Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Undiagnosed hypertension in rural healthcare(Montana State University - Bozeman, College of Nursing, 2023) Charlo, April Lee; Chairperson, Graduate Committee: Sandra Benavides-VaelloHypertension is a disease that affects numerous people worldwide. It often goes undiagnosed, causing an increased risk of cardiovascular events. This project aimed to reduce the number of patients with undiagnosed hypertension within the observed population. This project occurred within a network of clinics associated with a 25-bed critical access hospital in rural Western Montana. Participants included clinic staff, physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, medical assistants, and a licensed clinical social worker. The Plan-Do-Check-Act was used as the framework for this quality improvement (QI) project. Hypertension was defined using the 2017 American College of Cardiology and American Heart Association Clinical Practice Guidelines. The Electronic Medical Record system was used to identify out-of-range blood pressures in the last 2 years and add these patients to a registry. Clinical personnel performed chart reviews to eliminate patients who did not meet the criteria defined by the stakeholders. EHR message functionality alerted providers offering to schedule patients for an office visit to rule in or out hypertension. The identified patients were contacted by a licensed clinical social worker and invited to schedule an appointment with a provider to address the possibility of undiagnosed hypertension. The final numbers were assessed 6 weeks after the undiagnosed hypertension project implementation. The multistep PDCA process resulted in a significant reduction in the overall number of potentially undiagnosed hypertensive patients. The initial data collection produced 3,617 patients between the ages of 18 and 85, and the last revealed only 1,210 patients that met the criteria. The most significant decrease in number was seen in the 56-65 age group, dropping from 700 to 188 patients. This quality improvement project aimed to identify potentially undiagnosed hypertensive patients and establish a system to assess those patients by a provider. This project accomplished that objective. This quality improvement project was structured on innovative research, a trusted conceptual framework, and current practice guidelines. If the quality improvement team were to extend this project, the next step would be implementing clinical practice guidelines and monitoring hypertension outcomes within the patient population.Item A survey relating to charting of nurses' notes as obtained from selected physicians and nurses of Montana(Montana State University - Bozeman, 1962) Cockerham, Mary MatherItem Factors that present challenges to healthcare staff during EMR implementation : an integrative review of literature(Montana State University - Bozeman, College of Nursing, 2013) Howland, Amy Lynn; Chairperson, Graduate Committee: Susan LuparellOver twenty years ago, the Institute of Medicine began urging the medical community to embrace the conversion from paper-based charting to electronic medical records (EMR) (National Assembly on School Based Health Care [NASBHC], n.d.). However, it has only been in recent years following the offering of financial incentives by the Department of Health and Human Services that hospitals and doctors' offices have begun the transition in documentation to an EMR (Haupt, 2011). As of the year 2009, it was reported that only 11.9% of US hospitals were using either a basic or comprehensive EMR, and only 2% of hospitals were using an EMR robust enough to comply with the federal government's "meaningful use" criteria (Jha DesRoches, Kralovec, & Joshi, 2010). One reason that so few healthcare organizations have completed the transition to an EMR system of documentation is due to the tedious implementation process and the challenges that arise during this process. The purpose of this integrative review of literature is to explore the factors that present challenges to healthcare staff during EMR implementation in healthcare organizations. This integrative review was performed by mining relevant literature from predetermined databases and all reference lists of the located literature. A total of 26 articles met the predetermined inclusion criteria. The results indicated that the factors that present challenges can be organized into two themes: personal/professional factors and organizational factors. Personal/professional factors include adequate time, inadequate computer skills, workflow disruption, user friendliness, negative impact on patient-provider relationship, security, and poor understanding of the EMR benefits. Organizational factors include cost, inadequate EMR standardization, information technology issues, and issues with implementation. After determining these factors that present challenges to healthcare staff during EMR implementation through careful literature review, the reviewer concluded that a standardized plan for successful EMR implementation in all healthcare settings including remedies for these challenges should be formulated. This standardized plan would offer healthcare organizations the best chance for smooth EMR implementation into practice for the staff, patients, and organization as a whole.Item Electronic medical record implementation in nursing practice : a literature review of the factors of success(Montana State University - Bozeman, College of Nursing, 2009) Steiner, Bridget Anne; Chairperson, Graduate Committee: Christina SieloffThis is a review of the current literature to discern what factors need to be present in an electronic medical record (EMR) implementation in order for it to be successful for nurses. An extensive literature search was performed by using databases CINAHL, MEDLINE, and Health Reference Center for primary sources of research that specifically addressed EMR implementation and nursing. A coding scheme was developed and applied to each article for analysis. It was found that fit of the EMR with nurse functions, education, and positive nurse attitude were the three most common factors associated with successful EMR implementation for nurses. Lack of computer system quality, lack of fit of the EMR with nurse functions, and time requirements of its use were most commonly associated with lack of success.Item A retrospective review of 30-day patient readmissions in a small community hospital to determine appropriate interventions for improving readmission rates(Montana State University - Bozeman, College of Nursing, 2012) Kujawa, Kallie Renee; Chairperson, Graduate Committee: Elizabeth S. KinionNationally, healthcare is in a state of substantial reformation. Quality and cost effectiveness of care provided, as well as evaluation of patient outcomes have become high priorities for healthcare organizations. Presently, national healthcare initiatives have a strong emphasis on improving quality of patient care through reduction in patient readmissions. Not only are hospital readmissions negatively impacting the quality of life for the patients being readmitted, but they are also costly to healthcare organizations and the federal government. This project is an effort to align practices at Bozeman Deaconess Health Services (BDHS), a small community hospital, to meet the current and upcoming federal regulations created through the Patient Protection and Affordable Care Act (PPACA), which aims to improve patient quality of care through reduced readmissions (Stone & Hoffman, 2010). This legislation mandates decreased reimbursement for services if a facility has high 30-day patient readmissions related to the three core measures of Congestive Heart Failure (CHF), Acute Myocardial Infarction and Pneumonia (PNM). A thorough assessment of the patient population at BDHS took place in the form of a retrospective review of patient readmission data from January 2009 through December 2010. Literature suggests common contributors to patient readmissions are poor communication, patients not following their care instructions, inadequate follow-up care and the location to which patients are discharged (Stone & Hoffman, 2010). Assessing the retrospective patient readmission population data for any trends and patterns, will better allow for appropriate intervention selection based on current available evidence for standards of care that reduce readmission rates. This project proposes policy and care process recommendations to incorporate the standard of care into nursing practice at BDHS in an effort to comply with federal regulations, decrease risk for financial penalties and most importantly to improve the quality of patient life by reducing 30-day readmission rates.