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.
2017
#1 Fort Bliss : "Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Bliss“ (MAJ Marlene Arias, CPT Landon Coleman)
Purpose: Program evaluation to determine effectiveness of BHIOP program outcomes including medical or administrative separations, inpatient admissions, readmissions, and return to duty rates.
Impact: Standardized BHIOP referral policies to maximize effects of participation and outcomes.
#2 Fort Hood : "Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Hood" (MAJ Alexander Aristizabal, CPT Lutisha Crawford, MAJ Marsha Walker)
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.
2018
#1 Wilford Hall Ambulatory Surgical Center: "Targeted COunseling to Reduce Occurence of Bacterial Vaginosis"
Purpose: Retrospective analysis of bacterial vaginosis incidence and utilizing targeted counseling to reduce occurrence of BV.
Impact: Targeted behavioral counseling and dissemination of self-care resources empowers women to take health actions to reduce the occurrence of Bacterial Vaginosis.
#2 Wright Patterson Air Force Base: "Incinility 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: Identifying sources of uncivil behavior can guide intervention strategies and promote workplace civility.
2016
Naval Air Station Jacksonville Project: Implementation of a Standardized Preoperative Diabetes Medication Management Guideline - A Process Improvement.
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.
2016
Wright-Patterson Air Force Base Project: Ketamine: An Adjunct to Multimodal Analgesia - Multimodal ketamine evidence based recommendations created 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.
2017
Naval Hospital Jacksonville Project: "Implementation of an Education Program for an Ultrasound-Guided Liposomal Bupivacaine Transversus Abdominis Plane (TAP) Block Protocol for Open Abdominal Procedures” (LT Robert Girolamo, LT Lisa O'Driscoll)
Purpose: Educate OR, PACU and floor staff in use of Liposomal Bupivacaine Transversus Abdominus Plane blocks.
Impact: Trained and verified that all anesthesia staff at NH Jacksonville could accurately place Liposomal Bupivacaine Transversus Abdominus Plane blocks for abdominal surgery and the post-anesthesia care staff could appropriately manage these patients
2018
#1 Naval Medical Center Portsmouth: " Barriers to Remifentanil Use for Labor Anaglesia: A Procress Improvement Initiative"
Purpose: Remove barriers to the appropriate use of patient-controlled intravenous administration remifentanil (PCIAR) in laboring patients.
Impact: PCIAR is safe and effective for labor pain in women who are ineligible for neuraxial analgesia.
#2 Fort Belvior Community Hospital: "Remifentanil for Labot Anaglesia: An Evidence-Based Practice Project"
Purpose: Develop an evidence-based protocol that standardized administration and nursing care for the parturient receiving remifentanil.
Impact: Implementing an evidenced-based remifentanil protocol standardizes care and improves patient experiences.
#3 Walter Reed National Military Medical Center: "Improving Success Rate of the Addcutor Canal Block (ACB) by Standardizing Technique"
Purpose: Standardizing technique of the (ACB) to improve the success rate of peripheral nerve blocks for knee and leg procedures.
Impact: Standardizing techniques used in ACB did not improve block success rate, but did reduce local anesthetic use while maintaining the same level of success.
#4 Eglin AIr Force Base: "Anxiety Management for Needle Localization"
Purpose: 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: Patients felt that anxiety medication given before needle localization prior to breast surgery was beneficial.
2016
Naval Base San Diego Project: Inpatient Respiratory Monitoring - Implementation of a CRM curriculum at Naval Medical Center San Diego 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.
2017
Naval Medical Center San Diego, CA Project: Improving outcomes for patients at risk for respiratory depression
Title: "Evaluation and Implementation of a Continuous Respiratory Monitoring Curriculum” (LT Wendy Choate, LT Erin Gagliano, LT Daniel Garcia, LT Ruben Mojica)
Impact: Developed/implemented/evaluated effectiveness of a Continuous Respiratory Monitoring Curriculum for ward staff.
Curriculum increased knowledge and confidence of staff caring for patients at high risk for respiratory depression.
2016
#1 Fort Belvoir Project: Evaluation of Anesthetic Techniques for Endoscopic Retrograde Cholangiopancreatography (ERCP) - 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.
#2 Naval Station Norfolk - Portsmouth Project: Use of Manometry in the OR for Guiding Endotracheal Tube Cuff Inflation - 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.
#3 Walter Reed National Military Medical Center Project: Measuring Competency in Ultrasound Guided Regional Anesthesia - 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.
2017
#1 Ft Bragg, NC Project: “Evidence Based Practice for Low Back Pain" (CPT James Brown, LTC Brent Donmoyer, CPT Osaze Okoro, CPT Alison Patton, CPT Lisa Taylor)
Purpose: Retrospective record review evaluating if active duty service members with nonspecific, acute LBP were managed according to the 2007 VA/DoD LBP CPG.
Impact: Gaps in LBP treatment impairs readiness - pain inhibits a service members ability to perform duties.
CPG’s + clinical judgment optimizes care.
Appropriate implementation of LBP guidelines can contain healthcare costs.
#2 Joint Base Lewis McCord (JBLM), WA Project: “Clinical Standard of Practice in the Assessment and Diagnosing of Adults with Attention Deficit and Hyperactivity Disorder" (CPT Kimberly Genkov (Duenow), MAJ Timothy Wical, MAJ Jennifer Witt)
Purpose: Clinical process evaluation of how adults with ADHD are assessed and diagnosed by behavioral health and primary care providers.
Impact: Diagnostic inconsistencies between providers and clinics. Evidence-based education was provided to standardize ADHD diagnosis in adults.
#3 Wilford Hall, Joint Base San Antonio, TX Project: “Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy” (Maj Cherie Little, Capt Angela McElroy, Maj Kenneth Smith, Capt Alyssa Turner)
Purpose: Evaluate the use of an evidence-based screening tool for OSA in the primary care setting in increasing referral accuracy.
Impact: 60% increase in sleep medicine referral accuracy - potential savings of at least $405,000 annually.
#4 Daniel K. Inouye Graduate School of Nursing, Bethesda, MD Project:Effectiveness of trigger films in preparing students for high risk/low volume events*
Title: "Trigger Films in Nurse Anesthesia Education" (LCDR Christopher Grey, Capt Megan Hylton, Capt Laura Ransom)
Purpose: “Difficult airway trigger film” developed and evaluated for effectiveness in preparing students for high risk/low volume anesthesia events.
Impact: Trigger films reduced decision time in critical “can’t intubate/can’t ventilate” situations.
2016
Eglin Air Force Base Project: Evidence Based Practice for Intraoperative Neuromonitoring for 1- and 2-level Lumbar Fusions: A Gap Analysis
Impact: This project aligns policy for IONM with evidence-based practice at Eglin AFB, improving the consistency of care and preserving health care resources.
2017
#1 Naval Base Kitsap (Bremerton) Project: 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.
#2 Fort Belvoir Community Hospital, VA Project: Improving clinic efficiency
Title: “Enhancing Efficiency in a Military Community Hospital Preanesthetic Clinic (PAC)" (CPT Marko Benito, CPT Jamie Cedola)
Purpose: Improve efficiency in the FBCH pre-anesthetic clinic by implementing an appointment design system.
Impact: Reduced patient-transit time, clinic idle time and patient-census variability.
2015
Travis AFB/Joint Base Lewis-McCord 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.
Fort Bragg, NC
2015:
Project #1: Process improvement project comparing the VA/DoD mTBI CPG to current practice.
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.
Project #2: Process improvement project evaluating spouse mTBI education programs.
Impact: mTBI spouse education is aligned with evidence based recommendations.
2016
Evaluation & Management of Mild Traumatic Brain Injury (mTBI) in the Garrison Setting
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.
2015
Ft. Hood : 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
#1 Fort Hood : Utilization & Barriers of HIT Tools in a Primary Care Clinic: SMS and PLR - 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.
#2 Fort Hood & Fort Bliss : 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.
2018
#1 Naval Base Kitsap: "Meeting Access to Care Through Innovation"
Purpose: Compare current use of Virtual Appointment tools to policy and evidence in the literature to improve operations and increase provider and patient satisfaction.
Impact: Standardizing Virtual Appointment processes improves provider satisfaction, increases the use of Health Information technology which increases outcomes and supports the MHS Quadruple Aim.
#2 Joint Base Lewis McCord: "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 help patients manage chronic health conditions.
2015
Joint Base Lewis-McCord Project: 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
Joint Base Lewis-McCord Project #1: Sexual Assault: ICD Coding Behaviors of Outpatient Service Providers - 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.
Project #2: Retrospective Chart Review of Sexual Assault Care Provided at Madigan Army Medical Center.
Impact: Implementing a tool such as the CFSPSA will ensure comprehensive care for the patient of sexual assault.
2017
Joint Base Lewis McCord (JBLM), WA Project: "Use of the Department of Defense Health Care Provider Response Resource for Management of Patients Disclosing Sexual Assault/Sexual Harassment to Improve Care” (MAJ Lindsay Drysdale, CPT Jennifer Esparza, MAJ Deanna Sheets, MAJ William Vanasse)
Purpose: Explore the usefulness of DoD Provider Response tool to support patients who disclose sexual assault/harassment.
Impact: Tool provided useful evidence-based support for providers caring for patients who disclose sexual assault or harassment
2018
Naval Station Norfrolk (Portsmouth), VA Project: "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 leads to early recognition and early intervention, providing better, safer care at a decreased cost while improving readiness.
2017
Joint Base San Antonio-Lackland Air Force Base Project: “Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy” (Maj Cherie Little, Capt Angela McElroy, Maj Kenneth Smith, Capt Alyssa Turner)
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.
2015
Ft. Bliss Project: 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.
2016
Fort Hood & Fort Bliss Project: 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.
2017
#1 Fort Bliss, TX Project: “VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity” (CPT Niles Motchenbacher, CPT Michael Rasmussen, CPT Scott Richardson, CPT Jennifer Siegert)
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: To optimize Clinical Practice Guideline adherence:
#2 Keesler AFB, MS Project: "Determinants of Successful Weight Loss in a Structured Weight Management Program” (Maj Susan Joseph, Capt Leah Sweeney)
Purpose: Compare evidence based components of effective weight loss programs with components of the Keesler MOVE! program.
Impact: Promoting a 5-10% weight loss goal could decrease costs associated with adiposity-based chronic disease and increase military readiness.
#3 Naval Hospital Portsmouth, VA Project: "Awareness and Utilization of Military Community Health Promotion Resources" (LT Alawah Davis, LCDR Monica Hall, LT Samantha Jennings, LT Patricia Smith)
Purpose: Gap analysis of provider/beneficiary awareness of resources to support weight loss
Impact: Neither providers nor patients agree on most effective weight loss resources & educational materials
Patient interviews:
2018
#1 Fort Braggs: "Increasing Human Papillomavirus Vaccination Rates in Active Duty Service Members: A Multi-Modal Interactive Education Program"
Purpose: Improve use of Human Papillomavirus (HPV) vaccinations in active duty Soldiers, by using a multi-modal interactive education program that included clinician and Soldier education combined with social media engagement.
Impact: Increased HPV vaccinations in service members, improving unit readiness, access to care, and the future health of the force.
#2 Kessler Air Force Base: "Dietary Supplement (DS) Adverse Event Reporting & Coding at Kessler Air Force Base"
Purpose: Assess current DS adverse event reporting and coding practices and identify and address knowledge deficits regarding reporting adverse events.
Impact: Improving health care provider knowledge about how and where to report adverse events related to DS can alert the DoD to potentially dangerous supplements.
#3 Naval Station Norfolk: "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: Using the VA/DoD Obesity Management CPG increases identification, surveillance and resources for obese patients.
2017
#1 Fort Hood, TX Project: "Reducing Military Unintended Pregnancies: Increasing Knowledge and Access" (MAJ Randy Rau, MAJ Ella Stallings, MAJ Vikki Varisce)
Impact: Reduce military unintended pregnancy rates, provide contraceptive training, and provide NexplanonTM training to providers at outlying clinics.
211 service members received contraceptive education and NexplanonTM insertion rate increased 88% after provider training.
#2 Travis AFB, CA Project: "Early Perinatal Loss and Its Implications on Women's Mental Health" (Capt Rachel Broussard, Maj Suzanne Mirts)
Impact: Evaluate, develop, and implement a prenatal loss CPG to better care for women experiencing miscarriage
CPG standardized psychological management of women after miscarriage and increased access to support services.
#3 Andrews AFB, Washington DC Project: "Problem Analysis: Cervical Cancer Screening in Primary Care" (Capt Kristin Kepler, Maj Jennifer McAndrews)
Impact: Evaluated current cervical cancer screening (CCS) practices in primary care and determined barriers to appropriate screening
Recommended changes at several levels
#4 Naval Hospital Portsmouth, VA Project: "Parturient Education for Neuraxial Analgesia: A Video Tool" (LCDR James Birkla, LT Jennifer Loran, LCDR Chad Phipps)
Impact: Developed a video on labor analgesia to improve knowledge & satisfaction in laboring women
Video improved knowledge about labor analgesia, and improved informed consent, but did not significantly impact maternal satisfaction.
2018
Wilford Hall/Lackland Air Force Base: "Targeted Counseling to Reduce Occurence of Bacterial Vaginosis"
Purpose: Retrospective analysis of bacterial vaginosis incidence and utilizing targeted counseling to reduce occurrence of BV.
Impact: Targeted behavioral counseling and dissemination of self-care resources empowers women to take health actions to reduce the occurrence of Bacterial Vaginosis.
Andrews AFB, Washington DC Project: "Problem Analysis: Cervical Cancer Screening in Primary Care" (Capt Kristin Kepler, Maj Jennifer McAndrews)
Impact: Evaluated current cervical cancer screening (CCS) practices in primary care and determined barriers to appropriate screening
Recommended changes at several levels
2016
Project: Evidence Based Practice for Intraoperative Neuromonitoring for 1- and 2-level Lumbar Fusions: A Gap Analysis
Impact: This project aligns policy for IONM with evidence-based practice at Eglin AFB, improving the consistency of care and preserving health care resources.
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.
2018
Title: "Anxiety Management for Needle Localization"
Project: 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: Patients felt that anxiety medication given before needle localization prior to breast surgery was beneficial.
2016
Project: Evaluation of Anesthetic Techniques for Endoscopic Retrograde Cholangiopancreatography (ERCP) - 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.
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 evidence-based practice project is to increase the appropriate utilization of remifentanil for labor analgesia by developing and implementing staff training and an evidence-based protocol.
Impact: The institution of an evidence-based protocol for remifentanil labor analgesia will minimize variation in practice and make available an alternative pain management method for laboring women for whom neuraxial analgesia is contraindicated or unwanted.
2019
Project: Implementation of a standardized provider handoff checklist
2015
Project: 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.
2016
Project: 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.
2017
#1 Project: “VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity” (CPT Niles Motchenbacher, CPT Michael Rasmussen, CPT Scott Richardson, CPT Jennifer Siegert)
Purpose: Current state of implementation of the VA/DoD CPG on screening/management of overweight and obese adults at Fort Bliss, Texas.
Impact: To optimize CPG adherence:
#2 Project: "Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Bliss“ (MAJ Marlene Arias, CPT Landon Coleman)
Purpose: Program evaluation to determine effectiveness of BHIOP program outcomes including medical or administrative separations, inpatient admissions, 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 Therapy
2015
#1 Project: Process improvement project comparing the VA/DoD mTBI CPG to current practice.
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 Project: Process improvement project evaluating spouse mTBI education programs.
Impact: mTBI spouse education is aligned with evidence based recommendations.
2016
Evaluation & Management of Mild Traumatic Brain Injury (mTBI) in the Garrison Setting
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.
2017
Title: “Evidence Based Practice for Low Back Pain" (CPT James Brown, LTC Brent Donmoyer, CPT Osaze Okoro, CPT Alison Patton, CPT Lisa Taylor)
Project: Retrospective record review to evaluate if active duty service members with nonspecific, acute low back pain were being managed according to the 2007 VA/DoD LBP CPG at a designated military treatment facility at Fort Bragg, NC.
Gaps in LBP treatment impairs readiness - pain inhibits a service members ability to perform duties
CPG’s + clinical judgment optimizes care
Appropriate implementation of LBP guidelines can contain healthcare costs
Impact: Variances were identified within the five focus areas. Evidence-based recommendations were communicated in a formal report and presented to key stakeholders.
2018
Title: "Increasing Human Papillomavirus Vaccination Rates in Active Duty Service Members: A Multi-Modal Interactive Education Program"
Purpose: Improve use of Human Papillomavirus (HPV) vaccinations in active duty Soldiers, by using a multi-modal interactive education program that included clinician and Soldier education combined with social media engagement.
Impact: Increased HPV vaccinations in service members, improving unit readiness, access to care, and the future health of the force.
2015
Project: 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
#1 Title: Utilization & Barriers of HIT Tools in a Primary Care Clinic: SMS and PLR - 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.
#2 Title: 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.
2017
Symptom stabilization after participation in a Behavioral Health Intensive Outpatient Program (BHIOP) Does completing a BHIOP reduce behavioral health symptoms
#1 Title: "Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Hood" (MAJ Alexander Aristizabal, CPT Lutisha Crawford, MAJ Marsha Walker)
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 Project: "Reducing Military Unintended Pregnancies: Increasing Knowledge and Access" (MAJ Randy Rau, MAJ Ella Stallings, MAJ Vikki Varisce)
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% after provider training.
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 commonly identify sleep disturbances in service members, but few receive formal sleep training. Education, access to screening tools and development of a DoD sleep CPG can increase identification and standardize management of sleep disturbances.
Class of 2015
#1 Project: 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.
#2 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.
Class of 2016
#1 Project: Sexual Assault: ICD Coding Behaviors of Outpatient Service Providers - 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.
#2 Project: Retrospective Chart Review of Sexual Assault Care Provided at Madigan Army Medical Center.
Impact: Implementing a tool such as the CFSPSA will ensure comprehensive care for the patient of sexual assault.
Class of 2017
#1 Project:
Utility of a DOD tool to Manage Patients Disclosing Sexual Assault/Harassment
"Use of the Department of Defense Health Care Provider Response Resource for Management of Patients Disclosing Sexual Assault/Sexual Harassment to Improve Care” (MAJ Lindsay Drysdale, CPT Jennifer Esparza, MAJ Deanna Sheets, MAJ William Vanasse)
Purpose: Explore the usefulness of DoD Provider Response tool to support patients who disclose sexual assault/harassment.
Impact:Tool provided useful evidence-based support for providers caring for patients who disclose sexual assault or harassment
#2 Project:
Standard of Practice in Assessing and Diagnosing Adults with ADHD
“Clinical Standard of Practice in the Assessment and Diagnosing of Adults with Attention Deficit and Hyperactivity Disorder" (CPT Kimberly Genkov (Duenow), MAJ Timothy Wical, MAJ Jennifer Witt)
Purpose: Clinical process evaluation of how adults with ADHD are assessed and diagnosed by behavioral health and primary care providers
Impact: Diagnostic inconsistencies between providers and clinics. Evidence-based education was provided to standardize ADHD diagnosis in adults
Class of 2018
#1 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 help patients manage chronic health conditions.
2017
Title: "Determinants of Successful Weight Loss in a Structured Weight Management Program” (Maj Susan Joseph, Capt Leah Sweeney)
Purpose: Compare evidence based components of effective weight loss programs with components of the 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 (DS) Adverse Event Reporting & Coding at Keesler Air Force Base"
Purpose: Assess current DS adverse event reporting and coding practices and identify and address knowledge deficits regarding reporting adverse events.
Impact: Improving health care provider knowledge about how and where to report adverse events related to DS can alert the DoD to potentially dangerous supplements.
2017
Title: “PCS Transitions of Care for Kitsap, WA Exceptional Family Members: Process Evaluation" (LT Lindsay McQuade, LCDR Virgilio Ocampo, LCDR Robyn White)
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: No standard DoD administrative process for transitioning EFMP families.
Standardization could improve continuity of care, patient safety, increase satisfaction and improve readiness.
2018
Title: "Meeting Access to Care Through Innovation"
Purpose: Compare current use of Virtual Appointment tools to policy and evidence in the literature to improve operations and increase provider and patient satisfaction.
Impact: Standardizing Virtual Appointment processes improves provider satisfaction, increases the use of Health Information technology which increases outcomes and supports the MHS Quadruple Aim.
2016
Project: Implementation of a Standardized Preoperative Diabetes Medication Management Guideline - A Process Improvement.
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.
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: Standardization of education for anesthesia providers and post-anesthesia care unit staff given to breastfeeding mothers to enhance breastfeeding after surgery.
Impact: Breastfeeding after surgery improves maternal satisfaction and may lead to better health outcomes for the mother and infant.
2016
Project: Use of Manometry in the OR for Guiding Endotracheal Tube Cuff Inflation - 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.
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
Project: 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: Using the VA/DoD Obesity Management CPG increases identification, surveillance and resources for obese patients.
#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 leads to early recognition and early intervention, providing better, safer care at a decreased cost while improving readiness.
2016
Title: Inpatient Respiratory Monitoring - Implementation of a CRM curriculum at Naval Medical Center San Diego 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.
2017
Title: "Evaluation and Implementation of a Continuous Respiratory Monitoring Curriculum"
Purpose: 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
#1 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: Identifying sources of uncivil behavior can guide intervention strategies and promote workplace civility.
#2 Title: "Intraoperative Anesthesia Handoff Checklist: A Tool to Improve Communication"
Purpose: Evaluate a standardized intraoperative handoff checklist and its impact on communication among anesthesia trainees during patient turnover.
Impacct: Using Intraoperative Anesthesia Handoff Checklists during care transitions improves efficiency, effectiveness, and communication.
2015
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: "Early Perinatal Loss and Its Implications on Women's Mental Health" (Capt Rachel Broussard, Maj Suzanne Mirts)
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: Anti-Stigma Intevention Programs and their Effectiveness in Reducing Mental Health Stigma
2019
#1 Project: Barriers to seeking mental health care among military service members
#2 Project: Implementation of the Enhanced Recovery After Surgery (ERAS) protocols for abdominal surgery.
2016
Project: Measuring Competency in Ultrasound Guided Regional Anesthesia - 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.
Checklist/GRS combination is feasible and useful in a clinical setting and tool could easily be integrated into MTF staffing/ credentialing policies.
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.
2018
Title: "Improving Success Rate of the Adductor Canal Block (ACB) by Standardizing Technique"
Purpose: Standardizing technique of the (ACB) to improve the success rate of peripheral nerve blocks for knee and leg procedures.
Impact: Standardizing techniques used in ACB did not improve block success rate, but did reduce local anesthetic use while maintaining the same level of success.
2017
Title: “Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy” (Maj Cherie Little, Capt Angela McElroy, Maj Kenneth Smith, Capt Alyssa Turner)
Purpose: Evaluate the use of an evidence-based screening tool for OSA in the primary care setting in increasing referral accuracy
Impact: 60% increase in sleep medicine referral accuracy - potential savings of at least $405,000 annually
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: Targeted behavioral counseling and dissemination of self-care resources empowers women to take health actions to reduce the occurrence of Bacterial Vaginosis.
#2 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: Critical medical readiness skills can be maintained at little added time or expense simply by optimizing training schedules.
#3 Title: "Brief Behavioral Therapy for Improved Sleep: A Process Improvement Project"
Purpose: Engage non-medical active duty Air Force service members (ADSM) to promote awareness of the importance of quality sleep, provide a validated self-assessment that allows ADSM to self-identify poor sleep quality, give ADSM information about sleep enhancement class and Cognitive Behavioral Therapy (CBT) treatment for sleep quality issues.
Impact: Community outreach, combined with immediate quantifiable data for commanders, increases care collaboration and provides insights into the sleep health of military units.
2016
Project: Ketamine: An Adjunct to Multimodal Analgesia - Multimodal ketamine evidence based recommendations created 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.
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.
2018
Title: "Intraoperative Anesthesia Handoff Checklist: A Tool to Improve Communication"
Purpose: Evaluate a standardized intraoperative handoff checklist and its impact on communication among anesthesia trainees during patient turnover.
Impact: Using Intraoperative Anesthesia Handoff Checklists during care transitions improves efficiency, effectiveness, and communication.
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
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