Scholarship & Research
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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 DianeItem 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.