Theses and Dissertations at Montana State University (MSU)
Permanent URI for this communityhttps://scholarworks.montana.edu/handle/1/732
Browse
8 results
Search Results
Item Medication reconciliation in ambulatory surgery to prevent adverse drug events(Montana State University - Bozeman, College of Nursing, 2021) Marion, Kirsten Ayres; Chairperson, Graduate Committee: Amanda H. LucasAdverse drug events (ADEs) cause a significant burden to the healthcare system. Medication reconciliation (MR) is a well-documented method to reduce ADEs in a variety of healthcare settings. The purpose of this project was to determine best practice for performing MRs, implement best practice into practice, and evaluate outcomes based on successful completion of MRs. This project was implemented at an ambulatory surgery center (ASC) in southwestern Montana with a focus on adult orthopedic patients. Four PDSA cycles were completed over a 6-week period to improve the MR process. Improvement of the MR process was deemed necessary to meet evidence-based MR guidelines for patient safety and to meet accreditation standards. The definition of a complete MR was based on current literature and state and national accreditation guidelines. Over the 6-week process, MR completion rates increased from 0% at implementation to 52% at project completion. Continuation of improvement utilizing the processes implemented in this project is recommended.Item Optimization of advanced practice clinician billing: the first key step to creating an APC-specific onboarding within a healthcare organization(Montana State University - Bozeman, College of Nursing, 2021) Overstreet, Jordan Marie; Chairperson, Graduate Committee: Yoshiko Yamashita ColcloughAdvanced practice clinicians (APCs) have proven to be a cost-effective solution to meet the demands of increasing needs for providing high-quality healthcare, these clinicians continue to report difficulty transitioning into their role. Organizations that employ APC-specific onboarding programs have resulted in improved role transition with reports of increased provider confidence, increased interdisciplinary collaboration, and improved provider competencies. One healthcare organization sought to develop and implement an APC-specific onboarding program. Problem: A healthcare organization was lacking an APC onboarding program to support and provide professional development for APCs. A needs assessment of 90 APCs in the organization resulted in over 30% of responses, reporting feeling less than confident in the skills to independently select billing codes for patient encounters. Also, 60% of respondents were interested in education for the optimization of billing practices. Methods: After collaborating with organizational stakeholders, it was determined a comprehensive educational intervention would be created. A video series of 15 educational modules was created and disseminated to all APCs along with a post-interventional survey. Results: 7 of the 90 APCs responded to the post-interventional survey resulting in positive, but inconclusive data. Due to slowed billing resulting from the pandemic, billing data was unavailable for analysis during the timeline for the project. Of the survey responses, 57% reported the intervention was useful for providers of all experience levels and 43% reported it was most beneficial for newly licensed or hired providers. Conclusions: While the project cannot state the intervention resulted in the optimization of APC billing practices, a comprehensive educational program was created and disseminated with positive responses from APCs participating in the survey. More work needs to be done to determine the effects of the education on billing practices. However, positive survey feedback indicates the intervention would be a feasible, beneficial first step and contributed to the development of a comprehensive onboarding program for all APCs within a healthcare organization.Item Human trafficking: what is the role of the healthcare professional?(Montana State University - Bozeman, College of Nursing, 2018) Jennings, Melissa Rae; Chairperson, Graduate Committee: Alice RunningThe idea of this professional project originated after a learning-needs assessment was performed by the education department on the Labor and Delivery/Mother Newborn unit at a healthcare facility in Montana. Information obtained from the learning-needs assessment indicated that the staff wanted more information on human trafficking in the healthcare setting. A literature review was completed regarding human trafficking in the healthcare setting and the evidence showed that healthcare professionals are not adequately trained in identification of a human-trafficking victim, rescuing a victim, or resource utilization for suspected victims. An educational presentation was developed and learning objectives were identified. The goal of the project was to increase staff awareness regarding human-trafficking victims, increase confidence in the ability to identify a trafficked victim, and provide staff with resources in the event that they encounter a human-trafficking victim. A pretest to assess knowledge of the topic was given immediately prior to the presentation and a posttest was given immediately after the presentation to assess attainment of learning objectives. Results showed an increased awareness of this topic post presentation and staff felt more confident in identifying a human-trafficking victim. Staff were given resources to utilize at the end of the presentation to assist them in identifying potential victims and use for referral purposes on their unit. Although this was one area to increase awareness of the problem of human trafficking, there continues to be a need for protocol development for healthcare providers, collaboration amongst law enforcement, service providers, and private organizations and increased research regarding this topic.Item Transportation of ST-segment elevated myocardial infarctions in rural Montana to percutaneous coronary intervention capable medical centers and achievement of goal treatment times(Montana State University - Bozeman, College of Nursing, 2019) Bothman, Nicole M.; Chairperson, Graduate Committee: Casey ColeBackground: Rapid reperfusion via primary percutaneous coronary intervention or thrombolytic therapy is critical to limit death and disability associated with ST-elevated myocardial infarction. However, the majority of Montanans reside in rural areas and require time consuming interfacility transportation for specialized cardiac care. Purpose: The aim of this scholarly project is to analyze the treatment and transfer process of adult patients experiencing a ST-elevated myocardial infarction with initial presentation to a rural medical facility requiring interfacility transfer for specialized cardiac care to generate quality improvement recommendations for changes in the care and transfer process to decrease door-to-needle, door-to-door, and door-to-balloon times among this patient population. Sample: Subjects were adults (18 years of age and older) diagnosed with a ST-elevated myocardial infarction at a rural medical facility and transferred to the nearest STEMI receiving medical facility for specialized cardiac services. Subjects transferred for primary PCI and post thrombolytic therapy were included in this project (n = 8). Methods: Retrospective data analysis of deidentified quality metric data was utilized to examine if treatment benchmarks set forth by the American Heart Association were met during the data collection period of January 2018 through September 2018. A voluntary survey was implemented at the rural medical facility to provide supplementary and clarifying information related to the treatment and coordination of transportation of ST-elevated myocardial infarction cases from February 2018 through August 2018 (n=3). Conclusions: Of the eight cases reviewed in this project, none met all of the applicable quality metric benchmarks; all eight met the door-to-ECG benchmark, one met the door-to-needle benchmark, none met door-to-door or door-to-balloon benchmarks. Providers in rural areas can provide quality care with positive clinical outcomes among ST-elevated myocardial infarction patients though adherence to treatment guidelines and working as a collaborative team with transporting agencies to facilitate rapid interfacility transportation (American Heart Association, 2015; National Clinical Guideline Centre, 2013).Item Grant Creek Center : a facility for the treatment of eating disorders, Missoula, MT(Montana State University - Bozeman, 1987) Albers, Paula JanelleItem Planning community health care : a feasibility study for Three Forks, Montana(Montana State University - Bozeman, 1986) Bollenbach, BruceItem An expandable health facility for Colstrip, Montana(Montana State University - Bozeman, 1974) Morin, Jeffrey J.Item The effect of an educational intervention on facility staff knowledge regarding pressure ulcer care(Montana State University - Bozeman, College of Nursing, 2010) Forseth, Cynthia Dawn; Chairperson, Graduate Committee: Karen ZulkowskiThree million pressure ulcers occur in the United States in a year. Pressure ulcers are painful, stressful, and costly to treat and may be preventable. In a frontier facility, staff education about new techniques for preventing and treating pressure ulcers is often problematic. In the rural area, there are fewer opportunities, less money, less time for training and education of staff as well as high staff turnover. These obstacles to nursing staff's ability to maintain competency can lead to less than optimal care. The simple act of reading an article or attending a lecture can increase pressure ulcer knowledge. The purpose of this study was to examine nursing staff knowledge before and after an educational intervention in a frontier critical access/nursing home facility. Knowledge scores did increase but because of the small sample, size statistical significance was not obtained although the knowledge score increased. Increased educational opportunities can improve pressure ulcer knowledge in a rural facility.