Browsing by Author "Reynolds, Staci S"
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Item Open Access A Quality Improvement Project to Decrease CLABSIs in Non-ICU Settings.(Quality management in health care, 2023-07) Engel, Jill; Meyer, Britt M; McNeil, Gloria Alston; Hicks, Tammi; Bhandari, Kalpana; Hatch, Daniel; Granger, Bradi B; Reynolds, Staci SBackground and objectives
Central line-associated bloodstream infections (CLABSIs) are a common, preventable healthcare-associated infection. In our 3-hospital health system, CLABSI rates in non-intensive care unit (ICU) settings were above the internal target rate of zero. A robust quality improvement (QI) project to reduce non-ICU CLABSIs was undertaken by a team of Doctor of Nursing Practice (DNP)-prepared nurse leaders enrolled in a post-DNP Quality Implementation Scholars program and 2 QI experts. Based on a review of the literature and local root cause analyses, the QI team implemented the evidence-based practice of using 2% chlorhexidine gluconate (CHG) cloths for daily bathing for non-ICU patients with a central line.Methods
A pre-post-design was used for this QI study. CHG bathing was implemented using multifaceted educational strategies that included an e-learning module, printed educational materials, educational outreach, engagement of unit-based CLABSI champions, and an electronic reminder in the electronic health record. Generalized linear mixed-effects models were used to assess the change in CLABSI rates before and after implementation of CHG bathing. CLABSI rates were also tracked using statistical process control (SPC) charts to monitor stability over time. CHG bathing documentation compliance was audited as a process measure. These audit data were provided to unit-based leadership (nurse managers and clinical team leaders) on a monthly basis. A Qualtrics survey was also disseminated to nursing leadership to evaluate their satisfaction with the CHG bathing implementation processes.Results
Thirty-four non-ICU settings participated in the QI study, including general medical/surgical units and specialty areas (oncology, neurosciences, cardiac, orthopedic, and pediatrics). While the change in CLABSI rates after the intervention was not statistically significant ( b = -0.35, P = .15), there was a clinically significant CLABSI rate reduction of 22.8%. Monitoring the SPC charts demonstrated that CLABSI rates remained stable after the intervention at all 3 hospitals as well as the health system. CHG bathing documentation compliance increased system-wide from 77% (January 2020) to 94% (February 2021). Overall, nurse leaders were satisfied with the CHG bathing implementation process.Conclusions
To sustain this practice change in non-ICU settings, booster sessions will be completed at least on an annual basis. This study provides further support for using CHG cloths for daily patient bathing in the non-ICU setting.Item Open Access Advancing Nursing Science Through Site-Based Clinical Inquiry: Designing Problem Pyramids.(AACN advanced critical care, 2022-06) Granger, Bradi B; Mall, Anna; Reynolds, Staci SItem Open Access An innovative DNP post-doctorate program to improve quality improvement and implementation science skills.(Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 2021-01) Reynolds, Staci S; Howard, Valerie; Uzarski, Diane; Granger, Bradi B; Fuchs, Mary Ann; Mason, Leslie; Broome, Marion EBackground
Doctor of Nursing Practice programs prepare nurse leaders for unique roles to address healthcare needs across the quality spectrum. However, additional mentoring and training in implementation science and analytical skills is needed to effectively lead system-wide quality initiatives.Purpose
The purpose of this article is to describe the planning, implementation, and evaluation of an innovative post-doctoral DNP Quality Implementation Scholars Program developed through an academic-practice partnership to address this need.Project method
Throughout the one year post-doctoral program, we evaluated student experiences qualitatively using focus groups and quantitatively using standardized course and instructor surveys to assess overall programmatic goals. Program outcomes were evaluated from the perspective of the academic-practice partnership planning committee through a Qualtrics© survey.Findings
Strengths of the program included the in-depth mentoring by faculty and relationships built across the larger health system. Both scholars and the planning team noted that the system-wide project implemented by the scholars was relevant, timely, and quality-focused.Conclusions
This innovative DNP post-doctoral program leveraged the skill-sets of DNP-prepared nurse leaders to lead system-wide quality improvement initiatives tailored specifically to healthcare organizations.Item Open Access Collaboration Between Infection Prevention and Clinical Education in Response to COVID-19.(Journal for nurses in professional development, 2021-01) Edwards, Pamela B; Green, Katrina; Sturdivant, Margaret H; Lobaugh-Jin, Erica; Oden, Mary; Reynolds, Staci SWith the rapid escalation of COVID-19 educational needs within hospitals, it was imperative for content experts of the infection prevention departments to lean on the expertise of nursing professional development specialists. This article provides a brief overview of how a clinical education and professional development department was deployed to assist and support the COVID-19 response efforts.Item Open Access Enhancement of infection prevention case review process to optimize learning from defects.(Journal of infection prevention, 2022-05) Reynolds, Staci S; Sova, Christopher; Lozano, Halie; Bhandari, Kalpana; Taylor, Bonnie; Lobaugh-Jin, Erica; Carriker, Charlene; Lewis, Sarah S; Smith, Becky A; Kalu, Ibukunoluwa CHospitals continue to struggle with preventable healthcare-associated infections. Whereas the focus is generally on proactive prevention processes, performing retrospective case reviews of infections can identify opportunities for quality improvement and maximize learning from defects. This brief article provides practical information for structuring the case review process using readily available health system platforms. Using a structured approach for case reviews can help identify trends and opportunities for improvement.Item Open Access Evaluation of DNP program essentials of doctoral nursing education: A scoping review(Journal of Professional Nursing, 2023-05-01) Waldrop, Julee; Reynolds, Staci S; McMillian-Bohler, Jacquelyn M; Graton, Margaret; Ledbetter, LeilaBackground: In 2021, the American Association of Colleges of Nurses revised the core competencies for professional nursing education. The revision includes a call for a transformation from a traditional approach to a competency-based approach for teaching and learning. Purpose: The purpose of this systematic scoping review was to provide a fuller understanding of how DNP programs have historically evaluated and documented attainment of the essentials of doctoral nursing education in a summative manner in order to inform developing methods for addressing the newly endorsed advanced-level competencies in nursing education. Methods: A systematic scoping review was completed using PRISMA for Scoping Reviews Guidelines. Databases searched included PubMed (MEDLINE), CINAHL, Education Full Text, Web of Science, and ProQuest Dissertations and Theses. Included reports needed to discuss student competencies and reflect the summative evaluation of the DNP essentials in a DNP program. Data extracted included title, lead author name, lead author affiliation, type of program, aims, design, process, results, competencies included, and DNP project inclusion. Results: Of the 2729 reports initially identified, five met inclusion criteria. These articles described diverse methods for documenting student attainment of DNP competencies including leadership narratives, electronic portfolios, and clinical logs. Conclusion: DNP programs have used summative evaluation methods to document fulfillment of the DNP essentials, but a competency-based education approach requires additional formative evaluations that incrementally support learners' progression toward achieving competencies. Faculty can modify exemplars presented from a review of the literature to serve as summative or formative evaluations of DNP advanced-level nursing competencies.Item Open Access Evaluation of lay health workers on quality of care in the inpatient setting.(PloS one, 2023-01) Basnight, Ramona; Berry, Peter; Capes, Kellie; Pearce, Sherri; Thompson, Julie; Allen, Deborah H; Granger, Bradi B; Reynolds, Staci SAims
To evaluate the impact of a lay health worker support role in the inpatient setting.Background
Healthcare systems are facing critical nursing and nurse assistant staffing shortages. These disciplines can be challenging to recruit and retain, leading healthcare leaders to identify innovative staffing models. Whereas lay health workers have been used in the community and low-income setting, there is scant evidence of their use in the inpatient setting. We implemented a lay health worker role, called Patient Attendant Service Aides (PASAs), on two medical/surgical units at a community hospital.Methods
A pre/post-implementation design was used for this study. An online survey was provided to nurses, nursing assistants, and PASAs on the two medical/surgical units to assess their satisfaction and perceptions of the role. Nursing quality metrics, patient satisfaction, and nursing and nursing assistant turnover were evaluated before and after implementing the role.Results
The online survey showed that nurses and nursing assistants felt that PASAs helped offload their workload, allowing them to focus on nursing-related tasks. PASAs felt supported by the team and believed they were making a meaningful contribution to the unit. There were slight improvements in patient satisfaction, although not significant. There was a significant improvement in nursing turnover on Unit A, from 71.1% to 21.6% (p = 0.009).Conclusions
This is one of the first studies to evaluate the use of lay health workers in the inpatient setting; we found this role to be a feasible way to offload tasks from clinical staff. This role may serve as a pathway for workforce development, as several PASAs are now enrolled in nursing assistant training. Nurse managers may consider using lay health workers in the inpatient setting as they face severe clinical staff shortages.Item Open Access Febrile Neutropenia: Improving Care Through an Oncology Acute Care Clinic(Clinical Journal of Oncology Nursing, 2023-02-01) Frith, Jennifer; Allen, Deborah Hutch; Minor, Kerry; Reynolds, Staci SBACKGROUND: Patients with cancer are at risk for oncologic emergencies, including febrile neutropenia (FN). Timely treatment of FN can prevent complications. Providing this care in the outpatient setting has been shown to be safe and effective. OBJECTIVES: This project implemented and evaluated a new process using an outpatient acute care clinic (ACC) to manage FN in patients with hematologic cancer. The aims were to reduce the time from fever identification to antibiotic administration, decrease emergency department (ED) visit rates, and evaluate patient satisfaction. METHODS: Using a pre-/postimplementation design, an interprofessional team was educated about a new process of caring for patients with hematologic cancer and FN at an outpatient ACC using a comprehensive algorithm. FINDINGS: 31 patients participated in the project (15 pre-and 16 postimplementation). Time to antibiotic administration decreased from 144.88 minutes to 63.69 minutes. Participant visits to the ED decreased by 2.33 times per month on average. Overall, patients were satisfied with the ACC. These findings support using a dedicated outpatient ACC for patients with FN receiving hematology care.Item Open Access Impact of Nursing Clinical Elective Courses on New Graduate Nurses' Clinical Practice: A Mixed-Methods Descriptive Study.(Nurse educator, 2024-05) Lewis, Lisa S; Hartman, A Michelle; Leonard, Christina; Cadavero, Allen; Reynolds, Staci SBackground
Clinical elective courses provide additional specialty knowledge for prelicensure nursing students; however, it is unknown how these courses impact nurses' clinical practice after graduation.Purpose
To describe how clinical nursing electives impact graduates' clinical practice.Methods
A mixed-methods descriptive design was used. Students who graduated from a prelicensure nursing program were sent an electronic survey and participated in qualitative interviews.Results
Thirty-three graduates completed the survey, with 9 participating in interviews. Sixteen graduates worked in the clinical practice areas that were the same, or related to, the clinical elective they took. Many graduates felt that taking the elective course improved their confidence in the clinical setting and provided increased knowledge that put them at an advantage over their peers.Conclusion
Clinical electives may offer a means to meet health care system needs by preparing a more confident, knowledgeable new graduate in specialty areas in which nurses are needed most.Item Open Access Implementation of an Advanced Practice Registered Nurse-Led Clinic to Improve Follow-up Care for Post-Ischemic Stroke Patients.(The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 2022-10) Mitchell, Erin; Reynolds, Staci S; Mower-Wade, Donna; Raser-Schramm, Jonathan; Granger, Bradi BAbstract
BACKGROUND: Ischemic stroke continues to be a leading cause of serious disability within the United States, affecting 795 000 people annually. Approximately 12% to 21% of post-ischemic stroke patients will be readmitted to the hospital within 30 days of discharge. Studies suggest that implementation of a follow-up appointment within 7 to 14 days of discharge improves 30-day readmission rates; however, implementation of these guidelines is uncommon, and follow-up visits within the recommended window are not often achieved. The purpose of this project was to evaluate the impact of an advanced practice registered nurse (APRN)-led stroke clinic on follow-up care for post-ischemic stroke patients. The aims were to improve time to follow-up visit and reduce 30-day unplanned readmissions. METHODS: A pre/post intervention design was used to evaluate the impact of a process to access the APRN-led stroke clinic. The intervention included a scheduling process redesign, and subsequent APRN and scheduler education. RESULTS: The time to clinic follow-up preintervention averaged 116.9 days, which significantly reduced to 33.6 days post intervention, P = .0001. Unplanned readmissions within 30 days declined from 11.5% to 9.9%; however, it was not statistically significant, P = .149. Age was not statistically different between preintervention and postintervention groups, P = .092, and other demographics were similar between the groups. CONCLUSION: An APRN-led clinic can improve follow-up care and may reduce unplanned 30-day readmissions for post-ischemic stroke patients. Further work is needed to determine the impact of alternative approaches such as telehealth.Item Open Access Implementation science in nursing education research: An exemplar.(Nurse education today, 2022-12) Reynolds, Staci S; Granger, Bradi B; Oermann, Marilyn HIntroduction
Using evidence-based teaching approaches can improve nursing students' learning. However, variation in how - or if - these approaches are implemented by faculty and nursing educators is prevalent. A thorough, applied understanding of how evidence-based teaching approaches can best be implemented in the educational setting is lacking.Objectives
The purpose of this project was to use an implementation science framework to implement and evaluate the quality of a doctor of nursing practice (DNP) course before and after implementing evidence-based revisions to course delivery and composition.Design
A pre/post design was used to evaluate course outcomes following implementation of evidence-based teaching approaches.Setting
A small, private university in the southeastern United States.Participants
Students who enrolled in a DNP healthcare quality improvement course.Methods
An implementation science framework for integrating evidence-based teaching approaches was used to guide this project. Revisions were made to a DNP course, with evidence-based teaching approaches implemented using strategies including a dedicated course facilitator, faculty education, interactive assistance to course faculty, and detailed rubrics to ensure consistency in grading between sections. Outcomes included course evaluation scores, qualitative student comments, and student engagement measured via the average number of discussion board posts authored and read.Results
After using the implementation science framework to translate evidence-based teaching approaches, there was a statistically significant improvement in three course evaluation questions and the overall course mean. Qualitative comments showed that students found the revisions beneficial to their learning. There was no change in student engagement.Conclusions
Using a structured implementation science framework and plan to translate and evaluate evidence-based teaching approaches resulted in significant improvements in course outcomes. Nurse educators should consider using an implementation framework to guide course revisions.Item Open Access Implementation Science Toolkit for Clinicians: Improving Adoption of Evidence in Practice.(Dimensions of critical care nursing : DCCN, 2023-01) Reynolds, Staci S; Granger, Bradi BBackground
Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence.Objective
Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects.Methods
We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice.Conclusions
Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.Item Open Access Implementing Venous Leg Ulcer Education and Clinical Decision Support: A Quality Improvement Project(Wound Management and Prevention, 2022-09-01) Beatty, Amelia; Jones, Penny S; Vail, Christopher; Thompson, Julie A; Reynolds, Staci SBACKGROUND: Venous leg ulcers (VLU) require early identification and treatment to prevent further harm. Health care providers often fail to initiate evidenced-based VLU treatment promptly because of a lack of knowledge of VLU guidelines. PURPOSE: To improve early treatment for patients with VLUs presenting to outpatient clinic settings. METHODS: Plan-DoStudy-Act cycles were used for this quality improvement project. Virtual education and a comprehensive clinical decision support (CDS) order set were implemented. Outcome metrics included the rate of ankle-brachial index (ABI) testing, mechanical compression therapy, and home health service referrals for patients with VLUs. The frequency with which the CDS order set was used was also measured. RESULTS: Forty health care providers attended the virtual education sessions among 3 outpatient clinics. There was an increase in ankle-brachial index testing from pre (n = 7; 15.9%) to post (n = 10; 18.2%) (P =.796), but there was a decline in mechanical compression therapy from pre (n = 15; 34.1%) to post (n = 4; 7.3%) (P =.002) and home health service referrals from pre (n = 11; 25%) to post (n = 9; 16.4%) (P =.322). The CDS order set was used 9 times over 13 weeks. CONCLUSION: Future Plan-Do-Study-Act cycles will include completing in-person education and reducing the VLU CDS order set length. Future projects should consider these approaches when implementing evidence-based VLU guidelines.Item Open Access Measuring and Evaluating Clinical Context in Implementation Science Research.(AACN advanced critical care, 2022-03) Woltz, Patricia C; Granger, Bradi B; Reynolds, Staci SItem Open Access Misuse of the P Value: Using Quality Improvement Analyses to Identify Clinically Significant Improvements.(Dimensions of critical care nursing : DCCN, 2024-03) Reynolds, Staci S; Waldrop, JuleeIntroduction
Quantitative research and quality improvement (QI) both seek to improve care provided to patients. However, clinicians often blur the lines between how to appropriately analyze data from these methodologies. Clinicians may inappropriately use statistical analyses for QI initiatives, rather than using run and statistical process control (SPC) charts to analyze improvements in outcomes.Objective
The purpose of this article was to address the analytic methods used for QI initiatives in the clinical setting in an effort to show clinicians how to identify meaningful improvements in clinical practice.Methods
In this article, we provide an example comparing the same evidence-based practice/QI initiative (chlorhexidine gluconate bathing in a medical intensive care unit) using a quasi-experimental pretest/posttest research design with statistical analyses completed with t tests with analyses using run and SPC charts to show the data trended over time. Using a pretest/posttest design, chlorhexidine gluconate bathing compliance improved from 63% to 65%, a nonsignificant change, P = .075. These same data plotted on run and SPC charts, however, show a shift and a trend, indicating clinically significant improvements per QI methodologies.Conclusion
The example in this article highlights the pitfall of relying only on statistical analyses and P values to determine the importance of a clinical project, and provides a practical example for how run or SPC charts can be used to identify improvements over time.Item Open Access Mock Nursing Research and Evidence-Based Practice Conference to Support Learning in Pre-Licensure Nursing Students.(Worldviews on evidence-based nursing, 2019-12) Reynolds, Staci SItem Open Access Program Evaluation of an Early Nurse Intervention Team.(AACN advanced critical care, 2022-03) Heitman, Sarah; Allen, Deborah H; Massengill, Jennifer; Orto, Victoria; Thompson, Julie A; Reynolds, Staci SBackground
Many hospitals have implemented early rapid response teams to improve detection of patients at risk for decline. However, formal evaluation of these programs is rare.Objective
To evaluate the Early Nurse Intervention Team program at a large community hospital in the southeastern United States.Methods
A retrospective evaluation was performed of unplanned intensive care unit transfers, hospital length of stay, length of stay index, ventilator days, and mortality in 2 patient groups: those with and those without an Early Nurse Intervention Team nurse present.Results
There was a marked decline in unplanned intensive care unit transfers as the Early Nurse Intervention Team nurse staffing increased. There were no significant interaction or main effects for length of stay, length of stay index, ventilator days, or mortality between the 2 groups.Conclusions
This study showed a positive impact of implementation of an Early Nurse Intervention Team program, with significant savings given the cost of unplanned intensive care unit transfers.Item Open Access Program Evaluation of Implementation Science Outcomes From an Intervention to Improve Compliance With Chlorhexidine Gluconate Bathing: A Qualitative Study.(Dimensions of critical care nursing : DCCN, 2022-07) Reynolds, Staci S; Woltz, Patricia; Keating, Edward; Neff, Janice; Elliott, Jennifer; Granger, Bradi BBackground and objectives
Evaluation of implementation science research is warranted to better understand and determine the success of translating evidence-based infection prevention practices at the bedside. The purpose of this program evaluation was to evaluate implementation outcomes from the perspectives of nurses and nursing leaders regarding a previously conducted chlorhexidine gluconate (CHG) bathing implementation science study among 14 critical care units.Methods
Focus groups and interviews, using semistructured interview questions, were conducted to examine the perceptions of nurses who participated in a CHG bathing implementation science study. A deductive qualitative analysis using Proctor and colleagues' implementation outcomes framework was used. Transcripts were analyzed and categorized using the framework as a predetermined code list to structure the implementation outcomes of acceptability, appropriateness, adoption, feasibility, and sustainability.Findings
A total of 19 nurses and nurse leaders participated in a focus group or interview. Participants noted that both implementation strategies used in the initial study (educational outreach and audit and feedback) were acceptable and appropriate and expressed that the evidence-based CHG bathing practice was feasible to integrate into practice and was being adopted.Discussion
The program evaluation identified strengths and opportunities for improvement related to the implementation strategies and evidence-based CHG bathing protocol. Findings can inform future studies that seek to implement CHG bathing protocols in the critical care setting using audit and feedback and educational outreach strategies.Item Open Access Reducing Clostridioides difficile Infections in a Medical Intensive Care Unit: A Multimodal Quality Improvement Initiative.(Dimensions of critical care nursing : DCCN, 2024-07) Barker, Lisa; Gilstrap, Daniel; Sova, Christopher; Smith, Becky A; Reynolds, Staci SBackground
Clostridioides difficile (C. diff) infection causes significant morbidity for hospitalized patients. A large medical intensive care unit had an increase in C. diff infection rates.Objectives
The aim of this project was to reduce the C. diff polymerase chain reaction (PCR) test positivity rate and the rate of C. diff PCR tests ordered. Rates were compared between preintervention (July 2017 to December 2019) and postintervention (January 2021 to December 2022) timeframes.Methods
Unit leadership led a robust quality improvement project, including use of quality improvement tools such as A3, Gemba walks, and plan-do-study-act cycles. Interventions were tailored to the barriers identified, including standardization of in-room supply carts; use of single-packaged oral care kits; new enteric precautions signage; education to staff, providers, and visitors; scripting for patients and visitors; and use of a C. diff testing algorithm. Statistical process control charts were used to assess for improvements.Results
The average rate of C. diff PCR test positivity decreased from 34.9 PCR positive tests per 10 000 patient days to 12.3 in the postintervention period, a 66% reduction. The average rate of PCR tests ordered was 28 per 1000 patient days in the preintervention period; this decreased 44% to 15.7 in the postintervention period.Discussion
We found clinically significant improvements in the rate of C. diff infection and PCR tests ordered as a result of implementing tailored interventions in a large medical intensive care unit. Other units should consider using robust quality improvement methods and tools to conduct similar initiatives to reduce patient harm and improve care and outcomes.Item Open Access Reduction in patient refusal of CHG bathing.(American journal of infection control, 2023-09) Destine, Yvette; Capes, Kellie; Reynolds, Staci SBackground
Daily chlorhexidine gluconate (CHG) bathing is a well-supported intervention to reduce patient's risk of central line associated bloodstream infection (CLABSI); however, compliance with this practice is suboptimal. One major barrier is patient refusals of CHG bathing. The purpose of this project was to implement tailored interventions to mitigate this barrier. The specific aims were to reduce patient refusals, increase compliance with CHG bathing, and evaluate CLABSI rates and nursing staff's knowledge of CHG bathing.Methods
Iterative Plan-Do-Study-Act (PDSA) cycles were implemented over the course of 6 months. Run charts were used to identify signals of improvement. Interventions included printed educational flyers for staff and patients, educational sessions, an electronic learning module, and a "badge buddy."Results
We saw a reduction in the median percentage of patient refusals documented, from 23% to 8% after the PDSA cycles. Documentation compliance with CHG bathing increased only slightly from 46% to 47%. CLABSI rates decreased 6% from 0.69 to 0.65.Discussion
Using interventions tailored to the clinical setting can impact patient outcomes. Other health care systems should consider implementing PDSA cycles to improve evidence-based practices.Conclusions
Using PDSA cycles can result in a reduction in patient refusal documentation, and may slightly improve CHG bathing compliance and CLABSI rates.