Theses and Dissertations at Montana State University (MSU)
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/732
Browse
11 results
Search Results
Item Interdepartmental transitions of care: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Crass, Kami Magdalene; Chairperson, Graduate Committee: Margaret HammerslaBackground: Lack of standardization and communication failures during interdepartmental transitions of care frequently contribute toward sentinel events and medical errors. Local Problem: At a hospital in Montana, lack of standardization and communication failures during interdepartmental handoffs resulted in potential and actual patient safety events. The purpose of this project was to implement a standardized interdepartmental handoff process utilizing a newly developed tool to improve patient safety and nursing staff satisfaction during intradepartmental handoffs. Methods: Incident reports and nurse satisfaction surveys pertaining to interdepartmental patient transfers from the Cardiac Cath Lab to the Intensive Care Unit (ICU) were reviewed pre-and post-implementation of the standardized handoff tool. Intervention: A standardized process utilizing a customized, paper IPASS (Illness severity, Patient summary, Action items, Situation monitoring/Contingency planning, and Synthesis) mnemonic tool was developed and implemented during this project. Results: No handoff incidents were reported and nurse satisfaction pertaining to handoff report between the Cardiac Cath Lab and ICU nurses improved after implementing the IPASS tool. Suboptimal tool usage rates indicate future improvements are required. Conclusions: This project implemented a customized, standardized, handwritten Cardiac Cath Lab-to-ICU handoff tool. Although reported patient safety events declined and nursing satisfaction improved, suboptimal tool use indicates the need for embedding the tool into the electronic medical record.Item Quality improvement project: comorbid eating disorders during psychiatric inpatient hospitalization(Montana State University - Bozeman, College of Nursing, 2023) Banta, Christine Michelle; Chairperson, Graduate Committee: Margaret HammerslaBackground. Eating disorders (ED) are the second leading cause of psychiatric deaths. Children and adolescents with psychiatric disorders are at an increased risk of comorbid ED. Local Problem. A pediatric psychiatric inpatient hospital has a reputable psychiatric inpatient program; however, the subspecialty of EDs is less established at the facility. Thirty-one percent of admissions over 12 months had positive ED screening results. Methods. This quality improvement (QI) project identified areas to improve communication and transitions of care using the Donabedian model, which focuses on structure, process, and outcome. The QI project was implemented over a seven-week timeframe, utilizing nursing, medical, and non-nursing professionals. Implementation. The QI project developed process modifications to increase the transition of care pathways, communication, and overall ED awareness. Four means of process changes involved the development of a community ED resource list, anticipated aftercare needs, documentation of positive ED screening results from admissions to the inpatient unit, registered dietitian referral, and anticipated discharge needs for follow-up care. Results. Over the QI seven-week timeframe, 42.6% of the psychiatric hospital admissions had positive ED screening. The process change compliance was strongest with nursing and family nurse practitioner staff. The anticipated aftercare needs and use of ED discharge follow-up provided limited data. Conclusion. More pathways need to be established to support comorbid ED care in the inpatient psychiatric setting and transition to outpatient care. The results identified further gaps consistent with current literature, which focuses on validated ED screening tools, barriers to implementation, routes of communication, and roles of PCPs. Comorbid EDs are complex and elusive, requiring treatment pathways to increase awareness, screening, communication, and support during transitions of care.Item Reducing ventilator days in the trauma ICU patient: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Olsen, Rette Marie Riley; Chairperson, Graduate Committee: Lindsay Benes; This is a manuscript style paper that includes co-authored chapters.Mechanical ventilation saves many lives in the Intensive Care Unit (ICU) but can also pose a substantial risk. Prolonged mechanical ventilation is associated with ventilator-associated adverse events, leading to increased hospital stays and mortality. To lower risks for patients, healthcare teams must implement evidence-based measures to decrease ventilator-associated adverse events. The use of an ICU liberation bundle reduces ventilator-associated complications, is associated with less risk for patients, and improves overall outcomes. At a level I trauma center in the northwestern United States, average ventilator days of trauma patients were twice the national average. This facility encourages the use of a liberation bundle, but not all elements of the bundle are consistently implemented. Based on a review of the literature, all aspects of the Society of Critical Care Medicine's ICU liberation bundle along with daily rounding to standardize care. Education on the ICU liberation bundle and interdisciplinary rounding was given to staff members. Daily interdisciplinary rounding with a standardized checklist was implemented over a six-week period. Frequency of rounds and documentation compliance were recorded. Average ventilator days was compared to the average from the same time in the previous year. Rounding occurred 90.20% of the time and trauma ICU patients were discussed in rounds daily. Documentation of the ICU Liberation bundle only occurred 14.71% of the time during the study. The average ventilator days were 3.8 days, compared to 4.8 days the previous year. Implementation of the interdisciplinary rounding process was successful and average ventilator days were reduced, although the unit saw a low number of trauma patients. Documentation compliance of the ICU Liberation bundle was low, potentially related to the lack of in person education prior to the intervention. This demonstrates that the documentation process needs significant improvement.Item Implementation of intermittent pulse oximetry in low-risk hospitalized bronchiolitis patients(Montana State University - Bozeman, College of Nursing, 2024) Donovan, Alaina Jean; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.Background: In 2014, the American Academy of Pediatrics (AAP) updated its guidelines, which recommend the utilization of intermittent pulse oximetry (IPOx) in low-risk and non-hypoxemic bronchiolitis patients. IPOx is the utilization of pulse oximetry monitoring intermittently at specified times. The overuse of pulse oximetry has been associated with an increase of hospital length of stay (LOS), alarm burden for RNs, and parental anxiety. Methods: A two-month QI project was implemented in a large Montana hospital's 10-bed inpatient pediatric unit. The project consisted of implementing an Inpatient Bronchiolitis Pathway utilizing IPOx. When criteria were met, IPOx orders were to be placed into the EMR. After each shift, RNs were asked to self-rate their adherence to the IPOx orders. At the end of each month, RNs completed a Likert-style questionnaire that assessed their satisfaction with the pathway and alarm fatigue. Results: During the QI project there were 12 bronchiolitis patients; of those, only eight patients met the necessary criteria. Six out of the eight had IPOx orders placed into the EMR. There was a 75% rate of IPOx order placement for the short and long-term goals. Adherence to the IPOx orders had a success rate of 73% during the month of January and a 57% adherence rate during the month of February. A comparison of mean LOS showed a mean difference of -5.9 hours in January and February of 2024 compared to 2023. The RN questionnaires showed overall satisfaction with the Inpatient Bronchiolitis Pathway and a reduction of alarm fatigue. Conclusion: The implementation of IPOx for inpatient bronchiolitis patients has been shown to decrease hospital LOS, unnecessary interventions, parental anxiety, and alarm fatigue. While the QI project does show possible improvement to LOS, a study with a longer time frame and increased sample size is needed to determine any clinical significance. The questionnaire suggests decreased alarm fatigue with the implementation of IPOx, which shows that even a small change could significantly impact RN alarm burden. Well-defined guidelines and education to staff and parents should be prioritized to continue to improve adherence to IPOx in the bronchiolitis population.Item Developing and implementing a fall prevention algorithm to improve patient safety: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2024) Doyle, Tera Ann; Chairperson, Graduate Committee: Elizabeth A. Johnson; This is a manuscript style paper that includes co-authored chapters.Statement of the problem: Approximately one million falls occur in U.S. hospitals every year. Inpatient falls are the leading cause of preventable hospital-acquired adverse events, accounting for 70% of all accidents reported by hospitals. Inpatient falls have significant impact on healthcare costs, due to increased patient morbidity, mortality and limited reimbursement. Fall prevention clinical practice guidelines lack consensus regarding effective fall prevention interventions. Inpatient falls continue to be a major concern across the globe despite extensive prevention efforts. Methods: A scoping literature review was conducted to explore the body of evidence available regarding known causes, impact, fall prevention strategies and interventions. A database search was conducted across multiple databases using keyword terms related to inpatient falls. Results were screened for inclusion eligibility based on several factors to produce a current, comprehensive, evidence-based review of the known literature. Results: The evidence within the literature is extensive regarding known causes and impacts but variable regarding effective solutions and prevention strategies. Inpatient falls are multifactorial, complex and often caused by non-modifiable risk factors. Implementation, interventions and risk assessment tools vary dramatically across and within organizations, making comparison of research findings difficult. Clinical practice guidelines offer vague and varying recommendations for fall prevention programs. There is emerging evidence that multifactorial approaches that incorporate evidence-based risk assessment tools, risk stratification and tailored interventions are the most effective strategy currently being utilized. Conclusions: Inpatient falls continue to be a concern due to the dramatic impact for both patients and organizations. The lack of consensus in evidence and guidance perpetuates this complex problem. Multifactorial approach fall prevention programs have emerged as the most effective strategy at reducing and preventing inpatient falls. Quality improvement projects which utilize multifactorial approaches are supported by the evidence within the literature as a cost- effective strategy to prevent and reduce inpatient falls.Item A descriptive study of patients hospitalized in an intensive care unit(Montana State University - Bozeman, College of Professional Schools, 1972) Siebert, Sheila Maureen; Chairperson, Graduate Committee: Virginia Ellen FeltonItem Nurses' expressions of their role as nurses in meeting spiritual needs of patients in a selected hospital in Montana(Montana State University - Bozeman, 1963) Lantz, Esther RubyItem A follow-up of patients dismissed from one Montana hospital with a recommended dietary modification(Montana State University - Bozeman, College of Professional Schools, 1966) Handlin, Helen AdeleItem How do nurses in critical care units assist patients and families to decrease fear and anxiety(Montana State University - Bozeman, College of Nursing, 1975) Scheer, Michael AnneItem Patient reactions to transfers from rural to urban health care institutions(Montana State University - Bozeman, College of Nursing, 1981) Schmidt, Judy Diane