Browsing Doctor of Nursing Practice (DNP) Projects by Subject "Safety Management"
Now showing items 1-3 of 3
Development and evaluation of a surveillance instrument for monitoring and cataloging staff injuries in a state mental hospitalThis quality improvement study was designed to: 1) review staff injury documentation instruments of public and private mental health facilities and other hospitals in different geographic areas, 2) develop an instrument to document staff injuries and their context, and 3) test the usability/acceptability and the ability to reliably capture relevant data elements.
Implementation of a Safety Campaign to Reduce the Rate of Needlestick InjuriesProblem and Purpose: Needlestick injuries are the most common cause of work-related bloodborne pathogen exposure among nurses. At the project site, 62.5% of preventable needlestick injuries reported during the first half of FY 20 were associated with failure to appropriately activate the safety mechanism on safety engineered devices (SEDs). A DNP project was implemented to reduce the rate of preventable needlestick injuries among inpatient nursing staff. Methods: Implementation strategies and tactics utilized were pre- and post-implementation surveys; visual cues; sharp safety huddles; revised new employee orientation; and assignment of an educational, post-injury module to staff. The number of preventable needlestick injuries was tracked during the data collection period; supplemental data included the unit, date and time of incident, hire date, and brief narrative. The number of inpatient nursing units that displayed the visual cue (n=20); the number of inpatient nursing units on which a formal/informal sharp safety huddle was held (n=13); the number of nurses who attended the revised new employee orientation (n=139); and the number of nurses who completed the post-injury module (n=3) was also tracked. Results and Conclusion: Pre-implementation survey data revealed 63% of respondents believed preventable needlesticks were a present concern within their organization (n=76) and 71% believed injuries were likely caused by inappropriate safety mechanism activation (n=86). In comparing pre- and post-implementation data, there were decreases in the percentages of staff who expressed that they disagreed or strongly disagreed with statements intended to measure knowledge about Safety Engineered Devices (SEDs), processes, and education. 95% (n=20) of inpatient nursing units displayed the visual cue during the implementation period. The baseline needlestick injury rate of 0.47 consistently decreased during the implementation period: October: 0.34; November: 0.12; and December 0.2. Needlestick injuries continue to be an occupational hazard for nursing staff, especially during a period of mass vaccination/widespread use of needles during the COVID-19 pandemic. A multifaceted approach including open dialogue with staff, promoting a consistent method for safety mechanism activation, increasing awareness, and ongoing staff education appeared to be associated with a reduced rate of needlestick injuries among inpatient nurses.
Implementation of De-Escalation Training to Medical-Surgical NursesProblem: The American Nurses Association reports only 20% of nurses’ feel safe in their area of practice with patient violence towards nurses happening more frequently on medical-surgical units (Cahill, 2008; OSHA, 2004). Purpose: To determine the effectiveness of de-escalation training on medical-surgical nurses’ confidence levels in handling agitated patients. Methods: This quality improvement project employs a non-experimental, single group, pre- and post-test design. Thackrey’s (1987) Confidence in Coping with Patient Aggression Instrument (CCPAI), a 10-item questionnaire, evaluates nursing confidence levels in dealing with agitated patients before and after implementing Richmond’s et al. (2012) Ten Domains of De-escalation. Outcomes: A one-sample t test comparing the pre- and post-test confidence scores showed the mean as significantly different from 55, a hypothetically neutral score. The post-test mean significantly increased (68.82, 95% CI [6.84 to 20.81]) from the pre-test, t(33) = 4.03, p = <.001 and showed a moderate to large effect size d = .72 (Pilot, 2010). A paired-sample two-tailed t test significantly increased from Time 1 pre-test (M = 49.82, SD = 10.11) to Time 2 post-test (M = 72.82, SD = 14.41), t(10) = 4.46, p < .001. The mean increase was 23.00 [95% CI, 11.51 – 34.49]; d = 1.84 indicating a large effect size (Pilot, 2010). A sensitivity analysis (Wilcoxon Signed Rank Test) showed a median difference amongst the matched pairs with a significant increase in confidence levels post-training, z =-2.847, p < .004. The median score increased from the pre-test (Md =51) to the post-test scores (Md = 71) (Pallant, 2013). Implications: This pilot project demonstrates improved medical-surgical nursing confidence in dealing with agitated patients. Further research using a larger sample size in several nursing units would add validity to the results.