Doctor of Nursing Practice - Scholarly Projects | 2020
Permanent URI for this collectionhttps://hdl.handle.net/11274/12211
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Item Identifying risk factors to reduce readmission rates for patients with psychiatric disorders: A quality improvement project(2020) Olayiwole, Folasade; Sancho, AnastasiaThis QI project was a response to increased 30-day readmissions at an inpatient psychiatric facility in SW Texas, identified as the project site. The long-term goal is to decrease 30-day readmissions by patients with schizophrenia and/or bipolar disorder at the project site. An audit tool was created for this QI project by combining the READMIT clinical risk index and site-specific variables that were identified by site experts. Findings showed the numbers of repeat readmission (p = .000) and the age (p =.031) demonstrated statistical significance in 30-day readmissions. There was an association between the number of repeat readmissions and the READMIT Tool Score (rs = 0.57, p < .001). The correlation coefficient between the two variables was (rs = .0575), which is moderately significant. There was a significant positive association between the READMIT Tool Score and repeat numbers of readmissions: (rs = 0.57, p < .001). Findings also indicate two statistically significant risk factors (age and number of readmissions). One clinically significant variable (discharge on injectable long-acting antipsychotic medication) and higher READMIT clinical risk index scores were associated with 30-day readmissions. Recommendations include adding the top-three risk factors identified (age, number of readmissions, injectable medications at discharge) to the admission and discharge process implemented by repeated PDSA cycles. Other recommendations are to join a state or national registry to help track 30-day readmissions and to conduct a one-year study, including chart audits, to access changes in the specific population.Item Identifying opportunities to improve transitional care of patients diagnosed with heart failure and diabetes: A quality improvement(2020) Butuk, Regina; Roussel, Linda; Smith, MelanieDiabetes mellitus (DM) and heart failure (HF) are intensifying public health concerns because of their mounting prevalence, high hospitalization and mortality rates, subsequent complications, and comorbidities. DM is characterized by high glycemic levels, and, in HF, the heart cannot efficiently pump oxygenated blood throughout the body. Individuals with DM are two to four times more likely to develop HF than those without DM. DM and HF have become pandemics at local, national, and global levels. As such, they affect all people, and their occurrences are projected to double over the next two decades. DM and HF share pathophysiological characteristics, which worsen the progressions of both diseases, decrease patients' quality of life, and increase healthcare costs. Lack of glycemic control may lead to impaired structural and mechanical functions in cardiovascular diseases (CVDs). It is, therefore, necessary to identify the risk factors related to glycemic control and to guide providers in managing DM and HF patients, offering options that may slow disease progression, improve the patients' quality of life, and reduce healthcare costs.Item Identifying risk factors to reduce readmission rates for patients with psychiatric disorders: A quality improvement project(2020) Sancho, Anastasia; Olayiwole, FolasadeThis QI project was a response to increased 30-day readmissions at an inpatient psychiatric facility in SW Texas, identified as the project site. The long-term goal is to decrease 30-day readmissions by patients with schizophrenia and/or bipolar disorder at the project site. An audit tool was created for this QI project by combining the READMIT clinical risk index and site-specific variables that were identified by site experts. Findings showed the numbers of repeat readmission (p = .000) and the age (p =.031) demonstrated statistical significance in 30-day readmissions. There was an association between the number of repeat readmissions and the READMIT Tool Score (rs = 0.57, p < .001). The correlation coefficient between the two variables was (rs = .0575), which is moderately significant. There was a significant positive association between the READMIT Tool Score and repeat numbers of readmissions: (rs = 0.57, p < .001). Findings also indicate two statistically significant risk factors (age and number of readmissions). One clinically significant variable (discharge on injectable long-acting antipsychotic medication) and higher READMIT clinical risk index scores were associated with 30-day readmissions. Recommendations include adding the top-three risk factors identified (age, number of readmissions, injectable medications at discharge) to the admission and discharge process implemented by repeated PDSA cycles. Other recommendations are to join a state or national registry to help track 30-day readmissions and to conduct a one-year study, including chart audits, to access changes in the specific population.Item Evidence-Based Practice Remote Patient Monitoring Curriculum Development: A Descriptive Pilot Project(2020-12) Wolf, Irene; Roussel, Linda; Tietze, Mari; Bailey, CatherineThe purpose of this project was to build a remote patient monitoring (RPM) evidence-based practice (EBP) curriculum using a curriculum matrix. The curriculum matrix includes technology, patient safety/quality, role, industry, and clinical skills to complete learning objectives regarding RPM information, applications, and clinical decision-making. Methodology: This quality improvement project used subject matter experts were used to obtain a Content Validity Index (CVI) score on pre- and post-test surveys that measured RPM knowledge, experience, and attitude. The pre-test survey, RPM module, and post-test surveys were presented to online students obtaining a master’s or doctorate. Results: Quantitative results indicated that knowledge and experience were significantly improved with RPM content. There was no difference in the attitude score, which may be related to the students themselves because of a high pre-survey score of 9.4 for attitude. The significant results from this pilot project warrant expansion to a larger sample and other universities.Item Improving Hospital-wide Inpatient I-PASS Handoff(2020) Niangar, Maria Luzalie; Roussel, Linda; Smith, MelanieIn line with The Joint Commission on Accreditation of Healthcare Organization (JCAHO) as well as The Accreditation Council for Graduate Medical Education’s (ACGME) priorities for accreditation, our institution identified handoffs as an essential factor to consider in preventing risk to patients and process failure. Effective communication between caregivers can help reduce medical inpatient errors and preventable deaths due to miscommunication. Our electronic medical record system, EPIC, includes I-PASS handoff. I-PASS is one of the standardized tools for handoffs. This mnemonic stands for Illness severity, Patient summary, Action list, Situation awareness, and Synthesis by the receiver. This QI project's primary objective was to improve the hospital-wide inpatient I-PASS handoff rate from 40% to 65% within two months following the interventions and improve provider satisfaction in using I-PASS handoffs in EPIC. Interventions included: education, tool modification, team meetings, and improving provider satisfaction in the use of I-PASS handoffs in EPIC. After our interventions, our results showed an increase in user satisfaction in the use of I-PASS. Our I-PASS percentage of handoffs also showed an increase from 40% to 50%, two months after implementation. There was also a notable improvement in the percentage of handoff numbers for both the surgical and medical side. The team also learned that we needed more buy-in from the institution’s leaders for this QI project to be more successful.Item Nurse practitioner-driven interprofessional heart failure education: A quality improvement project(2020) Luo, Lixian; Roussel, LindaHeart failure is a worldwide clinical concern, which has increased the healthcare expenditures, downgraded patient’s quality of life, and contributed to a large number of deaths every year. HF is the most common cause of readmission for Medicare patients in the United States. The cost of HF readmissions and Emergency Room visits are potentially preventable. Effective HF education can decrease 30-day readmissions and promote early post-discharge follow-up adherence. The nurse practitioner (NP)-led HF quality (QI) initiative provided to HF patients a 60-minute education program based on the American Heart Association guidelines. This QI project incorporated interprofessional team support to the participants during 30 days of the timeframe in a large teaching hospital. The results revealed the positive outcomes for targeted project measures among participants. The organization continues the HF educational program on the cardiology units based on the success of the project.Item Increasing awareness of over-the-counter measures to decrease allergy symptoms: A quality improvement project(2020) Dudley, Robert; Roussel, Linda; Tietze, MariProblem:Item Decreasing psychotropic medication use for nursing home residents with dementia(2020) Gore, Tundike; Bailey, Catherine; Roussel, LindaSkilled Nursing Facilities (SNFs) provide care for long-term care residents with multiple medical concerns as well as dementia. The number of the geriatric population showing dementia-related behavioral symptoms, such as agitation or screaming to get attention, is increasing. The traditional ways of using psychotropic medications to calm these residents have come under scrutiny. According to the Centers for Medicare and Medicaid (CMS), the practice of administering these medications to manage residents is no longer acceptable. In a selected SNF, there was a perceived need to implement a quality improvement project to replace nonpharmacological interventions with psychotropics as a solution to resolving the behavioral problems. Although there were limitations to the project, the findings indicated that the project effectively met the objectives of reducing the frequency of using psychotropic drugs for the residents of this SNF.