Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Certification of reprocessing standardization: preventing endoscopy associated infections(Montana State University - Bozeman, College of Nursing, 2023) Ranck, Aaron Thomas; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughBackground: Between 2012-2015, 25 outbreaks were linked to contaminated duodenoscopes worldwide due to human error or negligence during reprocessing. A standardized education and training reprocessing program is necessary to address nationally increasing Endoscopy Associated Infections (EAIs). Problem: A Montana endoscopy unit committed to adopting national standards. An unmet objective was the certification of endoscopy reprocessing (CER) requirement. This pilot project sted in developing a mandatory CER protocol to optimize infection control. Methods: A Plan-Do-Study-Act (PDSA) quality improvement method was employed, with pre- and post-intervention design to evaluate infection incidence and risk. This involved patient chart review and duodenoscope reprocessing log review. An aggregate comparison was made between a CER participant and eight non-CER technicians. To inform future program development, a survey was conducted to collect data on CER participant motivation, preparation, and perception of recommended educational materials. Intervention: A pilot study involving a single participant attempting to obtain nationally recognized CER was conducted. The facility manager shared the facility's intention of mandatory certification and via endoscope technician meeting, including incentives. Created certification-benefit video presentation and exam preparation materials were provided one month before the exam. Results: Zero infections occurred during pre- and post-intervention. Pre-intervention, the average infection risk scores per endoscope reprocessing were 12.2 relative light units (RLUs) for the unit and 11.1 RLUs for the CER participant. Post-intervention phase, these numbers were 15.7 RLUs by non-CER technicians and 2.8 RLUs by the CER participant. Conclusion: This study highlights the effectiveness of mandatory CER in reducing the risk of patient infections. Maintaining infection prevention and control in endoscopy procedures requires ongoing education, training, and motivation. Informing employees of the benefits of standardization may improve motivation.Item Development of an acuity scale for the inpatient hospice setting: a quality improvemtent project(Montana State University - Bozeman, College of Nursing, 2023) Blake, Angela Lynn; Chairperson, Graduate Committee: Sandra Benavides-VaelloBackground: Nurse burnout and care fatigue are troubling, prevalent issue within our medical community. Research has shown that high acuity and inequitable staffing assignments contribute to the problem. No streamline solutions have been proposed in the literature. Patient safety events such as falls, and medication errors have been shown to be interrelated to nurse burnout. Balancing workload and patient demands are essential in promoting safe care environments. A 21-bed hospice unit in North Idaho recognized this correlation and requested help in developing an acuity scale to promote nurse to patient staffing equitability thus lessening care burden. Method: A literature review reviled numerous articles promoting staffing balance to stave off care fatigue. Acuity scales are an efficient, concise way to quantify workload and promote balanced staffing assignments. Staff surveys were conducted prior to and post implementation of the tool to measure staff assignment satisfaction. Data was collected on fall rates and medication errors to detect correlation between the two factors. Intervention: Only one published hospice specific acuity scale was identified in the literature review done for this project, Mary Potter Hospice Acuity Tool. A unit specific tool was developed based of the framework provided by this published scale. The acuity tool was trialed on fifty new admissions into the hospice unit between February and March 2023. Results: Limited data was collected as the implementation phase of the project was delayed due to IRB approval and facility specific setbacks. The marginal data collected demonstrates nurse assignment satisfaction improved post intervention while fall rates and medication errors actually increased. Conclusion: This projects objectives were not fully realized due to the previously mentioned delays. The data collected was minimal and greatly impacted. This project provides a solid framework for future developments in unit specific acuity tool development. Future projects such as this one would benefit from a larger timeframe in which to revise the tool being developed and facilitate better impact on the metrics being studied.Item Alarm management on an inpatient surgical unit(Montana State University - Bozeman, College of Nursing, 2016) Whiteley, Rhyana Rose; Chairperson, Graduate Committee: Elizabeth S. KinionAlarm fatigue is a rapidly growing problem in hospitals across the nation, contributing to missed care opportunities and patient safety events. The purpose of the improvement project was to refine the use of audible alarms on an inpatient surgical unit by decreasing the frequency of false and non-actionable alarms, in turn decreasing clinician alarm fatigue and, ultimately, improving patient safety. The biggest culprit of false alarms we found on this type of unit that is of particular concern is the pulse oximetry alarm. Evidence from the literature indicated that capnography was superior to pulse oximetry in the detection of respiratory depression. Although capnography monitoring equipment was available, the current policy on monitoring patients post-operatively at the community hospital in Montana required the use of pulse oximetry and did not include the use of capnography. After determining that there was a gap in practice, an evidence-based practice project was implemented to include the use of capnography for monitoring patients post-operatively. By ensuring that audible alarms are specific to the patient condition, decreasing the frequency of false and non-actionable alarms, alarm fatigue should be lessened. Two policies were put in place that included the use of capnography, one directed at the monitoring of patients using patient-controlled analgesia and one directed at the monitoring of all high-risk patients receiving opioid analgesia. Education of staff regarding the practice change was multi-faceted and included both in-person and online education of the policy changes and both the cognitive and psychomotor aspects on the use of capnography. Additionally, competency validation was assessed in both the cognitive and psychomotor domains. Full assessment of the results of the practice change will take place in 2017.Item Understanding the relationship culture between physicians and nurses and their effects on perceived clinical outcomes and nursing outcomes(Montana State University - Bozeman, College of Engineering, 2014) Waliullah, Md.; Co-chairpersons, Graduate Committee: Nicholas Ward and Bill SchellThe US healthcare industry faces a variety of complex challenges. Simultaneously, pressures continue to mount with regard to the expectation for lower costs with improved quality of care. These problems have drawn the attention of many researchers seeking ways to improve healthcare delivery. These efforts regularly identify two key issues requiring solutions: 1) Improving clinical outcomes by reducing adverse patient conditions due to medical errors, and 2) Improving care delivery by reducing staffing shortages and turnover within the nursing profession. Several studies have shown that workplace culture and incivility can be a material contributor to both of these issues. While many researchers have investigated the nature of nurse-physician interaction, and their effects on clinical and nursing outcomes, they mostly focus on the 'perception' of nurses and not physicians. Perhaps more importantly, these studies generally did not distinguish between descriptive and injunctive norms suggested by Social Norms Theory (SNT). This study seeks to close both of these gaps. This study developed a new survey instrument to measure these norms and performed a sample survey of the physicians and nurses of Montana and Denver area. This study used SNT to identify any gaps between descriptive and injunctive norms of RNs and MDs regarding their relationship culture and their effects behaviors on perceived nursing outcomes (e.g. job satisfaction, retention, etc.) and perceived clinical outcomes (e.g. medical errors, quality of care). The study sought to investigate these gaps because SNT suggests that people tend to behave in the way they believe is most typical of and accepted by their peers (perceived norms). Unfortunately, perceptions of others' behaviors are quite frequently inaccurate, with views of problematic behaviors tending to be overestimated and healthy behaviors tending to be underestimated. SNT offers an innovative approach for addressing such situations by changing perceptions. The findings of the study suggest significant differences between the perceived norms of physicians and nurses when compared to their actual norms. The findings are expected to be helpful for developing an intervention program to improve the relationship culture between physicians and nurses which can contribute to improve quality of patient care and nursing retention.