UMB Digital Archive
Scholarship & History
The UMB Digital Archive is a service of the Health Sciences and Human Services Library (HSHSL) that collects, preserves, and distributes the academic works of the University of Maryland, Baltimore. It is a place that digitally captures the historical record of the campus.
Communities in the UMB Digital Archive
Select a community to browse its collections.
Recent Submissions
Item Using the Difficult Intravenous Access Score to Reduce Peripheral Intravenous Cannula Attempts(2025-05)Problem: Critically ill ICU patients frequently experience unsuccessful peripheral intravenous catheter (PIVC) placement attempts, resulting in pain, complications, and delays in care. An analysis of Electronic Health Record (EHR) data from 37 adult ICU patients between 2/12/24 and 2/26/24 showed an average of 2.62 PIVC placement attempts per patient by unit staff. Failed attempts waste nursing time, increase costs, and deplete viable veins. Despite these challenges, no standardized tool is used to identify patients at high risk for difficult IV access. Methods: This quality improvement project was conducted in a 24-bed surgical intensive care unit (SICU) in a large urban academic medical center. The aim was to reduce unsuccessful PIVC attempts by implementing the DIVA tool. The process goal was to ensure 100% of eligible patients had a documented DIVA score in the EHR, while the outcome goal was a 100% reduction in patients requiring more than two PIVC attempts. A QR code in patient rooms allowed nurses to complete the DIVA survey before the first PIVC attempt, with documentation shared during handoff. Results: Over 15 weeks, 332 ICU patients were assessed, and 283 (84%) required a PIVC. The outcome goal was met, with a 100% reduction in patients requiring more than two PIVC attempts. However, the process goal was not met, as only 37% of patients who received a PIVC had a documented DIVA score. Conclusion: A key facilitator in reducing PIVC attempts was the increased use of ultrasound-guided PIVC placement, with over 65% of SICU nurses trained in ultrasound use, leading to many bypassing the DIVA tool. The addition of a high-definition ultrasound further supported success. The DIVA score contributed to fewer PIVC attempts and was simple and quick to use.Item Implementing Manometer Use for Accurate Cuff Pressure Measurement in Intubated Pediatric Patients(2025-05)Problem & Purpose: In the perioperative department of a small community hospital 15% of pediatric surgical patients experienced postoperative sore throat, stridor, and laryngospasm with two requiring transfer to tertiary facilities. Root cause analysis revealed that anesthesia providers used subjective endotracheal tube cuff pressure assessment rather than objective technique, representing a gap in practice likely contributing to airway complications. This quality improvement project aimed to implement an evidence-based practice change by integrating manometers for objective cuff pressure measurement, ensure a safe pressure range of 20-30 cmH₂O, and reduce postoperative sore throat, stridor, and laryngospasm in intubated pediatric surgical patients. Methods: After literature review and mobilization of a multidisciplinary team including the clinical site representative, chief anesthesiologist, assistant director, director of perioperative services, and anesthesia technician, the project was implemented over 15 weeks in Fall 2024. Seven of eight anesthesia providers received education on manometer use and documentation requirements. Manometers were placed in two pediatric airway carts and visual reminders posted in operating rooms. Weekly chart audits and observations tracked adherence and outcomes in 72 patients. Results: Provider adherence was 61.1%. Cuff pressures were documented within safe range in 88.6% of cases. Negative outcomes occurred in 2.8% of patients, one sore throat in week 1 and one laryngospasm in week 10, representing a significant reduction from baseline. Conclusion: Findings align with existing literature and support the feasibility of integrating manometers into routine practice. Maintaining endotracheal tube cuff pressures within a safe range of 20-30 cmH₂O effectively reduces postoperative sore throat, laryngospasm, and stridor in the pediatric surgical patient.Item Implementation of SAGE Oral Cavity Health Assessment Tool(2025-05)Problem and Purpose: National average of daily oral care for non-ventilated hospitalized adults is about 30%. Oral care less than four times per day places patients at higher risk for non- ventilated hospital-acquired pneumonia (NVHAP), which can lead to increased morbidity and mortality. Chart audits conducted at a large urban medical center found approximately 15% of non-ventilated patients in the Cardiac Surgical Intensive Care Unit (CSICU) received daily oral care. The purpose of this quality improvement (QI) project was to implement and evaluate the SAGE Oral Cavity Health Assessment Tool (SAGE OCHAT) on oral care compliance among non-ventilated hospitalized adults in the CSICU. Methods: The QI Project Lead (QI-PL) mobilized an interdisciplinary team of stakeholders in the CSICU to implement structure and workflow changes: non-ventilated oral care kits present on all admissions, SAGE OCHAT screening once per shift, and increased oral care. A PowerPoint on SAGE OCHAT was presented to CSICU staff. QI-PL was present in the CSICU weekly to review SAGE OCHAT, address barriers, and update stakeholders. Results: SAGE OCHAT compliance averaged 19% (n = 71) and ranged from 0 to 50% per week. Oral care compliance averaged 2.7 times per day (n=146) and ranged from 2.2 to 3.8. There was a total of 7 cases of NVHAP throughout project implementation. All weekly data is collected, organized, and presented in run charts. Conclusion: Findings suggest that use of SAGE OCHAT correlates with oral care compliance. Though SAGE OCHAT, oral care frequency, and NVHAP were below project goal, oral care frequency improved compared to baseline and NVHAP decreased 85%.Item Improving Ambulation Rates for Adult Oncology Patients Using an Evidence-based Framework(2025-05)Problem & Purpose: Hospitalized oncology patients at a large urban academic hospital spend most of their time in bed. Only about 50% of ambulatory patients have documented mobility interventions and out-of-bed (OOB) activities in their electronic health record (EHR). Research shows that enacting nurse-driven mobility protocols or toolkits successfully improves patient outcomes. The purpose of this quality improvement (QI) project was to increase documented mobility interventions and ambulation rates among adult patients on an oncology unit by instituting the Mobilizing Older adults Via a systems-based Intervention (MOVIN) framework. Methods: Eligible patients were those that could ambulate with little to no assistance. The unit was measured in feet, distance markers were established, and an ambulation pathway was created. Physical therapy offered a three-hour psychomotor skills training. Whiteboards in patients’ rooms were utilized to communicate patients’ mobility goals. The unit culture was supported by encouraging staff and motivating patients to track the distance walked, with small prizes and staff recognition used as incentives. Results: Sixty percent of eligible staff received psychomotor training. Fifty percent of staff utilized the in-room whiteboards for goal setting. An average of 61% of patients had documented mobility interventions in their EHR, an increase of 11% from baseline, with a median ambulation count of one per day. The average daily distance walked per day increased by 253 feet. Conclusions: Enacting interdisciplinary, evidence-based mobility toolkits successfully improves patient mobility. Unit budgets, staffing, and the patient population must be considered when implementing new quality initiatives.Item Optimizing Therapeutic Hypothermia Implementation in Neonates with Hypoxic Ischemic Encephalopathy(2025-05)Problem: Hypoxic Ischemic Encephalopathy (HIE), caused by acute perinatal asphyxia, is associated with high mortality and poor neurodevelopmental outcomes. The standard treatment, therapeutic hypothermia (TH), involves initiating passive or active cooling within six hours of life. At a Level III NICU, only passive cooling was utilized. No formal TH policy existed and in six cases of HIE, no evidence-based standard was consistently applied. Purpose: This quality improvement project aimed to enhance early HIE intervention in the NICU by implementing an evidence-based TH algorithm. Methods: Education was delivered via virtual presentation and informal interactions. Knowledge acquisition was assessed using pre- and post-tests. The project lead (PL) developed an evidenced-based TH algorithm and conducted weekly chart audits to measure real-time algorithm adherence, time to target temperature, and goal temperature achievement. TH mock cases, created by the PL, were distributed weekly to assess adherence using targeted questions. Data was stored in REDCap, a secure data management system. Annually, this project was predicted to benefit 3–6 infants, their families, nursing staff, and the hospital. Results: Of two infants requiring TH, adherence was observed in one case (50% adherence). Adherence based on case study performance averaged 57.9%. Overall, median adherence combining real-time TH infants and case studies was 68.35%, below the 80% goal. Some case studies showed strong performance; however, variable participation limited the measurement of widespread adherence. Conclusion: Despite moderate improvement in adherence, variability in algorithm use and low participation highlight the need for structured protocols, enhanced training, and workflow integration.