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Item An Algorithm to Increase Diabetic Education Referrals in a Primary Care Clinic: A Quality Improvement Project(Creighton University, 2026-04-30)Purpose: The purpose of this quality improvement project was to increase referral rates to diabetic education for patients with type 2 diabetes. Background: Type 2 Diabetes affects 14.7% of the United States population and is associated with serious complications when poorly controlled. Diabetes self-management education and support (DSMES) is a structured, evidence-based process proven to improve A1C levels and self-management, yet referrals to DSMES remain low. Sample/Setting: Eligible patients with type 2 diabetes who met criteria for referral to diabetic education were included, which was conducted in a Midwestern primary care clinic and implemented by a doctorate-prepared nurse practitioner. Methods: A pathway developed by the American Diabetes Association focused on referrals to DSMES to increase provider referral rates was implemented. The pathway was accessible in all patient exam rooms to be referenced during each patient encounter. Chart reviews and paper-based data sheets were utilized for data collection. Results: Pre-intervention data showed 15 referrals to diabetic education in 2024 for a 20% referral rate. For this project, there were 24 patient encounters; 46% of patients (n=11) met criteria for a DSMES referral. Of those, 11 referrals were placed by the provider, three patients refused education and one patient was already being followed by a diabetic educator. Total referrals to DMES equated to 29% (n=7). This was a 9% increase over 12 weeks. Provider adherence to the clinical pathway was 100% for referrals to DSMES for patients with a new type 2 diabetes diagnosis. Conclusion: The implementation of a DSMES referral pathway improved referrals to diabetic education for patients with type 2 diabetes. Having a standardized method improved identification of criteria that qualifies a patient for DSMES therefore improving adherence. Further clinic involvement and follow-up with patients who refused the initial referral can lead to continued improvements in diabetes care. - No Thumbnail Available
Item Improving Pain Recognition in Advanced Dementia: A Quality Improvement Project Using the PAINAD Tool(Creighton University, 2026-05-15)Abstract Background: Dementia affects more than 57 million people worldwide, with the global economic burden projected to reach $2.8 trillion by 2030. As the disease progresses, up to 80% of individuals experience pain daily; however, pain is frequently under-recognized, particularly in hospice settings where patients are often unable to verbalize discomfort. Purpose: To improve recognition of pain in nonverbal patients with dementia through implementation of the Pain Assessment in Advanced Dementia (PAINAD) tool, combined with targeted nurse and caregiver education. Design: This quality improvement project was conducted in a Midwest hospice organization. Nurses received education on standardized PAINAD use and incorporated the tool into routine visits. Caregivers received educational pamphlets on behavioral indicators of pain. PAINAD assessments were documented in the electronic medical record (EMR), with additional data on interventions and caregiver education collected via a QR code-based tool. Findings: Education attendance was high, with 18 of 19 nurses participating (95%); 15 subsequently utilized the PAINAD tool. Over the 8-week period, 167 PAINAD assessments were documented across 74 unique patients. Among QR-reported assessments, 100% of PAINAD scores ≥1 were followed by interventions. A total of 22 caregiver education pamphlets were distributed. No PAINAD assessments were documented in the three months prior to implementation. Implications for Practice: Implementation of the PAINAD tool improved recognition and documentation of pain in nonverbal patients with advanced dementia and increased adoption of a previously underutilized assessment within the EMR. Integration into existing workflows and targeted education supported feasibility and sustainability. This scalable, low-burden approach can enhance pain assessment and person-centered care for individuals with advanced dementia and related cognitive impairment. - No Thumbnail Available
Item The Creightonian, 2026-04-17(Creighton University, 2026-04-17) - No Thumbnail Available
Item Implementing OSA Screening Using the STOP-Bang Questionnaire for Patients in the Primary Care Setting(Creighton University, 2026-05-15)Background: Obstructive sleep apnea (OSA) is a common, underdiagnosed condition linked to higher morbidity and increased healthcare utilization. In primary care, screening is often inconsistent and symptom-driven, delaying diagnosis, especially in high-risk patients. Objective: To improve early identification and referral of adults at risk for OSA using the STOP-Bang questionnaire in a primary care setting. Methods: An eight-week quality improvement initiative was conducted in a primary care clinic. Adults ≥18 years with at least one OSA risk factor were screened during routine visits. Patients scoring ≥3 received education and were offered referral for polysomnography. Screening and referral outcomes were analyzed using descriptive and inferential statistics, with advanced practice registered nurse (APRN) feedback collected post-implementation. Results: Among 105 patients screened (100% screening rate), 52% were low risk, 30% intermediate risk, and 18% high risk. All intermediate- and high-risk patients received education. Eighteen percent accepted referral, with higher acceptance among high-risk individuals. Older age was associated with referral refusal. Conclusions: STOP-Bang screening was feasible and improved identification and referral of at-risk patients. Routine use supports earlier OSA diagnosis and improved outcomes. Implications for APRNs: APRN-led screening can enhance preventive care and timely OSA management. - Loading...
Item Improving Depression Screening and Documentation of Care Plans Through Implementation of a Provider Toolkit(Creighton University, 2026-04-17)Abstract Depression is one of the most common mental health disorders, but may present with vague symptoms that go unrecognized and contribute to significant comorbidity (Hohls et al., 2021; Jackson & Machen, 2019; Maurer et al., 2018; Morden et al., 2022). Depression screening has been recommended by the USPSTF and documentation of a depression care plan is the focus for many quality improvement (QI) programs and is included in governmental financial incentives to providers (Department of Health and Human Services, n.d.; Morden et al., 2022). The setting for this QI project was a primary care clinic within a large health system. A toolkit was adapted to this setting and shared with providers. A retrospective chart review was completed which showed depression screening was completed in 93% of pre-intervention encounters and 95% of post-intervention encounters; a depression care plan was documented in 98% of pre-intervention encounters and 97% of post-intervention encounters. A provider survey was completed pre- and post-intervention with a focus on confidence in screening, diagnosing, and treating depression as well as the usefulness of the provided toolkit. Providers who responded to the survey reported increased confidence in recommending pharmacologic treatment for depression. More providers reported ‘always’ documenting a depression care plan in the post-intervention survey. All participants reported using the toolkit and finding at least one portion of it useful in their practice. A major limitation to this QI project was an organization initiative to increase depression care documentation which was implemented during the development of this project.