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 "Thaxton, Cheryl"
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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 An Evaluation of the Utilization of Telehealth for Patients with Hypertension- A Quality Improvement Project(2022-06-20) Grant-Mirle, Keely; Chrostowski, Susan; Thaxton, CherylBackground and purpose: Hypertension is the contributing cause of death for nearly half a million people living in the United States each year. Although this condition increases an individual’s risk of stroke, heart attack, and kidney failure, only one out of four people who have been diagnosed with hypertension have their blood pressure under control. The purpose of this project is to determine if patient engagement via a patient portal can be used effectively for improving blood pressure readings in patients with hypertension. Objective: This quality improvement project aims to enhance patient engagement, improve communication between patient and provider, and reduce blood pressure < 140/90 for those patients with hypertension. Methods: A quasi-experimental design study was performed at a community health clinic in the Northeast area of Tarrant County. Forty-three patients agreed to participate. Blood pressures were compared before and after application use. The Patient Activation Measure survey was selected to assess patient engagement. Findings: Paired t-test revealed an improvement of blood pressure readings after portal implementation, and the Pearson coefficient confirmed that patients who consistently accessed the system had better outcomes in their readings. Conclusion: Increased demands are being placed on healthcare providers. Alternative methods to provide care should be considered. Patient portals are an effective form of utilizing technology to manage hypertension.Item The Impact of a Nurse Practitioner-Led Targeted Intervention Guideline to Prevent 30-Day Readmissions Among High-Risk Heart Failure Patients: A Health Care Outcomes Project(2022-06-20) Roberts Jnofinn, Natasha; Thaxton, Cheryl; Brydges, GarryHeart failure (HF) is a chronic disease in which the heart muscle cannot pump enough blood to meet the body's blood and oxygen requirements. HF is a leading cause of hospitalization and readmissions in the United States, causing a public health problem affecting patients, families, and communities, contributing to increased healthcare expenditures. Recurrent readmissions have also been associated with poor self-care, suboptimal inpatient and discharge treatment, and increasing risks of morbidity, mortality, and disability, emphasizing the necessity of this quality improvement (QI) project. This DNP QI project aimed to evaluate the Nurse Practitioner's (NP) use of the American Heart Association (AHA) HF Guidelines Toolkit as a targeted intervention for high-risk HF patients at a large tertiary care facility in southern Texas. The project patients were identified using the EPIC (electronic health record) scoring system (LACE+ BOOST score), focusing on the adult high-risk HF inpatient population in the red zone. Using the AHA HF guidelines toolkit helped standardize practice in the adult high-risk HF inpatient population by reducing variability, resulting in lower readmission rates for the facility. The toolkit focused on medication management, self-management, and the lack of communication and referral/outpatient needs process. The toolkit standardizes care by promoting patient self-care, leading to enhanced inpatient and discharge management. In addition, this toolkit offers suggestions that standardize practice that helps reduce the risk of readmission for HF patients transitioning from inpatient to home care. Data comparison between the AHA HF toolkit versus no use was collected for 30-days with the ultimate goal of decreasing readmissions for the facility. The model for improvement was the framework guiding the QI project through development, testing, and change implementation. The study revealed that utilizing the AHA HF Guidelines Toolkit in the adult high-risk HF inpatient population showed a clinically significant reduction of heart failure readmissions in 30 days. The previous readmission rate was 23.1% compared to 14.8% displaying an 8.3% reduction in readmissions. Guidelines reduce practice variability by improving the quality of patient care. The AHA evidence-based guidelines toolkit for high-risk HF patients showed a clinically significant decrease in readmission rates. AHA HF guideline fills in any gaps, answers questions, promotes self-care, and helps to educate the patient on the disease process.Item The Implementation of an Evidence-Based Guideline for the Management of Polypharmacy in the Geriatric Population: A Quality Improvement Project(2022-07) Hollins-Henderson, Kashaelyn; Thaxton, Cheryl; Aaron, LoriAim: The primary goal of this study was to evaluate the impact of evidence-based polypharmacy guidelines in managing polypharmacy and deprescribing. Geriatric patients are at high risk for polypharmacy and increasing their knowledge will increase awareness. Methods: A quality improvement (QI) project, which included a cross-sectional study, was performed on patients 65 and older during wellness medical visits over four weeks. The Patient Attitudes Towards Deprescribing (PATD) survey was given to each patient to evaluate pre- and post-intervention knowledge. The Beers criteria, polypharmacy clinical flow chart, and polypharmacy deprescribing flow chart were additional interventions utilized during the study. The exclusion criteria were patients aged less than 65 years, those who were not taking five or more medications, and those who were cognitively impaired. Results: A total of 161 elderly patients were identified at risk for polypharmacy and overprescribing. Of the 161 patients with the prevalence of polypharmacy, 68 (42%) were deprescribed by utilizing the 2019 American Geriatrics Society Beers criteria. The average number of medications taken pre-intervention were 8.12 and 7.65 post-intervention. Patients’ knowledge, across all questions, increased by 0.04% based on a paired samples t test. There was a slight growth despite the small effect size of 0.27, which was statistically significant P < 0.001. Clinically significant aspects of the project were the reduction of pill burden, the reduction in chances of adverse events, and the decrease in financial hardships due to unnecessary prescribing of medications. Conclusion: The findings show a decrease in polypharmacy and an increase in deprescribing and patient knowledge.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.