Doctor of Nursing Practice - Scholarly Projects | 2022
Permanent URI for this collectionhttps://hdl.handle.net/11274/13621
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Browsing Doctor of Nursing Practice - Scholarly Projects | 2022 by Author "Smith, Melanie"
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Item Evaluation of an Evidence-based Algorithm for Patients with Acute Respiratory Failure: A Quality Improvement Project(2022-01-20) Wilson, LaTisha; Thaxton, Cheryl; Smith, MelanieBackground: The past decade, and particularly the past few years, there has been an increased focus on early recognition and responding to deteriorating hospitalized patients. One emerging approach gaining support is the use of early warning scoring (EWS) systems. These systems are designed to detect potential patient deterioration which can lead to initiate early intervention and management, such as increasing nursing attention and informing the provider. However, many hospitals across the United States are not utilizing these systems (Casserly, 2015). The Epic Deterioration Index (EDI) is an EWS. For patients at risk for acute respiratory failure (ARF), the utilization of EDI can promote early detection, which will lead to timely intervention and improve patients’ outcomes. In addition, the EDI can help promoting awareness of the need for institutions to independently validate evidence-based practice algorithms for timely intervention to prevent failure to rescue in patients with ARF. The purpose of this quality improvement (QI) project is to evaluate the implementation of an ARF evidence-based algorithm in the intermediate unit (IMU) to help facilitate timely intervention to patients at risk. Method: IMU providers were given instruction and training in the use of EDI in the context of the hospital’s electronic medical records system. Post-intervention data associated with patient intubation or unplanned transfers to the intensive care unit (ICU) was collected and analyzed against similar pre-intervention data. Statistical analyses of changes in patient care were based in the Pearson’s chi-square procedure. Results: There was a reduction but not statistically significant in the difference of pre- and post-intervention on intubation rates and unplanned transfer to the ICU. However, there was a statistically significant in the use of EWS reports to prompt use of the evidence-based clinical algorithm and promoting appropriate patient care. Conclusion: The evidence-based algorithm utilization is a valid tool to alert healthcare providers in identifying a deteriorating patient condition for timely escalation of care.Item Evaluation of an Evidence-Based Guideline for the Management of Immune-Mediated Diarrhea/Colitis(2022-03-29) Saji, Alice; Thaxton, Cheryl A.; Smith, Melanie; Tietze, MariCancer is the second leading cause of death in the United States as well as in Texas. The introduction of Immune checkpoint inhibitors (ICIs) has been extremely promising for cancer treatment in the last decade. Immune-mediated diarrhea and colitis (IMDC) are one of the main toxicities related to ICI treatment. Early diagnosis and proper management of IMDC helps patients to achieve clinical remission, which ultimately helps patients restart their cancer treatment. This quality improvement (QI) project compared outcomes between patients admitted to the inpatient setting with IMDC in 2017 and 2019 after implementing an IMDC practice guideline in 2018 for standardizing the IMDC practice. Baseline demographic and clinical data were obtained through chart review. The final cohort included 126 patients. Consultation to GI was completed in 55 (82%) in 2019 and 31 (53%) of the patients in 2017 during their first hospitalization for IMDC. Endoscopy evaluation was done for 37 (55%) patients in 2019, and for 20 (34%) patients in 2017. The readmission rate was significantly reduced in 2019 compared to 2017: 30 (51%) patients had multiple hospitalizations in 2017 compared to 17 (25%) patients in 2019. The recurrence of IMDC occurred in only 16 (24%) patients in 2019 compared to 29 (49%) patients in 2017. For the 2019 cohort, 34 (51%) patients followed up in the GI clinic compared to 19 (32%) in 2017. As the number of patients with ICI treatment increases, the number of patients with IMDC also increases. Early GI intervention with endoscopic evaluation and medical management and proper follow-up in GI clinic will help in reducing the readmission rate, recurrence rate, and remission rate for IMDC.Item Improving Care and Outcomes for Patients Receiving Titratable Vasopressors Medications: A Quality Improvement Project(2022) Shenoy, Preeni; Smith, Melanie; Dello Stritto, RitaThe Surviving Sepsis Campaign guidelines (Dellinger, 2013) recommend that vasopressors be used to stabilize hypotensive patients unresponsive to volume resuscitation. Vasopressors are an integral part of hemodynamic management for patients with sepsis and septic shock. These medications are managed by nurses who initiate and increase infusion rates until patients are hemodynamically stable, then “wean” medications once therapeutic targets can be maintained. Vasopressors save lives but can also cause lethal complications, particularly when underdosed or overdosed. Therefore, it is critical that titration order instructions are clear and accurate so that weaning delays, practice variability, and medication errors are mitigated. The Joint Commission has set evidence-based safety standards on the use of vasopressors. Clear administration orders and accurate documentation are centerpieces of these guidelines. In the critical care unit at a community hospital in Texas, review of vasopressor use data revealed that a high percentage of patients remained on vasopressors after therapeutic endpoints had been met. A root cause analysis was conducted to identify reasons for weaning delays. Based on results, a quality improvement project was developed aimed at improving consistency in vasopressor titration practices and appropriate discontinuation. Interventions included creation of a Joint Commission compliant smart phrase addition to current computerized order sets clarifying vasopressor administration instructions, and an educational refresh for nurses on vasopressors management best practices. A Likert-scale tool was used to survey nurses on their confidence in managing vasopressors. The project results indicated improved timely vasopressor weaning and a statistically significant improvement with a p value of 0.00 in nursing self-confidence with vasopressor management.Item Improving Cervical Cancer Screening Rates and Utilization of Evidence-Based Treatment Guidelines at a Rural Primary Care Clinic(2022-05-09) Ugwuegbulam, Ugochi; Smith, Melanie; Thaxton, CherylCancer is the second leading cause of death in the United States, exceeded only by heart disease; one of every four deaths in the United States is due to cancer (Center for Disease Control and Prevention, 2018). Cervical cancer is the fourth most common cancer in women, leading to an estimated 528,000 cases and 266,000 deaths worldwide in 2012(Campos et al., 2016). Cervical cancer screening through the Papanicolaou (Pap) test is an effective means of detecting precancerous cell changes within the transformational zone of the cervix and reducing the incidence of cervical cancer in the asymptomatic stage (Everett et al., 2014). Purpose & Objective: This quality improvement project is intended to increase the rate of cervical cancer screening by introducing a home human papilloma virus (HPV) testing option with increased patient education and to standardize the utilization of the 2019 American Society for Colposcopy and Cervical Pathology (ASCCP) guideline in a primary care setting. Method: Evidence-based interventions implemented included providing an option for home HPV testing with augmented teaching and a workflow change to ensure ASCCP guidelines are followed to manage abnormal results. Data analyses were done utilizing a run chart, descriptive statistics, and a Chi-square test to analyze changes in pre-and postintervention outcomes. Result: Findings showed a 46% increase in post-project cervical cancer screening rates at the facility compared to the preintervention phase of the project. Increased providers’ adherence to ASCCP guidelines in managing abnormal cervical cancer screening result noted postintervention.