GSN Practice Partnerships

GSN Faculty and Staff

Practice Partnerships

The DNP project demonstrates student synthesis of evidence-based practice and research concepts taught across the program while laying the foundation for future scholarship. The DNP  students select a project topic determined collaboratively with practice partners, stakeholders and faculty members. The topic forms the foundation for the DNP project with the goal of improving outcomes for individuals, groups, populations, communities and/or systems within Military and Federal Healthcare Systems.

 

GSN-DNP Projects by Priority Areas

Class 2017: 2

  • William Beaumont Army Medical Center, Ft Bliss:

Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Bliss

  • Darnall Army Medical Center, Ft Hood:

Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Hood

 

Class 2018: 4

  • Wilford Hall Ambulatory Surgical Center - Lackland AFB:

Brief Behavioral Therapy for Improved Sleep: A Process Improvement Project

  • William Beaumont Army Medical Center, Ft Bliss:

Ensuring Active Duty Service Members with PTSD Receive Evidence-Based Treatment

  • David Grant Medical Center, Travis AFB:

Mental Health Stigma Reduction: Piloting the LINKS Anti-Stigma Program

  • Naval Medical Center San Diego + 88th Medical Group, WPAFB:

Incivility in the Workplace: An Evidence-Based Practice Pilot Project

 

Class 2019: 4

  • Darnall Army Medical Center, Ft Hood:

Adherence to Evidence-Based Practice for Major Depressive Disorder

  • Madigan Army Medical Center, JBLM:

Utilization of the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale for the DSM-5 (CAPS-5) to Assess PTSD Symptom Severity in an Intensive Outpatient Program

  • Naval Medical Center Portsmouth:

An Evaluation of the Caregiver Occupational Stress Control Program at Naval Medical Center Portsmouth

  • David Grant Medical Center, Travis AFB/ Madigan Army Medical Center, JBLM:

Postvention Program for Clinicians after Loss of a Patient to Suicide

Class 2016: 1

  • Naval Hospital Jacksonville:

Implementation of a Standardized Preoperative Diabetes Medication Management Guideline

 

Class 2016: 1

  • 88th Medical Group, WPAFB:

Ketamine: An Adjunct to Multimodal Analgesia

 

Class 2017: 1

  • Naval Hospital Jacksonville:

Implementation of an Education Program for an Ultrasound-Guided Liposomal Bupivacaine Transversus Abdominis Plan (TAP) Block Protocol for Open Abdominal Procedures

 

Class 2018: 4

  • Naval Medical Center Portsmouth:

Barriers to Remifentanil Use for Labor Analgesia: A Process Improvement Initiative

  • Ft Belvoir Community Hospital:

Remifentanil for Labor Analgesia: an Evidence-Based Practice Project

  • Walter Reed National Military Medical Center:

Improving Success Rate of the Adductor Canal Block (ACB) by Standardizing Technique

  • 96th Medical Group, Eglin AFB:

Anxiety Management for Needle Localization

 

Class 2019: 2

  • Womack Army Medical Center, Ft Bragg

Assessing Adherence to Chronic Opioid Therapy for Pain Clinical Practice Guideline

  • 59th Medical Wing (Wilford Hall Ambulatory Surgery Center), JBSA:

Risk Mitigation in Chronic Opioid Therapy for Pain

Class 2016: 1

  • Naval Medical Center San Diego:

Inpatient Respiratory Monitoring: Implementation at a Large Military Treatment Facility

 

Class 2017: 1

  • Naval Medical Center San Diego:

Evaluation and Implementation of a Continuous Respiratory Monitoring Curriculum

Class 2018: 1

  • 59th Medical Wing (Wilford Hall Ambulatory Surgery Center), JBSA:

Use It or Lose It: Addressing Insidious Readiness Skills Attrition Among Health Care Providers

Class 2016: 3

  • Ft Belvoir Community Hospital:

Evaluation of Anesthetic Techniques for ERCP

  • Naval Medical Center Portsmouth:

Use of Manometry in the OR for Guiding Endotracheal Tube Cuff Inflation

  • Walter Reed National Military Medical Center:

Measuring Competency in Ultrasound Guided Regional Anesthesia

 

Class 2017: 4

  • Womack Army Medical Center, Ft Bragg:

Evidence Based Practice for Low Back Pain

  • Madigan Army Medical Center, JBLM:

Clinical Standard of Practice in the Assessment and Diagnosing of Adults with ADHD

  • 59th Medical Wing (Wilford Hall Ambulatory Surgery Center), JBSA:

Use of STOP-BANG Screening Questionnaire in OP settings to Improve OSA and Polysomnography Referral Accuracy

  • Walter Reed National Military Medical Center/ 88th Medical Group, WPAFB/ 96th Medical Group, Eglin AFB:

Trigger Films in Nurse Anesthesia Education

 

Class 2018: 2

  • Darnall Army Medical Center, Ft Hood / Madigan Army Medical Center, JBLM:

Sleep Restoration in the Active Duty Population

  • Naval Hospital Jacksonville:

Breastfeeding After Surgery: Influencing Postoperative Recommendations

 

Class 2019: 6

  • Naval Hospital Jacksonville:

Postoperative Nausea and Vomiting Prevention: Screening and Interventions

  • Naval Medical Center San Diego:

Pharmacological Approaches to Postoperative Nausea and Vomiting Prevention

  • Naval Hospital Bremerton:

Impact of a Reward Efficiency, Set Priorities, Empower Teams (RESET) Pilot Program in Family Medicine Clinics

  • Naval Hospital Portsmouth

Residual Neuromuscular Blockade (RNMB) Educational Project for Post Anesthesia Care unit (PACU) Nurses

  • 88th Medical Group, WPAFB:

Evaluation of Cricothyroidotomy Training During a 'Can’t Intubate, Can’t Ventilate' Scenario

Class 2016: 1

  • 96thMedical Group, Eglin AFB:

Evidence-Based Practice for Intraoperative Neuromonitoring for 1- and 2-level Lumbar Fusions: A Gap Analysis

 

Class 2017: 2

  • Naval Hospital Bremerton:

PCS Transitions of Care for Kitsap, WA Exceptional Family Members: Process Evaluation

  • Ft Belvoir Community Hospital:

Enhancing Efficiency in a Military Community Hospital Preanesthetic Clinic (PAC)

 

Class 2018: 1

  • Naval Medical Center San Diego:

Intraoperative Anesthesia Handoff Checklist: A Tool to Improve Communication

 

Class 2019: 4

  • Ft Belvoir Community Hospital:

Implementation of a Standardized Intraoperative Handoff Tool for Anesthesia Providers

  • Ft Meade (Kimbrough Ambulatory Care Center)

Malignant Hyperthermia Crisis Preparedness

  • David Grant Medical Center, Travis AFB:

An Evaluation of Utilization of Enhanced Recovery After Surgery Protocols at Travis AFB

  • Walter Reed National Military Medical Center:

Achieving High Reliability in High-Level Disinfection of Flexible Endoscopes at Walter Reed National Military Medical Center

Class 2015: 1

  • David Grant Medical Center, Travis AFB/ Madigan Army Medical Center, JBLM:

LGBT educational program for military healthcare providers

Class 2015: 2

  • Womack Army Medical Center, Ft Bragg:

Review and Comparison of VA/DoD mTBI CPG to Current Practice

  • Womack Army Medical Center, Ft Bragg:

Evaluating Spouse mTBI Education Programs

 

Class 2016: 1

  • Womack Army Medical Center, Ft Bragg:

Evaluation & Management of mTBI in the Garrison Setting

Class 2015: 1

  • Darnall Army Medical Center, Ft Hood:

Program Evaluation of PCMH Alignment with NCQA PCMH 2011 Standards 1 and 3 (Access/Continuity and Plan/Manage Care)

 

Class 2016: 1

  • Darnall Army Medical Center, Ft Hood:

Utilization & Barriers of HIT Tools in a Primary Care Clinic: SMS and PLR

 

Class 2018: 2

  • Naval Base Kitsap (Bremerton):

Meeting Access to Care Through Innovation

  • Madigan Army Medical Center, JBLM:

Group Medical Visits for Chronic Conditions

Class 2015: 1

  • Madigan Army Medical Center, JBLM:

Sexual Assault Screening Practices in Outpatient Primary Care

 

Class 2016: 3

  • Madigan Army Medical Center, JBLM:

Sexual Assault: ICD Coding Behaviors of Outpatient Service Providers

  • Madigan Army Medical Center, JBLM: Retrospective Chart Review of Sexual Assault Care Provided at MAMC
  • 59th Medical Wing (Wilford Hall Ambulatory Surgery Center), JBSA:

Military Sexual Assault: The Current State of Policy, Screening, and Follow-up Care

 

Class 2017: 1

  • Madigan Army Medical Center, JBLM:

DoD Provider Response Resource for Management of Patients Disclosing SA/SH

 

Class 2018: 1

  • Naval Station Norfolk (Portsmouth):

Behaviors and Barriers to Sexual Violence Screening by Healthcare Providers at Naval Medical Center Portsmouth

Class 2017

  • Wilford Hall Ambulatory Surgical Center - Lackland AFB:

Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy

 

Class 2018: 2

  • Wilford Hall Ambulatory Surgical Center - Lackland AFB:

#1 Sleep Restoration in the Active Duty Population

#2 Brief Behavioral Therapy for Improved Sleep: A Process Improvement Project

Class 2015: 1

  • William Beaumont Army Medical Center, Ft Bliss:

Evaluation of Evidence Underlying AR 600-9

 

Class 2016: 1

  • William Beaumont Army Medical Center, Ft Bliss/ Darnall Army Medical Center, Ft Hood: Integrating Exercise Recommendations into the Army Medical Home

 

Class 2017: 3

  • William Beaumont Army Medical Center, Ft Bliss:

VA/DoD CPG for Screening and Management of Overweight and Obesity

  • 81st Medical Group, Kessler AFB:

Determinants of Successful Weight Loss in a Structured Weight Management Program

  • Naval Station Norfolk (Portsmouth):

Awareness and Utilization of Military Community Health Promotion Resources

 

Class 2018: 3

  • Womack Army Medical Center, Ft Bragg:

Increasing Human Papillomavirus Vaccination Rates in Active Duty Service Members: A Multi-Modal Interactive Education Program

  • 81st Medical Group, Kessler AFB:

Dietary Supplement Adverse Event Reporting & Coding at Keesler Air Force Base

  • Naval Station Norfolk (Portsmouth):

Obesity Management: Standardizing the Process within Primary Care

 

Class 2019

  • 81st Medical Group, Kessler AFB:

Improving VA/DoD Obesity Clinical Practice Guideline Compliance Among Primary Care Providers

  • Naval Medical Center Portsmouth:

Implementation of Video-Based Weight Loss Education in Primary Care

Class 2017: 4

  • Darnall Army Medical Center, Ft Hood:

Reducing Military Unintended Pregnancies: Increasing Knowledge and Access

  • David Grant Medical Center, Travis AFB:

Early Perinatal Loss and its Implications on Women’s Mental Health

  • 79th Medical Wing (Malcolm Grow Medical Clinics & Surgery Center), JB Andrews: Cervical Cancer Screening in Primary Care
  • Naval Medical Center Portsmouth:

Parturient Education for Neuraxial Analgesia: A Video Tool

 

Class 2018: 1

  • Wilford Hall Ambulatory Surgical Center - Lackland AFB:

Targeted Counseling to Reduce Occurrence of Bacterial Vaginosis

GSN-DNP Projects by Military Treatment Facility

2016:

Title: "Evidence Based Practice for Intraoperative Neuromonitoring for 1- and 2-level Lumbar Fusions"

Purpose: Perform a gap analysis between the evidence in support of  intraoperative neuromonitoring for 1- and 2-level lumbar fusion procedures and the current policy at Eglin AFB.

Impact: This project aligns policy for IONM with evidence-based practice at Eglin AFB, improving the consistency of care and preserving health care resources.

  • Performed a gap analysis of neurosurgical and anesthesia policies for 1- and 2-level lumbar fusions.
  • Aligned policy with practice, improving consistency of care and conserving health care resources.

 

2018:

   Title: "Anxiety Management for Needle Localization"

   Purpose: To improve the patient experience by implementing a standard operating procedure for the assessment and management of anxiety in patients undergoing needle localization prior to breast surgery.

   Impact: After implementation, more patients felt that medications given before needle localization were beneficial and reported a discomfort-free experience.

2016:

Title: "Evaluation of Anesthetic Techniques for Endoscopic Retrograde Cholangiopancreatography (ERCP)"

Purpose: Determine the safest, most efficacious anesthetic technique for patients undergoing endoscopic retrograde cholangiopacreatography (ERCP) and pilot a change in practice at Fort Belvoir Community Hospital (FBCH).

Impact: Anesthesia providers were educated on evidence-based ERCP decision-support algorithm. All respondents to a follow up survey critically appraised the evidence and over 50% changed their practice as a result of the training which may improve patient safety and procedural success rates for ERCPs.

  • Determined safest, most effective anesthetic approach for patients undergoing ERCP and pilot a practice change.
  • Evidence-based ERCP decision-support algorithm created, anesthesia providers educated and follow-up survey demonstrated that >50% of providers changed their practice.

 

2017:

Title: "Enhancing Efficiency in a Military Community Hospital Preanesthetic Clinic (PAC)"

Purpose: To improve the efficiency of the Fort Belvoir Community Hospital preanesthetic clinc.

Impact: Developed a stratified appointment based clinic design that demonstrated a reduction in patient-transit time, clinic idle time and patient-census variability at FBCH using discrete-event system simulation software.

 

2018:

   Title: "Remifentanil for Labor Analgesia: an Evidence-Based Practice Project"

   Purpose: The purpose of this EBP project was to develop an evidence-based protocol that standardized administration and nursing care for the parturient receiving remifentanil.

   Impact: Implementation of the evidenced-based remifentanil protocol and order set moved FBCH closer to becoming a high reliability organization and improved patient experience by standardizing practice.

 

2019:

Title: "Implementation of a Standardized Intraoperative Handoff Tool for Anesthesia Providers"

Purpose: Implementation of a standardized intraoperative handoff tool for anesthesia providers.

Impact:  Using an anesthesia-specific handoff tool enhanced communication between providers during anesthetic transfers in care, and positively impacts patient safety by reducing the risk for

miscommunication contributing to preventable medical errors.

2015:

Title: "Evaluation of Evidence Underlying AR 600-9"

Purpose: A five faceted project conducted to evaluate the evidence underlying AR 600-9 and the local implementation of that regulation. 

Impact: AR 600-9 achieves its intended objectives, but several recommendations were made: identify more accurate tools for measuring body fat, improve provider education related to assisting soldiers with weight loss goals and add behavioral health interventions to the regulation.

 

2017:

#1 Title: "VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity"

   Purpose: Identify the current state of the VA/DoD clinical practice guideline implementation for screening and management of overweight and obesity for adult beneficiaries at Fort Bliss, Texas.

   Impact:  Optimize adherence to the VA/DoD Clinical Practice Guideline which outlines evidence-based interventions and lifestyle modifications for sustained weight loss.

 

   #2 Title: "Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Bliss"

   Purpose: Program evaluation of BHIOP and determine effectiveness of meeting intended outcomes (administrative/medical separations, BH inpatient admissions, BHIOP readmissions, and return to duty rates).

   Impact:  Standardized BHIOP referral policies to maximize effects of participation and outcomes.

 

2018:

Title: "Ensuring Active Duty Service Members with PTSD Receive Evidence-Based Treatment"

Purpose: Ensure active duty service members with PTSD receive evidence-based treatment

Impact: This DNP project increased awareness of the VA/DOD CPG for the management of PTSD and made recommendations for staff education, clinical practice, and department policy.

2015:

#1 Title: "Process Improvement Project Comparing the VA/DoD mTBI CPG to Current Practice"

Purpose: Completed a current state mapping of current practice related to the management of mTBI and compared that practice with the VA/DoD CPG.

Impact: Overall, mTBI management is well aligned with the VA/DoD mTBI CPG, but several areas for improvement were identified.  Provider knowledge of concussion care process and services varied widely across the system. Soldiers did not receive formal mTBI training prior to participating in high risk events, at risk soldiers were not consistently identified, and once diagnosed, soldiers were inconsistently tracked to ensure they received appropriate follow-up.

 

#2 Title: "Process Improvement Project Evaluating Spouse mTBI Education Programs"

Purpose: Evaluated the current practice of educating spouses in regards to the medical management of mTBI.

Impact: mTBI spouse education is aligned with evidence based recommendations.

 

2016:

Title: "Evaluation & Management of Mild Traumatic Brain Injury (mTBI) in the Garrison Setting"

Purpose: To develop a process to identify soldiers with mTBI and begin treatment.

Impact: Providers will be able to identify treatment priorities and increase soldier’s medical readiness in order to return soldiers to a fully capable duty status as soon as possible.

  • Evidence review of Army EXORG 165-13 Department of the Army Guidance for Management of Concussion/Mild Traumatic Brain Injury in the Garrison Setting at Fort Bragg.
  • 1streview of provider use of algorithms and recommendations in EXORG 165-13.  Results can be used to evaluate effectiveness of EXORG 165-13 in improving patient outcomes, and used as a template for other MTF’s interested in improving mTBI management in their communities.

 

2017:

Title: "Evidence Based Practice for Low Back Pain"

Purpose: Retrospective record review to evaluate if active duty service members with non­specific, acute low back pain were beingmanaged according to the 2007 VA/DoD LBP CPG at a designated military treatment facility at Fort Bragg, NC.

Impact: Variances were identified within the five focus areas. Evidence-based recommendations were communicated in a formalreport and presented to key stakeholders.

 

2018:

Title: "Increasing HPV Vaccination Rates at Fort Bragg, North Carolina"

PurposeTo determine if a multi-modal interactive education program for both clinicians and patients increases HPV vaccinationrates in active duty Soldiers at Fort Bragg, North Carolina,  as compared to current vaccination rates.

ImpactThe goal of the project is to increase HPV vaccination rates of active duty   personnel through an easily replicable, multi- modal project.

 

2019:

Title: "Risk Mitigation in Chronic Opioid Therapy for Pain"

Purpose: Describe the use of risk mitigation strategies for patients on chronic opioid therapy for pain in primary care at Fort Bragg.

Impact: Risk mitigation strategies were overall consistent with VA/DOD CPG; few benzodiazepine co-prescriptions; high naloxone co-prescription; inconsistent UDT due to vague guidelines.

2015:

Title: "Program Evaluation of PCMH Alignment with NCQA PCMH 2011 Standards 1 and 3 (Access/Continuity and Plan/Manage Care)"

Purpose: Program evaluation of PCMH implementation in one clinic to determine alignment with the NCQA PCMH 2011 Standards 1 and 3 (Access/Continuity and Plan/Manage Care).

Impact: Variances identified in 47% of 58 factors assessed.  Evidence-based recommendations for all variances communicated in a formal report and numerous presentations.

 

 

2016:

Title: "Utilization & Barriers of HIT Tools in a Primary Care Clinic: SMS and PLR"

Purpose: Comparative analysis of current AMSMS and CP4G tool usage at an Army Medical Home compared to policy and evidence in the literature to improve utilization.

Impact: Some of the most promising capabilities of secure messaging and list registry tools (AMSMS & CP4G) are not being used at the health system/patient interface. These tools if optimized could to the fullest capacity at a Medical Home could have a positive impact on preventative services, communication, and overall satisfaction, which benefit the organization’s transition toward a patient-centered model of care and supports the priorities of the MHS’s Quadruple Aim.

  • Explored secure messaging and list registry tool policy, evidence and use in a PCMH.
  • Assessment data for AMSMS and CP4G tools indicate both are not used to the fullest capacity [AMSMS: >1/3rd of the capabilities are unused, 3% utilization rate for those registered for AMSMS; CP4G: 4 of 7 capabilities used by > 60%]. A total of 6 system and user-based issues were identified that impede use. Total of 13 evidence-based recommendations were outlined to leadership to improve utilization.

 

2017:

    #1 Title: "Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Hood"

   Purpose:  Determine whether the completion of the BHIOP provides clinically significant outcomes supporting reduction in behavioral health symptoms reported in BHDP.

   Impact:  BHDP patient report scales are not useful as BHIOP patient outcomes. Factors, such as readiness, care cost, reduced hospitalizations and functional improvement may be more useful.

 

#2 Title: "Reducing Military Unintended Pregnancies: Increasing Knowledge and Access"

Purpose: Reduce military unintended pregnancy rates, provide contraceptive training, and provide NexplanonTM training to providers at outlying clinics.

Impact: 211 service members received contraceptive education and NexplanonTM insertion rate increased 88%.

 

2019:

Title: "Adherence to Evidence-Based Practice for Major Depressive Disorder"

Purpose: Determine if providers are screening, diagnosing, and managing depressed patients following VA and DoD CPG for MDD to increase performance measure adherence relevant to MDD and improve compliance to the CPG for MDD.

Impact: Targeted educational interventions improved provider knowledge and understanding of CPG

recommendations for the assessment, diagnosis, and management of MDD by providers caring for

active duty service members; and therefore, may improve clinical outcomes for MDD.

Joint Base Andrews (Malcolm Grow Medical Clinics and Surgery Center), MD

2017

Title: "Problem Analysis: Cervical Cancer Screening in Primary Care"

Purpose: Evaluated the current practice of cervical cancer screening (CCS) in primary care clinics at Malcolm Grow Medical Clinics and Surgery Center and determined barriers to appropriate screening. 

Impact: The project communicated the current state of practice at MGMC and made recommendations for improvement in CCS guideline adherence.

 

2015:

Title: "Sexual Assault Screening Practices in Outpatient Primary Care"

Purpose: Identify current sexual assault screening practices in outpatient primary care.

Impact: 25% of patients are routinely screened for sexual assault.  Patients and providers agree that regular sexual assault screening should be conducted using a standardized set of screening questions. 

 

2016:

#1 Title: "Sexual Assault: ICD Coding Behaviors of Outpatient Service Providers"

Purpose: Develop and disseminate a web-based questionnaire regarding the challenges and barriers, encountered by outpatient healthcare providers at a Military Treatment Facility, to documenting patient disclosure of a previously unreported sexual assault, and analyze those results for future implications.

Impact: Results identified barriers and discrepancies among healthcare providers that indicate a need for a creation of a clinical practice guideline and standardized training regarding sexual assault documentation in the EHR.

  • Described how health care providers document patient disclosure of a previously unreported sexual assault (SA).
  • Limited training on how a SA diagnosis should be coded in the Electronic Health Record (EHR). Clinical practice guidelines and standardized sexual assault documentation training is needed.

 

#2 Title: "Retrospective Chart Review of Sexual Assault Care Provided at MAMC"

Purpose: To develop a flow sheet to improve access to comprehensive care for SA victims.

Impact: Implementing a tool such as the CFSPSA will ensure comprehensive care for the patient of sexual assault.

  • Described primary care for sexual assault (SA) victims from initial assault through follow-up.
  • Using a Clinical Flow Sheet Post-Sexual Assault (CFSPSA) tool could improve access to comprehensive care for SA victims in acute, primary care and behavioral health settings. Particularly important for time sensitive interventions (sexually transmitted infection testing and physical exams).

 

2017:

   #1 Title: "Clinical Standard of Practice in the Assessment and Diagnosing of Adults with Attention Deficit and Hyperactivity Disorder"

   Purpose: Clinical process evaluation for the assessment and diagnosis of adult ADHD by behavioral health and primary care providers at IDLM.

   Impact: Several practice variances identified with evidence-based recommendations provided to address variances in practice.

 

#2 Title: "Use of the Department of Defense Health Care Provider Response Resource for Management of Patients Disclosing Sexual Assault/Sexual Harassment to Improve Care"

Purpose: Explore the perceived usefulness of using the DoD Health Care Provider Response resource in support of patients disclosing a sexual assault/sexual harassment incident.

Impact: Demonstrated the usefulness of the SA/SH resource in providing evidence-based care for victims of sexual assault.

 

2018:

   Title: "Group Medical Visits for Chronic Conditions"

Purpose: Introduce and equip healthcare providers with initial tools to establish an evidence-based solution, Group Medical Visits (GMV), for the treatment of chronic conditions.

Impact: Group medical visits are an innovative care model that is proven to help patients manage their chronic conditions. This project motivated the desire to utilize GMVs in the treatment of chronic conditions.

2016:

Title: "Military Sexual Assault: The Current State of Policy, Screening, and Follow-up Care"

Purpose: Outline the current state of provision of care for sexual assault victims at LBSA.

Impact: Recommend enhancing/expanding provider training and patient education, update MSA policies and procedures and increase MSA research to improve the health and well-being of U.S. service members and their families.

  • Described military sexual assault (MSA) policies, examined screening and assess to follow-up care.
  • No mandate in DoD or USAF policy for pre-accession SA screening, despite strong association between prior victimization and adverse outcomes in individuals with a SA history. Recommendations: provide MSA provider training to improve SA follow-up care; create policies addressing provider training, case management and patient education.

 

2017:

   Title: "Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy"

   Purpose: Evaluate the employment of an OSA evidence-based screening tool in a primary care setting for increased referral accuracy.

   Impact: Implementation of the STOP-BANG questionnaire (SBQ) resulted in a 180% in SBQ utilization and 60% increase in PSG referral accuracy with potential annual savings for a large military treatment facility of at least $405,000.

 

2018:

#1 Title: "Targeted Counseling to Reduce Occurrence of Bacterial Vaginosis"

Purpose: Retrospective analysis of bacterial vaginosis incidence and utilizing targeted counseling to reduce occurrence of BV.

Impact: Implementing targeted behavioral counseling and dissemination of self-care resources empowers women to take efficacious health actions that will reduce occurrence of BV.

 

   #2 Title: "Brief Behavioral Therapy for Improved Sleep: A Process Improvement Project"

Purpose: The purpose was to engage non-medical active duty Air Force service members (ADSM) to promote awareness of the importance of quality sleep, provide a validated self-assessment to allowing members to self-identify poor sleep quality, and giving ADSM information about sleep enhancement class providing Cognitive Behavioral Therapy (CBT) treatment for sleep quality issues.

Impact: This project supports the development of a sustainable outreach program to improve sleep quality among the Air Force ADSM population. Engaging with ADSM through a community outreach within units, combined with immediate, quantifiable data for commanders gives insight to unit sleep health and allows for collaboration of care.

 

#3 Title: "Use It or Lose It: Addressing Insidious Readiness Skills Attrition Among Health Care Providers"

Purpose: Inform future protocols of optimal evidence-based readiness training intervals.

Impact: Optimized training schedules will produce perpetually ready providers, proficient in critical medical readiness skills, ensuring best patient outcomes, while incurring little to no additional time commitment or expense.

 

2019:

Title: "Reporting Compliance with the Clinical Practice Guidelines for Opioid Therapy for Chronic Pain"

Purpose: Developed and published a monthly provider compliance report of overall long-term opioid therapy numbers and rates of naloxone co-prescription, benzodiazepine co-prescription, and urine drug screening.

Impact: Improvement in numbers of long-term opioid therapy orders and co-prescription of naloxone. Formal Care Point application reporting projects variables in production for future sustainability.

2017:

Title: "Determinants of Successful Weight Loss in a Structured Weight Management Program"

Purpose: Compare current literature supporting components of an effective weight loss program with components of Keesler MOVE! program.

Impact: Identified strategies to increase effectiveness of structured weight management interventions.  Recommendations made to promote a 5-10% weight loss goal that could decrease costs associated with adiposity-based chronic disease and increased military readiness.

 

2018:

Title: "Dietary Supplement Adverse Event Reporting & Coding at Keesler Air Force Base"

Purpose: The purpose of this DNP project was to assess current DS adverse event reporting and coding practices at Keesler Medical Center (KMC) and identify and address knowledge deficits regarding reporting adverse events.

Impact: Improving health care provider knowledge on how and where to report DS adverse events can positively impact the health of the Force by alerting the DoD to potentially dangerous supplements.

 

2019:

Title: "Improving VA/DoD Obesity Clinical Practice Guideline Compliance Among Primary Care Providers"

Purpose: Implementation of VA/DoD Obesity CPGs among providers improved documentation, coding, interventions, and referrals for lifestyle management modification recommendations.

Impact: Provider education on the CPG for the management of obese patients along with the assistance of an audit-and-feedback tool resulted in accountability and guideline adherence. This intervention supports the MHS 's Quadruple Aim priorities.

2016:

Title: "Implementation of a Standardized Preoperative Diabetes Medication Management Guideline"

Purpose: Develop standardized guidelines for the preoperative medication management of diabetic patients.

Impact: Improved preoperative diabetes medication management knowledge and confidence scores among anesthesia providers through process standardization and creation of a Preoperative Diabetes Medication Instruction tool.

  • Created a standardized preoperative diabetes medication instruction.
  • Preoperative diabetes medication instruction tool standardized preoperative diabetes medication instruction and improved provider knowledge and confidence scores.

 

2017:

Title: "Implementation of an Education Program for an Ultrasound-Guided Liposomal Bupivacaine Transversus Abdominis Plane (TAP) Block Protocol for Open Abdominal Procedures"

Purpose: To educate staff in the placement and postoperative management of Liposomal Bupivacaine Transversus Abdominus Plane blocks.

Impact: The project removed barriers to Liposomal Bupivacaine Transversus Abdominus Plane block placement, contributing the availability of safe and effective postoperative analgesia for patients undergoing abdominal surgery at NH Jacksonville.

 

2018:

Title: "Breastfeeding After Surgery: Influencing Postoperative Recommendations"

Purpose: To standardize the education anesthesia providers and post-anesthesia care unit staff provide to breastfeeding mothers in regards to breastfeeding after surgery.

Impact: Improved patient experience secondary to improved patient satisfaction for the mother and potentially better health outcomes for the mother and child which are consistent with three of goals of the Military Health System.

 

2019:

Title: "Postoperative Nausea and Vomiting Prevention: Screening and Interventions"

Purpose: To standardize PONV risk assessment and recommended prophylactic interventions.

Impact: The standardization and utilization of the APFEL score and suggested prophylaxis guidelines can decrease PONV rates while improving patient comfort and satisfaction.

2017:

Title: "PCS Transitions of Care for Kitsap, WA Exceptional Family Members: Process Evaluation"

Purpose: Evaluate current process for transition of care for families of children enrolled in EFMP to Naval Hospital Bremerton and develop standardized process for transition of care.

Impact: Implementation of recommended process for medical transition of care will improve safety, satisfaction and readiness.

 

2018:

Title: "Meeting Access to Care Through Innovation"

Purpose: Comparative analysis of current VA tool usage compared to policy and evidence in the literature to improve the efficiency and operations of the tool, simultaneously improving both provider and patient satisfaction.

Impact: Standardization of the VA process will result in improved provider satisfaction, enable use of already purchased HIT to benefit the organization’s goal of the patient-centered model of care, and support the priorities of the MHS’s Quadruple Aim.

 

2019:

Title: "Impact of a Reward Efficiency, Set Priorities, Empower Teams (RESET) Pilot Program in Family Medicine Clinics"

Purpose: Comparative analysis of a RESET-based pilot program to the usual state using metrics of provider burnout, access to care, and PCM continuity in a Family Medicine clinic.

Impact: A locally developed RESET-based program has the potential to reduce provider burnout while still meeting and potentially improving Patient-Centered  Medical Home and Defense Health Agency metrics of access to care and PCM continuity.

2016:

Title: "Inpatient Respiratory Monitoring - Implementation of a CRM curriculum at Naval Medical Center San Diego"

Purpose: To improve knowledge and confidence among nurses taking care of patients at risk for respiratory depression.

Impact: Data from CNS evaluation was overwhelmingly positive and deployment of the CRM curriculum via Learning Management System was implemented.

  • Improved knowledge and confidence among nurses caring for patients at risk for respiratory depression.
  • CRM curriculum developed and deployed via Learning Management System, post education evaluation overwhelmingly positive.

 

 

2017:

    Title: "Evaluation and Implementation of a Continuous Respiratory Monitoring Curriculum"

   Project: To develop, implement and evaluate the effectiveness of a Continuous Respiratory Monitoring (CRM) Curriculum for ward staff at NMCSD, ultimately with the goal of improving knowledge and confidence among ward staff caring for patients at risk of respiratory depression. 

Impact: Data show the CRM curriculum increased ward staff knowledge and confidence levels when providing care to patients at risk for respiratory depression at NMCSD. 

 

2018:

Title: "Intraoperative Anesthesia Handoff Checklist: A Tool to Improve Communication"           

Purpose: To evaluate a standardized intraoperative handoff checklist and its impact on communication among anesthesia trainees during patient turnover at Naval Medical Center San Diego.

Impact: Utilizing a handoff checklist during transitions of care improved handoff efficiency, effectiveness, and communication. The long-term impact includes the potential adoption of the checklist by at NMCSD anesthesia department and other clinical areas in the hospital.

 

2019:

Title: "Pharmacological Approaches to Postoperative Nausea and Vomiting Prevention"

Purpose: Implement a PONV practice guideline identifying key risk factors with a suggested algorithm for prophylactic treatment to increase adherence to PONV evidence-based practice among anesthesia providers at NMCSD.

Impact: There was an increased staff awareness of evidenced-based PONV recommendations and potential cost savings with a decrease in rescue antiemetics utilized.

2016:

Title: "Use of Manometry in the OR for Guiding Endotracheal Tube Cuff Inflation"

Purpose: A systematic literature review of the utility of manometry-guided endotracheal tube cuff inflation with dissemination to stakeholders and sustainment via policy.

Impact: Evidence supports use of manometry in the operating room. Findings disseminated to Portsmouth NMC Anesthesia Department. Procedural and purchase information to implement and sustain manometry use made available to Department Chairperson.

  • Explored usefulness of manometry-guided endotracheal tube (ET) cuff inflation.
  • Manometry most effective way to assess and maintain ideal ET Cuff inflation pressure between 20-30 mmhg.

 

 

2017:

   #1 Title: "Awareness and Utilization of Military Community Health Promotion Resources"

   Purpose: Conduct a gap analysis to assess provider and beneficiary awareness of resources available to support family centered weight loss. 

Impact: Improve accessibility for families to learn healthy behavioral modification.

 

#2 Title: "Parturient Education for Neuraxial Analgesia: A Video Tool"

Purpose: To develop and assess the impact of a video about labor analgesia on parturient knowledge and satisfaction.

Impact: Viewing the video was associated with improvements in subjective and objective knowledge about labor analgesia, and thus improved informed consent, but did not significantly impact maternal satisfaction at NMCP.

 

 

2018:

#1 Title: "Obesity Management: Standardizing the Process within Primary Care"

   Purpose: A standardized process using evidence-based practices and stakeholder input to ensure implementation of the VA/DoD CPG for Screening and Management of Overweight and Obesity within the primary care setting.

   Impact: A standardized process optimizing he use of VA/DoD CPG through early surveillance, accurate identification, and resource referrals for obese patients supports the priorities of the MHSs Quadruple Aim.

 

#2 Title: "Behaviors and Barriers to Sexual Violence Screening by Healthcare Providers at Naval Medical Center Portsmouth"

Purpose: Survey to complete a needs assessment of healthcare providers sexual violence screening behaviors and potential barriers.

Impact: Routine screening for sexual violence can lead to early recognition and early intervention to provide better, safer care at a decreased cost while improving readiness.

 

#3 Title: "Barriers to Remifentanil Use for Labor Analgesia: A Process Improvement Initiative"

Purpose: Purpose of this project was to remove barriers to the appropriate use of patient-controlled intravenous administration remifentanil in laboring patients at Naval Medical Center Portsmouth.

Impact: When utilized properly, PCIAR is a safe and effective alternative for labor pain in women who are ineligible for neuraxial analgesia. In our facility, an evidence-based revision of the SOP combined with staff education and collaboration with key stakeholders was effective in improving staff knowledge about PCIAR and in decreasing barriers to its appropriate use.

 

 

2019:

#1 Title: "Implementation of Video-Based Weight Loss Education in Primary Care"

Purpose: Develop and implement a video-based educational offering in Primary Care to increase awareness of weight loss programs that is sensitive to known time constraints and facilitates provider-patient dialogue.

Impact: Video-based education was well-received in the Primary Care setting and aligns with VA/DOD Clinical Practice Guideline recommendations for obesity management.

 

#2 Title: "An Evaluation of the Caregiver Occupational Stress Control Program at Naval Medical Center Portsmouth"

Purpose: The primary purpose of this DNP project was to determine the impact and effectiveness of the CgOSC program at Naval Medical Center Portsmouth.

Impact: Results from this project can strengthen local and regional leadership’s efforts in promoting systematic measurements for the impact and effectiveness of the CgOSC program.

 

#3 Title: "Residual Neuromuscular Blockade (RNMB) Educational Project for Post Anesthesia Care unit (PACU) Nurses"

Purpose: Increase the knowledge and confidence of PACU staff in their ability to recognize and manage RNMB.

Impact: Implementation of this training video to PACU staff across the MTFs can lead to decreased costs, enhanced patient outcomes, and improved customer satisfaction.

2017:

   Title: "Early Perinatal Loss and Its Implications on Women's Mental Health"

   Purpose: Evaluate, develop, and implement clinical practice guideline for psychological management of women experiencing  miscarriage at DGMC's women's  health clinic.

   Impact: The clinical practice guideline standardized  psychological management of women after miscarriage and increased their support services.

 

 

2018:

Title: "Mental Health Stigma Reduction: Piloting the LINKS Anti-Stigma Program"

Purpose: Pilot-study of the LINKS evidenced-based anti-stigma program to measure outcomes and determine efficacy in the target population (military mid-level leadership).

Impact: Implementation of the LINKS program produced statistically significant reduction in MH stigma, and can positively impact the MHS’s Quadruple Aim priorities through enhanced military readiness, risk mitigation, and improved mental health outcomes.

 

 

2019:

#1 Title: "Postvention Program for Clinicians after Loss of a Patient to Suicide"

Purpose: After providing education on the impact of patient suicide on providers, assessed the perceived need for clinician-focused suicide postvention guidelines at an Air Force MTF.

Impact: 95.24% of participants reported that a clinician-focused  postvention program would be helpful. A future pilot study could lead to implementation of postvention guidelines across the MHS and ultimately foster a culture of support and clinician readiness in the aftermath of patient suicide.

 

 

#2 Title: "An Evaluation of Utilization of Enhanced Recovery After Surgery Protocols at Travis AFB"

Purpose: Evaluate the utilization of Enhanced Recovery After Surgery (ERAS) protocols for Total Hip Arthroplasty and Total Knee Arthroplasty surgeries at David Grant Medical Center, Travis AFB, CA. Make recommendations to the perioperative team for implementation and barrier resolution.

Impact: Increased provider and nursing knowledge of the benefits of ERAS protocols to improve patient outcomes, reduce postoperative complications, and decrease length of stay, costs, and readmissions.

2016:

Title: "Measuring Competency in Ultrasound Guided Regional Anesthesia"

Purpose: Determine the feasibility and the usability of a Test-Specific Checklist and Global Rating Scale (GRS) in evaluating Ultrasound Guided Regional Anesthesia competency in CRNAs at Kimbrough Ambulatory Surgery Center (KACC), and secondarily evaluate inter-rater reliability of the checklist and GRS.

Impact: This project demonstrated that the checklist and GRS combination is a feasible and useful tool when used in the clinical setting, and that this tool could be easily integrated into the staffing/ credentialing policies at KACC.

  • Determined feasibility/usability of a Test-Specific Checklist and Global Rating Scale (GRS) in evaluating CRNA Ultrasound Guided Regional Anesthesia competency. Evaluate inter-rater reliability of checklist and GRS.
  • Checklist/GRS combination is feasible and useful in a clinical setting and tool could easily be integrated into MTF staffing/ credentialing policies.

 

 

2018:

Title: "Improving Success Rate of the Adductor Canal Block (ACB) by Standardizing Technique"

Purpose: Standardizing technique of the adductor canal block to improve the success rate of peripheral nerve blocks for knee and leg procedures.

   Impact Standardization of the ACB technique did not improve overall block success rate, however, we were able to reduce the volume of local anesthetics by 50 mg (10mL) while maintaining the same level of success.

 

 

 

2019:

Title: "Achieving High Reliability in High-Level Disinfection of Flexible Endoscopes at Walter Reed National  Military Medical Center"

Purpose: Implement an evidence-based audit process for program evaluation of high level disinfection in support of HRO goals: quality, safety, and continuous process improvement. 

Impact: Overall improvement of 5.5% with implementation of 22 system/process initiatives and 28 practice improvements, impacting over 135 areas and enhanced quality, safety, and continuous process improvement related to HLD processes across the organization.

2016:

Title: "Ketamine: An Adjunct to Multimodal Analgesia"

Purpose: Develop evidence based recommendations for the administration of Ketamine for anesthesia providers with dissemination through an education module and elimination of formulation barriers that impacted utilization.

Impact: Sustained usage and improved outcomes translates to safer anesthetics besides increased patient satisfaction.

  • Examined why Ketamine, a highly effective non-opioid analgesic, is not widely used in anesthesia practice.
  • Developed curriculum, trained providers, explored pharmacy formulations and drafted policy to increase perioperative use of Ketamine.

 

 

 

2019:

Title: "Evaluation of Cricothyroidotomy Training During a 'Can’t Intubate, Can’t Ventilate' Scenario"

Purpose: Determine how the implementation of standardized, hands-on cricothyroidotomy training affects the competency and proficiency of student registered nurse anesthetists (SRNA) in performing this skill.

Impact: Cricothyroidotomy training will result in increased competency and provider readiness, a better experience of care, decreased per capita cost for the Military Health System, and improved health outcomes.

GSN-DNP Multi-site Location Projects

2016:

Title: "Integrating Exercise Recommendations into the Army Medical Home"

Purpose: Integrating exercise recommendations into the Army Medical Home

Impact: Local impacts included joining multiple exercise resources and broadening interest in community efforts to integrate an evidence-based model aimed to improve the health of the community and ultimately reduce costs associated with care. By focusing on the health benefits of exercise, the organization creates a standard that is in line with the Surgeon General’s Performance Triad and the U.S. Army Medical Command’s Move to Health initiative.

  • Resources and alignment of “Exercise is Medicine” (EIM) processes with the American College of Sports Medicine EIM exercise participation.
  • Inconsistent application of EIM at Ft Hood. Integrated multiple exercise resources and integrated an evidence-based exercise model to increase participation in exercise.

2018:

Title: "Sleep Restoration in the Active Duty Population"

Purpose: Determine who screens for sleep disturbances and how sleep concerns are managed in an Active Duty Population.

Impact: Medics and support personnel identify many Active Duty service members with sleep disturbances, yet they rarely receive formal training. The implementation of a CPG, validated screening tools and algorithms to the EHR, coupled with appropriate education will improve identification and management of sleep disturbances.

2018:

Title: "Incivility in the Workplace: An Evidence-Based Practice Pilot Project"

Purpose: Assess workplace incivility among perioperative nurses in an MTF and implement an evidence-based intervention consistent with findings.

Impact: A baseline workplace incivility assessment identified sources of uncivil behaviors which guided intervention strategies. Promotion of workplace civility within this single MTF were concerted efforts towards the continued growth of a high-reliability organization and achievement of the MHS Quadruple Aim.

2015:

Title: "LGBT Educational Program for Military Healthcare Providers"

Project: Develop, implement, and evaluate the effectiveness of an LGBT educational program for military healthcare providers.

Impact: The program increased provider knowledge of many aspects of providing appropriate care for the LGBT community, and may improve healthcare delivery and outcomes for this vulnerable and often underserved population.

2017:

Title: "Trigger Films in Nurse Anesthesia Education"

Project: This TSNRP-funded project developed a difficult airway trigger film, and evaluated its effect on student nurse anesthetist performance in a simulated difficult airway situation.

Impact: Students demonstrated improvements in time to make critical decisions in the difficult airway scenario, thus resulting in students who are better prepared to manage can’t intubate/can’t ventilate situations in clinical practice.

The USU Archives preserves and provides access to the USU theses, dissertations, and Doctor of Nurse Practice (DNP) projects on its web site. The public can discover these full text materials through search engines like Google or by visiting the USU Archives web site directly, select "Browse All" in the Theses/Dissertations collection, then on the left hand side of the navigation column, sort by Degree --> DNP