Scholarship & Research
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Item SBAR in long-term care: a quality improvement initiative(Montana State University - Bozeman, College of Nursing, 2024) van Houte, Alyshia Grace; Chairperson, Graduate Committee: Jamie M. Besel; This is a manuscript style paper that includes co-authored chapters.Background: The Situation-Background-Assessment-Recommendation (SBAR) tool was adapted by hospitals from the United States Navy in the late 1990s to improve communication during critical situations. SBAR is regularly used in the hospital setting, but its applicability to long-term care is often underutilized. Local Problem: At a 135-bed long-term care facility, there is no institutionally endorsed standard of communication between nurses and providers. Providers receive instant-messaging style communications from nursing staff that often lack structure and pertinent clinical information. An incomplete clinical picture increases the need for clarification, causing delays to patient care. Communication barriers serve as a source of frustration for nurses and providers. Methods: An interdisciplinary approach was used to develop an educational template that was incorporated into the facility's nursing orientation material. Attendance at staff huddles and face-to-face discussions with floor nurses provided education and introduced SBAR as the standard for nurse-provider communication. The Jefferson Scale of Attitudes Towards Nurse and Physician Collaboration (JSAPNC) measured staff satisfaction regarding interdisciplinary collaboration. SBAR utilization was monitored through regular audits of patient progress notes. Results: No statistically significant change was found in JSAPNC scores pre- and post-intervention; post-intervention rates did not meet the long-term goal of 75% utilization of SBAR for nurse-provider communication. Conclusion: Introductory and regularly interval education fosters high-fidelity use of SBAR, but the impact of SBAR utilization on nurse and provider satisfaction with interdisciplinary communication was indeterminate and requires further study.Item Medical technology and mortality transition: the diphtheria antitoxin and childhood mortality in the United States, 1880-1910(Montana State University - Bozeman, College of Agriculture, 2023) Salimi Rad, Sadiq; Chairperson, Graduate Committee: D. Mark AndersonDiphtheria was a deadly infectious disease in the late 19th and early 20th centuries, particularly among children. In 1895, an antitoxin was developed that could effectively treat the disease. This was the first and only infectious disease in the United States at the time with a scientifically-based treatment. To gauge the impact of access to the antitoxin on child mortality, I leverage large and stable differences in physicians per capita rates across 38 U.S. cities. Physicians were the primary distributors of the antitoxin at the time. For every percentage point increase in the rate of physicians per capita prior to the antitoxin's availability, there is a corresponding one percent reduction in child mortality. These findings suggest that the introduction of the antitoxin played an important role in saving children's lives and had a significant impact on the course of medical technology and child health in the United States.Item Medical flight handoff: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Sunden, Peter Scott; Chairperson, Graduate Committee: Alice RunningBackground: Flight medicine, transporting patients from small facilities over long distances, is essential in rural areas. Providing pertinent patient information to receiving care teams is critical and evidence suggests that over half of the pertinent patient information is omitted. Problem: Incomplete patient information provided by the flight medicine community can negatively impact patient safety and receiving team care. Methods: This QI project intended to increase efficiency of patient handoff to receiving care teams by way of a "drop sheet". The drop sheet was developed using the Mechanism Injuries Signs/Symptoms Treatment (MIST) mnemonic. One carbon copy of the drop sheet was left with the receiving nurse; the flight crew retained the other. A QR code was printed at the bottom of the drop sheet linked to a Likert-type survey assessing the comfort, completeness, timeliness, and effectiveness of the flight crew's patient handoff. Interventions: Training on the drop sheet and survey coincided with the project roll-out January 10th, 2023. Flight crews were instructed to complete a drop sheet on every patient and to leave a copy of the drop sheet with staff on the receiving team. Results: At the projects conclusion, (03/10/2023), 64 flights were completed; drop sheets were used 67% of the time. Four surveys were completed during the data collection time. Conclusions: According to the literature, consistent information provided by flight crew handoffs can improve patient safety and report completeness to the receiving care team. Drop sheets were successfully utilized though receiving care team satisfaction with the process remains inconclusive.Item Improving communication and patient outcomes with SBAR at a skilled nursing facility: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2023) Westphal, Mackenzie Sue; Chairperson, Graduate Committee: Margaret HammerslaBackground: Improving patient outcomes depends on high-quality communication among healthcare providers. The aim of this project is to improve communication between geriatric providers and a skilled nursing facility during after-hour phone calls. Local Problem: Geriatric providers expressed concerns about inadequate communication during after-hours phone calls from a Medicare-Medicaid-certified skilled nursing facility. Methods: This quality improvement project utilized the Plan-Do-Study-Act method to create sustainable change. Communication was quantified by establishing 11 key elements of SBAR created based on the Agency for Healthcare Quality and Research TeamSTEPPS curriculum and provider preferences. A needs assessment was conducted to determine baseline data and identify gaps in communication. Phone audits and surveys were used to collect data. Interventions: The Agency for Healthcare Quality and Research's TeamSTEPPS curriculum provided the foundation to create a facility specific SBAR training for staff. The inperson training included a presentation, sample SBAR reports, and resources to reference. Results: The SBAR training at the skilled nursing facility resulted in 10% increase in average SBAR components reported to providers. There was an increase in SBAR elements reported in the Situation, Assessment, and Recommendation categories. There was not a significant change in provider satisfaction, staff satisfaction, or staff confidence. Several residents were unnecessarily transferred to the hospital and received interventions that could have been performed at the facility. Conclusions: SBAR can improve communication between geriatric providers and nursing staff during after-hour calls. Improving communication in skilled nursing facilities is vital to quality patient outcomes and reducing preventable hospitalizations.Item Improving access to peer-to-peer support for caregivers of children and youth with special health care needs: a quality improvement project(Montana State University - Bozeman, College of Nursing, 2022) Patera, Caitlyn Ashley; Chairperson, Graduate Committee: Margaret HammerslaCaregivers of children and youth with special health care needs (CYSHCN) experience stress, burden, and social isolation, which are powerful predictors of poor health outcomes for both the caregivers and their children. Supporting caregivers of CYSHCN in a clinical setting is critical in holistically supporting a CYSHCN medical home. The Montana Parent Partner Program (MTPPP) is an evidence-informed peer-to-peer support opportunity aimed at improving health and social outcomes for caregivers. This program is funded by the Department of Public Health and Human Services (DPHHS) and is available to Montana health care clinics that serve the CYSHCN at no cost to the clinic. At the selected practice site location (PSL), the referral rate and enrollment rate to the program were low; in November and December 2021, only two enrollments were completed into the program out of the 66 patients evaluated aged 0-21 years--a total enrollment rate of 3%. The referral rate was not historically tracked. DPHHS, the PSL, and the MTPPP partnered together in a quality improvement (QI) effort to achieve a referral rate into the MTPPP between January and February 2022 of 50%. The QI team identified barriers to referring and enrolling caregivers into the MTPPP and subsequently proposed opportunities for improvement to reach their goal. First, the team aimed to educate providers at the PSL on the evidence, benefits, and services of the MTPPP. Once the team expressed increased confidence in referring patients to the program, the team re-developed the workflow, referral, consent, and enrollment process and integrated information technology to streamline the processes. Regular PDSA cycles were used in meetings to elicit feedback and address barriers. The results established a referral rate of 40% and an increased enrollment rate of 14% from the previous two months. The findings of this effort can inform current MTPPP hosts and future practices to utilize the PDSA cycle to improve processes. Although the results are affirmative, more time should be dedicated to the quality improvement effort, allowing for more data collection and PDSA cycle completions.Item Concussion education practices among high school coaches in Montana(Montana State University - Bozeman, College of Education, Health & Human Development, 2021) Hughes, Patrick Michael; Chairperson, Graduate Committee: Tricia SeifertConcussions in high school sports present a legitimate threat to athletes across the United States. In the absence of qualified healthcare providers, coaches are most often the individuals who are tasked with making sideline analyses of removing the injured athlete from participation. To help ensure the most optimal outcomes for these athletes, it is important to accurately determine the most effective ways of training coaches. This study analyzed high school coaches in the state of Montana to determine their familiarity with different types of concussion education programs. In addition, particular focus was placed on determining if coaches' familiarity of concussion education programs differed significantly between coaches in urban versus rural school settings and between coaches of different sports.Item Implementation of Lean management in family practice to decrease overall clinic visit time(Montana State University - Bozeman, College of Nursing, 2020) Quist, Rochelle Eileen; Chairperson, Graduate Committee: Angela JukkalaVariations in the patient rooming process have created inefficient practices for staff in a clinic setting. Negative impacts from these variations have been correlated with increased patient wait times, delayed patient care and decreased patient satisfaction. Through patient complaints with frustrations in delayed care and wait times, this scholarly project found discrepancies in the patient flow process. Variations existed within several primary care patient settings based on individual provider training and personal habits, style, and preferences. Utilizing Lean Management ideals to improve rooming and throughput were strongly indicated within recent healthcare journals as a means to reduce waste and improve efficiency in patient care processes. Developing interventions based on Lean Management principles discovered in the literature review will be outlined for execution. Following implementation of interventions, a follow up time study will be completed to compare to the original data, as well as repeat patient satisfaction surveys. This scholarly project expands nursing knowledge by addressing the gaps in past studies by examining throughput in an outpatient clinic setting, potentially decreasing patient wait times, delays in care and increasing patient and provider satisfaction.Item Post-sepsis syndrome: improving morbidity & mortality following hospitalization(Montana State University - Bozeman, College of Nursing, 2020) Woods-Tatarka, April Ann; Mauws, Amanda Frances; Chairperson, Graduate Committee: Angela JukkalaSepsis is the life-threatening organ dysfunction caused by a dysregulated host response to infection. Globally, statistics are grim with 19 million cases diagnosed annually. Each year in the United States (US) there are over 1.6 million people diagnosed with sepsis; over 250,000 of these will not survive. Currently, it is a leading cause of morbidity, mortality, and hospital readmissions in the US. The population of focus was those residing within the north-central Montana region. The purpose of this project was to explore the topic of post-sepsis syndrome (PSS) and its occurrence following a primary diagnosis of sepsis. The goal of this project was the development of a quality improvement initiative focused on establishing a care-management program for patients diagnosed with sepsis. Ultimately, maximizing patient health and healthcare organization outcomes. An interprofessional team was convened to develop an evidence-based quality-improvement plan to decrease the human and financial costs of sepsis and PSS. The purposed evaluation of the quality-improvement project includes monthly PDSA cycles with project goals reviewed bi-annually.