Doctor of Nursing Practice Final Document Projects

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Improving Pediatric Primary Care Universal Lipid Screening in 9-11-year-olds
(The Ohio State University, 2023-08) Shaw, Lindsey; Militello, Lisa
Cardiovascular disease is the leading cause of death in the United States and is linked to childhood dyslipidemia. 30-60% of childhood dyslipidemia cases are missed due to lack of universal screening. In 2011, the National Heart Lung Blood Institute (NHLBI) lipid screening guidelines were updated to include universal screening in 9–11-year-olds. The American Academy of Pediatrics (AAP) endorsed these guidelines in 2014 and added them to the Bright Futures recommendations. At the project site, the primary care providers (PCPs) were not aware of the universal lipid screening guidelines and not performing childhood lipid screening as indicated by the NHLBI and AAP. The purpose of this EBP project was to increase provider adherence with NHLBI and AAP Bright Future's recommended universal lipid screening guidelines during 9–11-year-old well child visits to identify dyslipidemia and potentially reduce future risks and complications of heart disease. An Advanced Practice Registered Nurse (APRN) conducted a quality improvement (QI) project utilizing the plan, do, study, act model to improve PCPs' knowledge and adherence to ordering universal lipid screening at 9-11 year well child visits (WCV). The primary care providers completed a knowledge survey and attended an educational in-service. Criteria for adherence to the guidelines included documentation of correct diagnosis code with an associated lipid profile order. Results of the QI project demonstrated 1) an improvement in baseline knowledge regarding the universal lipid screening guidelines and 2) an increased ordering rate of universal lipid screenings baseline of 0.5% to 82% by the end of the second month of data collection. Findings support in-service as a mode to support primary care staff to improve adherence to NHLBI universal lipid screening guidelines.
A Quality Improvement Project Using a Mindfulness Application to Help Combat the Effects of Burnout among Primary Care Healthcare Professionals
(The Ohio State University, 2023-08) Fugate, Stacy; Tussing, Todd
The U. S. Surgeon General published an urgent advisory on healthcare worker burnout, as more than half of nurses, physicians, and mental health workers were experiencing burnout (USDHHS, 2022). The literature identified an intervention that demonstrated effectiveness to decrease burnout among healthcare professionals, using online mindfulness strategies, such as Headspace®, to help combat stress and burnout. The project purpose was to decrease stress and burnout in healthcare professionals working in a primary care FQHC office setting by supporting their use of mindfulness. The design of this project was for participants to utilize at least one activity within Headspace® daily for eight weeks. Participants completed pre and post surveys to compare data for clinical significance based on responses to the Perceived Stress Scale (PSS-10) and single-item burnout questionnaire. The project population consisted of 26 health professionals working within a rural Federally Qualified Health Center (FQHC) primary care office setting. The single item burnout question revealed that the average pre-implementation response was 3.7 out of 6 with a post-implementation average of 2.5 out of 6 (lower value indicates improvement). Comparing the weighted average for each question within the PSS-10 indicates that there was improvement in outcomes on the post-survey when compared to presurvey responses. Project findings indicate a positive clinical significance with respect to using a mindfulness app on employees' perception of work burnout and stress. Post-implementation data analysis and interpretation indicates that implementation and utilization of an online mindfulness-based application can help improve stress and decrease burnout for healthcare employees working in primary care.
Implementation of a Patient Centered Care Tool on an Acute Care of the Elderly (ACE) Unit
(The Ohio State University, 2023-08) Caldwell, Anna; Tate, Judith
Background: Despite the importance of patient centered care (PCC), adoption into routine acute care practice remains inconsistent (Moore et al., 2017). Older adults who are frail or have cognitive impairment can be easily overlooked in the acute care setting. One strategy for implementing PCC is the use of a "Get to Know Me" (GTKM) tool to help improve communication, identify patient values and personalize care interventions (Fick et al., 2013). Aims: The purpose of this DNP project was to promote PCC on an ACE unit through use of a "Get to Know Me" poster with the aims to increase patient satisfaction and nursing perception of providing patient centered care. Methods: This was a quality improvement (QI) project that was conducted over 4 weeks on an ACE unit in a community hospital. The GTKM posters were completed using information from patients/family and posted during the hospital stay. Patient satisfaction was measured through interviews performed at random with 3-4 patients/family members weekly. The Person-Centered Care Assessment Tool (P-CAT) was used to describe nurse perceptions pre- and post-implementation. Additionally, nursing perceptions of the poster were collected weekly during audits of completion. Results: Increased perception of patient centered care was accomplished by a 24% increase in "Agree" and "Strongly Agree" responses on the P-CAT survey subscale 1. Of the patients/families interviewed 83% reported that they perceived the poster as being helpful in the care received. Both nursing and patient/families reported the GTKM poster increased communication. Conclusion: The "Get to Know Me" poster was perceived as a useful tool for providing patient centered care and increasing communication on an ACE Unit by nursing staff and patients/families
Enhancing Personal Leadership Skills in Novice Nurse Managers
(The Ohio State University, 2023-05) Mergos, Carolyn; Bowles, Wendy
The COVID-19 pandemic required a shift in priorities and redeployment of resources, leaving professional development opportunities lacking for staff across a pediatric teaching hospital in the Midwestern United States. This absence was particularly felt by novice nurse managers who found themselves needing to provide leadership during a critical time, with minimal training in the necessary skill set. To prepare nurse managers to successfully transition into their leadership role, an evidence-based leadership development program was implemented. Nine nurse managers in the first 12 months of their role participated. The program consisted of three, 1.5-hour sessions focused on the leader within domain of the American Organization for Nursing Leadership Nurse Manager Competencies Framework and included lecture, reflective practice, and group discussion. Objectives included: implementing a leadership development program for nurse managers who were in the first 12 months of their role, increasing competence in the leader within domain of the AONL nurse manager skills inventory by 20%, and gathering program evaluation data on relevance and intent to apply the learning, with the goal of 90% of participants rating the sessions as "very" or "extremely relevant" and "probably" or "definitely" intending to apply the learning to their work. Six managers completed all sessions, with four completing the post-assessment. These four participants did show a 20% increase in the leader within domain of the AONL manager competency self-assessment following the program. On the program evaluations 100% of respondents stated that they would "probably yes" or "definitely yes" use what they learned, and 83.3% to 100% stated that content was "very relevant" or "extremely relevant" to their job. This project demonstrated the potential effectiveness of the program, while being limited by a small group of participants. The program evaluation highlighted areas for ongoing education, the impact of peer interaction on learning, and time as a barrier to managers' ability to participate in necessary leadership development.
Implementation of a Mentorship Program to Reduce New Graduate Nurse (NGN) Turnover
(The Ohio State University, 2023-05) Bell, Susan; Rose, Karen
Objective: To implement an evidence-based mentorship program to improve new graduate registered nurse (NGN) retention. Background: About 17% of NGN leave within the first year of employment. The average turnover cost for a registered nurse (RN) in the United States is $46,131. A significant opportunity exists for healthcare organizations to protect the investment of NGNs. Methods: A 3-month mentorship program for NGNs was implemented at a Magnet-designated Midwest community-based healthcare center about 11 weeks after hire. Twenty matched pairs participated in the inaugural program guided by the American Medical Surgical Nurses Mentorship Program. Mentors volunteered, and mentees were selected based on the hire date from a subset of the incoming pool of NGN. Results: Participant characteristics show that 90% of the mentors and 85% of the mentees were female. Demographic data revealed average age (mentors 43.1 years versus mentees 24.9 years), degrees (mentors 65% with master's degree versus mentee 100% with bachelor's degrees), and years in nursing (mentors 60% greater than 11 years and mentees 100% less than one year). Post implementation, 100% of the mentees (N = 20) remained employed. Mentee confidence from baseline to 3 months post-implementation showed a slight increase. Mentee intent to stay and job satisfaction scores post-implementation were moderately high, with 35% and 40% responding, respectively. The average program satisfaction score for both groups was 69.5%, with 35% of the mentees and 95% of the mentors responding. Conclusion: Implementation of a mentorship program is cost-effective and can impact NGN retention and turnover.
A Peer Support Tool Kit to Increase Exclusive Breastfeeding Rates in African American Women
(The Ohio State University, 2023-05) Gladney, Annedra; Masciola, Randee
This DNP quality improvement project aims to create a peer support tool kit based on identified gaps recognized in the organizational assessment to improve and increase the effectiveness of the outpatient lactation peer support group (PSG). The first phase of a longitudinal project is to use strategies to increase PSG attendance with the goal of increasing exclusive breastfeeding rates in African American women (AAW). Exclusive breastfeeding is defined as breast milk only with no solids, water, or other liquids. The exclusive breastfeeding rates in postpartum (PP) patients was investigated over a one-month period. The toolkit includes the following evidenced based strategies to help increase PSG attendance: a breastfeeding support resource document (BSRD) listing local and national breastfeeding resources and support groups for all patients, an inclusive advertisement flyer, and microlearning sessions. As a result of the toolkit, 100% of the PP participants received a copy of the new BSRD during their discharge education. The marketing team was unable to coordinate a meeting with the student to discuss marketing strategies and the revision of the PSG advertisement flyer. The IBCLCs agreed to have the microlearning sessions implemented into the PSG. The project concluded that ensuring each pp patient receives a copy of the BSRD during discharge education, continuing to provide breastfeeding education, and the continued usage of the PSG tool kit would be effective strategies for increasing PSG attendance and, ultimately, exclusive breastfeeding rates. The next steps will include continuing to work with the marketing team to create more inclusive flyers and advertisement, use the peer support tool kit during less active sessions, continue ensuring each pp patient receives a copy of the BSRD before discharge, and have the women's health clinical manager continually monitor the month-to-month trends and percentages of the exclusive breastfeeding rates.
The Effectiveness of Teach Back Method on Blood Pressure Control in Patients with Hypertension
(The Ohio State University, 2023-05) Connors, Christopher; Anderson, Cindy
The DNP quality improvement project evaluated the effect of teach back (Tback) on blood pressure (BP) control in a hypertension population over a period of 1 month. Tback is an education method where the provider educates the patient on their health, after which the patient repeats it back to the provider. Tback has been shown to improve self-management. The DNP project was implemented in the first month of a 3-month long existing self-monitoring blood pressure community referral program (SMBPCRP) at a Federally Qualified Health Care facility. The SMBPCRP comprises of an initial registration appointment, 2-week follow-up , monthly follow up with a pharmacist/nurse practitioner, and optional meetings with a registered dietitian. Tback was used at the initial registration appointment where education on lifestyle modifications was introduced, tailored to the patient's unique needs. Blood pressure control and self-management were evaluated among those who received Tback (n=18) and those who received routine care (n=15). Participants who received Tback had improved blood pressure control with decreased systolic and diastolic BP as well as higher daily SMBP frequency in the first three weeks in the group who had received Tback. Incorporation of Tback improves BP control and self-management in the short term. Refinement of Tback timing and reinforcement may have beneficial effects in the long term.
Using the After-Visit Summary to Facilitate Education, Guide Care, and Reduce Nurse Call Volume: A Quality Improvement Project
(The Ohio State University, 2023-05) Lu, Angela; Tucker, Sharon
The purpose of this quality improvement project was to implement a practice change of using the after-visit summary (AVS) to facilitate patient education, guide care, and reduce nurse call volume in an ambulatory pediatric orthopedic practice. Nurse calls from patients/families reached an all-time high within the orthopedic practice which led to prolonged wait for return calls leading to unnecessary ED visits, inappropriately self-scheduled patients in clinic, decreased patient outcomes, and decreased patient satisfaction. A critical appraisal of evidence clearly demonstrated that appropriate patient education after provider visits was correlated with fewer questions from patients and caregivers. Reduction of calls to the nurse call line allows for prioritization of the patient/parent questions the patient/parent questions that have a higher level of critical need and may require provider intervention. Implementation of this project had the potential to improve patient satisfaction as well as patient outcomes because of the impact on the nurse call line volume. The model used to guide this quality improvement project was the IHI Model for Improvement; the Plan, Do, Study, Act (PDSA) cycle proposed for this project is an implementation of a team-based, best practice use of the AVS with patient education. Pre- and post-data collected included an analysis of call logs and AVS use. Results showed significantly increased compliance with providing the AVS to patients by 26%, however only 2% reduction of education related calls. Patient satisfaction scores did increase over time on average by 7%. Limitations of this project includes the short time frame and specialty specific location of the implementation.
Improving the ability of health care professionals to address health misinformation: a quality improvement project
(The Ohio State University, 2023-05) Roll, Katie; Teall, Alice
Background: Health misinformation is a serious threat to public health, as it not only causes confusion but also sows mistrust of health professionals and the healthcare delivery system. By virtue of professional obligation, nurses, nurse practitioners, physician assistants and physicians have a responsibility to confront false or misleading health beliefs; however, to truly engage with patients, health professionals must feel confident in their communication skills, which can be improved through training and quality improvement (QI) efforts. Objective: The purpose of this evidence-based QI project was to improve health professionals' ability to effectively address health misinformation. Methods: Pre- and post-surveys were used to assess the confidence, knowledge, and skills of health professionals practicing in an outpatient oncology setting in which all have experienced at least weekly encounters in which a patient shares their beliefs in health misinformation. WordPress was used to design an asynchronous educational module on an open platform site to provide training to learn communication strategies for addressing health misinformation. Results: Following project implementation, the percentage of health professionals (n=14) who were moderately or extremely confident in effectively addressing health misinformation increased from 26.67% to 42.85%. Health professionals agreed or strongly agreed (92.86%) that the microlearning modules were helpful in learning communication skills to address misinformation. Conclusions: A critical contribution toward future mitigation of health misinformation will be the universal training of health professionals in knowing how to confidently encounter a patient with strongly held beliefs that are in opposition to evidence-based research and science.
Implementation of Geographical Nursing Assignments on a Medical-Surgical Unit: An Evidence-Based Project to Improve Nurse Efficiency, Nurse Satisfaction, and Patient Outcomes
(The Ohio State University, 2023-05) Jackson, Amy; Chipps, Esther
Nurse-patient assignments have an influence on both nursing staff and patient care. It is identified that inpatient hospital units prioritize nurse-patient assignments based on patient acuity and do not account for their geographical location; therefore, nurse-patient assignments are geographically dispersed throughout the inpatient unit. The focus of the project was to create nurse-patient assignments using geographical clustering (GC) on an inpatient Medical-Surgical unit, making their assignments closer together to improve nurse satisfaction, patient satisfaction, and quality measures. The literature stated that nurses who have closer proximity to their patients results in nursing step reduction, patient satisfaction, and increased direct patient-care time. Geographical clustering of nurse-patient assignments on the inpatient project host unit had a total implementation period of ten weeks. Data measures collected include nursing satisfaction, patient satisfaction, and unit quality data pertaining to falls, HAPIs, and call-lights. Pre-implementation data from July 1, 2022, to September 18, 2022, was compared to post-implementation data from September 19, 2022, to November 30, 2022. The findings support that GC improves nurse satisfaction, patient satisfaction, reduced patient falls and falls with injury, along with improving call-light responsiveness and reduction in number of times patients pressed their call-light. Ongoing data methods need to be collected to determine if GC reduces the number of steps nurses take during their shift.
IMPACT OF TEAMSTEPPS ON RN-TO-RN INTERACTION
(The Ohio State University, 2023-05) Cottrell, Barbara; McNett, Molly
Background: The performance of a nursing team is a key component of hospital quality and safety. Baseline data at this practice site was below the national benchmark for RN-to-RN Interaction on the National Database of Nursing Quality Indicators (NDNQI) Job Satisfaction Scale. Findings from the literature demonstrate TeamSTEPPS and interactive learning is one method to address teamwork and support among a healthcare team. Purpose: The purpose of this Doctor of Nursing Practice evidence-based practice project was to increase teamwork among nurses after implementation of TeamSTEPPS. Methods: Registered nurses on a medical-surgical unit completed escape room sessions to learn about TeamSTEPPS concepts. The primary outcome measure included NDNQI RN-to-RN Interaction scores. Additional data was gathered on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Nurse Communication scores and TeamSTEPPS rounding observations. Results: The primary outcome data measuring NDNQI RN-to-RN Interaction demonstrated an overall increase from baseline. Secondary outcome data measuring HCAHPS Communication with Nurses showed a positive influence on scores after intervention. The third outcome measure of TeamSTEPPS rounding observations demonstrated very good to excellent understanding and skill on how to apply the appropriate learned techniques. Conclusions: Integration of TeamSTEPPS tools and strategies in an escape room session is a fun, interactive way to learn while providing an effective team-building activity. Implications for Nursing: The integration of TeamSTEPPS had overall practical significance on the impact of RN-to-RN Interaction when delivered in an escape room setting. This has the potential to help organizations needing to improve teamwork and communication among nurses.
Why The Wait? Reducing Length of Stay for Patients with Lacerations
(The Ohio State University, 2023-05) Oman, Scott; Hoying, Jacqueline
Introduction: Patients with facial/scalp lacerations navigate several steps prior to wound repair. These steps include intake, triage, assignment to an exam room, and assessment by a provider who then orders topical anesthetic gel. This gel requires 30 minutes to reach full effect before the repair procedure can begin. The following describes an evidence-based practice project aimed at reducing overall length of stay (LOS) for patients with facial/scalp lacerations presenting to the urgent care of a large urban pediatric hospital. Methods: A literature search was conducted for articles relevant to using topical anesthetics in triage. The articles were critically appraised for strength of evidence and relevance to the project. The evidence revealed that using topical anesthetic gels in triage can decrease LOS, a key driver of patient/caregiver satisfaction. The project's intervention is the implementation of a workflow in which triage nurses ask a provider to assess the patient's laceration during triage and, if appropriate, order topical anesthetic gel to be administered immediately. LOS data were trended before and after the intervention. Results: The data showed a 48-minute decrease in average LOS. The analysis was compounded by a significant fluctuation in patient volumes due to a nationwide surge in pediatric respiratory viruses. Despite this, additional ad-hoc analysis demonstrated that the intervention had an effect in the demonstrated reduction in LOS (Cohen's d = 0.46). Discussion: These results indicate that expansion of the new workflow across the healthcare network may be beneficial in helping to decrease LOS for similar patients across other sites.
Evaluation of an Evidence-Based Genomics Education Program for Oncology Nurses
(The Ohio State University, 2023-05) Dickman, Erin; Overcash, Janine
Rapid developments in technology and therapy based on genomic information has allowed precision oncology to become the standard approach to cancer care over the last decade. As essential members of the healthcare team, it is imperative that oncology nurses understand basic genomic concepts to inform patient care. However, a genomic knowledge deficit exists among oncology nurses at all levels of practice because a gap in curriculum in pre-licensure nursing programs and limited continued education. The objectives of this project were to evaluate oncology nursing attitudes, improve knowledge, and increase likelihood of adoption of genomics after engaging in a multi-modality genomics education program. A pre- and post-educational survey was offered to the program participants. Descriptive statistics and t-tests were performed to evaluate scores on the pre and post surveys. Cohen's d was used to measure effect size. Most of the participants (N=257) were baccalaureate (42%) prepared and 87% reported no genomics content in pre-licensure nursing education. Attitudes of nurses regarding integrating genomics into oncology were not significantly different upon pre (0.86) and post intervention (0.89) evaluation (p=0.10) but were high at baseline. Tested knowledge of genomics increased post intervention from 0.58 to 0.69 (p=0.0001). Approximately, 90% reported an intent to integrate genomics into their practice whether that be to inform patient education (34%), educate colleagues (20%), or enhance their patient assessment (19%). A genomics education program that provided adult learning opportunities and integrated clinical practice resources to be used in daily practice increased participant's perceived and tested knowledge.
Implementation of a Cognitive Behavioral Skill Building Program to Improve Well-Being in Nurse Managers
(The Ohio State University, 2023-05) Young, Christine; Amaya, Megan
Background: The American Organization for Nursing Leadership study (2021) found that nurse managers are experiencing high levels of stress which is negatively impacting their well-being. Purpose: The purpose of this project was to implement a cognitive behavioral skill building program for nurse managers to improve well-being. Methods: The population was 22 nurse managers who work in an acute care setting in a midwestern pediatric hospital. The MINDBODYSTRONG program was implemented using a virtual platform with one session per week for a 7-week period. Outcome measures were perceived stress, job satisfaction, overall health, intent to leave, and program evaluation. Data collection was completed via survey one week prior to implementation and one week after program completion. Survey tools used were the 4-item Perceived Stress Scale (PSS-4), 7-item Job Satisfaction Scale (JSS), overall health question from the RAND 36-Item Short Form Health Survey (SF-36), Intent to Leave questions and a program evaluation. Results: There were no statistically significant differences between pre- and post-survey scores for perceived stress, job satisfaction, overall health, or intent to leave scores. There were large and medium effect sizes for single items on the PSS-4 and JSS. Program evaluations showed that one hundred percent of participants felt the program was helpful. Conclusion: Clinical significance of the program was demonstrated with impact on perceived stress and job satisfaction as measures of well-being. Participants reported the program was beneficial on the program evaluation. Further analysis of qualitative themes from the program evaluation is recommended to evaluate the impact of the program.
Development of a Mentoring Program to Increase Leadership Competency for Early Career Nurse Leaders: An Evidence Based Project
(The Ohio State University, 2023-05) Chesnick, Holly; Chipps, Esther
Early career nurse leaders (ECNL) often lack the leadership competencies necessary to support staff and a healthy work environment (HWE). Deficits in competency leads to performance problems, frustration, and intent to leave the role. The purpose of the evidence-based project was on developing a mentoring program to improve leadership competency of ECNLs, to positively impact job satisfaction, reduce burnout, and intent to leave. The mentoring program, based on the American Organization of Nursing Leaders (AONL) essential competencies (2015), created a structured approach for mentored support for ECNLs with less than three years of experience at the selected hospital. Weekly mentored sessions focused on AONL's nurse manager learning domains, case studies, lived experiences, and reflective journaling to relate theory to practice. The mentoring program was evaluated utilizing the AONL Nurse Manager Assessment, Nursing Workplace Satisfaction Questionnaire (NWSQ), Maslach Burnout Inventory-General Survey (MBI-GS), and Houser's Intent to Leave survey. Data collected at baseline (N=7) was compared to post-program (N=5) data showing improvements of 0.4 to 0.8 in leadership competency domains, movement in three out of five participants' level of burnout, 18% increase in job satisfaction, and 60% neutral response with intent to leave the role. The mentoring program data shows positive improvements in competency, burnout, and job satisfaction, indicating a benefit to ECNLs development and satisfaction in their role.
Enhancing Fall Risk Reduction on an Ambulatory Oncology Hematology Clinic
(The Ohio State University, 2023-05) Kurzen, Amber; Overcash, Janine
Background: Falls affect one out of every two people who are diagnosed with advanced cancer which result in injury. Evidence recommends physical therapy (PT) as an important fall prevention intervention. Objectives: To increase the use of fall risk reduction interventions by increasing nurse self-efficacy (SE), increasing falls documentation, entering PT referrals, and reducing the monthly average of fallers. Methods: This evidenced-based practice project (EBP) included ambulatory care nurses at a large Midwest academic cancer center. A short falls learning module focused on falls screening documentation and PT referrals for high falls risk patients was provided live during the workday. The Self-Efficacy for Preventing Fall Nurse Scale (SEPFN) was administered before and following the falls learning module presentation. Descriptive statistics were calculated to evaluate documentation, number of PT referrals, and number of fallers pre- and post-intervention. Findings: The participants (N=11) included 6 pre-survey and 5 post-survey responses. SE level on the SEPFN increased following the module. Falls risk screening documentation increased post-intervention from 64.8% to 67.9%. PT referrals (N= 13) were entered out of 137 patients who screened as high falls risk. The monthly average of fallers decreased from 8.43% to 6.67%. A falls learning module and PT referrals enhance fall risk reduction.
Unmet Palliative Care Needs in the Medical Intensive Care Unit
(The Ohio State University, 2022-08) Skinner, Victoria; Browning, Kristine
Background: The implementation of high-quality palliative care in the intensive care unit (ICU) varies greatly. A lack of palliative care in the ICU has been shown to have a negative impact on patients, families, staff, hospital resources, and healthcare costs. Currently, there is no policy or guideline in place for palliative care integration within the ICUs at this medical center. Objective: The objective of this project is to evaluate if the implementation of an Advanced Practice Provider (APP)-driven standardized assessment tool to help identify patients with unmet palliative care needs impacts specialty palliative consults in the medical intensive care unit (MICU). Design: An unmet palliative care needs assessment tool was added to a daily ICU rounding checklist and the MICU APPs were asked to incorporate this tool within their daily practice. Prior to implementation, MICU APPs were provided with education on palliative care and available resources. Setting: Project implementation took place in a twenty-four bed MICU at a large academic medical center located in the Midwest. Results: Baseline data was compared to implementation data which revealed that the assessment tool had no impact on the number of palliative consults, hospice referrals, or the mortality index for the four-week implementation period in the MICU. APP responses to a post-implementation survey, which had a 50% completion rate, provided helpful feedback. Conclusion: Overall, this project provided potential future implications for improving palliative care within this such as the implementation of a palliative care tool within services outside of the MICU; focusing on the identification and management of cancer related symptoms in the MICU; and using a standardized tool to promote involving palliative services earlier in a patient's ICU or hospital stay.
Enhancing Pediatric Mental Healthcare in an Outpatient Primary Care Setting
(The Ohio State University, 2022-12) Rust-Overman, Sarah; Overcash, Janine
The Centers for Disease Control (CDC) estimates annually that 1 in 5 children has experience a mental disorder (CDC, 2022). Many barriers exist to establishing a mental health diagnoses and treatment plan in a timely manner. The purpose of this quality improvement (QI) project is to enhance the management of pediatric mental health in the primary care setting of a Federally Qualified Health Clinic in central Ohio. The primary objectives of this scholarly project include: 1) to increase access to pediatric mental health care and diagnosis which will be reflected in the number of office visits associated with mental health ICD.10 codes, and 2) to increase provider confidence in managing pediatric mental health as a result of the completion of the KySS Program modules and 3) to describe participant perceptions of the KySS learning modules. Participants will complete KySS training and confidence will be measured using a Healthcare Provider Confidence questionnaire pre- and post- educational intervention. The participants will also complete an anonymous survey to gather feedback and perceptions post- intervention. Frequencies of ICD.10 codes will be compared pre- and post-intervention. Means pre- and post- educational intervention will be compared using Wilcoxon rank-sum and Cohen's D will be used to measure effect size.
A Quality Improvement Project to Effectively Decrease Opioid Prescribing for Adolescents after Posterior Spinal Fusion Surgery
(The Ohio State University, 2022-08) Falcone, Kelly; Teall, Alice
Introduction: Pain is the greatest concern discussed preoperatively for patients undergoing a posterior spinal fusion (PSF) for Adolescent Idiopathic Scoliosis. Opioid stewardship for postoperative pain management is a priority for families and their clinical care team. The use of evidence-based interventions to reduce the reliance on opioids is key to any comprehensive institutional opioid policy. Methods: This Quality Improvement (QI) project included creating an opioid bundle consisting of parent/adolescent education, a suggested medication weaning schedule at discharge, updated prescribing guideline decreasing the number of opioids prescribed from 40 doses to 28 doses, and a consent for opioids to be prescribed. The spine team utilized IHI Plan, Do, Study, Act methodology to implement the opioid bundle over twelve-weeks. De-identified data was collected pre- and post- implementation regarding opioid use. Results: The opioid bundle was deployed 100% of the time for the patients that met inclusion criteria during this QI initiative. Prior to the QI initiative, the median number of opioid doses prescribed was 40, and after the opioid bundle was used, the median was 28 doses. After the QI initiative, the spine center did not find an increase in parent phone calls and no refills for opioids were given. Discussion: Addressing family concerns for effective post-discharge care for their adolescent at home needs to include education about the risks, side effects, benefits, and use of medications prescribed, including how to assess when medications are needed and how to monitor usage. This QI initiative provided hands-on tools to help with pain management in the home while successfully decreasing the number of opioids prescribed.
Identifying Barriers and Facilitators in Utilization of Tranexamic Acid for Anemia Prevention Using the Theoretical Domains Framework
(The Ohio State University, 2022-08) Vo, Alexis; McNett, Molly
Background: Patients who experience a hip fracture is an increasing population contributing to over 341,000 emergency department visits a year. These patients have an increased risk of anemia and blood transfusions that could increase their length of stay, readmission rate and even mortality. A literature search for best practice that affects this population's outcomes lead to a further evaluation of tranexamic acid (TXA) utilization. Methods: The aim of this study was to evaluate determinants of routine use of tranexamic (TXA) for hip fracture patients using the theoretical domains framework (TDF). An anonymous survey created in QualtricsXM was sent out via email to two network leaders in Ohio and Texas who disseminated the link to their peers for completion. Participants had to be involved in the intraoperative process within the hip fracture population. The survey was open for a 16-day window and consisted of 34 questions, 30 domain questions with a 1-5 Likert scale answer and 4 demographic questions. Results: Barriers and facilitators differed between registered nurses and physicians in the 11 domains that were evaluated. Registered nurses identified skills and social/professional role and identity to be barriers while physicians only identified the goals domain to be a barrier to utilization of TXA. Conclusion: This study was able to identify barriers and facilitators for TXA utilization within a small network of Ohio and Texas peers. If the survey were to be concentrated to one facility it would give insight into how to increase implementation success of TXA utilization within that facility.

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