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

2017

Fort Bliss 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.

 

Fort Hood Project: "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.

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.

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

 

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.

  • 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.

 

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

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.

  • 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

Naval Medical Center San Diego, CA ProjectImproving 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.

  • 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.

#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.

  • 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.

#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.

  • 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.

 

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.

  • 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.

 

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.

  • 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.
  • 1st review 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.

 

2015

Ft. Hood 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

Fort Hood  Project: 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.

  • 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.

 

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.

  • 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.

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.

  • 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.

 

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.

  • 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

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 Norfolk (Portsmouth), VA Project:  Early--Recognition of Survivors of Sexual Assault to Prevent Post Traumatic Symptoms

Purpose: Perform a needs assessment regarding the attitude and comfort level of primary care providers in initiating critical conversations regarding a previously unreported sexual  assault.

Impact:  The accessibility of the primary care provider enables them to provide first line impact on military  members' psychological survival. Early recognition and intervention to include referral to mental health could prevent suffering in the survivor of sexual assault.

 

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.

  • 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.

 

 

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)

PurposeIdentify 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:

  • Standardize height and weight screenings,
  • Train clinic SME’s to offer weight loss education
  • Educate staff on waist circumference
  • Add weight loss agents to pharmacy formulary

 

#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:

  • 72% aware of & use physical fitness resources
  • 20% aren’t aware of resources
  • 18% use nutritional resources

2017

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.

 

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.

 

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

  • Patient: tracking cards, guideline education
  • Practice: tracking/notification, opportunistic screening, utilize PCMH
  • Organization: open access appointments, updates to CarePoint & EMR

 

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.

GSN-DNP Projects by Military Treatment Facility

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

  • Patient: tracking cards, guideline education
  • Practice: tracking/notification, opportunistic screening, utilize PCMH
  • Organization: open access appointments, updates to CarePoint & EMR

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.

  • 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.

 

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 During Breast Biopsy

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.

  • 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 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.

  • 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.

 

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:

  • Standardize height and weight screenings,
  • Train clinic SME’s to offer weight loss education
  • Educate staff on waist circumference
  • Add weight loss agents to pharmacy formulary

 

#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.

  • 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.
  • 1st review 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" (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 HPV Vaccination Rates at Fort Bragg, North Carolina

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

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

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.

  • 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.

 

#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.

  • 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.

 

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

#1 Title: Anti-Stigma Intevention Programs and their Effectiveness in Reducing Mental Health Stigma

#2 Title: Sleep Restoration: A Primary Care Initiative

Purpose: In the Primary Care Setting, does the use of an evidence­ based sleep  algorithm-during  routine visits, compared  to not using one, result in improved identification :and management of insomnia?

Impact: In providing the clinical staff with training and standardized management algorithm that is easily implemented "into each patient encounter, the outcome will be mitigation of insomnia  and sleep related issues at the primary care level. This will translate to a direct and positive impact on patient quality of life, health, safety, and productivity.

 

2019

Topic/Title: Integrating the role of the PMH/FNP into PCMH (Introducing the role in the APRN program / using the program for “onboarding” new PMH and FNP into PCMH upon PCS)

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.

  • 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 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.

  • 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).

 

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

 ImpactDiagnostic inconsistencies between providers and clinics.  Evidence-based education was provided to standardize ADHD diagnosis in adults

 

Class of 2018

#1 Title: Sleep Restoration: A Primary Care Initiative

Purpose: In the Primary Care Setting, does the use of an evidence­ based sleep  algorithm-during  routine visits, compared  to not using one, result in improved identification :and management of insomnia?

Impact: In providing the clinical staff with training and standardized management algorithm that is easily implemented "into each patient encounter, the outcome will be mitigation of insomnia  and sleep related issues at the primary care level. This will translate to a direct and positive impact on patient quality of life, health, safety, and productivity.

 

#2 Title: Antidepressant Adherence with Medication Management Groups

 

Class of 2019

Project: Integrating the role of the PMH/FNP into PCMH (Introducing the role in the APRN program / using the program for “onboarding” new PMH and FNP into PCMH upon PCS).

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

Project: Brief Behavioral Therapy to Improve Adult Sleep Quality

 

2019

Project: Combined nutrition and exercise for weight management

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: Do primary care clinics that build virtual appointments into their templates experience greater provider satisfaction with using secure messaging than those who do not?

Impact: The standardization of template management processes, to include virtual appointments, will result in improved provider satisfaction and overall efficiency of the medical homeport.

 

2019

Project: Does adherence to patient secure messaging improve among primary care providers with the use of a standardized response tool compared to the current practice?

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.

  • 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: Postoperative Breastfeeding Recommendations for Mothers Undergoing Surgery

Purpose: Conduct a systematic review providing an evidence-based, standardized, post-operative breastfeeding teaching guideline ultimately influencing anesthesia provider and perianesthesia nurses recommendations for safe resumption of breastfeeding after surgery.

Impact: Identify best practice through a thorough review of the literature, and then standardize the guidance given by staff at Naval Hospital Jacksonville.

 

2019

Project: Implementing a Clinical Decision Support for PONV risk screening and prophylaxis

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.

  • 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

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: Meeting the Demand for Access to Primary Care through Innovation

 

#2 Title:  Early--Recognition of Survivors of Sexual Assault to Prevent Post Traumatic Symptoms

Purpose: Perform a needs assessment regarding the attitude and comfort level of primary care providers in initiating critical conversations regarding a previously unreported sexual  assault. Proposed Impact:  The accessibility of the primary care provider enables them to provide first line impact on military  members' psychological survival. Early recognition and intervention to include referral to mental health could prevent suffering in the survivor of sexual assault.

 

#3 Title: Nitrous Oxide: An Alternative in Labor Analgesia

 

2019

#1 Project: Treatment of ethanol abuse disorder in patients undergoing treatment for psychological comorbidities.

 

#2 Project: Community based weight loss

 

#3 Project: preventing residual neuromuscular blockade

2016

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.

  • 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 

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 Project: Anesthesia Handoff Checklist: A Tool to Improve Communication

 

#2 Project: Bullying in the OR / Workplace Incivility

Purpose: What are the best mechanisms for measuring workplace incivility and decreasing its incidence and/or severity in healthcare? PICO question: In the healthcare setting, does implementing workplace civility education, compared to no civility education, decrease severity and incidence of incivility?

Impact: Preventing incivility before it becomes a problem.

 

2019

Project: Implementing a Clinical Decision Support for PONV risk screening and prophylaxis

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.

  • 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.

 

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: An Evidence Based Practice Project

Purpose: The purpose of this project is to implement a standardized approach to ACB, utilizing the most effective technique. Impact: Higher success rates of ACB can lead to reduced length of stay/cost, improved patient satisfaction, reduced rate of falls, reduced length of postoperative time to ambulation, and reduced opioid use in patients undergoing lower extremity surgery.

 

2019

#1 Project: Team training for malignant hyperthermia

#2 Project: Standardizing Policy and Aligning Practice with RPGs to Improve Outcomes Associated with High-Level Disinfection of Duodenoscopes

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

Impact60% increase in sleep medicine referral accuracy - potential savings of at least $405,000 annually

 

2018

#1 Title: "Vaginitis"- In non-pregnant childbearing women, does standard interventions compared to alternative interventions prevent the recurrence of vaginitis?

Purpose: The purpose of this clinical question is the exploration of increased episodes of vaginitis among military women and beneficiaries. PICOT question: In non-pregnant women, ages 18-40, how does the current clinical practice compared to CDC guidelines, impact the frequency of vaginitis?

Impact: Standardization of clinical guidelines for diagnosis and treatment of vaginitis could decrease the occurrence of vaginitis among servicewomen and enhance quality of life and mission readiness.

 

#2 Title: Topic area – In adults aged 18 or older who self-report decreased sleep quality, does brief behavioral therapy for insomnia compared with cognitive behavioral therapy for insomnia improve sleep quality?  

 

#3 Title: Topic Area – APRN Utilization: “In military providers, what is the best method for sustaining life-saving skills relevant to the care of combat casualties?”

 

2019

Project: Adherence to CPGs for chronic pain/low back pain, with a focus on decreasing the number of new opioid prescriptions and improving the management of patients on chronic opioid therapy.

 

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.

  • 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.

 

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: Bullying in the OR / Workplace Incivility

Purpose: What are the best mechanisms for measuring workplace incivility and decreasing its incidence and/or severity in healthcare? PICO question: In the healthcare setting, does implementing workplace civility education, compared to no civility education, decrease severity and incidence of incivility?

Impact: Preventing incivility before it becomes a problem.

 

2019

Project: Improving infraglottic airway placement during “Can’t Intubate, Can’t Ventilate” simulation training.

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