Quality of life in long term care (LTC) is a concern for many stakeholders. The elders who are living in LTC facilities, their families, the staff, and government and policy makers are all interested in providing quality care and quality of life to those persons living within the facility. Culture change is one way for LTC facilities to begin to give decision making to the residents, and to increase quality of life of these elders. There are different culture change models that embrace the concept of person-centered care. No matter which model is chosen, the essence of the change is moving from a medical care model to a person-centered care model. vi The purpose of this project was to evaluate the effectiveness of a culture change intervention, teaching person-centered care to certified nursing assistants (CNA), on the quality of life (QOL) of alert and oriented residents living in a LTC facility. The elders, identified as alert and oriented by a score of 25 or greater on the Mini Mental State Exam (MMSE), participated in a QOL questionnaire. Two one hour in-services on person centered care were presented to the CNAs. The QOL questionnaire was re-administered to the elder participants after three months. The results illustrated that teaching person-centered care to CNAs showed significant improvement in the areas of dignity and security, and marginal significance in the area of individuality. This suggests the elder's increased feeling of respect from the staff, as well as an increased sense of belonging and confidence in the availability and assistance of the staff members. It also suggests the elders felt that they were known as individual persons and that their preferences were honored.

Abstract Purpose: The purpose of this project was to evaluate outcomes of an existing inpatient tobacco cessation counseling program with 30-day follow-up among recently admitted tobacco-dependent patients who were tobacco-dependent. Background/Significance: Tobacco use is considered the number one most preventable cause of disease, disability, and death in the United States. Despite associated dangers, approximately 21% Americans currently smoke. This has led to increased hospital admissions and chronic disease management, costing the United States approximately $96 billion per year. Decades of research and evidence-based clinical practice guidelines substantiate that inpatient tobacco cessation counseling has the potential to improve quit rates post-hospital discharge. Method: This quality improvement project utilized existing hospital data containing demographic and medical information about patients and tobacco use behaviors. The goal was to answer the question: Does the provision of a tobacco cessation program initiated during hospitalization for persons who are tobacco-dependent (a) increase quit attempts or (b) reduce tobacco consumption? The electronic medical record was queried for data related to: demographics, insurance type, and diagnosis. Data related to smoking status and the intervention was extracted from a paper chart maintained by the certified tobacco treatment specialist. Results: Out of 176 tobacco-dependent patients admitted to the hospital, 100 (57%) indicated an intention to quit (at admission time) while only 40 (23%) reported having quit within 30 days post discharge (McNemar Test, p=0.000, n=176). The mean number of cigarettes smoked per day dropped from 19 cigarettes on admission to 13 cigarettes post discharge. [t (158)=6.7476, p=0.000]. Conclusions: This quality improvement project showed that although an inpatient smoking cessation program did not improve quit rates, it did significantly improve reduction in tobacco consumption.

The purpose of this evidence-based project was to compare one-year outcomes for newly licensed Registered Nurses (NLRNs) in three organizations within the same healthcare system. All three have lower than nationally reported turnover and strategies for NLRN retention. Only one is using a Nurse Residency Program (NRP). NRPs are recognized as an effective strategy to retain newly licensed registered nurses (NLRNs) in their first year of employment (Institute of Medicine [IOM], 2010; The Advisory Board, 2007; Spector, 2007). The Commission on Collegiate Nursing Education (CCNE) (2008) defines an NRP as a series of learning sessions and work experiences that occur continuously over a 12-month period designed to assist NLRNs as they transition into their first professional nursing role. This cross-sectional, descriptive study utilized the Casey-Fink Graduate Nurse Experience Survey and intent to stay questions to collect data on NLRNs at one year post hire. Results indicated no statistically significant differences between the three sites and the subscales of the survey. There was a trend of a more positive score for professional satisfaction with Site A. Turnover was also similar between sites and lower than the reported 10% average, with Site A at 2%, Site B at 5%, and Site C at 4%. There was a statistically significant difference between Site A and C in the intent to stay in their current position, with Site A longer than Site C. The study supports the literature and evidence that a NRP is an effective strategy to decrease first year turnover. Further study is needed related to the effectiveness of the components of the NRP, length of time for mentorship, and the impact of accumulation of cohorts.

Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs. The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.

Conjunctivitis is the most common cause of red eye and one of the most frequent causes of visits to clinicians. There is significant controversy on the diagnosis and treatment of the disease and the use of ophthalmic antibiotics. The inconvenience of the untimely diagnostic tests led to the trend of treating conjunctivitis empirically with ophthalmic antibiotics. Subsequently, the diagnosis of bacterial conjunctivitis is higher than it should be resulting in overuse of antibiotics. Consequences of inappropriate diagnosis and treatment include increased virulence, increased health care costs, and incorrect use of antibiotics leading to possible adverse reaction and antibiotic resistance. Appropriate diagnosis and treatment will assist to reduce the diagnosis of bacterial conjunctivitis and use of ophthalmic antibiotics resulting in reduced virulence and reduced health care costs. The AdenoPlus test has been shown to be effective in appropriately diagnosing viral conjunctivitis and subsequently decreasing the use of ophthalmic antibiotics however this evidence in limited. A national retail clinic has adopted the use of this tool to assist with proper diagnosis and treatment of viral conjunctivitis. Data has not yet been analyzed to determine if the implementation of this test changes the practice of clinicians at the national retail clinic.

Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a thorough literature review focusing on intravenous ketamine as an adjunct to standard opioid-based analgesia for postoperative pain. Four systematic reviews published in the last 10 years support the safety and efficacy of ketamine when administered intravenously in sub-anesthetic doses. The purpose of this project was to provide evidence-based education to anesthesia providers regarding the benefits of ketamine and follow-up to evaluate for evidence of changes in practice after the educational At a large community hospital data concerning ketamine utilization by anesthesia providers as a component of multimodal analgesia was collected for a six-month period, including three months pre- and three months post-educational intervention. Despite various methods utilized to present evidence regarding the safety and efficacy of ketamine, the results of this study demonstrated no significant change in practice. Based upon the extensive published literature the evidence is compelling that the addition of a sub-anesthetic (0.5 mg/kg) dose of ketamine to the surgical patient’s operative pain management plan would improve comfort and decrease opioid-related side effects with minimal negative impact.

In an era of value based purchasing and healthcare reform, hospitals face the challenge of delivering high quality care in an environment of diminishing resources. This performance improvement project describes the use of master’s prepared nurses on medical surgical units to improve quality and patient satisfaction. The setting was five medical surgical units in a 200+ bed hospital in the southeastern United States. Declining resources necessitated an increase in the nurse to patient ratios on the units (from 5:1 to 6:1). The project involved the modification of the model of care through the change in nurse/patient ratios and the addition of master’s prepared nurses to coordinate and supplement the care of the staff RNs for complex patients. While inconclusive, the literature review confirmed the impact of master’s prepared nurses on quality metrics and did not conclusively confirm that delivering high quality, safe care was not possible with nurse/patient ratios of 1:6. The goal of the project was to determine if the presence of the master’s prepared nurse could mitigate the changes in ratios and produce high quality and satisfaction outcomes. Measures of success were drawn from archived standardized quality measures in the realms of service (HCAHPS questions), patient safety (CABSI, HAPU) and quality outcomes (core measures and 30 day readmissions). The project design was a retrospective, one-group pre-post design looking at two six-month intervals—before and after project implementation. Results demonstrated sustained or improved quality in six of ten measures. Highest positive impact was in readmissions and nurse sensitive indicators. The most negative results were in patient satisfaction. Modifying the model of care is an iterative process requiring continued evaluation and changes to improve outcomes. Results of this project supported the further evaluation of staffing and expansion of the number of master’s prepared nurses on medical surgical units.

Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening. The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at a volunteer medical clinic for the working uninsured. In this retrospective, time series observational evaluation, data were collected via chart review regarding adherence to the guideline. The intervention consisted of the placement of a visual algorithm educational tool for clinical decision-making for cervical cytology screening in each exam room. Data were collected during three time periods: (1) the 3 months prior to initial education of clinic staff regarding the guideline; (2) the 3months between initial education and introduction of the algorithm; and (3) the 3 months post introduction of the algorithm. A total of 335 charts were reviewed. There was a significant difference in the proportion of appropriate screening among the three groups (Χ2= 6.83 p=.03). There was also a significant difference in appropriate screening rates between the new and established patients’ group, controlling for group (p<.0001). The use of the interventional algorithm is recommended to improve adherence to evidence-based practice guideline related to cervical screening as it decreases harm(s) to the patient by reduction of fear, cost to the patient, and overtreatment of benign regressive lesions.

Patient outcome data are an important factor in healthcare. Reports by the Institute of Medicine between 1999 and 2001, as well as recent research by Linda Aiken and her colleagues have added more emphasis to measures that can be taken to improve patient outcomes. Because of the role they play in healthcare facilities, nurse leaders are in a position to take the lead in improving patient outcomes. There is evidence to suggest that nurse leaders' transformational leadership behaviors are associated with positive patient outcomes. The purpose of this project was to identify the effect of transformational leadership skill-building training on nurse leaders' behavior in the acute care setting. The project included assessments of nine nurse leaders by those nurses which are supervised by the nurse leaders. The results indicated the nurse leaders' behavior score of 3.1 was in the transformational range (3.0-3.75.) Transformational leadership skill-building training followed the assessment process. A post training evaluation by the previous assessors followed the training. The distribution of the transformational leadership behavior scores did not change following the training.

In today's hospital environment, good care has become synonymous with positive patient outcomes. Marring this landscape is the alarming rate of hospital acquired (nosocomial) infections. Urinary tract infection (UTI) is one of the most common hospital acquired infections. The major cause associated with these infections is the use of indwelling urinary catheters. Bacteria invade the lower urinary tract by ascending through or around the catheter. Morbidity associated with urinary catheter-associated UTI can be minimized by prudent decisions concerning catheter usage and good catheter care. The principle route of dispersal of nosocomial infections is likely from patient-to-patient via transiently contaminated hands of hospital personnel. The purpose of this evidence-based project was to determine if hospital-acquired catheter-associated urinary tract infection rates among patients admitted to an acute care facility could be decreased through staff education and consistent application of nursing care using selected perineal infection control interventions. The setting was a 43-bed medical/surgical floor in a 321 bed not for profit Magnet hospital in Northeast Florida. Twenty-four registered nurses and 18 patient care technicians completed targeted in-service education on general nosocomial infections, perineal care, and hand hygiene. A catheter dwell time notification system was also implemented. Chart review data was obtained from 383 admissions (197 pre-intervention, 133 after the educational intervention, and 53 after the dwell time notification). There was a significant difference in catheter-associated urinary tract infection rates after the interventions (11.17 pre-intervention, 10.53 after the educational intervention and 0.392 after the dwell time notification). A longer length of time in practice an on this hospital unit was associated with lower infection rates.