DNP Projects

 

The DNP-prepared nurse utilizes practice inquiry to translate meaningful health research into the practice setting to improve patient outcomes. The DNP Residency Project provides an opportunity for the student, supported by a three-member committee, to engage in clinical scholarship by identifying a problem or need in an area of nursing practice, healthcare delivery, or policy. Utilizing new or refined skills in organizational and systems leadership and quality improvement, students work within a system to implement a program evaluation, evidence-based practice change, or policy effort. Students then evaluate the impact and provide a “tangible and deliverable academic product” (AACN, 2006, p.20) consisting of an abstract, a paper or executive summary, and an electronic poster. The findings are presented to faculty, stakeholders, and students for evaluation and dissemination. Examples of DNP Residency Projects are shown below.

2021 SPRING DNP PROJECTS

STUDENT AND COMMITTEE MEMBERS ABSTRACTS POSTERS

AGCNS – DNP Student

Connie Kaiser, MSN, RN, ACNS-BC

Chair:

Carolyn Crumley, DNP, RN, ACNS-BC, CWOCN

Committee members:

Shawn Zembles, DNP, APRN, CEN, CCRN, NPD-BC, ACNS-BC

Tabitha Galloway, MD

 

PREOPERATIVE EDUCATION TO DECREASE DISTRESS IN RECONSTRUCTION PATIENTS

Introduction: Head and neck free flap reconstruction (HNFFR) patient treatment physical and psychological sequelae create a unique risk of developing distress measured on the Distress Thermometer and Problem List Tool (DTPL).

Method: Fourteen patients received HNFFR wound photo education with clinician explanation during preoperative visit and inpatient stay. The preoperative/ postoperative clinic DTPL scores were evaluated along with thirty-days tallied postoperative triage calls and wound visits compared to 60 prior HNFFR patients.

Results: Average DTPL scores preoperative 4.33 (SD = 4.09) to postoperative 2.0 (SD = 2.96) revealed moderate-large decreasing effect without statistical significance (p = .098, d = .6). 74 charts reviewed triage calls and wound visits. 37.0% majority made 0 calls, (n = 27) with 28.8% only one call (n = 21) revealed moderate-large decreasing effect on calls without statistical significance, χ2 = 8.62, df = 5, p = .13, Φ = .3. Majority 46.6% had one visit (n = 34) with 30.1% had two visits (n = 22) revealing small decreasing effect on wound visits without statistical significance, χ2 = 3.26, df = 4, p = .52, Φ = .2.

Conclusion: HNFFR wound photo education decreased distress scores, triage calls, and wound visits. Limitations include small sample size and DTPL broadness. Improvements include increasing sample size and creating HNFFR wound photo education for reconstructed sites.

FNP – DNP Student

Kelsey Allen, RN, BSN

Chair:

Gina Oliver, PhD, APRN, FNP-BC, CNE

Committee members:

LeeAnne Sherwin, PhD, MS, FNP-BC

Annamarie Mandacina, MSN, RN, ANP-C

IMPACT OF NURSE PRACTITIONER INITIATED PROTOCOLS ON REDUCING READMISSIONS FOLLOWING CARDIAC SURGERY

Introduction: Reduction of 30-day CABG readmission is needed. NP-initiated early follow-up and calls has the potential to enhance outcomes and reduce readmission rates. This study examined the impact of a NP-lead readmission reduction protocol. 

Methods: Consecutive patients (n = 122) undergoing CABG were retrospectively analyzed using chart record abstraction. The 30-day readmission rates were compared between standard practice (pre-intervention [pre], n = 57) versus early follow-up (within 7-days of discharge) and phone call (within 3-days of discharge) (post-intervention [post], n = 65).    

Results: The population was predominantly white (91%), male (82.0%) and older than 66 years (51.6%). The average STS risk was 1.5% + 2.6%. Groups were similar except for more commercial payors post (p = 0.02). Post subjects were twice as likely to have early follow-up compared to pre with a trend towards statistical significance (14.03% vs. 24.6%; OR = 2.0, 95% CI [0.78, 5.1], X2 = 2.2, p = 0.1). Overall compliance with calls was low at 21.5% (n = 14).  Overall, 30-day readmission rate was 8.2% with no difference between pre and post (8.8% vs. 7.7%, p = 0.83). There were no significant predicators for readmission, however, the presence of more comorbidities (p = 0.13) and longer post-operative length of stay (p = 0.1) trended towards predicting the likelihood of a 30-day readmission.  

Conclusions: The impact of early NP follow-up following isolated CABG had minimal effect on 30-day readmission rates. Improving intervention compliance and enhancing the study population with greater and higher risk patients warrants further study.  

Poster Allen

FNP – DNP Student

Emily Farr, BSN, RN, CCRN

Chair:

Gina Oliver, PhD, APRN, FNP-BC, CNE,

Committee members:

Laurel Despins, PhD, APRN, ACNS-BC,

Brandi French, MD

PROMOTING STROKE EDUCATION AT FOLLOW-UP: A QUALITY IMPROVEMENT PROJECT

Introduction: 10-17 million new strokes occur annually, with hospital readmission rates as high as 55%. Stroke education is not mandated at follow-up. Lack of knowledge regarding self-care and resources leaves survivors at risk for readmission. Using a printed stroke resource guide and provider initiated education at follow-up may decrease hospital readmissions.

Methods: A convenience sample with a pre and post-test design with two groups was used to evaluate the effect of education on provider education documentation and the effect of a stroke resource guide given at 30-day stroke follow-up appointments on post-stroke hospital readmission rates.

Results: There was a statistically significant decrease in 90-day hospital readmission rates between the baseline group (20%, n = 15) and intervention group (8.1%, n = 6), χ2 = 16.19, df = 2, p <.001, Φ = .3. Provider education documentation increased significantly from 0% to 3.4% after the intervention (χ2 = 16.43, df = 2, p <.001, Φ = .3). Utilization of the guide was 73%.

Conclusions: Two of three objectives were met, a 5% reduction in 90-day hospital readmissions after implementation of the intervention and 30% utilization of the stroke resource guide at follow-up appointments. The third objective, a 10% increase in provider documented education was not met, but a statistically significant increase in education documentation was seen.

dnp poster

FNP – DNP Student

Anna Griffith BSN, RN, CRRN

Chair:

Miriam Butler, DNP, NP-C, FNP-BC.

Committee members:

Sherri Ulbrich, PhD, RN, CCRN.

Robin Harris, DNP, RN   

SELF-CARE FOR NURSES: A QUALITY IMPROVEMENT INITIATIVE FOR REGISTERED NURSE GRADUATE STUDENTS

Introduction: Registered nurses often neglect to take care of themselves, despite their extensive healthcare knowledge and resources. The evolving delivery of health care has changed expectations of nurses which has created unhealthy work environments.  The graduate nursing student wellness initiative is designed to improve knowledge of available resources and improve student connections to manage stress and enhance self-care practices using an online forum.

Methods: A convenience sample of graduate nursing students at the University of Missouri, Columbia was evaluated through pre and post survey using the Health Promoting Lifestyle Profile II (N = 27). Surveys were administered through an internet-based program and addressed the self-care subsets of nutrition, physical activity, interpersonal relations, stress management, health responsibility, and spiritual growth.

Results: Overall wellness scores as well as stress scores remained stable at 3 month follow-up. Participants demonstrated positive changes in taking time for relaxation, using methods to control stress, improving vigorous exercise, eating vegetables, and reading labels on packaged foods.  There was a small improvement in the health responsibility scores, and interpersonal relation scores. 

Conclusion: Results were unable to demonstrate an improvement in self-care practices over this time period. However, over time, there may be greater participation and more robust discussion leading to desirable outcomes. The ability to provide more in-person wellness options was a limitation of this study and should be included in future projects.  In a time of significant stress in the nursing profession, it is imperative that interventions are in place to address well-being and health of nurses.

Grifith dnp poster

FNP – DNP Student

Emily Kusgen, BSN, RN

Chair:

Jan Sherman, PhD, RN, NNP-BC

Committee members:

LeeAnne Sherwin, PhD, MS, FNP-BC.

Leah Hermanson, MSN, FNP-BC.

 

UTILIZATION OF COPD ACTION PLANS TO REDUCE EXACERBATIONS IN RURAL PRIMARY CARE

Introduction: Exacerbations of COPD increase morbidity and mortality rates and negatively impact the severity of the disease. Although initially used for asthmatics, action plans have recently proven favorable in COPD patients to recognize early onset of an exacerbation before its worsening. Personalized action plans have shown numerous positive outcomes including decreased number of exacerbations.

Methods: Providers were given education regarding personalized COPD action plans. A purposive convenience sample utilizing simple random sampling (n = 28) were evaluated for two outcomes including documentation of an action plan and number of exacerbations. The project was evaluated through medical record review at T1 and T2 and was completed at a rural internal medicine clinic.

Results: The mean number of exacerbations decreased from 0.68 at T1 to 0.32 at T2 (p = .07).

In total, the number of exacerbations decreased from 15 at T1 to six at T2. 19 of the 28 (67.9%) patients had a documented action plan at T2, whereas zero (0%) of the 28 patients had documentation of an action plan at T1.

Conclusions: Providing education and implementing personalized action plans demonstrates meaningful future impact on number of exacerbations in COPD patients. The low cost and low risk of this intervention showed great benefit in regards to reduction of overall exacerbations for patients whom self-management strategies are critical.

DNP project poster

FNP – DNP Student

Danielle Leonard, BSN, RN

Chair:

Lori L. Popejoy, PhD, RN, FAAN,

Committee members:

Miriam Butler, DNP, NP-C, FNP-C,

Andrea Naes, FNP-C, RN, DNP 

IMPROVING PREOPERATIVE ESOPHAGECTOMY PATIENT UNDERSTANDING WITH A PATIENT-CENTERED APPROACH

Introduction: Quality, patient-centered education provided during the preoperative period increases patient understanding about what they will experience during hospitalization and decreases feelings of anxiety while awaiting surgery. Preoperative esophagectomy patients receive verbal and printed education materials from the surgeon during the initial office visit, but remaining questions and concerns may linger without opportunity for resolution prior to surgery.

Methods: Semi-structured interviews with seven preoperative esophagectomy patients recruited from a hospital in St. Louis, Missouri were conducted to understand their perception of the preoperative education they received. Transcripts were coded and analyzed thematically. Post-discharge phone calls were made to six patients who participated in initial interviews and to six additional postoperative patients to discuss patient perspective and experience in order to evaluate the adequacy of their preoperative preparation.

Results: Analysis of pre- and postoperative esophagectomy patient interviews revealed three major themes: 1) the current practice of verbal and printed education provided by the surgeon in the office setting is appreciated by patients; 2) patients were positive about receiving a nurse phone call during the preoperative period which would provide an opportunity to ask questions and increase comfort; and 3) patient education at any point of the process should not occur without caretakers or partners being present.

Conclusions: Esophagectomy patients identified areas where the current education protocol functioned well and suggested improvements. Providing a second opportunity for patients to ask questions before surgery and involving support persons in the process may be beneficial to patient understanding and comfort.

Leonard DNP Poster

FNP – DNP Student

Ashley Mierkowski RN, BSN

Chair:

Miriam Butler, DNP, NP-C, FNP-BC,

Committee members:

Julie Miller, DNP, MBA, FNP-BC, NEA-BC, CNOR(E),

Maria Hamakiotis, MSN, RN, NE-BC,

GUIDELINES TO IMPROVE TRIAGE: TELEPHONE TRIAGE AND THE EMERGENCY PAGER SYSTEM

Introduction: At Northwestern Medical Group, non-medical dispatch staff utilize an emergency pager system to route urgent patient calls to nurse telephone triage.  The most common emergency pages are “extreme pain” and “high blood pressure” pages.  The dispatchers create an encounter note in the electronic medical record describing the patient’s symptoms.  The content of these encounter notes lacks the detail necessary for nurses to triage these pages efficiently.

Method: A preintervention convenience sample was analyzed for the content of extreme pain and high blood pressure encounter notes.   Telephone triage nurses were then given a nurse satisfaction 13 item Likert scale survey based on the McCloksey-Mueller Satisfaction Survey (MMSS) and The Practice Environment Scale of the Nursing Work Index (PES-PWI).  Dispatch staff were given a mandatory live training session, in which an educational PowerPoint regarding changes to pain and hypertension pages were presented. Postintervention pain and hypertension pages were analyzed for content, and a repeat satisfaction survey invitation was sent to telephone triage nurses.

Results:  The content of pain encounter notes was significantly increased in the postintervention group (p < .001).  The postintervention group was more likely to include the blood pressure measurement in the encounter note than the preintervention note (p = 0.01).  Overall nurse satisfaction was not significantly different postintervention (p = .129).

Discussion: After call center education, the content of encounter notes for both extreme pain and high blood pressure pages increased significantly one month after training. However, changes to call center processes must continue to improve nurse satisfaction.

Mierkowski DNP Poster

FNP – DNP Student

Sarah Miller, EdD, MSN, RN

Chair:

Gina Oliver, PhD, APRN, FNP-BC, CNE

Committee members:

Jan Sherman, PhD, RN, NNP-BC

Amanda Lewton, MD

 

INCREASING HPV VACCINATION RATES IN A RURAL CLINIC

Introduction: The human papilloma virus (HPV) vaccination rate in rural areas in the United States is historically lower than that of urban areas. At least one dose of the vaccine can help prevent HPV and associated cancers and infections, yet parents are hesitant to vaccinate their children.

Methods: A convenience sample of charts for patients ages nine to 26 years of age were reviewed to determine if an educational intervention aimed at providers would increase the HPV vaccination rate for the clinic. Educational flyers were placed on walls in each patient examination room to help prompt the provider to initiate a conversation about the HPV vaccine with patients and/or their parents. A total of 793 charts were reviewed for this project.

Results: There was a decrease in the incidence of patients receiving HPV vaccines between groups from 32% to 23% despite an educational intervention, though the amount of scheduled office visits decreased while walk-ins increased, which posed a limitation for the recommendation and administration of HPV vaccines. Providers who were new to the clinic had an increase in patients receiving a vaccine from 13% to 15%.

Conclusion: Results indicate there is a need to provide additional education to providers regarding the HPV vaccine and how to initiate conversations with patients and/or parents regarding the need to vaccinate. The COVID-19 pandemic likely limited the incidence of vaccination recommendations given that office visits decreased, and walk-ins increased, as walk-in visits are problem focused. Education and provider notifications may increase HPV vaccination rates.

Miller dnp poster

FNP – DNP Student

Miranda M. Pickens BSN, RN

Chair:

Gina Oliver, PhD, APRN, FNP-BC, CNE,

Committee members:

Miriam Butler, DNP, NP-C, FNP-BC

Shawna Surman, FNP

INCREASING HUMAN PAPILLOMAVIRUS VACCINATION RATES IN PRIMARY CARE

Introduction: The human papillomavirus (HPV) is very common and leads to many new cases of cancer and thousands of new cases of recurrent respiratory papillomatosis (RRP). While many strains are preventable with the HPV vaccine, the administration of the vaccine is suboptimal. The use of educational posters and provider education may potentially increase vaccination rates.

Method: A convenience sample of eligible patients were evaluated through analysis of two groups at two time points: pre and post intervention between 11/1/20 and 3/1/2021 at Midwest clinic utilizing Epic health record.

Results: There was an improvement of HPV vaccination initiation, as post-intervention No HPV Vaccine status reduced to 46.8% from 53.2%, showing a 6.4% increase in HPV vaccination initiation. There was an 81.8% increase in the amount of total HPV vaccines given showing a significant statical significance t = 15.88, df = 1, p = .000.  Female patients were more likely to complete the series as compared to males. The initiation of recent HPV vaccine post-intervention increased in male patients at 100% and female patients by 83.3% demonstrating the clinical effectiveness of the use of educational posters and provider education.

Conclusion: The primary objective for the project was achieved. Findings are semi-consistent with previous studies and vaccination rates could improve with more educational poster exposures in waiting rooms.

FNP – DNP Student

Shelby Rock, DNP student

Chair:

Shelby Thomas, DNP, APRN, FNP-BC, CLNC

Committee members:

Jo-Ana Chase, PhD, APRN-BC,

Melissa Dowler, RN-BC, MSN 

KNOWLEDGE AND COMFORT OF HEART FAILURE DISCHARGE EDUCATION AMONG STAFF NURSES

Introduction: Heart failure is one of the leading causes of death and debilitation for older adults and inadequate knowledge among these patients is evident in the high rates of hospital readmission. Discharge education initiatives are necessary to increase patient knowledge of the disease process and self-management behaviors to decrease readmissions related to heart failure.

Method: A convenience sample of staff nurses employed on University of Missouri Health Care’s (UMHC) cardiovascular floor was evaluated on the knowledge, comfortability, and frequency of delivering heart failure discharge education to patients.

Results: Participants ranked themselves from one to seven on a Likert scale for the ability to deliver discharge education.  Participants also ranked themselves on the frequency of delivering education from one to ten on a Likert scale. There was a significant difference (α=.05) in the comfortability and frequency scores for 33 questions. There was not a significant increase (α=.05) in participants knowledge of heart failure after education than before education. Mean scores ranged between 3.81 and 4.82 out of five for The Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure.

Discussion: Three out of the four objectives for this project were met. Findings are consistent with previous research and support the continued need for heart failure discharge education initiatives. A small sample size was the greatest limitation for this projection and should be considered in future studies.

Rock DNP Poster

FNP – DNP Student

Kelly Schwager, RN, NP-C

Chair:

Jan Sherman, PhD, RN, NNP-BC. 

Committee members:

Robin Harris, DNP, RN.

Karla Clubine, RN, FNP

IMPROVING ADHERENCE RATES TO HERPES ZOSTER VACCINE GUIDELINE IN ADULTS

Introduction: Immunization among all age groups continues to be one of the most effective primary preventative measures against disease and illness.  Despite national adult immunization goals, coverage remains low for most routinely recommended vaccines.  One such illness is herpes zoster (HZ).  HZ is an acute vesicular rash caused by the varicella-zoster virus (VZV).  HZ causes substantial morbidity and a significant amount of pain, especially among older adults.  Provider education can be beneficial in improving HZ vaccination rates among adults.

Methods: A purposive convenience sample of 160 charts were reviewed pre-intervention and one-month post-intervention.  The educational intervention consisted of a 30-minute PowerPoint presentation on vaccine effectiveness, guidelines, and contraindications.  It included techniques to improve vaccine rates, potential barriers, and methods to overcome these barriers.

Results: The rate at which the vaccine was ordered increased by 19% pre-intervention (n = 0) and post-intervention (n = 31), χ2 (2, N = 320) = 59.259, p = .000, Φ = .4.  The number of vaccines received increased by 8% pre-intervention (n = 5) and post-intervention groups (n = 18), χ2 (1, N = 320) = 7.917, p = .005, Φ = .2.  The provider survey had a 100% response rate with 100% of providers feeling strongly that the information provided would be beneficial to their patients and practice.

Conclusion: The brief educational intervention and handouts met all of the project’s objectives by increasing the rate of vaccine ordering and vaccine administration.  Provider attendance and beliefs that the educational intervention was useful was also met.

Schwager DNP Poster

FNP – DNP Student

Rosemary Werner, RN, BSN 

Chair:

Jan Sherman, PhD, RN, NNP-BC.

Committee members:

Miriam Butler, DNP, NP-C, FNP-BC.

Lisa Schuller, DNP, RN, NNP-BC

EVALUATION OF THE GOLDEN HOUR OF INFANT STABILIZATION

Introduction: Extreme prematurity is a major contributor to infant morbidity and mortality.  The Golden Hour (GH) is a set of timed interventions aimed at optimizing postpartum stabilization of infants born prematurely.  When executed correctly, the GH is linked to improved clinical outcomes in premature infants.

Methods: A GH quality improvement (QI) team was developed at St. Louis Children’s Hospital to increase adherence to an existing GH protocol. A purposive convenience sample of 120 charts were evaluated before (T1) and after (T2) QI team implementation to evaluate overall protocol compliance.

Results: The mean protocol compliance score increased from 2.35 (SD = .3) for T1 to 2.43 (SD = .3) for T2, t (238) = -2.3, p = .02, d = .3. Improved blood glucose regulation was achieved with a 16% increase in normoglycemia for T2 (n = 88) compared to T1 (n = 68), χ2 (2, N = 240) = 2.6, p = .02, ϕ = .2. No difference was observed between groups for thermoregulation.

Conclusions: This QI project met two of the three objectives by improving adherence with the GH protocol and decreasing the rate of hypoglycemia in the first hour of life. The third objective of a decrease in the rate of hypothermia was not met, but the overall rate of hypothermia was low both before and after intervention. Continued use of the QI team to improve temperature outcomes and decrease the time to intravenous fluid and antibiotic initiation could further increase protocol adherence in the future.

Werner DNP Poster

FNP – DNP Student

Amber Williams, RN, BSN

Chair:

Shelby Thomas, DNP, APRN, FNP-BC

Committee members:

Gina Oliver, PhD, APRN, FNP-BC, CNE

Erica Augustyniak MSN, FNP

 

OPPORTUNISTIC SCREENING FOR TYPE II DIABETES MELLITUS IN ADULTS

Introduction: Type II Diabetes Mellitus (T2DM) is a progressive disease process that decreases quality of life while increasing morbidity and mortality. Early recognition and prevention are pivotal to decrease disease progression. The American Diabetes Association (ADA) has created a Diabetes risk assessment screening questionnaire that can be utilized to opportunistically screen individuals for T2DM. Proactive delivery systems in primary care should focus on utilizing the risk assessment screening questionnaire for early recognition of T2DM.

Method: A convenience sample of primary care patients in rural Missouri, who were in clinic for evaluation by a nurse practitioner were evaluated using the ADA Risk Assessment screening tool.

Results: Post-implementation ADA risk assessment screening was 36%. Eleven participants scored five or greater, placing them at an increased risk for T2DM. The mean HbA1c level for post-intervention participants was 5.15%. No statistical significance was found between HbA1c frequency of testing prior to and following implantation of the screening tool. The screening tool and the HbA1c test results had an indirect, moderate effect.

Discussion: Neither of the objective were achieved. Findings are not consistent with previous studies. The sample size was small, and no clear conclusion can be made as to the effectiveness of the use of the ADA risk assessment screening tool in primary care increasing HbA1c screening rates. One nurse practitioner was evaluated, limiting input and background education from other types of providers. Future evaluation should include use of EMR for documentation of risk and increased clinical education for staff members and patients.

Williams DNP Poster

Leadership – DNP Student

Elizabeth Fuchser MSN, APRN, CCNS,

Chair:

Jan Sherman, PhD, RN, NNP-BC

Committee members:

Shelby Thomas, DNP, APRN, FNP-BC

Tina Gulbronsen, MSN, RN, ACNO

 

EVALUATION OF A DISCHARGE LOUNGE TO IMPACT DELAYED HOSPITAL DISCHARGES

Introduction: Delayed inpatient discharges have consequences that affect areas throughout the hospital.  These delays cause substantial wait times for patients who need to be admitted. A discharge lounge may be used as a way to move patients with delayed discharges off inpatient units so ED patients can be admitted.

Methods: A purposive convenience sample of 89 participants was transferred to the discharge lounge. A policy was created and brief education was given to unit staff. Evaluation of the discharge lounge during the month of June 2020 was done to evaluate time spent in the discharge lounge, the population transferred, and barriers to use of the discharge lounge. 

Results: Data on the discharge lounge was only available for one month, June 2020. Total use of the discharge lounge was 74.4 hours. Patients waited in the discharge lounge for an average of 51.15 minutes (SD = 47.263). Patients were predominantly Caucasian (74,2%) between 61-70 years of age (29.2%), male (55.1%), and single (50.6%). Patients were followed predominantly by Internal Medicine Providers (69.7%), had Medi-Cal insurance (46.1%), and were admitted for cardiac related issues (23.6%). Top barriers to transfer were nurse related (27.3%) and patient mobility (27.3%).

Conclusions: Incorporation of a discharge lounge is a feasible method to release medical/surgical patient beds sooner. This project demonstrated a savings of over 74 hours by transferring patients with delayed discharge.  Better education of staff to help identify patients appropriate for transfer and management follow-up is needed to improve the appropriate use of the discharge lounge.

Fuscher DNP Poster

Leadership – DNP Student

Brittany Stone, AGACNP-BC

Chair:

Mary Beck, DNP, RN, NE-BC, FAONL

Committee members:

Laurel Despins, PhD, RN

Jane Terhune, MHA, RRT-NPS, CPPS, LSSGB

UTILIZATION OF A CLINICAL PATHWAY FOR THE ISOLATED CORONARY ARTERY BYPASS GRAFTING SURGERY PATIENT

Introduction: Standardized care of cardiac surgery patients via use of clinical pathways has demonstrated improved patient outcomes.  Clinical pathways provide clear instruction and guidance, allowing for improved communication and collaboration between all team members involved in the care of patients.

Method: A clinical pathway was implemented in a cardiac intensive care unit. Retrospective chart reviews were completed on two groups of inpatients [baseline non-clinical pathway group (N=59) and the clinical pathway group (N=30)] between May 2019 and February 2021. Significance was evaluated using an unpaired t-test.

Results: Two objectives evaluated were length of stay and other clinical outcomes.  There were no significant changes after implementation of the clinical pathway: hospital length of stay, p=.388;  prolonged intubation, p=.388; atrial fibrillation, p=.416; readmission rate, p=.984; reoperation, p=.510; sternal wound infection, p=.510; acute kidney injury, p=.479; acute kidney failure, p=.479; stroke, p=.989; pneumonia, p=.627. The pathway was utilized on 24 out of 30 patients (80%), achieving the third objective, pathway utilization in 80% of the patients

Conclusion: Only one of the three desired objectives were achieved. Possible limitations include patient acuity and the Covid-19 pandemic, effecting sample size. Anecdotal feedback from nursing staff and educators suggest clinical pathway utilization increases the ability to improve communication and collaboration of care of the isolated coronary artery bypass patient.

Stone DNP Project

Leadership – DNP Student

Martina Taylor-Campbell MSN, RNC-OB

Chair:

Valerie Bader RN, PhD

Committee members:

Stefanie Birk, DNP, MBA, RN 

Susan Hopkinson

EVALUATION OF A MATERNAL FETAL TRIAGE INDEX IMPLEMENTATION PROGRAM

Introduction: The program evaluation examined the Maternal Fetal Triage Index (MFTI) algorithm educational implementation to examine if it decreased the overall time from admission to discharge, 2. Improved the accuracy of categorization according to acuity level, and 3. increased compliance with the Algorithm tool. The MFTI program was implemented in January of 2020.

Method: A review of 1,284 records was conducted over 4 months comparing the central tendencies. A Cohen’s Kappa measured the degree of accuracy and reliability between each classification. The data were measured with an ANOVA test, t-test, and a Kruskow-Willis to assess statistically significant difference between the means.

Results: Overall time in triage MFTI implementation decreased the overall time from triage admission to discharge by over 35%. Comparing acuity data from January to April showed a 35% decrease the overall time from triage admission (145).  (t-value 7.716, p< .05).  STAT times had the shortest overall time in triage while the NONURGENT had the longest overall triage time. The OB time from admission to triage room time averaged of 3.42 minutes which is than the recommended average time of 10 minutes.

Accuracy: There was no statistical difference in the accuracy of the categorization according to acuity level (f (4,15) = 2.07, p = 0.13). The Levene’s test revealed homogeneity of variance. A Kruskow-Wallis test revealed a 64% chance the data does not have any effect on the data which retains the null hypothesis and rejects the claim of statistical variance among each category. Cohen’s Kappa score was 0.868 showing almost perfect agreement between each classification.

Compliance: For compliance with the algorithm tool, there was a statistically significant difference between the groups (f (3,61) = 3.31, p = 0.026). The test revealed no homogeneity of variance rejecting the null hypothesis of no statistical variance in compliance, supporting the statistical significance The Pearson correlation (0.47) showed slight correlation.

Conclusion: Two of the three objectives were achieved. Findings were consistent with the literature review. The outcomes support the need for continuous triage education and process improvement to increase nursing compliance and accuracy.

Campbell DNP Poster

PMHNP – DNP Student

Fatma Aisha Ahmouda, BSN, RN

Chair:

Jane Bostick, RN, PhD, PMHCNS-BC

Committee members:

Nancy Birtley, DNP, APRN, PMHCNS-BC, PHMNP-BC

Ahmad Taranissi, M.D.

 

 

EVALUATION OF REFILL CLINIC EFFECTIVENESS AT IMPROVING TREATMENT ADHERENCE IN THE MENTALLY ILL

Introduction: One in five adults with serious mental illness are able to obtain treatment. For patients with serious mental illnesses, medications are effective in treating 70%-80% of illnesses; however, only 50%-60% of those who experience a positive response to medication continue to be adherent with treatment (El-Mallakh & Findlay, 2015; Levin et al., 2014).

Methods: A purposive, convenience sample of outpatients who attended one refill clinic day was evaluated through data collection of medical charts at baseline and 3-months post-intervention. The walk-in refill clinic occurs one day a week, and is aimed at improving treatment nonadherence.

Results: Of all attendees, regularly scheduled patients comprised the majority (82.9%, n = 97), while refill clinic attendees made up 17.1% (n = 20).  There was a small to moderate clinical significance in future kept appointments in refill clinic attendees (p = .07, ϕ = .2). Of the 20 refill clinic subjects, 55% (n = 11) kept the next scheduled appointment, while 40.0 % (n = 8) did not, and 5% (n = 1) attended a future refill clinic appointment. There was a statistically significant finding in female refill clinic attendees, (n = 10, p = .05) in that only 40% (n= 4) kept the next follow-up appointment.

Conclusions: Based on the observation that a majority (55%) of refill clinic attendees go on to keep future appointments, it is recommended that the refill clinic be continued. The refill clinic is helping patients by offering a simple, flexible and efficient way to stay medication adherent.

Ahmouda DNP Poster

PMHNP – DNP Student

Susan Gripp, BSN, RN

Chair:

Jane Bostick, RN, PhD, PMHCNS-BC

Committee members:

Nancy M. Birtley, DNP, APRN, PMHCNS-BC, PMHNP-BC

Dianna Clyne, MD, DNP 

IMPLEMENTATION OF A MULTI-ITEM CRAVING ASSESSMENT TO IMPROVE CLINCIAN-TO-PROVIDER REFERRAL FOR MEDICATION ASSISTED TREATMENT

Introduction: Drug cravings are an important consideration in the treatment of addictions across substances of abuse, identified as a potential indicator for risk of relapse. Craving-specific assessments are designed to measure craving frequency and intensity and may be used to make referrals for evaluation and inform the prescribing and effectiveness of medication assisted treatments.

Methods: A multi-item drug craving assessment was adapted and implemented within weekly clinician and client counseling sessions at an inpatient drug treatment center over three months. An SBAR communication tool was introduced to staff to guide the referral process. A staff communication satisfaction survey was implemented at baseline, six weeks post-implementation, and three months post-implementation.

Results: The rate of referral for medication assisted treatment evaluation increased from baseline by 10.2% (n = 10), however, 89.8% (n = 88) of participants had no documentation of a referral outcome (yes or no) based on assessment results. Based on counseling sessions in which the multi-item craving assessment could be utilized, use of the assessment increased by 60.2% (n = 59) from baseline (p < .001). Overall satisfaction with staff communication increased from 40% (n = 5) at baseline to 50% (n = 4) at three months post-implementation. There was a statistically significant increase in report of drug cravings from baseline with implementation of the multi-item assessment (p < .001).

Conclusion: Results suggest that the consistent use of a craving-specific assessment tool throughout drug treatment programming may improve identification of drug cravings and assist in structuring referrals for medication evaluation.

Gripp DNP Poster

PMHNP – DNP Student

Melissa Holcomb, RN, MSN

Chair:

Jane Bostick, RN, PhD, PMHCNS-BC

Committee members:

Valerie Bader

Merideth Lehman

IMPROVING PROVIDER SUPPORT FOR PERINATAL GRIEF

Scholarship over the past five decades has established that perinatal loss is common and under-acknowledged. Healthcare professionals encounter patients living with grief associated with perinatal loss in diverse settings and may not feel prepared by their clinical education for interactions with patients experiencing perinatal grief. Perinatal loss often results in normal grief, but a significant minority of those who experience perinatal grief will go on to develop severe grief-related symptoms that adversely affect quality of life. Duration of pregnancy is a poor predictor for who may benefit from supportive care after a loss. The theoretical framework supporting the Perinatal Grief Intensity Scale provides explanatory value for variations in intensity of perinatal grief. Although few clinical trials to date support the universal efficacy of specific interventions, existing comprehensive reviews of qualitative and descriptive studies suggest that training health professionals working in a variety of settings to be prepared to offer support for perinatal bereavement may address existing gaps in quality of care for those experiencing intense grief following perinatal loss. A quality improvement project consisting of a brief online teaching intervention significantly increased the perceived preparedness of health professionals to address perinatal grief by equipping participants with a conceptual model for understanding factors affecting intensity of perinatal grief and offering insight into the use of the electronic medical record to guide collaborative care in addressing complicated perinatal grief. The intervention encouraged participants to incorporate what they learned into clinical practice by suggesting key resources for support of perinatal grief.

Holcomb DNP Poster

PMHNP – DNP Student

Elizabeth O’Brien, MSN, FNP-BC

Chair:

Nancy Birtley, DNP, APRN, PMHCNS-BC, PMHNP-BC,

Committee members:

Bonnie J. Wakefield, PhD, RN, FAAN

Mary C. Bauer, APRN, PMHNP-BC

EVALUATING THE EFFECTIVENESS OF BATTLEFIELD ACUPUNCTURE ON PAIN AND DEPRESSION IN VETERANS

Introduction: Chronic pain and depression are highly prevalent in the United States Veteran population and negatively impact quality of life and health outcomes. Battlefield acupuncture (BFA) is an emerging method of reducing pain and depressive symptoms with few side effects.

Methods: This was a program evaluation with a single group cohort with a pre-post design. A convenience sample of adult Veterans was utilized at a Midwest Veterans Administration (VA) medical center. Effects of BFA were measured by scores on the NRS-11 and PHQ-9.

Results: While not statistically significant, there was a small to moderate decrease in scores on the PHQ-9 after participation in BFA (p = .06, d = .34) with 65.6% (n = 21) noting improvement. Most participants reported improvement in NRS-11 scores after participation in BFA, with 65.6% (n= 21) noting improvement. There was a moderate to large statistically significant decrease in NRS-11 scores after participation in BFA, p < .0005, d = .71.

Conclusions: The primary objectives of a 5% improvement in perceived depressive symptoms measured on the PHQ-9 and a 5% decrease in self-reported pain measured on the NRS-11 were met. In the sample there was a mean 17.3% decrease in scores on the PHQ-9 after participation in BFA.  There was a mean 18.2% decrease in pain scores. There were clinically significant improvements in depressive symptoms after participation in the BFA program and statistically significant improvement in pain scores.

OBrien dnp poster

PNP – DNP Student

Kathryn Hoemann, BSN, RN

Chair:

Jan Sherman, PhD, RN, NNP-BC

Committee members:

Shelby Thomas, DNP, APRN, FNP-BC, LNC

Kristine Tejeda, MSN, RN, CLC

EVALUATION OF A HEMATOLOGY/ONCOLOGY UNIT TO OPERATING ROOM

HANDOFF BUNDLE

Introduction: Poor nursing communication is associated with sentinel events and delayed treatment. Communication skills and occurrence of adverse events can be improved by the use of Illness severity, Patient summary, Action list, Situation awareness and contingency plans, and Synthesis by receiver (I-PASS) during handoff interactions.

Methods: A purposive convenience sample of pediatric hematology/oncology and pre-operative nurses was given education for the use of a standardized I-PASS Handoff bundle. The bundle was evaluated by the number of adverse events and participants completed self-evaluations using the Handoff CEX tool during I-PASS handoff between the hematology/oncology unit to the pre-operative unit.

Results: There was improvement in effective communication (p = .002), clinical judgement (p = .003), and handoff setting (p = .001) between T1 and T2. There was a large, clinically significant increase in patient focused handoff (p = .12, A = 1.21) between T1 and T2. 95% of handoffs were completed using I-PASS; 92% of these were superior quality. Adverse events decreased 100% from T1 (2) to T2 (0). 42.9% of participants reported extreme satisfaction with the I-PASS tool. Overall, 71.4% of participants reported excellent communication with I-PASS.

Conclusions: The education and utilization of the I-PASS Handoff Bundle intervention met all of the project objectives by decreasing adverse events and increasing I-PASS compliance. Findings are consistent with previous studies and support the impact of I-PASS to produce high quality handoff. Use of I-PASS reduces the gap between standardized intrahospital handoff and current handoff practices, thus potentially improving patient care that nurses provide.

Hoemann DNP Poster

PNP – DNP Student

Sydnie Schneider, BSN, RN

Chair:

Janeth Todd, DNP, RN, PCNS-BC

Committee members:

Jan Sherman, RN, NNP-BC, PhD

Tammy Rood, DNP, CPNP- PC, AE-C

EVALUATION OF AN EXISTING SCREENING TOOL: REFERRAL FOR POLYSOMNOGRAM IN A PULMONARY CLINIC

Introduction: Asthma and obstructive sleep apnea (OSA) are two common conditions with significant long-term consequences that often coexist and can exacerbate each other. While asthma can be controlled through medications and avoiding overall triggers, recent evidence suggests if these coexisting conditions are minimized or removed asthma control can be improved. The current study looked at the PSQ-22 Sleep Questionnaire to see if patients referred obtained a polysomnogram and what diagnosis was made following.

Methods: A convenience sample of pediatric pulmonary patients in Columbia, MO, who were referred for a polysomnogram following a positive PSQ-22 screening, were reviewed at 4- and 8-month time points to determine 1) if a polysomnogram was ordered for elevated PSQ-22 score; 2) if the polysomnogram was completed; 3) polysomnogram results, including the presence of OSA; 4) what referrals were made; and 5)  other measures of asthma control post polysomnogram.

Results: Analysis of chart reviews revealed three important results: 1) over half (56.5%) of patients referred for a polysomnogram obtained one; 2) 43.5% of polysomnogram results confirmed an OSA diagnosis; and 3) when results were provided 39.1% had improved asthma control test scores and 30.4% had improved spirometry results. Patients were also referred to a sleep clinic provider 43.5% of the time.

Conclusions: Inclusion of the PSQ-22 screening tool exhibited a meaningful future impact on polysomnogram referrals and a definite diagnosis of OSA, therefore, it is recommended that providers continue to use the PSQ-22 to screen patients with asthma for OSA.

Schneider DNP Poster

FNP – DNP Student

Patricia Darland, BSN, RN

Chair:

Shelby Thomas, DNP, APRN, FNP-BC, LNC

Committee members:

Gina Oliver, PhD, APRN, FNP-BC, CNE

Justin Puckett, D.O., FAAFP, FOMA, FACOFP

CHRONIC KIDNEY DISEASE IN PRIMARY CARE

Introduction: Early diagnosis of chronic kidney disease is associated with earlier management and better health outcomes in adult patients. This project evaluates whether educating providers and providing educational materials to patients in the primary care setting about the KDIGO guidelines improves patient understanding of CKD in adults according to the Kidney Knowledge Survey (KiKS).

Methods: For the first objective, a sample of 39 adult patients with CKD were included at a family clinic using purposive, convenience sampling. A descriptive pre-test, post-test design was used to evaluate this objective. For the second objective, a sample of 80 charts were evaluated using systematic random sampling. A retrospective chart review was completed before and after the intervention. The third objective will include a staff nurse that monitors the diagnosis of CKD on incoming patients and documented whether the patient received an educational handout provided during this project.

Results: The first objective was analyzed using a 2 tailed, one sample t-test of improvement score and was statistically significant (t=12.477, df=38, p= .000). The second objective was analyzed using a 2 tailed, paired t-test of chart reviews and was mildly statistically significant (p= .045, df=79, t= .296). The third objective was completed by the staff nurse, who documented that 80% of CKD patients seen in clinic were provided with educational handout.

Conclusions: Two of the three objectives were completed. Findings show that increased education of providers regarding the KDIGO guidelines and patients about their CKD diagnosis and management can improve patient understanding of their disease.

Darland DNP Poster

Leadership – DNP Student

Lisa Job RN, MSN, ACNS-BC

Chair:

Jan Sherman, RN, NNP-BC, PhD

Committee members:

Miriam Butler, DNP, NP-C, FNP-BC,

Carol Jordan, MSN, RN, CIC, DNP 

PREDICTION AND PREVENTION OF CLOSTRIDIOIDES DIFFICILE INFECTION

IN HOSPITALIZED ADULT PATIENTS

IntroductionClostridioides difficile infection (CDI) is one of the most common healthcare associated infections in the United States, causing immense suffering and even death, and placing a large financial strain on the nation’s healthcare system.  The use of a screening tool to promote identification of risk factors and facilitate appropriate testing can be beneficial in the reduction of CDI.  

Methods:  A purposive convenience sample of 54 charts were reviewed between two timepoints.  The intervention consisted of education and use of a C. difficile verification tool to screen patients prior to testing, and included risk factors, symptoms, and criteria for testing for CDI.   

Results:  The stool specimen met criteria for testing on the majority of the patients screened (70%, n = 29) with no significant differences between the two timepoints (p = .32).  Although the use of the tool by staff was 17.6% (= 9), the use of the screening tool prior to testing did result in cancellation of C. difficile tests for 21.9% of patients screened that did not meet testing criteria.  Healthcare facility onset CDI (HO-CDI) cases and standardized infection ratio (SIR) decreased by 48% in 2020 (SIR 0.544, n = 13) compared to 2019 (SIR 0.985, n = 25). 

Conclusion:  The use of a screening tool by staff met the project’s objective of reduction of HO-CDI cases.  The compliance in use of the tool by staff was not met.  Continued use of the screening tool and incorporation of the tool in the electronic health record are recommended. 

Job DNP Poster

PMHNP – DNP Student

Betty Wilson Long MSN, APRN, FNP-BC

Chair:

Jane Bostick. RN, PhD.

Committee Members

Nancy Birtley, DNP, APRN, PMHCNS-BC, PMHNP-BC

Robin Christal

AFFECTING MOTIVATION AMONG INPATIENT DRUG TREATMENT CENTER PATIENTS

Introduction: Although upwards of 21 million people have been diagnosed with Substance Use Disorders (SUD), there is a large discrepancy between those diagnosed and those who seek treatment. Two in five people who perceived a need for addiction treatment did not receive it because they were not ready to stop using substances.

Methods: Using a pretest- posttest study design, a customized educational intervention on motivation and its contributing factors was implemented at an inpatient drug treatment facility. A convenience sample of adult inpatient clients was utilized. Four weekly 45- minute group educational sessions were administered using the group therapy format that is standard for the facility. Motivational interviewing was used during the group discussion. The Texas Christian University (TCU) Treatment Motivation Scale, a self-administered, 29- point Likert- scale survey was used to measure motivation.

Results: The Wilcoxon signed-ranks test revealed statistical significance with a large effect for the following two questions: Clients agreed that it is urgent to find help immediately for their drug use (p = .02, A = 2.2) and also reported feeling a lot of pressure to be in treatment (p = .04, A = 2.4). A third question did not reach statistical significance but was close: clients reported that they can quit using drugs without any help (p = .07, A = .3).

Conclusions: One of two objectives was met. Utilizing consistent education on motivation and its effect on maintaining sobriety could prove to be helpful among inpatient drug treatment center clients attempting to maintain sobriety.

 

Long DNP Poster

PNP – DNP Student

Jordan Mondt, RN

Chair:

Jan Sherman, RN, NNP-BC,PhD

Committee Members:

Tammy Rood, DNP, APRN, CPNP-PC, AE-C.

Donna Gfeller, PhD. 

REDUCING STRESS IN PARENTS OF CHILDREN WITH AUTISM

Introduction: Parents of children with developmental disorders are more likely to experience higher levels of stress, depression, and anxiety (Padden & James, 2017). The Autism Parenting Stress Index (APSI) was designed by Silva and Schalock in 2011 to help identify areas of stress where parents need support and to assess the effectiveness of supportive interventions. The authors demonstrated that the APSI is a highly reliable instrument to measure parenting stress (α = .83, test-retest coefficient = .88). One proven strategy to improve parent stress and reduce distressing behaviors in children with ASD is parent training (Postorino et al., 2017). Parent training is a method of teaching parents to identify causes of disruptive behaviors, employ strategies to reduce these behaviors, and reduce family stress burden overall.

Methods: A purposive convenience sample of 50 parents were surveyed pre-intervention and post-intervention.  The educational intervention consisted of a 35-minute PowerPoint presentation via Zoom on information regarding sleep differences in autism, the importance of sleep, medical reasons for poor sleep, common misconceptions, and strategies to improve sleep patterns.

Results: There was large statistically significant decrease in reported parental stress associated with three domains on the APSI including: “sleep problems” (p = .05 & A = .83); “tantrums/meltdowns” (p = .03, A = 1.08); and “communication” (p = .08, = .75). There was a 25% decrease in mean target APSI score among those who participated and completed post-webinar surveys (n = 6).  28% of those who were recruited attended the educational webinar. There was a small to moderate improvement in scores for the following questions: “I feel a sense of support from other parents” (p = .16, A = .58), “I feel that other parents understand my family’s stressors” (p = .18, A = .67). with a large increase in “I feel confident in my knowledge of different strategies to improve my child’s sleep” (p = .1, A = .75).

Conclusion: The brief educational intervention met all of the project’s objectives by decreasing in the target APSI score and improving parent sense of support, understanding, and competence. Participation goals were also met.

PNP – DNP Student

Jillian Miller MSN, RN

Chair:

Tammy Rood, DNP, CPNP, RN

Committee Members

Carolyn Crumley, DNP, RN, ACNS-BC, CWOCN

Michel Wendell, EdD

USING MINDFULNESS IN A SCHOOL SETTING TO DECREASE ANXIETY IN SCHOOL-AGED CHILDREN

Approximately 4.4 million children have diagnosed anxiety, which has increased due to the COVID-19 pandemic. The purpose of this project is to identify anxiety in school-aged children using a standardized screening tool Screen for Child Anxiety Related Emotional Disorders (SCARED) and incorporate a meditative deep breathing exercise during school. It was completed at a Catholic school in St. Louis, Missouri. Inclusion criteria for participants included: students in fourth and seventh grade. The SCARED tool was sent home with the students for both the parent and children. The parents graded the tool and then returned it by a provided pre-paid stamped envelope to the project coordinator. A daily mindful breathing exercise was completed by the teachers. The teachers logged participation. A second screen was sent home with the students at the end of the month to evaluate effectiveness. Six children out of 16 were identified at risk. Only two post-intervention responses, a statistical analysis was unable to be completed. The two responses did report the exercise did help to decrease anxiety, which shows clinical relevance of the intervention.

Miller DNP Poster

2021 FALL DNP PROJECTS

STUDENT AND COMMITTEE MEMBERS ABSTRACTS POSTERS

Leadership – DNP Student

Mellisa Martinez MBA, BSN, RN, CENP, CPHQ

Chair:

Dr. Laurel Despins

Committee Members

Kari Lane

Amanda Warren

EVALUATION OF A SEPSIS PROGRAM IN A LONG-TERM ACUTE CARE HOSPITAL
Introduction:
Sepsis is a serious health condition that develops when an infection triggers a systemic inflammatory response causing damage to tissues and organs, leading to significant morbidity or death. Early recognition and treatment of sepsis has been shown to reduce mortality and complications. Patients in post-acute settings could benefit from early sepsis identification screenings and treatment protocols.

Method: A pre/post intervention program evaluation was conducted.  A convenience sample of patient charts (n = 165) admitted to an LTACH were reviewed before and after implementation of a new Code Sepsis Protocol. The new program consisted of nurse orders to complete a sepsis screening assessment each shift, a treatment protocol for positive sepsis screenings, an SBAR provider notification tool, and provider bundle orders for sepsis. 

Results: A 4.6% increase in nurse initiation of sepsis screening orders upon admission from 46.1% to 50.8% was found, resulting in a 3% increase in overall compliance with nurse completion of every shift sepsis screenings from 95% to 98%.  Provider notifications with a positive sepsis screening increased from 28.6% to 100%, which correlated with an increase in the initiation of provider sepsis bundle orders with a positive screening from 14.3% to 100%.

Conclusion: Implementation of a nurse driven Code Sepsis Protocol can increase the initiation of evidence-based sepsis treatment in an LTACH.

Martinez DNP Poster

Leadership – DNP Student

Jen Wenberg MSN, RN,

Chair:

Jan Sherman, PhD, RN, NNP-BC. 

Committee Members

Stefanie Birk, DNP, MBA, RN. 

Patricia Golden, DO. 

INCREASING COLORECTAL CANCER SCREENING COMPLIANCE THROUGH TARGETED OUTREACH

Introduction: Colorectal cancer remains a highly prevalent cause of death in the United States and rates of patient screening compliance average 62-65%.  Screening for colorectal cancer is a valid clinical practice to decrease morbidity and mortality rates of colorectal cancer. 

Methods: This QI project is an evaluation of an existing outreach program to improve colorectal cancer screening compliance through outreach.   Chart audits were used to determine the completion of either a colonoscopy, FIT, or Cologuard by each patient in the sample.

Results: There were 55 total patients in the sample with 12 that completed screening and 43 that did not complete screening. There was no statistically significant difference between interventions designed to increase the screening, including sending a letter (7.7%, n = 13, p = .16), calling the patient (23%, n = 22, p = .42), or having a primary care visit (25.6%, n = 39, p = .28). However, those receiving the outreach call were one and a half times more likely to complete screening (OR = 1.69, 5% CI [.47, 6.13], p = .42, ϕ = .1). While not statistically significant, there was a small clinically significant increase in screening as patients with a primary care visit were almost two and a half times more likely to complete screening (83%, n = 12) (OR = 2.41, 95% CI [.47, 12.53], p = .28 ϕ = .1).

Conclusion: There was a clinically significant relationship between patients that had a visit with their primary care provider and completion of recommended screening.  Results suggest that the relationship between a care provider and patient has a substantial impact on compliant behaviors with screening recommendations.

Wenberg DNP Poster

PMHNP – DNP Student

Nichole Baucan BSN, RN

Chair:

Nancy Birtley

Committee Members

Becky Largent

Laurie Corey, MSN, RN

ICU NURSE EDUCATION FOR INPATIENT DELIRIUM AND CAM-ICU ASSESSMENT

Introduction: Delirium is the most common clinical manifestation in the ICU. Unfortunately, many nurses have difficulty recognizing signs and symptoms of delirium and applying the proper interventions. Studies show low efficacy of single interventions for reducing and treating delirium; furthermore, multiple coordinated interventions must be applied. The purpose of this project is to provide evidence-based education to nursing staff regarding delirium, administration of the CAM-ICU, and the application of interventions.
Methods: A convenience sample of 209 charts in a rural, midwestern ICU. The quality improvement project consisted of 23 nurses were educated on delirium with a 30-minute PowerPoint presentation with an immediate 10-question post-quiz. A data analysis was completed using chi-square of the chart audit.

Results: An analysis of charts revealed the primary objective of a 10% increase in CAM-ICU documentation was met with an increase in 10.4%. CAM-ICU documentation was almost two times more likely to have a CAM-ICU completed, OR =  1.9, 95% CI [1.4, 2.5]. The second object was met due to no documented falls within the intervention time frame. The third object was not met with only a 1% decrease in antipsychotic administration.

Conclusion: The use of the CAM-ICU is a quick, and effective way to assess for delirium in the ICU setting. With proper education nurses can and will use the assessment tool to properly identify whether a patient has delirium.

Buacan DNP Poster

PMHNP – DNP Student

Dava McGougan

Chair:

Nancy Birtley

Committee Members

Jane Bostick

Dr. Laurence Lum

THE EFFECTS OF A PSYCHOTROPIC PROTOCOL ON REDUCING UNNECESSARY PSYCHIATRIC MEDICATION IN THE LONG-TERM CARE SETTING

Introduction: Antipsychotic medications are commonly utilized as first line pharmacological treatment for dementia behaviors. Antipsychotics pose significant risks including cerebrovascular events, metabolic syndrome, delirium, and even death.
Methods: The project was a longitudinal, quality improvement project with the goal to reduce antipsychotics by 1%. Interventions consisted of informational letters to physicians and staff-educational sessions with a pre-test, post-test, as well as formation of a quality improvement team to conduct systematic reviews of antipsychotics. A pre and post-intervention chart review was conducted to measure change in antipsychotic rate and was compared to the CMS report of antipsychotic rate.
Results: From pre- to post-implementation, the facility antipsychotic rate decreased from 18% to 14% compared to a change from 10% to 8.5% according to CMS. Twenty-six staff members attended the education sessions with 65% (n = 17) completing the pre- and post-test. The education was beneficial with mean score increase from 2.24 (sd = .831) on the pre-test to 8.35 (sd = .862) on the post-test (t = -21.627, p < .001). Four of the eight staff comprising the quality improvement team also completed the education sessions. 

Conclusions: Objective one was met as antipsychotics decreased by 4% and 1.5%, respectively. The second goal was met as 65% of nursing staff completed education and demonstrated improved knowledge with improved test scores from pre- to post-test. The third objective was met with 50% of the quality improvement team successfully completing the education.

McGougan DNP Poster