Doctor of Nursing Practice Final Document Projects

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Integrating Implementation Science to Mitigate Ongoing Hospital Acquired Pressure Injuries in A Large General Surgical Intensive Care Unit
(The Ohio State University, 2024-08) Morrison, T. Cody; McNett, Molly
The purpose of this evidence-based quality initiative is to address the high occurrence rate of hospital-acquired pressure injuries (HAPI) on a general surgical intensive care unit. This project is twofold: first, it verifies the evidence supporting use of a STAND Skin protocol for HAPI assessment and prevention; second, it highlights how the use of tailored implementation strategies can impact adoption and fidelity to this evidence-based practice. Current literature supports the use of bundled protocols for HAPI prevention and staff adherence. Integrating implementation science using the CFIR framework and ERIC implementation strategy matching tool identifies barriers to practice change and specific strategies for successful implementation. Barriers to implementation were identified through a comprehensive unit assessment. Tailored strategies were then matched to address barriers and included an educational intervention, auditing and feedback, and identifying a project champion. Results for this initiative demonstrated high protocol adoption rates, which remained throughout project implementation. A steady state of protocol fidelity was achieved for turning and positioning with an 8.64% increase from week 1 to week 7; however, no substantial change was observed with offloading device utilization. Fidelity for wound consultation saw a 33.55% increase from week 1 to week 6. Implications from this project seek to highlight the benefits of implementation science methodology, demonstrate economically-conscious approaches to practice change, and sustainable delivery of care.
Defining Applied Cognitive Informatics Competencies Focused on Human Factors in Healthcare Using a Delphi Approach
(The Ohio State University, 2020-12) Hoeksema, Lynda; Hardy, Lynda
Objective: Obtain expert consensus on cognitive informatics core competencies related to human factors (HF), usability, and human-computer interaction (HCI) for quality improvement purposes within organizations. Materials and Methods: A 3-round Delphi approach was used to assess 23 proposed knowledge, skills, and attitude (KSA) competencies by informatics and HF experts with clinical, academic, research, and technical experience. Knowledge and skills statements aligned to Bloom’s Revised Taxonomy. Consensus was defined a priori at 78% relevancy agreement. Results: Informatics and HF experts reached consensus on 26 competencies (10 Knowledge, 9 Skills, 7 Attitudes) within two rounds. Prioritization of competency statements during round 3 demonstrated high priority levels (mean=1.69 on a 4-point scale). Discussion: The 83 total responses were from a diverse, interprofessional population with advanced degrees (80% held doctorates). Sixteen years or more experience by respondents was reported in informatics (60%) and/or HF (31%). The overall title summarizing the competency statement scope was the most difficult item to achieve agreement (final round had tied ratings for first choice). One limitation was snowball sampling and anonymity prohibited determination whether individual respondents participated in multiple rounds (building on their prior responses and comments). Conclusion: This project addressed gaps and identified and prioritized applied cognitive informatics core competency statements related to HF, usability, HCI, user experience, and workflow enhancement for practicing healthcare informatics professionals. Future work in the discipline is needed to create assessment tools, curriculum objectives, and instructional content to enhance and facilitate achievement of these core competencies by current and future practicing informatics professionals.
Implementing Shared Medical Appointments for Cancer Patients to Cancer Survivors: An Evidence-Based Project for Breast Cancer Survivorship
(The Ohio State University, 2024-05) Song, Jung-Min; Chipps, Esther
More than 2 million new cancer cases are expected by 2024 in the United States. The fast-growing cancer survivors are estimated to be up to 18.4 million, 5.4% of the population in the United States, by 2032. Breast cancer is the most common cancer in women, following skin cancers in the United States. Breast cancer survivors often struggle with physical, mental, psychosocial, and financial difficulties following cancer treatments. The implementation of SMA for breast cancer survivorship is an evidence-based quality improvement initiative. Shared medical appointments (SMAs) for breast cancer survivorship can provide effective and efficient survivorship care to address unmet survivorship needs. The 90-minute survivorship SMA consists of an individual visit with a clinician and comprehensive education, counseling, and peer support with multidisciplinary oncology providers in groups of three patients. Three multidisciplinary-led SMA sessions weekly provided a comprehensive survivorship care plan for nine patients at a community cancer center. Following the SMA session, all patients received a treatment summary and individualized survivorship care plan. Eleven of the sixty-eight eligible breast cancer patients agreed and scheduled for SMAs, and nine patients (82%) attended the SMA sessions. Most participants expressed high satisfaction with SMA, rated 3.64 out of 4. Overall, most participants indicated a gain in knowledge through SMA sessions, with post-survey knowledge scores increasing by an average of 17%. Multidisciplinary-driven SMA can provide comprehensive survivorship care and individualized care plans to address difficulties during the cancer journey.
Implementing an Evidenced-Based Quality Improvement Project to Standardize Foot Screening in Adults with Type 2 Diabetes
(The Ohio State University, 2024-05) Seiter, Allison; Teall, Alice
Introduction: In the United States, over 37 million adults have type 2 diabetes mellitus (T2DM), with 23% of them unaware of their condition. Diabetes contributes to significant health complications, including over 270,000 deaths, 16 million emergency visits, and 7.8 million hospitalizations annually. Individuals with T2DM are prone to peripheral arterial disease and neuropathy; approximately 25% of people with diabetes will develop a foot ulcer during their lifetime, leading to significant medical expenses, lost productivity, and reduced quality of life. Regular screening and education can prevent up to 85% of diabetes-related amputations. Evidenced- based practice guidelines recommend integrating a process for standardized foot screening in primary care. Purpose: The purpose of this project was to standardize foot screening for patients with T2DM within a comprehensive primary care clinic. Methods: This quality improvement project standardized foot screening using the Inlow's 60-Second Diabetic Foot Screen, a validated, rapid screening tool created for primary care that includes use of the 10-g monofilament test and key risk stratification scoring. Utilizing the Plan-Study-Do-Act model, an educational in-service during the project kick-off provided an opportunity for clinicians and staff to practice using the Inlow’s Screen. The healthcare team involved in integrating the standardized screening in practice included four family medicine physicians, two nurse practitioners, one licensed practical nurse, nine medical assistants, the office manager, and several nonclinical office specialists. Results: Pre-implantation data was collected from primary care visits to evaluate the percent of patients with T2DM who received an annual foot exam within the four weeks prior to the project; the data revealed 49.8% of patients with T2DM (n=287) received a foot exam utilizing a monofilament tool. Following project implementation, 55% of adults with T2DM seen in the office (n=209) had a completed comprehensive foot exam. Based on scores from the Inlow's 60-Second Diabetic Foot Screen, three patient referrals were placed for specialist evaluation of their DFU risks. Implications for Practice: Implementation of an evidenced-based, standardized foot screening in primary care can result in an increase of completed foot exams for individuals with T2DM. Leadership buy-in and team collaboration is needed to create an environment that supports practice change.
Systematic Screening for Suicidal Ideation in an Ambulatory Oncology Harm Reduction Clinic
(The Ohio State University, 2024-05) Parker, Gina; Browning, Kristine
The risk of suicide among patients with cancer is up to four times greater than the general population and up to seven times greater within the first 6 months after cancer diagnosis. National clinical practice guidelines (CPGs) and a National Patient Safety Goal (NPSG) from the Joint Commission provided rationale for selecting patients who should be screened for suicidal ideation (SI). However, routine SI screening at the Ohio State University Wexner Medical Center James Comprehensive Cancer Center (OSUWMC James) was only required in the emergency department (ED) and inpatient units. Patients in the ambulatory setting received depression screening informed by an internal practice guideline. The purpose of this initiative was to systematically implement routine suicide screening in an outpatient cancer supportive care clinic for patients with an increased risk for SI. A sub-objective within the project was to determine the nurses self-reported confidence level with the SI screening process. A nurse-led implementation team applied rapid Plan-Do-Study-Act (PDSA) cycles to systematically implement an evidence-informed, validated SI screening tool to patients at every clinic and telehealth visit. All patients were provided with information on mental health resources, regardless of screening outcome. Outcomes from this project demonstrated an 11.4% improvement in completed SI screening over the 6-week implementation period. A confidential survey of clinic nurses revealed high levels of comfort with asking and documenting SI screening. Findings from this initiative suggested routine screening for SI is an achievable outcome for outpatient oncology clinics.
An Evidence-based Guideline for Patients with Acute Leukemia to Promote Antibiotic Stewardship
(The Ohio State University, 2022-05) Kulpa, Carl; Momeyer, Mary Alice
Antibiotic overuse is a significant global problem accounting for increased health care spending and the emergence of multi-drug resistant organisms (MDROs) and Clostridium difficile infections in patients and the community. Patients with acute leukemia (AL) are particularly vulnerable populations treated with extensive antibiotics courses during their cancer treatment. An exhaustive search, evaluation, and synthesis of the literature point to implementing evidence-based practice guidelines to improve antibiotic stewardship and outcomes in patients with AL. Based on these findings, an evidence-based quality improvement project was undertaken at a large Midwestern academic medical center from September 2021 to December 2021. The purpose of the project involved the creation of an evidence-based practice guideline for managing febrile neutropenia in hospitalized patients with AL to promote antibiotic stewardship. The Model for Improvement conceptual framework served as the impetus for the practice change. Weekly audit and feedback using the Plan-Do-Study-Act (PDSA) cycle were employed to promote guideline fidelity across providers. Once guideline adherence was achieved at six weeks, long-term metrics for antibiotic utilization and Clostridium difficile rates for the inpatient unit were evaluated. Outcomes of the project revealed clinically meaningful reductions in antibiotic utilization and Clostridium difficile rates on the AL nursing unit. These findings yield encouraging results and highlight the importance of greater resource allocation for future projects to curb antibiotic misuse in this population
Choosing Lifestyle Changes for Promoting Cardiovascular Risk Reduction in a Church Setting
(The Ohio State University, 2024-05) Moore, Valerie; Tussing, Todd
Background: According to the Centers for Disease Control and Prevention hypertension (HTN) affects approximately 55% of African Americans. The frequency of uncontrolled hypertension is 27.4% in Black communities compared to 17% in White communities. Purpose: This initiative's purpose was to provide a 6-week Biblically enhanced With Every Heartbeat is Life (WEHL) program in a church setting. The program emphasized self-care management, lifestyle change, and health education to lower blood pressure readings. Method: The Faith Community Nursing (FCN) Model and WEHL structured program guided its implementation. FCN emphasizes concepts of lifestyle change, patient education, and spiritual support. The WEHL program aligns biblical scripture with each weekly lesson promoting lifestyle change or health education. Outcome: Outcomes revealed a decline of 13 millimeters of mercury in the group’s systolic blood pressure measurement. There was a decline of 10 millimeters of mercury in the group’s diastolic blood pressure measurement. Conclusion: The FCN model along with a structured program emphasizing self-care, disease management, lifestyle change, health promotion, and education positively influences outcomes. The church is an ideal setting for health programs targeting the African American/black community. Nursing Implications: A primary focus of nursing is health promotion and education. Nurses are well positioned to embrace the concepts of community-based care that emphasizes lifestyle changes as a standard treatment modality for hypertension. Keywords: Hypertension, African Americans/Blacks, faith community nursing, With Every Heartbeat is Life
Evaluation of a Leadership Mentor Pilot Program for Nurses of Color
(The Ohio State University, 2024-05) Stith, Keeli; Tucker, Sharon
Background Mentoring is critical for career advancement, especially for leadership and succession planning. Problem A significant proportion of the United States (U.S.) healthcare workforce comprises people from Black and Minority Ethnic backgrounds. Evidence shows that this population is under-represented from management to C-suite levels. Method To support the development of a more racially diverse inclusive nursing workforce and nursing leadership pipeline, implementing a nurse leadership mentor program for nurses of color addresses the disparity of racial and ethnic diversity in nursing leadership. The project aimed to examine the impact of a mentorship program designed for emerging nurses of color interested in pursuing leadership positions. Intervention The three-month initiative “Stepping Up”, adopted a quality improvement framework for implementation and evaluation. The program design principles were adapted and integrated from the Leadership Institute for Black Nurses (LIBN) (Wesley & Dobal, 2009). The program consisted of 3 monthly 1.5 hour educational and group mentoring workshops led by experienced leaders focused on three main leadership topics: 1.) Leadership 101, emotional intelligence, and effective communication; 2.) Networking and Building Meaningful Relationships; and 3.) Resume Building and Interviewing. Supplemental literature relevant to new leaders were offered as resources to the program participants. Each mentor had 2-3 mentees in their pod, where group mentoring took place after the sessions. Mentors and mentees also had the opportunity to set up 1:1 time to further assist their career enhancement. Mentors were provided a guide to aid in interactive discussions utilizing psychologist Albert Bandura 4 sources of self-efficacy (see Appendix F), “the belief that you can accomplish a particular task” (Brown-DeVeaux et al., 2021). The project began with collectively gathering qualitative individual participants (mentees) confidence in themselves to lead others and their beliefs in how their leaders will support their leadership. Evaluation of the program included a narrative qualitative approach using feedback sessions to thematically analyze qualitative feedback about the mentorship program. The program findings included informative qualitative feedback on the necessity of a mentorship program supporting nurses of color to pursue leaderships. Participants reported the program provided greater insight on leadership aspects to make them successful and feeling more confident in networking within the organization.
Improving Communication Between Doulas and Hospital Care Team: A Quality Improvement Project
(The Ohio State University, 2024-05) Graves, Kimberly; Alston, Angela
Black maternal health is in a health crisis state. Maternal mortality rates progressed from 55.3 to 69.9 deaths per 100,000 live births in 2020 versus 2021, respectively. There is strong data showing that doula services improve maternal health outcomes and result in a more positive birth experience. However, doulas are integrated into the healthcare team in diverse ways, making interprofessional communication a challenge. First, a brief discussion is provided regarding the history of medical injustice among Black individuals as a reference of the mistrust that needs to be acknowledged to better understand and meet individual health care needs. Next, opportunities and barriers are discussed regarding community-based solutions for the maternal health crisis among Black birthing persons. The purpose of this DNP scholarly project is to develop, implement, and evaluate a toolkit to improve communication between community-based doulas, hospital-based doulas, and hospital care providers. The literature demonstrates that doulas have a positive impact on patients' emotional and physical well-being. To determine the communication toolkit’s effectiveness, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and post-survey data was utilized.
REDUCING LABORATORY ERRORS THROUGH THE ADOPTION OF TWO PATIENT IDENTIFIERS
(The Ohio State University, 2024-05) Freeman, Doreen; Buck, Jacalyn
This project centers on an evidence-based quality improvement initiative to decrease lab labeling errors associated with patient identification procedures within a labor and delivery unit. The initiative highlights the importance of accurate patient identification and highlights a pivotal strategy for enhancing patient safety and reducing medical errors. The primary objectives of this initiative were to achieve a 10% reduction in lab labeling errors associated with patient identification and to decrease the overall number of patient identification errors by 10%. Through the adoption of evidence-based strategies, the focus was on improving patient safety outcomes and mitigating errors linked to patient identification. Employing a comprehensive approach, the initiative incorporated evidence-based interventions, including staff education on proper patient identification techniques and the effective use of barcode scanners. Efforts were also made to heighten awareness among patients, families, and healthcare professionals regarding the significance of precise patient identification. The initiative yielded favorable outcomes, indicating a positive trend in decreasing lab labeling errors associated with patient identification. These outcomes affirm the efficacy of the implemented strategies. In conclusion, the initiative effectively reduced lab labeling errors associated with patient identification, underscoring the impact of evidence-based practices on enhancing healthcare safety. By reducing lab labeling errors related to patient identification inaccuracies, the initiative promotes a safer healthcare environment.
Impact of Telehealth Interventions in Patients with Diabetes and in Obesity Management
(The Ohio State University, 2024-05) VanHoose, Teresa; Rose, Karen
Obesity and type 2 diabetes are conditions that can be challenging to manage in primary care due to clinical and socioeconomic barriers including limited provider appointment availability, limited appointment time for evidence-based interventions that promote positive outcomes, deficits in patient’s knowledge in self-care and resources, challenges in transportation, and work-related barriers. The purpose of this quality improvement project was to implement evidence-based telehealth interventions in the management of type-2 diabetes and obesity in middle-aged adults. Four telehealth appointments were completed per participant which focused education on the American Diabetes Association’s seven self-care behaviors. A pre- and post- survey of facilitators, barriers, and knowledge or use of community resources was performed. SMART goals were established and measured weekly. Pre- and post-biometric measures were obtained. 100% of participants reported an increase in diabetic self-care knowledge and physical activity as well as decreases in financial and emotional barriers. SMART goals were partially or wholly met (combined) 100% weekly. Initial biometric measures demonstrated overall decreases in weight, body mass index, glycated hemoglobin, and total cholesterol. Findings supported positive outcomes with the implementation of telehealth interventions in diabetic and obese populations.
Managing Adult Depression with the PHQ-8 at Telehealth Follow-Up Visits: A Quality Improvement Project
(The Ohio State University, 2024-05) Chambers-Chrisp, Andrea; Alston, Angela
Telehealth has become an increasingly common route of healthcare delivery since the COVID-19 pandemic that caused global shutdowns and necessitated reimagining how care is delivered. Using objective tools to evaluate and treat depression in the telehealth arena is necessary. Review of literature supports using a validated Patient Health Questionnaire such as the PHQ-8 or PHQ-9 to reassess depressive symptom severity in response to treatment or no treatment. Within the project practice site, the PHQ-8 was not being implemented for telehealth depression follow up appointments. Consultation with a psychiatrist within the organization confirms that the psychiatry department was also not administering the PHQ-8 electronically at depression follow up appointments. The project involved administering the PHQ-8 questionnaire at all telehealth depression follow up visits for the pilot provider. The project achieved 100% assigning of the PHQ-8 to all depression telehealth follow up visits for the pilot provider over the six-week implementation period. There was a 28.5% completion rate by patients due to challenges within the EHR system where the PHQ-8 was not visible to patients for completion. Project challenges support the importance of small tests of change as well as the inclusion of information technology (IT)support into the interdisciplinary team when planning implementation of a quality improvement projects involving EHR systems. Solutions to address the technological issues are needed to expand and sustain the practice change of administering the PHQ-8 to all depression telehealth follow up visits at Organization O.
Implementation of a Nurse Manager Evidence-Based Practice (EBP) Leadership Course
(The Ohio State University, 2024-05) Keene, Jacklyn; Alston, Angela
Background: Evidence-based practice (EBP) correlates with improved patient outcomes. Leadership has been identified as a critical barrier or facilitator when translating evidence into practice. However, nurse managers are not required to complete EBP leadership training at the project site. Objective: The purpose of the Doctor of Nursing Practice (DNP) initiative was to create and measure the impact of a 4-hour educational offering on EBP leadership effectiveness. Methods: The Nurse Manager Leadership Competencies to Support Evidence-based Practice (EBP) Self-Assessment Tool developed by Caramanica et al. (2022) was used to measure nurse manager leadership competencies in supporting clinicians use of EBP. Nurse manager participants (n=10) completed an immediate pre-intervention self-assessment with an immediate post-intervention comparison. Outcomes: Nurse manager self-assessment ratings increased in 21 of the 22 nurse manager leadership competencies. The largest positive changes in self-assessment ratings were realized in statements regarding the nurse manager’s role in enabling EBP, championing EBP projects, prioritizing EBP projects to align with the organization's goals, and providing staff access to EBP education.
Psychosocial Distress Management in an Outpatient Oncology Clinic: A Quality Improvement Project
(The Ohio State University, 2024-05) Rhoades, Jill; Dush, Jennifer
People with cancer have a high prevalence of psychosocial distress. Distress affects treatment adherence, medical service utilization, quality of life, and mortality. Identifying distress through screening and referral to supportive services alleviates psychosocial distress and improves health outcomes. Despite the Commission on Cancer distress screening requirements for accreditation, compliance is variable. An evidence-based quality improvement project was implemented in an outpatient oncology clinic to improve distress screening for all new and established patients using an adapted version of the National Comprehensive Cancer Network Distress Thermometer and Problem List distress screening tool. The project also aimed to improve documentation on distress screening based on a pre- and post-chart audit. A learning module was developed, and the project was implemented over 6 weeks. A multidisciplinary team collaborated to identify workflow barriers to screening compliance and to improve the workflow process. The Practice & Process Improvement Model was used to ensure ongoing evaluation of the workflow to improve screening rates. Preliminary data showed distress screening was completed with only 65% of newly referred patients; established patients were not screened before this project. Screening rates post-implementation improved to 100% among both newly referred and established patients. Chart audits showed that clinical documentation of distress screening results improved. The multidisciplinary team reported that participation in this continuous quality improvement of distress screening and referrals increased their awareness of the importance of distress screening and improved their referral to appropriate resources.
Gastric Ultrasound Education for Nurse Anesthetists
(The Ohio State University, 2024-05) Wechsel, Kendra; Hu, Jie
Background: Student nurse anesthetists (SRNAs) are now required to track clinical hours spent engaging in point of care ultrasound (POCUS) clinical experiences. Additionally, the absence of POCUS utilization can negatively impact patient outcomes. Gastric ultrasound (GUS) is a POCUS exam, and provides an objective method to assess for adequate gastric emptying prior to anesthesia administration. Purpose: The purpose of this evidence-based quality improvement project was to implement an educational program for nurse anesthetists (CRNAs) on GUS following the I-AIM model. Upon completion of this education program, CRNAs would demonstrate an increase in knowledge regarding GUS. Methods: This doctor of nursing practice (DNP) project took place at the Ohio State University Wexner Medical Center (OSUWMC) within the anesthesia department. Anesthesia advanced practice providers (AAPPs) were recruited to participate in education on GUS. Guided by the I-AIM model, a blended curriculum of didactic and hands-on education was provided. Knowledge was tested using the Gastric ultrasound knowledge assessment tool, which was distributed prior to GUS education, and after completion of education. Results: Thirty-one AAPPs completed the pretest survey, 20 participants attended the didactic session in-person, and additional AAPPs participated remotely. Twenty AAPPs participated in the hands-on education session, and 10 completed the posttest survey. The educational program demonstrated a 28.47% increase in knowledge regarding GUS. Conclusion: The implemented curriculum was shown to increase AAPPs knowledge regarding GUS. This program could be used to further establish competency protocols for GUS, as well as serve as a blueprint for future POCUS education.
Using the I-PASS Standardized Report Tool in the Emergency Department: Quality Improvement Project
(The Ohio State University, 2024-05) Orecchio, Caroline; Jun, Jin
Medical errors from poor communication in hospitals is a common occurrence that is costly, yet avoidable. Patient handoffs between nurses are one of the most common periods where communication breakdown occurs due to a myriad of contributing factors, such as busy nurses, lack of standardization of handoff, and lack of proper handoff techniques. Communication breakdown poses a major risk to patient safety and is a large source of financial strain for hospitals. I-PASS (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) is an easy-to-use, effective, and cost-efficient tool to standardize handoff communication between emergency departments and inpatient units. The purpose of this quality improvement project was to implement the use of I-PASS to improve the communication between the emergency department and inpatient units at a large, metropolitan hospital while improving nurses’ perception of patient safety. Registered nurses in the emergency department received training on the use of I-PASS in multiple approaches: staff meetings, emails, and continued education. An assessment was distributed to nurses to assess pre- and post-intervention on the usability and potential implications in the ED setting. At the end of the 6-week implementation, 61.4% of nurses (n = 54) self-reported using I-PASS in 75% or more of handoff communications. In general, the nurses reported that I-PASS was easy, simple, and usable (n=31). Lastly, 97.1% of nurses (n = 67) agreed that I-PASS would improve handoff practices and 98.6% of nurses (n =70) agreed that the I-PASS handoff tool would be effective for patient safety.
Electronic Standardized Handoff for Anesthesia Providers: An Evidence-Based Quality Improvement Initiative
(The Ohio State University, 2024-05) Dalzell, Christina; Beckett, Cindy
Communication errors have been identified as a contributing cause of patient harm and death in healthcare. Handoffs of care are error-prone and a source of risk. The initiative implementation organization reports an average of four communication errors per month related to intraoperative handoff of care. The literature identified that intraoperative handoff of anesthesia care is associated with worse patient outcomes and that standardization of the process can improve quality of handoff as well as provider satisfaction. The purpose of this initiative is to implement an intraoperative standardized handoff for anesthesia providers; with the goal to decrease variation in handoffs, improve communication, and improve provider satisfaction. This evidence-based quality improvement initiative was designed as a staged roll-out for intraoperative anesthesia providers to use an organizational derived handoff tool at ten anesthesia sites. Participants included certified registered nurse anesthetists, anesthesia residents and anesthesia assistants. Participants filled out a pre-implementation and post-implementation Qualtrics survey. Improvements were shown in provider satisfaction with the new handoff process, as well as increased use of a standardized handoff process. Pre-implementation the site averaged one communication error related to handoff per quarter. Post-implementation, zero communication errors were reported for the data collection quarter. Initiative findings show an increase in the use of a standardized handoff, improved satisfaction, and decreased communication errors. This initiative was well received and has the potential to lead to improvements in intraoperative anesthesia handoff of care once implemented to more anesthesia sites with improved compliance.
Implementation of a Geriatric Pathway for Trauma Patients: An Evidence-Based Quality Improvement Initiative
(The Ohio State University, 2024-05) Mulder, Courtney; O'Brien, Tara
Background The United States’ population of older adults is expected to surpass 87 million by the year 2050. Trauma is the leading cause of morbidity and mortality. Despite appropriate trauma resources, the older adult cannot handle the trauma impact, due to natural biologic changes and medical comorbidites. As the population continues to age, partnership between trauma and geriatric services is paramount to provide optimal care. Purpose The purpose of this quality improvement project was to evaluate the implementation of an evidence-based practice frailty pathway on length of stay and 30-day read mission rates in geriatric trauma patients. Methods The frailty pathway was revised at a Midwest academic medical center hospital, which included all patients older than 70 receiving a geriatric consult. Staff was educated in an individual and group setting. Pre- and post-implementation data were collected, including hospital length of stay, number of geriatric consults, 30-day read mission rates, percentage of frailty screening, and in-hospital complications. Results From 2022 to 2023, geriatric patients increased from 315 to 360 patients. Despite no increase in frailty screening or geriatric consults, the hospital length of stay decreased from 6.56 to 6.39 days and readmission rates stayed consistent from 2.53 to 2.77%. Implication for Practice Despite the unexpected setting challenges and 115% increase in patient census, hospital length of stay for geriatric trauma patients decreased and hospital readmission rates stayed consistent with the implementation of a geriatric frailty pathway.
Enhancing Computer Assisted Provider Documentation Software Usage and Adoption: An Evidence-based Quality Improvement Initiative
(The Ohio State University, 2024-05) Rivers, Crystal; Gillespie, Shannon
Background: Many providers describe the clinical documentation clarification process as painstaking, leading some healthcare organizations to purchase technological solutions such as computer-assisted provider documentation software to combat these issues. This solution assists providers with compliant documentation while reducing provider burden and improving documentation quality. However, despite these benefits, provider usage and adoption is low. Purpose: This quality improvement initiative aimed to identify and implement an evidence-based strategy to enhance acute care provider computer-assisted provider documentation usage and adoption. Project: A comprehensive literature search identified seventeen relevant articles. The pertinent evidence informed compiling of a six-component strategy, which addresses commitment to success, marketing and awareness, technical readiness, training and enablement, data monitoring, and program sustainability during software deployment at three sites. At eight weeks post-deployment, usage and adoption was evaluated and compared to historical data from 19 comparator sites representing acute care academic and community facilities across 10 states. The three implementation sites were similar with 342 to 544 acute care beds. Findings: The three deployment sites demonstrated a 38.07% lower average view rate, a 23.09% higher average resolve, and a 55.91% higher documentation rates than the comparator sites. Conclusions: Findings suggest that an evidence-based implementation strategy can support better computer-assisted provider documentation adoption metrics, i.e. resolve and documentation rates. Additional assessments are needed to determine the strategy’s effect on the view rate, as a technical defect affected the results. Despite this defect, the strategy may be of keen interest to teams working to increase usage and adoption of computer-assisted provider documentation and related healthcare software.
Implementing the 10 Dimensions of Wellness to Reduce Clinician Burnout in Ambulatory Care: An Evidence-based Quality Improvement Initiative
(The Ohio State University, 2024-05) Escalon, Griselda; Beckett, Cindy
Background: Our nation is experiencing high rates of ambulatory and acute care clinicians and healthcare staff burnout. Burnout causes personal and individual loss in the clinician’s mental and physical health, it causes an increase in social and economic costs for their organizations, and it causes a decline in the quality of care provided to patients. Healthcare leaders need to advocate and implement major improvements in the clinical work and learning environments to overcome this national and local crisis. Purpose/Aim: This EBQI initiative took place at a Federally Qualified Health Center (FQHC) clinic located in the Rio Grande Valley. The loss of healthcare clinicians at this clinic jeopardized the fulfillment of the FQHC mission to provide the community with access to high-quality and cost-effective healthcare. This initiative aimed to improve clinician well-being and reduce burnout. Methods/Implementation: This EBQI initiative implemented the 10 Dimensions of Wellness over 10 weeks at Su Clinica’s four clinic sites. The Maslach Burnout Inventory Emotional Exhaustion (MBI: EE) measure was used to measure provider burnout. Strategies to promote well-being were implemented by conducting monthly and individualized meetings, and by promoting effective communication between administrators and other stakeholders. The implementation also included bringing awareness and validation to the symptoms of provider burnout through education. Outcomes: Implementation of the 10 Dimensions of Wellness resulted in providers reporting decreased burnout and an increase in their ability to improve their well-being. Conclusions/Implications for Practice: Ambulatory care is critical in meeting the growing healthcare needs across communities. With the increasing number of uninsured or underinsured patients being treated in ambulatory care settings, the demands on the nurses, providers, and staff can be overwhelming. The stresses can lead to burnout and turnover. Integrating a wellness program, such as the 10 Dimensions of Wellness, can provide strategies for preventing burnout and enhancing clinical well-being.

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