and thirty-two percent (n=8) answered “agree”. Discussion: The educational intervention in this project did not educate participants on any specific OUD screening tool, numerous nurses expressed interest in learning more about how to implement a specific tool at the bedside. This may have been represented by a decrease in the percentage of nurses who felt prepared to screen their patients for OUD/opioid use on the postsurvey. This unit would benefit from further OUD screening tool education.
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    The Impact of a Community-based Doula-led Breastfeeding Support Meeting on Breastfeeding Rates and Breastfeeding Self-Efficacy in Black Women: A Program Evaluation
    Lockhart, Keisha; Simmons, Staci; Chappell-McPhail, Molly
    Introduction: Rates of breastfeeding continuation in Black women are abysmal compared to those of their White counterparts, the United States national average, and the Healthy People 2030 goal. Synthesized findings show increases in breastfeeding continuation rates in Black women to be positively correlated with the provision of early, ongoing, high-quality education and support from healthcare professionals, community, and family. This program evaluation assessed the effects of a community-based doula-led monthly breastfeeding support meeting on breastfeeding rates and self-efficacy in pregnant and postpartum Black women receiving standard care in a health system. Methods: Program participants were surveyed on infant feeding practices initially and once monthly to elucidate breastfeeding rates for three months. A breastfeeding self-efficacy scale distributed at these checkpoints assessed changes in breastfeeding self-efficacy. Qualitative and quantitative data were utilized in descriptive statistical analyses. Results: The monthly breastfeeding support meeting increased both breastfeeding self-efficacy and breastfeeding rates in Black mothers. Discussion: Support from healthcare professionals, community, and family and culturally appropriate, multitiered educational opportunities are instrumental in increasing breastfeeding continuation rates in Black women.
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    Reducing 30-day Acute Care Readmissions for Heart Failure Patients Through Implementation of a Discharge Bundle
    Lindsey, Jason; Welch, Teresa
    Introduction Hospital readmissions have been a long-standing problem in the American healthcare system. Despite many efforts, programs, papers, and interventions identified and studied, 14% of all adult admissions result in a readmission. Readmissions are mostly considered preventable and are considered an indicator of care quality for a hospital. Due to unexpected readmissions, patients are at an increased risk for illness or injury, increased stress, financial strain, and diminished quality of life. Readmissions also negatively impact hospital systems related to decreased bed availability, stretched resources, and potential financial penalties and payment reductions. Patients with an admission related to heart failure are at an increased risk of readmission, with a national readmission rate of 23%. Methods A gap analysis identified procedural and organizational reasons for readmission in the heart failure population at North Oaks Medical Center. Using evidence-based best practice guidelines established by the American Heart Association, American College of Cardiology, and the Heart Failure Society of America, a 4-pronged proactive discharge bundle was implemented using the plan-do-study-act framework for continuous improvement. All patients admitted to the telemetry units with a primary or secondary diagnosis of heart failure received the discharge-planning bundle: 1) an early assessment by the case management department, 2) patient-centered specialty heart failure education, 3) pre-discharge medication delivery, and 4) pre-discharge physician follow up appointment scheduling within seven days of discharge. Results The evidence-based project was implemented over seven weeks, September through October of 2023 on the medical telemetry units. A total of 133 patients were evaluated for inclusion in the heart failure cohort. Of those, 52 patients received the evidence-based intervention with 2 of the patients experiencing a readmission due to heart failure (3.85%). Incidentally, it was found that patients without a readmission had an average of 2.3 completed interventions while those with readmissions had an average of 1.5 interventions. Discussion Findings from this quality improvement project suggest the use of the evidence-based, four-pronged approach to discharge planning for the heart failure patient population reduced the risk and rate of heart failure-related readmissions for the involved nursing units. These findings also surmise that there is a correlation between the number of interventions and the rate of readmission in the heart failure patient. Efforts to further implement this approach to include previously excluded patients should be explored. Additionally, it is recommended that additional interventions related to care transitions be implemented and tested to determine further improvement opportunities in heart failure readmission reduction.
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    Implementation of The City Birth Trauma Scale Screening Tool to Increase Awareness of Post-Traumatic Stress Disorder in NICU Mothers
    Zamulinski, Natalie; Welch, Teresa; George, Julie
    Introduction/Purpose: In the early 1990s, conversations on a growing trend emerged in healthcare surrounding traumatic birth experiences and the development of childbirth posttraumatic stress disorder (PTSD). Being exposed to stress-related trauma directly or indirectly or having witnessed death, threatened death, actual or threatened severe injury, or sexual violence predisposes one to post-traumatic stress disorder. It is included in the Diagnostic and Statistical Manual (DSM-5) as a new classification of trauma and Stressor-Related Disorders. The impetus for this DNP project comes from the identified lack of screening for the postpartum patient population to identify and screen for childbirth post-traumatic stress disorder (PTSD). Implementing the City Birth Trauma Scale will help identify those experiencing PTSD needing support and further interventions with referral. Methods: The evidence-based process improvement project utilized the City Birth Trauma Scale, a proven, reliable, and valid assessment tool to assess postpartum NICU mothers for symptoms of PTSD. This twenty-nine-question instrument was derived from the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) and created explicitly for this patient population to identify PTSD. This easy-to-use questionnaire is available in 22 languages and used in 18 countries. It was provided to NICU mothers as a part of the admission process between September and December 2023. Results: Implementation of the City Birth Trauma Scale screening tool positively impacted the recognition of PTSD and referral for this high-risk patient group. One hundred NICU mothers were provided with the survey and information on participation, with 31 completed surveys returned for analysis. Individuals who answered ‘yes’ to questions one and/or two meet DSM-5 diagnostic criteria for PTSD. Data analysis revealed that of the 31 completed surveys returned, 66% of the respondents answered ‘yes’ to either one of both diagnostic questions, demonstrating a high probability of PTSD in NICU mothers. Further data analysis revealed that of those mothers identified as having PSTD, 42% were at high risk, 42% were at moderate risk, and 16% were not at risk. Discussion: Data findings demonstrate the significance of PTSD screening and support the continued screening of NICU mothers. The City Birth Trauma Scale has effectively improved recognition and care in this vulnerable population. There is a need for future studies and the creation of departmental standards of care and guidelines for screening for PTSD at different periods in the post-partum period.
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    Implementing the Clinical Opiate Withdrawal Scale in a Mental Health Crisis Unit:
    Tidwell, Jessi B.; Scott, Letisha; Martin, Rebecca; True, Terry
    Introduction: Dual-diagnosis patients frequent the mental health crisis units across Alabama. Opioid abuse, if left untreated, can lead to opiate withdrawal due to opioid dependence. Without prompt initiation of treatment, opiate withdrawals can precipitate life threatening conditions. The Clinical Opiate Withdrawal Scale (COWS) tool allows providers to track early withdrawal symptoms, determine the severity of opiate withdrawal, and guide the treatment plan. Administering COWS is a nurse's intervention that requires education, skills, and confidence due to the ability to trigger opiate withdrawals when initiating the intervention too soon. Purpose: To provide nursing education, improve assessment skills in utilizing COWS, and promote confidence in providing clinical assessment data to the provider. Methods: This quality improvement project used a pre and post education survey study design to assess nurses' baseline knowledge of COWS assessment before and post-education, including evaluating confidence in utilizing the tool and communicating withdrawal symptoms to the provider. Nursing competency and confidence in COWS was assessed using a 4-point Likert scale from Schollaert- Culwell (2020). Nurses provided education via power point presentation. Results: Quantitative surveys were analyzed via descriptive statistics to summarize the characteristics of the data set. Data was collected to determine the tool's usage post COWS education at weeks three, four, and five. Discussion: Post test survey revealed increase in nursing confidence in assessing via COWS after formal education. Notable improvement in the usage of COWS tool after education.
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    Enhanced Anxiety Screening in Primary Care for Children with ADHD
    Spears, Angela; Lee, Amy
    Introduction Attention-deficit hyperactivity disorder (ADHD) and anxiety have been found in a multitude of previous studies to have a high likelihood of co-occurrence in children and adolescence. These studies have identified co-occurrence of anxiety and ADHD is diagnosed in around 50% of pediatric cases. Finding the correct treatment options for children with this dual diagnosis is important for the child’s quality of life and can impact both their academic and social functioning. Ensuring prompt and early diagnosis and treatment is key to helping each child with a dual diagnosis to have the best quality of life possible. Methods The aim of this project was to assess if routine screening for anxiety in the primary care setting helps with improved diagnosis of comorbid anxiety in children with ADHD. For this project design data was collected in a pediatric private practice in the state of Virginia on children ages 11-17 utilizing chart reviews and then administering the Generalized Anxiety Disorder -7 screen for Adolescents (GAD-7A) to assess for diagnostic criteria of anxiety in patients who already had an ADHD diagnosis. To find out effectiveness of the assessments a pre chart review of children diagnosed with ADHD was conducted prior to the start of routine anxiety screening of children with ADHD who come in for medication checks, well checks, and sick visits. Six weeks after the start of administration of the GAD-7A a post chart review was conducted to reassess if administering the inventories had helped identify more patients meeting criteria and needing treatment for anxiety. Results Post project chart review revealed that 63% of participants (n=35) had been diagnosed with anxiety and offered treatment measures compared to 29% that had previously been documented as having a diagnosis for anxiety. McNamar’s test revealed a significant (p=0.000532) increase in anxiety diagnosis for children with known ADHD. Conclusion Anxiety and ADHD are commonly occurring comorbid diagnosis’ in children and identification and treatment of these disorders can improve a child’s social and emotional growth. This project has provided insight into the importance of regularly screening for anxiety in children already diagnosed with ADHD in the primary care setting and supports routine anxiety screening in primary care as an effective way to help identify and offer treatment for anxiety to children with an ADHD diagnosis.
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    Walking as a Standardized Intervention in Type 2 Diabetes Mellitus: A Quality Improvement Project within the Primary Care Setting
    Harrison, Rebecca; Wilson, Kimberly; Harrison, Katherine
    Introduction/Purpose: Type 2 diabetes mellitus (T2DM) is a multifaceted disease. Implementing interventions focused on physical activity (PA) can aid in reducing the risk of developing devastating complications. The objective of this project was to evaluate the effectiveness of an educational and PA intervention on activity levels, weight, BMI, and weekly average blood sugar levels. Methods: The quality improvement (QI) project provided consented participants with a 15-minute educational presentation via printed handouts tailored from the American Diabetes Association toolkit. Participants then began a six-week walking intervention of 30-minutes, five days a week and received weekly phone reminders. The International Physical Activity Questionnaire-Short Form (IPAQ-SF), weight, height, BMI, and participants’ report of average weekly blood sugar level were collected pre- and post-intervention. Results The results of the dependent t-test (n = 7) did not show a statistical difference in the participants report of physical activity between pre-intervention (M = 6109.9, SD = 5934.4 ) and post-intervention (M = 4812.9, SD = 5337.4) IPAQ-SF survey scores, t(0.5768) = 6, p < 0.5850. However, the average results of post-intervention weight, BMI, and BS level (224.7, 35.4, and 118 respectively) showed a 2%-5% decrease compared to pre-intervention results (228.7, 36.1, and 122). Discussion: In clinical practice, achieving optimal glycemic control on a long-term basis is challenging, since the reasons for poor control in T2DM are multifaceted. (“Factors that Correlate with Poor Glycemic Control in Type 2 ... - ophrp”) In view of this, interventions aimed at PA using evidence-based guidelines must be initiated at time of diagnosis to reduce the severity of disease and prevent complications.
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    Standardizing Perinatal Depression in the Ambulatory Setting
    Spaulding, Nicole; Wilson, Kimberly; Brigance, Heather
    Perinatal depression (PND) affects one out of seven women in the United States. Professional organizations such as the American College of Gynecologists and Obstetricians provide recommendations to clinicians on the screening and treatment of PND. The purpose of this quality improvement project was to improve patient outcomes by developing and implementing a standard operating procedure (SOP) to standardize PND screening using the Edinburgh Postnatal Depression Scale (EPDS). Methods An SOP was created defining times in the perinatal period that the EPDS would be administered over six weeks. Data collection included the number of completed EPDS screens, the score, and the number of referrals to the Maternal Mental Health Clinic (MMHC). Results Data collection was analyzed using SPSS (version 27) to conduct a chi-square analysis. Results concluded that the number of positive PND screens pre-implementation (8, n = 58) was not significantly different from the number of positive screens post-implementation (26, n = 131), 𝜒𝜒2 (1, n = 189) = 1.00, p = .318. Additionally, the number of referrals post-implementation (10, n = 131) was significantly greater than the number of referrals pre-implementation (0, n = 58), 𝜒𝜒2 (1,n = 189) = 4.68, p = .031. Conclusion The SOP aligned the project site with current recommendations from ACOG and filled the gap in PND screening processes that currently existed. The site saw an increase in the total number of PND screenings and positive PND screens, and referrals to the MMHC helping to improve patient outcomes.
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    Implementing a Checklist as an Inpatient Fall Prevention Intervention: A Quality Improvement Process
    Cameron, Tina; Acker, Kristi; Korrapati, Vijaya
    Introduction and Purpose: Older adults have a higher risk of acute setting falls, based on a multitude of factors, leading to prolonged lengths of stays and thousands of dollars in additional healthcare costs. The DNP project aimed to identify whether integrating a nurse-led Fall Prevention Checklist, alongside standard fall prevention interventions, reduces inpatient falls in older adults within a single oncology/medical-surgical inpatient setting. Methods: The project focused on decreasing falls in an inpatient setting over six weeks. Nurses were educated on the current clinical need for fall reduction, and “fall champions” were identified to help provide momentum in tool adoption. Moreover, the implementation strategy was evaluated, and nurse feedback was collected through a voluntary and anonymous post-implementation survey. Results: Nurses completed 663 Fall Prevention Checklists during shift changes. Fall rates between the implementation period and baseline rates were analyzed. The number of falls pre-implementation (6, n = 6) was significantly more significant than the number of falls post-implementation (2, n = 6), 𝜒2 (1, N = 12) = 6.00, p = .014; a decrease in the fall rate by 66.7%. Conclusion: The improvement in fall rates supports the idea that implementing a simple yet valuable tool, such as a Fall Prevention Checklist during shift change, can reduce fall rates. Only 4.5% of nurses provided feedback following the intervention, limiting nurse insight into the utility of the instrumentation. Based on the project limitations, findings should be viewed cautiously. However, the initial findings support that augment strategies, such as utilizing a Fall Prevention Checklist, can provide meaningful impacts on improving patient outcomes.
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    Pediatric Anesthesia Emergence Delirium Scale Quality Improvement Project and Retrospective Chart Review
    Bakker, Melissa Gayle; Owings, Clara; Langford, Patsy
    Pediatric anesthesia emergence delirium (PAED) is a prevalent postoperative occurrence in a complex patient population. Presentation can manifest in school-aged children as disorientation, confusion, agitation, hallucinations, hypersensitivity, irritability, inconsolability, hyperactive physical behavior, emotional lability, and inconsolable crying. The unpredictability and variable presentation require prompt recognition by staff. The PAED scale developed by Sikich, N. & Lerman (2004) is the most reliable in diagnosing pediatric emergence delirium (PED). Implementation is underutilized postoperatively. Application of the PAED scale in the perioperative setting is not considered standard of care; however, given the potentially harmful outcomes to patients, staff, and family members, utilization may be instrumental in postoperative management. Preventative measures and techniques continue to evolve in research; some have been successful but inconclusive. The aim of this project was a quality improvement pilot study to assess the probable rate of PED, provide recommendations on whether to implement an appropriate assessment scale and provide up-to-date anesthesia perioperative guidelines for PED. A retrospective chart review examined the probable rate of PAED over the last year. Further analysis and evaluation of the anesthetic techniques and potential triggers were assessed. Recommendations for scale implementation and preventative measures for anesthesia were constructed.
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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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.