Nursing (Doctor of Nursing Practice)

Breast cancer affects people all ages, genders, and races. The ways in which providers prevent and detect breast cancer have change significantly over the years. Healthcare providers have a number of resources to utilize to screen patients for breast cancer appropriately. However, providers do not always follow the guidelines that are recommended likely due to lack of knowledge. The purpose of this evidence-based quality improvement project was to increase healthcare provider knowledge about current breast cancer screening guidelines and recommendations. In August of 2024 over a two-week period, healthcare providers at a federally qualified health center look-alike were asked to participate in an evidence-based quality improvement project concerning breast cancer screening guidelines. Participants completed a pretest and posttest questionnaire to measure if there was an increase in knowledge after completing the presentation. Fifteen participants completed both the pretest and posttest. A paired-samples t-test was utilized to analyze data which resulted in a statistically significant finding. These results conclude that a breast cancer screening guidelines presentation helps to increase provider knowledge.

Cardiac arrest is a global issue. Research has been done over the years to create the golden standard within the American Heart Association (AHA) that chest compressions matter. The research now is advancing beyond just the quality aspect. The new knowledge of the quality has led more researchers into the specific timing which is known as the ratio of chest compression fraction (CCF) time. The initiative behind the implementation of this project was to address the problem that the institution did not have any means of measuring either the quality of manual compressions or the CCF. CCF is the time doing compressions divided by the overall time of the cardiopulmonary resuscitation event.

Education was provided to staff on ways to reduce interruption: pre-charge defibrillator, establish pulse prior to holding compression and hoover over the chest for next compressor on the opposite side of the patient. In addition to education on current protocols, a manual compression feedback device was used to monitor real-time feedback. Quality improvement implementation of the measurement of CCF. Data was collected by using a manual feedback device. Reviewing the quality % of compressions. Data was collected for baseline, then post-implementation of education regarding the importance of measuring CCF.

Data were compared for pre and post-intervention, by reviewing overall patient outcomes and looking at the 30-day post resuscitation mark. The post-intervention data included 10 patients. Six of the patients had CCF greater than 80%, Four events used the manual compression feedback device, and two with the mechanical compression device. Four patients had a return of spontaneous circulation at the time of the resuscitation event. However, there were zero survival patients at the 30-day post-resuscitation mark. The data had no difference between the pre and post-interventions for the 30-day survival rate.

Clinical inertia is the failure to initiate or intensify treatment in a timely manner in people with type-2 diabetes mellitus (T2DM) in primary care (PC) where collaborative care can be an approach to overcome inertia. Diabetes care network (DCN) is a telehealth based collaborative care model to address clinical inertia in the PC environment. In DCN, initial care was delivered via E-Consult by hub diabetes team for Veterans with A1c of 9% or higher and the longitudinal collaborative care delivered by PC liaison with weekly team huddle. To study the difference in the clinical outcomes with DCN vs PC practices, we compared the DCN cohort (97.7% male, 90.8% white, with a mean age 67.2 (8.9), with a PC cohort (100% male, 94.9% white, mean age: 68 year (10.5), with A1C >9%). Methods: Means (SD), frequencies. and percentages were presented. The DCN cohort had a significant decline in the baseline A1C of 10.2% (1.4), to 8.1% (0.99), 7.6% (0.96), 7.5 % (0.86) at 3, 6, and 12 months while A1c in PC cohort stayed poor with baseline A1C of 10.1% (0.89), to 10.2% (1.69), 9.7% (1.74) and, 9.5% (1.83) at 3, 6, and 12 months. Patients who achieved A1c less than 8% in DCN cohort were 38 (43.6%), 56 (64%), and 56 (64%) at 3, 6, and 12 months and were 1(1.7%), 5(8.5%), and 6(10.2%) at 3, 6, and 12 months in PC cohort. An A1c of less than 7% was achieved in DCN cohort in 10 (11.4%), 21 (24.1%), and 23 (26.4%) patients at 3, 6, and 12 months and only 1(1.7%), 0(0%), and 0(0%) patients achieved A1c less than 7% at 3, 6, and 12 months in PC cohort. Our study shows participation in the DCN telehealth program for 1 year was associated with significant improvement in A1c. This improvement was not seen within the PC with traditional care practices. Thus, addressing clinical inertia in PC will need a paradigm shift in current practices. The proposed collaborative approach of DCN can overcome clinical inertia in PC and improve care for people with T2D by supporting PC access to specialty care expertise, decreasing the burden of diabetes care for patients and PC providers.

Compassion fatigue, also known as secondary traumatic stress disorder, results from repeated exposure to the suffering of others, eventually exhausting his or her ability to show compassion. Self-care has been suggested as a potential preventative or treatment strategy in compassion fatigue however there has been limited documentation to validate this relationship. This study utilized a non-experimental, descriptive correlational design in order to determine if EMS professionals in Northwestern Pennsylvania, who practice self-care, experience less compassion fatigue than those who do not. A survey which was comprised of The Professional Quality of Life (ProQOL) scale, a validated tool for assessing compassion fatigue by evaluating secondary traumatic stress, burnout, and compassion satisfaction, as well as the Health Promotion Lifestyle Profile (HPLP) II, a tool to evaluate health promotion/self-care, was completed by 164 EMS professionals in Northwestern Pennsylvania. Spearman’s rank correlation coefficient was utilized to determine the relationship between self-care and compassion fatigue. The results demonstrated a negative correlation between self-care and burnout (p<.000), a negative correlation between self-care and secondary traumatic stress (p<.000), and a positive correlation between self-care and compassion satisfaction (p<.000), suggesting lower levels of compassion fatigue in those who practice self-care. These findings suggest that the implementation of self-care may result in decreased compassion fatigue, improving the EMS professional’s quality of life as well as patient outcomes.

During the COVID-19 outbreak in the spring of 2020, the nursing department responsible for facility-wide heart failure (HF) interdisciplinary communication was disbanded and redirected to other hospital needs. With that change and the subsequent lack of cohesive educational efforts, the hospital readmission rate climbed to 29.85%. This hospital system has consistently had readmission rates greater than the Centers for Medicare & Medicaid Services (CMS) national benchmark of 21.9%, which is both detrimental to our patients and the hospital to incur readmission penalties yearly. Before this program began there was no process to transition care from inpatient to outpatient for the HF population; key members that touched HF patients operated in silos. Based on consistently high readmission rates and the need for improved outcomes, a comprehensive HF discharge program was designed and implemented house-wide. Transitional care coordination includes providing education, scheduling post-discharge follow-up appointments, and providing HF toolkits. There was a retrospective analysis of data three months after the implementation of QI initiatives. Our facility’s all-cause 30-day readmission rate has progressively declined by 7.63% since the HF transitional program’s implementation (Study period 25.37% down to 17.74%). Readmission average rate for 2019 was 24.9% (n=241) (July 6-September 30, 2019) and compared to after implementation in 2020 was 22.56% (n=195) (July 6-September 30, 2020). Overall, we have found having an advanced practice provider (APP) led multi-disciplinary program to be the best practice for the HF population while improving outcomes and the ability for self-care while decreasing 30-day readmission.

Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents; patients are commonly treated even in the absence of signs or symptoms of a UTI being present. This research study’s objective is to reduce the amount of unnecessary antibiotic prescribing and assess the impact of educational interventions in nursing home residents that have asymptomatic bacteriuria (ASB). The design of this research study is quasi-experimental. The setting is Butler Memorial Hospital, a non-profit organization and an independent community hospital with 296 beds located in rural Pennsylvania. Population of interest includes nursing home residents that present to Butler Memorial Hospital’s Emergency Department with consecutive positive urine cultures. A multifaceted educational intervention will be provided to Emergency Department staff to reduce the number of unnecessary antibiotic prescribing in ASB cases. There were 105 in the sample population that resided in an institutional facility for the elderly that were seen in Butler Health System’s Emergency Department. Out of the DEFERRING ANTIBIOTIC PRESCRIBING IN NURSING HOME RESIDENTS WITH ASYMPTOMATIC BACTERIURIA 4 105-sample population, 73 were encountered before educational intervention. Twelve out of the 73 pre-educational sample population met the study’s inclusion criteria. Out of the 105 sample population, 32 were encountered after educational intervention. 4 out of the 32 post-educational sample population met the study’s inclusion criteria. In conclusion, this pilot study showed that there was a 3.9 percent overall reduction in nursing home residents that were being inappropriately diagnosed with a UTI and placed on unnecessary antibiotics when in fact they had ASB and met the criteria to defer prescription. While this was a small change the potential for changing prescribing habits with educational programs is encouraging and more studies should be done with larger samples sizes.

Background: According to the Centers for Disease Control, (CDC, 2018) at least thirty percent of outpatient antibiotics are unnecessary. A retrospective 2018 study by Incze, M.A., Redberg, R.F. and Katz, M. found forty nine percent of antibiotic prescriptions in the urgent care setting were for inappropriate diagnosis. The aim of this study was to educate providers on one method of reducing antibiotic prescriptions and incorporate new patient instructions into the electronic health record. Participants included physicians associates and nurse practitioners.
Methods: The Quality improvement approach of Plan Do Study Act was utilized for this project. A literature review was completed to study methods of antibiotic stewardship. The electronic health record system was queried for delayed prescribing discharge instructions. Informal discussions among providers revealed absence of a cohesive approach to reducing unnecessary prescriptions for antibiotics.

Interventions: A PowerPoint was emailed to all providers on the use of delayed prescribing for antibiotics along with a Likert-Scale survey on provider perceptions of implementation. New instructions for patients on delayed prescribing of antibiotics was added to the existing electronic health record system. For a period of 30 days the number of times delayed prescribing instructions sheets were printed for patients was monitored along with the number of patients seen at each location. The provider survey was also reviewed.

Results: Provider survey demonstrated favorable attitudes toward antibiotic stewardship. The delayed prescribing instruction set was utilized twenty-seven times over the thirty-day period. There were 2,579 patient encounters during the study for a 0.9% utilization rate.

Conclusions: This was a new process in the clinic where the study was completed and though the utilization was low there was favorable consensus among providers on the value of antibiotic stewardship. There are many opportunities going forward including tracking diagnosis codes along with antibiotic prescriptions and following up to determine how many delayed prescriptions were filled. This research can provide a starting point for any outpatient facility looking to decrease rates of antibiotic prescribing.