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Increasing the HPV vaccination rate in a family practice: A quality improvement project
(2017-05-19)
The purpose of this DNP project was to identify barriers in a family practice setting to recommending the HPV vaccine and to use this information to develop a practice protocol to enhance the delivery of the vaccine ...
Recommendations for breast feeding mothers after anesthesia: A quality improvement project
(2017-06-26)
Quality improvement projects aim to address a clinical issue and subsequently improve patient care. Projects may improve or promote safe care, interpersonal care aspects, and life quality.1 The clinical issue addressed by ...
Treating depression and sleep impairment to improve pain levels and quality of life for patients with sickle cell disease: A quality improvement project
(2017-05-19)
Background: Vaso-occlusive crisis (VOC) pain is both an acute and chronic factor for patients with sickle cell disease (SCD). Acute, recurrent, and unrelenting pain is often joined by other affective disorders that impact pain chronicity, and some patients with sickle cell disease have depression and/or sleep disturbances that may impact pain levels and quality of life.
Aim: The purpose of this quality improvement project is to improve the process of assessment and treatment of depression and sleep disturbance in patients admitted to Bridgeport Hospital, Bridgeport, CT with VOC. The goal of this project is to improve overall pain levels and quality of life for patients with SCD through efficient and effective evaluation and treatment for depression and sleep disturbance.
Method: An interdisciplinary team, led by the palliative care (PC) advance practice registered nurse (APRN), used the Stetler Model to guide the process of translating existing research regarding the impact of depression and sleep impairment on pain and quality of life in patients presenting with VOC, into evidence-based practice. The team created the Guideline for the Evaluation and Treatment of Depression and Sleep Impairment in Sickle Cell Disease. Patients were assessed, offered treatments and reassessed during the project period.
Results: Both depression and QOL scores showed significant improvement by the end of the project. Significant correlations were found between pain, depression and sleep; depression, pain, sleep and QOL; sleep, pain, and depression; and QOL and depression. Patient admissions as well as average length of stay decreased over the course of the project.
Limitations: The small convenience sample size limits the generalizability of the results to other practice sites. Patients who were not readmitted during the project timeframe were lost to follow-up, and were not reassessed to determine the effects of treatment recommended by the guideline.
Conclusions: Interdisciplinary teams are effective in creating a guideline to assess and treat depression and sleep impairment and their effects on pain and QOL in patients with SCD.
Implications for Practice: PC APRNs provide support and symptom management to patients with life-limiting and serious illnesses, including patients with SCD, as a means of improving QOL. This project has significance for APRNs in both palliative care and specialty SCD/Hematology care as a means to translate existing research into evidence-based practice; as well as provide an efficient and effective means to evaluate and treat depression and sleep impairment and their impact on pain and quality of life....
Bridging the gap in the continuum of care for spine surgery patients: A quality improvement project
(2017-03-24)
The purpose of this paper is to discuss the inadequate communication between patient settings and the practice settings, review the literature regarding communication and risks of readmission for spine surgery patients, ...
Decreasing urinary incontinence in the home health setting
(2017-08-30)
BACKGROUND: Urinary incontinence (UI) in the home care population poses a risk for complications and hospitalization. The aim of this project was to develop and implement a protocol for UI to promote continence in the home health agency UI population.
METHODS: Data were collected from a convenience sample of 26 participants 80 years of age or older in a suburban midsized home care agency. All participants were diagnosed with UI as documeted in the Outcomes and Assessment Information Set (OASIS). OASIS question M1610 was used to identify patients with UI status, and M1650 was used, to identify UI frequency. The outcomes for these questions were assessed to examine chnage over time in UI status and frequency.
INTERVENTION: Eligible patients completed a three-day bladder diary.Then, patient education was conducted on UI, risk factors, bladder training, pelvic floor exercises and hydration/nutrition parameters. Patients then completed three-day bladder diaries post intervention.
RESULTS: At pretest, 100% of the participants were incontinent. At posttest, twenty four participants (92.3%) were incontinent. The results suggested that the median frequency of urinary incontinence declined overtime from 2 (range :1-4) at pretest to 1 (range: 0-4) at posttest. The decline was statistically significant (z = -3.83; p=
CONCLUSIONS: The intervention had a positive effect on UI status and frequency. Future studies should examine changes in the UI complications and hospitalization rates....
Delirium assessment in the medical-surgical population: A quality improvement project
(2017-01-11)
Background: Delirium is a complex syndrome that can affect many patients resulting in adverse outcomes. The use of a delirium assessment tool assists in the identification of delirium. The aim of this project was to determine ...
Social isolation in long term care: Improving assessment and decision-making skills
(2017-08-30)
The purpose of this project was to evaluate the effect of a quality improvement project with a multicomponent intervention on assessment and decision-making skills for healthcare professionals who are responsible for the care of elderly residents at risk for social isolation. A group of 20 healthcare professionals working in a small long term care facility participated in the project. A quasi-experimental with a pretest and posttest design was used to collect and compare scores achieved on each exam. A matched t-test statistical procedure was utilized to determine whether a quality improvement project with a multicomponent intervention had significant impact on assessment and clinical decision-making skills of healthcare professionals. Following the implementation of the quality improvement project, healthcare professionals scored significantly higher on the posttest (with a mean of 94.5%) than on the pretest (with a mean of 55.75%). The quality improvement project with a multicomponent intervention had a significant impact on assessment and clinical decision-making skills. These results concluded that healthcare professionals responsible for the care of elderly residents at risk for or currently experiencing social isolation should implement quality improvement projects as a continuous method to improve assessment and clinical decision-making skills. ...
A quality improvement plan to decrease acute care transfers through better staff communication about status changes among assisted living residents
(2017-01-12)
Elderly residents of assisted living facilities (ALFs) are generally frail and may have multiple comorbidities (National Center for Assisted Living, 2010). Inadequate communication of changes in resident status precludes ...
Quality improvement program: Implementation of chronic care management services in an affordable care organization
(2017-06-23)
Chronic diseases are the leading cause of death and disability in the United States each year. According to the Group Health Research Institute (2015), almost one-half of all Americans have one or more chronic health ...
Teach-back and its impact on hospital consumer assessment of healthcare providers and systems (HCAHPS)
(2017-04-18)
Successful patient outcomes rely heavily on patient engagement, patient/family education, and promotion of self-management. Teach-back methodology offers the healthcare team a proven technique to determine learner's health ...