Past Jonas Nurse Scholar Recipients
Abstract: Falls among Older Adults (OAs) are significant problems especially for those living in Long Term Care (LTC) units. The incidence of falls and resulting injuries continue to rise in OAs, 65 years and older. The literature is rich in information regarding the risk factors of falls and methods for correcting them. Yet, OAs continue to fall and sustain injuries that can lead to mortality, increased morbidity, decreased functioning, and quality of life. As outlined by the Centers for Medicare and Medicaid Services (CMS), the Deficit Reduction Act of 2005 and the Prospective Payment System Final Rule (2009) placed the financial burden of fall prevention on hospitals. CMS will no longer reimburse hospitals for injuries sustained secondary to falls that occurred within the hospital setting. According to CMS guidelines, these types of fall are preventable. Thus, without CMS reimbursement, the costs associated with secondary falls will cause an extreme financial burden to the healthcare system. The goal of this Doctor of Nursing project was to evaluate the effectiveness of the interdisciplinary, multicomponent interventions implemented for reducing recurrent falls with the Post Fall Huddle (PFH). The PFH is a brief gathering of an interdisciplinary (ID) team of individuals who are directly involved with the patient’s care. The ID team convenes to identify the cause and risk factors associated with the fall incident. This PFH occurs within 15 minutes of the fall. Based upon a retrospective chart review, it was determined that there was a 78% reduction in recurrent falls, a 65% reduction in the number of falls and 100% compliance in the performance of the Post Fall Huddle after each fall incident. The active involvement of the patient with the ID team in creating an individualized and meaningful intervention plan resulted in a safer patient environment.
Abstract: Radiographic imaging procedures using iodinated contrast media are an essential part of the clinical management of many patient conditions, yet these procedures are not without complications. Iodinated contrast media can cause contrast-induced acute kidney injury (CI-AKI) or nephropathy (CIN). Contrast-induced nephropathy impacts healthcare costs and affects patient morbidities. It is a patient safety concern and a serious adverse event as it only happens after iodinated contrast exposure. For this quality improvement project, a radiology contrast media policy aimed at preventing kidney harm to patients at high risk for developing CIN was modified from the Veterans Integrated Systems Network (VISN) 22 Imaging Services, and implemented in a single outpatient vascular clinic of a large national healthcare system. Using The Johns Hopkins Quality and Safety Research Group Framework, the project lead worked to engage stakeholders and an interdisciplinary team to systematically implement a comprehensive organized change. During the first six months of 2015, of 1289 vascular clinic outpatients, 62 were deemed high risk for CIN based upon policy criteria (4.8%). For most of these at risk patients (64.5%), the modified policy was appropriately implemented. Those who received the policy recommendations (including the intravenous (IV) hydration) experienced no unexpected or complications beyond those that accompany procedures using iodinated contrast media. No patient who received the recommended screening and follow up care was found to have CIN. By adhering to a policy of early screening, stratifying, and IV hydration, quality could be improved for outpatients requiring iodinated contrast for radiographic imaging.
Abstract: This Doctor of Nurse Practice project focused on the development of a guideline for the implementation and planned evaluation of a system-wide Telematernity Peripartum Collaborative Care Program (TPCCP) for women veterans (WV) receiving maternity care services in the Veterans Healthcare Administration (VHA). Informed by the Ottawa Model of Research Use Framework, the guideline contents were developed subsequent to a literature review, needs assessment, and input from key stakeholders, including the team members from Maternity Care Coordinators and members of the Women Veterans Health Program.
The new guideline includes the following elements: learning activities on peripartum depression, an algorithm for guiding care, documentation templates, strategies for establishing a collaborative work environment, and a communication network with national groups for women’s health care. Notes and documentation templates are provided for each of the four services. Educational modules were developed to train the staff to perform screening and therapeutic interventions. Metrics are provided for planned program evaluation.