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Now showing 1 - 5 of 17

Recent Submissions

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    Improving Medication Adherence in Pediatric Asthma Patients Using an Application Based Mediation Reminder Tool
    (Creighton University, 2024-05-09) Stride, Lee Ann
    Abstract Purpose: The purpose of this quality improvement (QI) project is to identify patients with poorly controlled asthma due to medication nonadherence and increase medication adherence for pediatric asthma patients using a technology based smart phone application. Background: Asthma is the most prevalent chronic disease in the world. While there is no cure for asthma, with proper treatment and management the symptoms and exacerbations can be greatly reduced. Adherence to inhaled corticosteroids used to treat asthma is crucial in the prevention of complications related to asthma including multiple hospitalizations, emergency room visits, missed school days, high financial burdens on the family and economy, and morbidity and mortality. Less than half of pediatric patients prescribed inhaled corticosteroids adhere to their medication regimen. Sample/Setting: Patients aged 13-18 years old in a pediatric pulmonary clinic diagnosed with asthma who have been identified as being non-adherent to asthma medications. Methods: Patients identified as non-adherent using the Medication Adherence Report Scale for Asthma (MARS-A) were instructed on the use of a downloadable mobile phone-based application to report their daily asthma medication use. Patients would then send a report to the clinic via the application for provider review. Results: Paired samples t-tests were utilized to assess changes in MARS-A scores between the pre-implementation and post-implementation periods. The analysis revealed no significant difference in MARS-A scores (t(5) = -1.9069, p = 0.1148, Figure 1). Moreover, data indicated that five out of eight participants reported utilizing the app for over 50% of the time (62.5%, 95% CI = 28.49%-91.48%), while six out of eight participants reported using the app at all (75%, 95% CI = 34.91%-96.8%). Discussion/Conclusion: While the majority of the participants utilized the Medisafe app more than 50% of the time, there was not a significant difference in MARS-A scores pre and post-implementation. However, the limited size of the sample likely hindered the ability to identify a significant difference, with a power analysis indicating a need for at least 15 participants for an 80% chance of detecting such a difference. These findings suggest the potential benefits of a larger sample size and a longer timeframe for future investigations. Keywords: pediatric(s), asthma, medication, adherence, non-adherence, management, technology, application, electronic, reminder
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    Reducing Surgical Site Infections in an Ambulatory Surgical Center Using a Perioperative Care Bundle: A Quality Improvement Project
    (Creighton University, 2024-05-09) Sangtongaroonkul, Lily
    Background: Surgical site infections (SSIs) pose a significant burden to the healthcare system. The lack of mandatory reporting in ambulatory surgical centers (ASCs) has led to underreported SSI rates within this setting. Thus, guidelines recommend adopting a standardized preventative checklist to reduce the incidence of SSIs. Purpose: This quality improvement project aimed to assess the efficacy of using a perioperative SSI bundle to reduce SSI rates among breast reconstructive surgery patients in an ASC. Methods: A 5-item perioperative SSI checklist was implemented in an ASC, focusing on women aged 18 to 65 undergoing breast reconstructive surgery from October to December 2023. Participants were evaluated for SSI at 1-, 4-, and 8-week post-procedure. The comparison group was comprised of women who had breast surgery in the preceding eight weeks. The primary outcome was the reduction of SSI rates among women who underwent breast reconstructive surgery, with staff compliance to the SSI bundled checklist as the secondary outcome. Results: A total of 24 participants underwent breast surgery during the eight-week implementation period, with 2 (8.33%) diagnosed with SSIs, compared to 6 (16.7%) in the comparison group of 36 participants. There was no statistically significant difference in the incidence of SSI during pre-intervention (16.7%, OR = 0.2) compared to the post-intervention period (8.33%, OR 0.91; Fisher’s exact p = -0.457). Additionally, staff adherence to the SSI bundle was 100%. Advanced age, BMI, and type of procedure had significant predictor effects for increased SSI risk, with BMI being the most predictive model, which resulted in a 4.09-fold increase in SSI risk for every one-unit increase in BMI. Conclusion: Although the decrease in SSI was not statistically significant, SSI rates declined by nearly 50%, from 16.67% to 8.33%. This highlights the importance of ongoing efforts to refine and implement standardized SSI prevention bundles to enhance patient outcomes. High compliance rates and ease of implementation support the integration of these bundles into routine practice to mitigate the burden of SSIs. Further research and refinement of strategies are warranted to optimize the effectiveness of these interventions. For future studies, analysis of patient variables, such as high BMI, advanced patient age, and type of breast surgery, may be beneficial as potential predictors of SSIs.
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    Nursing Faculty Professional Identity: A Quality Improvement Project
    (2024-05-09) Davenport, Sally
    The purpose of this quality improvement project was to implement an intervention to improve nurse educators’ nursing professional identity. Inadequate nurse educator professional identity is associated with dissatisfaction and subsequent intent to leave employment, leading to an inadequate faculty workforce to educate future nurses. Nursing leaders have been called to action to develop, reinforce, and sustain nurses’ professional identity. The setting was a school of nursing at a liberal arts university in the south Midwest. A convenience sample of 58.3% of 12 full-time faculty nurse educators participated in the project. One participant was doctoral prepared and the remainder masters. The doctoral educator had 18 years of educator experience; masters educators ranged from two to 14 years (average 7.6 years). The plan, study, do, act (PDSA) quality improvement process was utilized in the project. Participants completed the Professional Identity in Nursing Scale (PINS) then viewed an in-service about professional nursing identity and completed a faculty meeting reflective activity. Post intervention, participants again completed the PINS. Weighted means of self and environment domains and subconstruct items were calculated and percent change in domains identified. Pre-intervention domain ratings were 3.22 to 3.86 with self-ratings higher in all domains than nurse colleague environment ratings. Post intervention, all domains improved and the “values and ethics” self-rating and “knowledge” self and environment ratings increased to above 4.0. Percent change in self-ratings ranged from 4.15 to 12.46% and environment from 13.98 to 17.50%. The lowest sub-construct items were “takes care of one’s self” (self) and “effective communication,” “self-awareness” and “self-regulation” (environment). The intervention resulted in an improvement in all domains and provided focus areas for future development.
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    Intensive Care Unit Liberation: A Quality Improvement Project on the Role of Early Mobilization in Mechanically Ventilated Patients
    (2024-03-06) Stanton, Amanda
    Background: This project addressed the issues surrounding the lack of early mobilization in mechanically ventilated patients in an adult, medical intensive care unit (ICU). The aim was to improve patient outcomes, reduce ventilator time, and minimize ICU length of stay (LOS) through an early mobilization protocol. The objectives included development, implementation, and evaluation of an evidence-based early mobilization protocol. A literature review indicated that early mobilization mitigates muscle atrophy, reduces ventilator time, and ICU LOS. Based on findings, a protocol for early mobilization was developed. Kurt Lewin's Change Theory helped guide this project, offering a systematic approach to change and transitioning to new, evidence-based interventions. Methods: Over 10 weeks in a 24-bed ICU with mechanically ventilated patients, seventy staff members completed a 2-week education period on early mobility. Eligible patients underwent early mobility with daily data collection on demographics, ventilator time, and ICU LOS. Evaluation was based on the ability to participate, time on the ventilator, and ICU LOS compared to current practice. Feedback from providers was also collected to assess feasibility of the protocol. Outcomes: Seventy-one patients (N=71) were included, with 55 receiving early mobility. The average days on ventilator decreased from 6 +/- 1 days to 4.85 days (p = .007), with the ICU LOS decreasing from 12 +/- 5 days to 9 days (p = .099). Recommendations: This project recommends integrating early mobility interventions into critical care by adopting tailored protocols, fostering multidisciplinary collaboration, and implementing ongoing education initiatives.