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Now showing 1 - 5 of 17

Recent Submissions

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    Development of Standardized Approach for Ultrasound-Guided Peripherally Inserted Central Catheters in Infants in the Neonatal Intensive Care Unit
    (Creighton University, 2024-04-18) Vuong, Brandon
    Purpose: The purpose of this quality improvement project was to increase the NNPs’ confidence levels utilizing ultrasound for PICC line placement to improve first-attempt cannulation success rates in PICC line placement using ultrasound guidance in a 12-week period. Background: The transition from intrauterine to extrauterine life can be difficult for infants who are premature, extremely-low-birth-weight, or have any respiratory, cardiac, or gastrointestinal abnormalities. These health needs often require prolonged intravenous access. A PICC line is the current standard of care in neonates due to its ability to provide long term access, safely deliver nutrition, protect the infant’s vessel from medications, and avoid punctures to replace peripheral lines. Sample/Setting: The setting of this project was a level IV NICU in southeast Minnesota. The sample for this project was all NNPs who placed a PICC line in an infant in the NICU. Methods: An educational procedural guideline on the use of ultrasound technology for PICC line placement was developed and disseminated to all NNPs. The NNPs received hands-on-learning with the ultrasound machine and practiced catheterization in training models. Outcomes were analyzed through data collection forms by the success and failure rates of PICC line cannulation. Results: During the 12-week intervention period, 16 PICC line placements were reported. Seven of the 16 placements utilized ultrasound guidance. There was a 57% overall cannulation success rate with ultrasound use. However, of the successful placements, there was a 75% first attempt cannulation success rate. Conclusion: Implementation of the procedural guideline demonstrated the potential impact ultrasound guidance can have for PICC line placement. However, additional resources, education, and QI initiatives are needed to sustain the continued use of ultrasound and advance neonatal practices.
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    Recommending Gardasil-9 at 9 in the Primary Care Setting: A Quality Improvement Project
    (Creighton University, 2024-04-19) Leister Morton, Kaitlyn
    HPV vaccination rates in the United States lag far below Health People 2030’s benchmark of 80% of children between the ages of 9-26 being fully vaccinated. Inadequate HPV vaccination is a multifactorial issue, but parental vaccine hesitancy and the lack of strong provider recommendations to vaccinate play key roles. Parental vaccine hesitancy has only worsened since the COVID-19 pandemic, making providers’ efforts to vaccinate even harder. The purpose of this Doctor of Nursing Practice (DNP) QI project was to increase HPV vaccination rates using a comprehensive strategy, which included implementing a new clinic protocol to start routinely recommending HPV vaccination at 9 years old, and providing healthcare providers with in-person education and a toolkit of resources in order to enable them to provide strong recommendations for vaccination, especially to vaccine-hesitant parents in a primary care setting, over a 10-week period.
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    Increasing Suicide Screening in a Pediatric Primary Care Clinic: A Quality Improvement Project
    (Creighton University, 2024-05-09) Cooper, Elizabeth
    Purpose: The purpose of this quality improvement (QI) project was to implement the use of the ASQ Toolkit and clinical pathway to identify and make referrals for adolescents at risk for suicide in a pediatric primary care clinic setting. Background: Mental health in adolescents is a rising concern in the U.S., with 4.1 million adolescents reported having major depressive episodes, and only 41.6% seeking care. Suicide is the 2nd leading cause of death for 15–24-year-olds in the U.S. Half of adolescents that committed suicide were seen by a provider within four weeks of their death. Population: Two pediatric nurse practitioners, one physician assistant, and two medical assistants in a pediatric in primary care clinic. Methods: The Ask Suicide-Screening Questions (ASQ) toolkit was utilized by administering the PHQ-9 and ASQ for adolescents ages 12 and above at well child visits upon arrival to the exam room Upon review by the best next steps were determined with the assistance of the NIMH pathway. An updated referral and resource list was also created. Results: Over an 8-week period, 48 of 49 patients were screened with both the PHQ-9 and ASQ. 6 or 7 high scoring patients were given referrals or resources. 12 patients were given resources or referrals for mental health care. All of the patients were properly billed and coded in the EHR. Staff satisfaction was high amongst all providers as a way to streamline care and have supportive guidelines.
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    Data collection for the identified patients occurred only once with the pre- or post-intervention data collection. Secondary data collection would only occur if the patient were to undergo a code status change again with another procedure during the same hospital stay while admitted to the identified units.
    (Creighton University, 2024-05-09) Golden, Natalie C.
    Discordant CPR continues to occur in hospitals across the U.S leading to undesirable patient health outcomes, patient dissatisfaction, and related legal and malfeasance difficulties. In hospitals where discordant CPR occurs, a gap in code status order versus action was identified. Many hospitals choose to invoke a Full code status prior to patients undergoing procedure or surgery in contrast to the patient’s elected code status of MDNR or DNR. After procedure, the code status is not returned to the original order and discordant CPR can occur. An intervention was introduced using a smartphrase in the EMR. The intervention alerted providers to evaluate the code status order and return to the original order when appropriate. An increase in return to original code status order post- procedure was achieved. No discordant CPR events occurred for those patients whose code status order was not returned to the original.
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    Treatment of Anxiety and Depression in Primary Care: Reducing Barriers to Access
    (Creighton University, 2024-05) Kane, Mallory
    Purpose: The purpose of this quality improvement project was to develop and implement a standardized follow-up plan for all adult patients with anxiety and/or depression who were newly being referred to a counseling center by their primary care provider. Background: The majority of mental health disorders, specifically anxiety and depression, are treated by primary care providers. They identify patients who need referral to mental health specialists. Sample/Setting: The setting was within pod 5 of the family practice department of large semi-rural, multi-tenant medical center in Hudson, Wisconsin. The sample included 4 family practice physicians & two-family nurse practitioners, the medical assistants within pod 5, & Hudson Medical Center’s referral team. Methods: Key outcomes included the percentages of patients receiving handouts on local mental health services, 2-week follow up calls, and clinic notifications from counseling centers. A post-survey assessed the referral team's perception of sustainability. Results: 20 adult patients participated (65% men, 35% women). Ages ranged from 18 to 85 years. Diagnosis: 25% depression, 30% anxiety, 45% both. All patients received mental health service handouts. 40% had follow-up within 2 weeks; 60% after 2 weeks. 40% successfully scheduled outpatient mental health appointments. 37.5% of successful participants had notification letters sent to counseling center. Reasons for declining referrals: lack of time, interest, cost concerns, personal situations. Post-survey themes from referral team: lack of time, insurance issues, patient non-compliance, long wait times. Conclusion: This project sheds light on the challenges and successes of implementing a standardized follow-up plan for mental health referrals within a primary care setting, underscoring the importance of addressing barriers to optimize patient care.