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.
Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Bliss
Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Hood
Ensuring Active Duty Service Members with PTSD Receive Evidence-Based Treatment
Mental Health Stigma Reduction: Piloting the LINKS Anti-Stigma Program
Incivility in the Workplace: An Evidence-Based Practice Pilot Project
Adherence to Evidence-Based Practice for Major Depressive Disorder
Utilization of the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale for the DSM-5 (CAPS-5) to Assess PTSD Symptom Severity in an Intensive Outpatient Program
An Evaluation of the Caregiver Occupational Stress Control Program at Naval Medical Center Portsmouth
Postvention Program for Clinicians after Loss of a Patient to Suicide
Antidepressant Medication Adherence in Patients Diagnosed with Depression
Evaluation of Primary Care Provider Adherence to the VA/DoD 2016 Clinical Practice Guideline (CPG) for Major Depressive Disorder (MDD) and Patient Outcomes”
Single-site, multi-year
Primary Care Medical Home Program evaluation, IT utilization
Class 2015: 1
Program Evaluation of PCMH Alignment with NCQA PCMH 2011 Standards 1 and 3 (Access/Continuity and Plan/Manage Care)
Class 2016: 1
Utilization & Barriers of HIT Tools in a Primary Care Clinic: SMS and PLR
Class 2018: 2
Meeting Access to Care Through Innovation
Group Medical Visits for Chronic Conditions
Class 2019: 1
Impact of a Reward Efficiency, Set Priorities, Empower Teams (RESET) Pilot Program in Family Medicine Clinics
Class 2020: 1
A Needs Assessment of the Documentation Intake in Military Primary Care
Single-site, single-year
Educational instruction tool development
Implementation of a Standardized Preoperative Diabetes Medication Management
Single-site, single-year
Educational module development
Ketamine: An Adjunct to Multimodal Analgesia
Implementation of an Education Program for an Ultrasound-Guided Liposomal Bupivacaine Transversus Abdominis Plan (TAP) Block Protocol for Open Abdominal Procedures
Barriers to Remifentanil Use for Labor Analgesia: A Process Improvement Initiative
Remifentanil for Labor Analgesia: an Evidence-Based Practice Project
Improving Success Rate of the Adductor Canal Block (ACB) by Standardizing Technique
Anxiety Management for Needle Localization
Risk Mitigation in Chronic Opioid Therapy for Pain
Reporting Compliance with the Clinical Practice Guidelines for Opioid Therapy for Chronic Pain
Battlefield Acupuncture in the Management of Non-Traumatic Low Back Pain in Service Members”
Applying Telephone Triage and Treatment to Acute Low Back Pain
Battlefield Acupuncture in the Management of Non-Traumatic Low Back Pain in Service Members
Analysis of Barriers to Implementation of the Defense Health Agency Procedural Instruction (DHA-PI) on Pain Management and Opioid Safety in the Military Health System
Risk factors for persistent post-surgical pain: Implementation of a risk assessment questionnaire
Implementation of an opioid-sparing guideline in the post anesthesia recovery unit
Single-site, multi-year
Curriculum development
Inpatient Respiratory Monitoring: Implementation at a Large Military Treatment Facility
Evaluation and Implementation of a Continuous Respiratory Monitoring Curriculum
Single-site, single-year
Policy review and/or Process evaluation
Use It or Lose It: Addressing Insidious Readiness Skills Attrition Among Health Care Providers
Single-site, single-year
EBP decision-support algorithm, review of literature for decision-making, standardization of
Practice, educational programs
Evaluation of Anesthetic Techniques for ERCP
Use of Manometry in the OR for Guiding Endotracheal Tube Cuff Inflation
Measuring Competency in Ultrasound Guided Regional Anesthesia
Evidence Based Practice for Low Back Pain
Clinical Standard of Practice in the Assessment and Diagnosing of Adults with ADHD
Trigger Films in Nurse Anesthesia Education
Breastfeeding After Surgery: Influencing Postoperative Recommendations
Implementation of a Standardized Intraoperative Handoff Tool for Anesthesia Providers
Postoperative Nausea and Vomiting Prevention: Screening and Interventions
Pharmacological Approaches to Postoperative Nausea and Vomiting Prevention
Implementation of a Standardized Intraoperative Handoff Tool for Anesthesia Providers
Residual Neuromuscular Blockade (RNMB) Educational Project for Post Anesthesia Care unit (PACU) Nurses
An Evaluation of Utilization of Enhanced Recovery After Surgery Protocols at Travis AFB
Pharmacogenetic Testing Education Effect on Psychiatric Prescriber Genetic Testing Practices
Evaluation of Flexible Endoscope Reprocessing Training and Education Programs
The Effect of Same-Day Vaccination Adherence Rates For Pediatric Patients Age 0-5 Years
Improving Military Provider Confidence in Basic Ultrasound Skills
Implementation of a conductive fabric warming mattress to maintain normothermia in Cesarean Deliveries
Implementation of an Enhanced Recovery After Surgery (ERAS) protocol for orthopedic total joint arthroplasties
A training program for obstetrical staff on the utilization of nitrous oxide for parturient analgesia: An Evidence-Based Project
Intrathecal morphine dosing strategy to reduce pruritus after cesarean delivery
Single-site, single-year
Policy review and/or Process evaluation
Evidence-Based Practice for Intraoperative Neuromonitoring for 1- and 2-level Lumbar Fusions: A Gap Analysis
PCS Transitions of Care for Kitsap, WA Exceptional Family Members: Process Evaluation
Enhancing Efficiency in a Military Community Hospital Preanesthetic Clinic (PAC)
Intraoperative Anesthesia Handoff Checklist: A Tool to Improve Communication
Malignant Hyperthermia Crisis Preparedness
Achieving High Reliability in High-Level Disinfection of Flexible Endoscopes at Walter Reed National Military Medical Center
Evaluation of Cricothyroidotomy Training During a 'Can’t Intubate, Can’t Ventilate' Scenario
Project #1: Implementation of a Neuraxial Task Trainer during the didactic phase of the registered nurse anesthesia program at the Uniformed Services University
Project #2: Perioperative emergency manuals for low-incidence high-risk events
Single-site, single-year
Education program development
LGBT educational program for military healthcare providers
Single-site, multi-year
CPG review, spousal education, clinical management
Review and Comparison of VA/DoD mTBI CPG to Current Practice
Evaluating Spouse mTBI Education Programs
Evaluation & Management of mTBI in the Garrison Setting
Class 2015: 1
Program Evaluation of PCMH Alignment with NCQA PCMH 2011 Standards 1 and 3 (Access/Continuity and Plan/Manage Care)
Class 2016: 1
Utilization & Barriers of HIT Tools in a Primary Care Clinic: SMS and PLR
Class 2018: 2
Meeting Access to Care Through Innovation
Group Medical Visits for Chronic Conditions
Multi-site, multi-year
Policy evaluation, retrospective chart audit, CPG implementation, curriculum development
Sexual Assault Screening Practices in Outpatient Primary Care
Sexual Assault: ICD Coding Behaviors of Outpatient Service Providers
Military Sexual Assault: The Current State of Policy, Screening, and Follow-up Care
DoD Provider Response Resource for Management of Patients Disclosing SA/SH
Behaviors and Barriers to Sexual Violence Screening by Healthcare Providers at Naval Medical Center Portsmouth
Multi-site, multi-year
Use of STOP-BANG Screening Questionnaire in OP settings to Improve OSA and Polysomnography Referral Accuracy
Sleep Restoration in the Active Duty Population
Brief Behavioral Therapy for Improved Sleep: A Process Improvement Project
Multi-site, multi-year
Army Regulation evaluation, program development
Evaluation of Evidence Underlying AR 600-9
VA/DoD CPG for Screening and Management of Overweight and Obesity
Determinants of Successful Weight Loss in a Structured Weight Management Program
Awareness and Utilization of Military Community Health Promotion Resources
Increasing Human Papillomavirus Vaccination Rates in Active Duty Service Members: A Multi-Modal Interactive Education Program
Dietary Supplement Adverse Event Reporting & Coding at Keesler Air Force Base
Obesity Management: Standardizing the Process within Primary Care
Improving VA/DoD Obesity Clinical Practice Guideline Compliance Among Primary Care Providers
Implementation of Video-Based Weight Loss Education in Primary Care
Single-site, single-year
Program evaluation
Reducing Military Unintended Pregnancies: Increasing Knowledge and Access
Early Perinatal Loss and its Implications on Women’s Mental Health
Parturient Education for Neuraxial Analgesia: A Video Tool
Targeted Counseling to Reduce Occurrence of Bacterial Vaginosis
Project 1: Implementation of a Pre-Deployment Well-Woman Visit - A Mechanism to Increase Access to Comprehensive Contraceptive Counseling to Active Duty Women for Pregnancy Prevention and Menstrual Suppression in a Deployed Setting
Project 2: I Implementing an Evidence-Based Algorithm for the Diagnosis and Evaluation of Iron Deficiency Anemia (IDA) in Female Basic Military Training Recruits
Educating Parturients in Labor Analgesia
2016:
Project: Evidence Based Practice for Intraoperative Neuromonitoring for 1- and 2-level Lumbar Fusions: A Gap Analysis
Overall Impact: This project aligns policy for IONM with evidence-based practice at Eglin AFB, improving the consistency of care and preserving health care resources.
2018:
Title: Anxiety Management for Needle Localization
Purpose: To improve the patient experience by implementing a standard operating procedure for the assessment and management of anxiety in patients undergoing needle localization prior to breast surgery.
Impact: 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).
Overall 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
2018:
Title: Remifentanil for Labor Analgesia: an Evidence-Based Practice Project
Purpose: The purpose of this EBP project was to develop an evidence-based protocol that standardized administration and nursing care for the parturient receiving remifentanil.
Impact: Implementing an evidenced-based remifentanil protocol standardizes care and improves patient experiences.
2019:
Title: "Implementation of a Standardized Intraoperative Handoff Tool for Anesthesia Providers"
Purpose: Implementation of a standardized intraoperative handoff tool for anesthesia providers.
Impact: Using an anesthesia-specific handoff tool enhanced communication between providers during anesthetic transfers in care, and positively impacts patient safety by reducing the risk for miscommunication contributing to preventable medical errors.
2020
Education of Clinical staff (RNA)
Title: “A training program for obstetrical staff on the utilization of nitrous oxide for parturient analgesia: An Evidence-Based Project" (LT Papenfuss and Capt Vance)
Purpose: Evidence-based application of Adult Learning Theory principles to a multimodal, in-service training program in order to enhance staff’s readiness for a new labor analgesic.
Impact: Apply these methods were successful in enhancing staff’s readiness for a new labor analgesic. Other healthcare sites may consider incorporating similar education strategies to effectively engage adult learners. .
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.
2017:
Title: VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity
Purpose: Identify the current state of the VA/DoD clinical practice guideline implementation for screening and management of overweight and obesity for adult beneficiaries at Fort Bliss, Texas.
Impact: Optimize adherence to the VA/DoD Clinical Practice Guideline which outlines evidence-based interventions and lifestyle modifications for sustained weight loss.
Title: Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Bliss
Purpose: Program evaluation of BHIOP and determine effectiveness of meeting intended outcomes (administrative/medical separations, BH inpatient admissions, BHIOP readmissions, and return to duty rates).
Impact: Standardized BHIOP referral policies to maximize effects of participation and outcomes.
2018:
Title: Ensuring Active Duty Service Members with PTSD Receive Evidence-Based Treatment
Purpose: Ensuring Active Duty Service Members with PTSD Receive Evidence-Based Treatment
Impact: The project made education, practice, and policy recommendations and increased awareness of the VA/DOD PTSD CPG
2020
Using telephone triage for acute low back pain (NP)
Title: “Applying Telephone Triage and Treatment to Acute Low Back Pain” (CPT Geiger, CPT Martin)
Purpose: implementation of pre-appointment triage, an automatic activity limiting profile, and prescription of non-steroidal anti-inflammatory medications for service members with acute, non-traumatic, low back
Impact: Telephone triage can easily adopted by primary care clinic in use of. Identifying and managing patients before their scheduled appointments reduces suffering and increases compliance with HEDIS measures.
2015:
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.
Project: Process improvement project evaluating spouse mTBI education programs.
Impact: mTBI spouse education is aligned with evidence based recommendations.
2016:
Project: Evaluation & Management of Mild Traumatic Brain Injury (mTBI) in the Garrison Setting
Overall 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
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.
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.
2019:
Title: "Risk Mitigation in Chronic Opioid Therapy for Pain"
Purpose: Describe the use of risk mitigation strategies for patients on chronic opioid therapy for pain in primary care at Fort Bragg.
Impact: Risk mitigation strategies were overall consistent with VA/DOD CPG; few benzodiazepine co-prescriptions; high naloxone co-prescription; inconsistent UDT due to vague guidelines.
2015:
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:
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.
Overall 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.
2017:
Title: Evaluation of Behavioral Health Intensive Outpatient Programs at Fort Hood
Purpose: Determine whether the completion of the BHIOP provides clinically significant outcomes supporting reduction in behavioral health symptoms reported in BHDP.
Impact: BHDP patient report scales are not useful as BHIOP patient outcomes. Factors, such as readiness, care cost, reduced hospitalizations and functional improvement may be more useful.
Title: Reducing Military Unintended Pregnancies: Increasing Knowledge and Access
Purpose: Reduce military unintended pregnancy rates, provide contraceptive training, and provide NexplanonTM training to providers at outlying clinics.
Impact: 211 service members received contraceptive education and NexplanonTM insertion rate increased 88%.
2019:
Title: "Adherence to Evidence-Based Practice for Major Depressive Disorder"
Purpose: Determine if providers are screening, diagnosing, and managing depressed patients following VA and DoD CPG for MDD to increase performance measure adherence relevant to MDD and improve compliance to the CPG for MDD.
Impact: Targeted educational interventions improved provider knowledge and understanding of CPG recommendations for the assessment, diagnosis, and management of MDD by providers caring for active duty service members; and therefore, may improve clinical outcomes for MDD.
2019
Title: "Malignant Hyperthermia Crisis Preparedness"
Purpose: The purpose of this project was to improve Anesthesia and Operating Room staff's perception of the Stanford Emergency manual in the management of a patient with MH and include critical event checklists as part of their treatment plan.
Impact: The routine use of cognitive aids in the management of MH decreases the number of missed critical treatment steps and may improve patient outcomes in true emergencies
2017
Title: Problem Analysis: Cervical Cancer Screening in Primary Care
Purpose: Evaluated the current practice of cervical cancer screening (CCS) in primary care
clinics at Malcolm Grow Medical Clinics and Surgery Center and determined barriers to appropriate screening.
Impact: The project communicated the current state of practice at MGMC and made recommendations for improvement in CCS guideline adherence.
2015:
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:
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.
Overall 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: Retrospective Chart Review of Sexual Assault Care Provided at Madigan Army Medical Center.
Overall Impact: Implementing a tool such as the CFSPSA will ensure comprehensive care for the patient of sexual assault.
2017:
Title: Use of the Department of Defense Health Care Provider Response Resource for Management of Patients Disclosing Sexual Assault/Sexual Harassment to Improve Care
Purpose: Explore the perceived usefulness of using the DoD Health Care Provider Response resource in support of patients disclosing a sexual assault/sexual harassment incident.
Impact: Demonstrated the usefulness of the SA/SH resource in providing evidence-based care for victims of sexual assault.
Title: Clinical Standard of Practice in the Assessment and Diagnosing of Adults with Attention Deficit and Hyperactivity Disorder
Purpose: Clinical process evaluation for the assessment and diagnosis of adult ADHD by behavioral health and primary care providers at IDLM.
Impact: Several practice variances identified with evidence-based recommendations provided to address variances in practice.
2018:
Title: Group Medical Visits for Chronic Conditions
Purpose: Introduce and equip healthcare providers with initial tools to establish an evidence-based solution, Group Medical Visits (GMV), for the treatment of chronic conditions.
Impact: Group medical visits help patients manage chronic health conditions.
2019
Title: "Utilization of the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale for the DSM-5 (CAPS-5) to Assess PTSD Symptom Severity in an Intensive Outpatient Program"
Purpose: Improved utilization of CAPS-5 as an evidence-based practice tool for better diagnostic clarity of PTSD.
2020
Title: “Improving Military Provider Confidence in Basic Ultrasound Skills”(MAJ Thorp & CPT Watson)
Purpose: Improved military providers confidence following evidence based ultrasound course
Impact: Familiarization with ultrasound increases providers' confidence to utilize ultrasound. A recommendation for future studies includes more ultrasound education to improve provider competency before deploying to ensure provider skills as requested on deployment checklists.
2016:
Project: Military Sexual Assault: The Current State of Policy, Screening, and Follow-up Care.
Impact: Recommend enhancing/expanding provider training and patient education, update MSA policies and procedures and increase MSA research to improve the health and well-being of U.S. service members and their families.
2017:
Title: Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy
Purpose: Evaluate the employment of an OSA evidence-based screening tool in a primary care setting for increased referral accuracy.
Impact: Implementation of the STOP-BANG questionnaire (SBQ) resulted in a 180% in SBQ utilization and 60% increase in PSG referral accuracy with potential annual savings for a large military treatment facility of at least $405,000.
2018:
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.
Title: Brief Behavioral Therapy for Improved Sleep: A Process Improvement Project
Purpose: The purpose was to engage non-medical active duty Air Force service members (ADSM) to promote awareness of the importance of quality sleep, provide a validated self-assessment to allowing members to self-identify poor sleep quality, and giving ADSM information about sleep enhancement class providing Cognitive Behavioral Therapy (CBT) treatment for sleep quality issues.
Impact: Community outreach, combined with immediate quantifiable data for commanders, increases care collaboration and provides insights into the sleep health of military units.
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.
2019:
Title: "Reporting Compliance with the Clinical Practice Guidelines for Opioid Therapy for Chronic Pain"
Purpose: Developed and published a monthly provider compliance report of overall long-term opioid therapy numbers and rates of naloxone co-prescription, benzodiazepine co-prescription, and urine drug screening.
Impact: Improvement in numbers of long-term opioid therapy orders and co-prescription of naloxone. Formal Care Point application reporting projects variables in production for future.
2020
Improving access to comprehensive contraceptive counseling before deployment (FNP)
Title: Implementation of a Pre-Deployment Well-Woman Visit - A Mechanism to Increase Access to Comprehensive Contraceptive Counseling to Active Duty Women for Pregnancy Prevention and Menstrual Suppression in a Deployed Setting (Major Edwards, Capt Shawell and Capt Viesson)
Purpose: Will implementing a well woman visit on predeployment checklist impact the number of women who seek out contraceptive counseling predeployment
Impact: The well woman counseling resulted in a 38% increase in female deployers who elected to schedule an appointment to discuss menstrual suppression with or without comprehensive contraception counseling. This project offers valuable data to support practice change across the Air Force and DHA pre-deployment health policies.
Best practices in monitoring iron deficiency anemia in female recruits (FNP)
Title: “Implementing an Evidence-Based Algorithm for the Diagnosis and Evaluation of Iron Deficiency Anemia (IDA) in Female Basic Military Training Recruits “ (Capt Everage, Capt Frazier, Capt Robertson, and Capt) Simmons
Purpose: Improved adherence rate to the American Academy of Family Physicians (AAFP) algorithm for the evaluation and diagnosis of IDA among reproductive-aged female BMT recruits
Impact: 43.75% increase in compliance to the AAFP algorithm resulting in a reduction in diagnostic studies post-implementation which resulted in an estimated savings of $105,248.00 annually. DHA/DOD-wide policy adoption for facilities managing healthcare for a similar target population enrolled in rigorous training programs may lead to an estimated cost-savings approaching $500,000.00 annually
2017:
Title: Determinants of Successful Weight Loss in a Structured Weight Management Program
Purpose: Compare current literature supporting components of an effective weight loss program with components of Keesler MOVE! program.
Impact: Identified strategies to increase effectiveness of structured weight management interventions. Recommendations made to promote a 5-10% weight loss goal that could decrease costs associated with adiposity-based chronic disease and increased military readiness.
2018:
Title: Dietary Supplement Adverse Event Reporting & Coding at Keesler Air Force Base
Purpose: The purpose of this DNP project was to assess current DS adverse event reporting and coding practices at Keesler Medical Center (KMC) and identify and address knowledge deficits regarding reporting adverse events.
Impact: Improving health care provider knowledge about how and where to report adverse events related to Dietary Supplement can alert the DoD to potentially dangerous supplements.
2019:
Title: "Improving VA/DoD Obesity Clinical Practice Guideline Compliance Among Primary Care Providers"
Purpose: Implementation of VA/DoD Obesity CPGs among providers improved documentation, coding, interventions, and referrals for lifestyle management modification recommendations.
Impact: Provider education on the CPG for the management of obese patients along with the assistance of an audit-and-feedback tool resulted in accountability and guideline adherence. This intervention supports the MHS 's Quadruple Aim priorities.
2020
Implementation of the (DHA-PI) on Pain Management and Opioid Safety (NP)
Title: “Analysis of Barriers to Implementation of the Defense Health Agency Procedural Instruction (DHA-PI) on Pain Management and Opioid Safety in the Military Health System” (Major Fernandez, Kimmell, Obiah)
Purpose: Identification of perceived barriers to implementation of DHA-PI 6025.04 at KMC using the Consolidated Framework for Implementation Research (CFIR)
Impact: Adopting targeted strategies to the most significant barriers identified with the validated ERIC tool, will assist in implementing DHA-PI 6025.04 at KMC.
2016:
Project: Implementation of a Standardized Preoperative Diabetes Medication Management Guideline - A Process Improvement.
Overall 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: To standardize the education anesthesia providers and post-anesthesia care unit staff provide to breastfeeding mothers in regards to breastfeeding after surgery.
Impact: Breastfeeding after surgery improves maternal satisfaction and potentially better health outcomes for the mother and infant.
2019:
Title: "Postoperative Nausea and Vomiting Prevention: Screening and Interventions"
Purpose: To standardize PONV risk assessment and recommended prophylactic interventions.
Impact: The standardization and utilization of the APFEL score and suggested prophylaxis guidelines can decrease PONV rates while improving patient comfort and satisfaction.
2020
Improving Post-Cesarean care (RNA)
Title: "Intrathecal morphine dosing strategy to reduce pruritus after cesarean delivery" (LT Dunston, LT Curtis, LT Dan, LT Payne)
Purpose: To standardize an intrathecal morphine dosing strategy to reduce pruritus after cesarean delivery.
Impact: An evidence-based practice project was developed to encourage anesthesia providers to use the 0.1mg dose as a strategy to prevent pruritus. Treatment required pruritus in the 0.1 mg group was 13% vs 57% in the 0.2 mg group. Of the providers who participated, 56% indicated they would change their practice long-term in favor of the 0.1 mg dose of intrathecal morphine.
2017:
Title: PCS Transitions of Care for Kitsap, WA Exceptional Family Members: Process Evaluation
Purpose: Evaluate current process for transition of care for families of children enrolled in EFMP to Naval Hospital Bremerton and develop standardized process for transition of care.
Impact: Implementation of recommended process for medical transition of care will improve safety, satisfaction and readiness.
2018:
Title: Meeting Access to Care Through Innovation
Purpose: Compare current use of Virtual Appointment tools to policy and literature evidence to improve operations and increase provider and patient satisfaction.
Impact: Standardizing Virtual Appointment processes improves provider satisfaction, increases the use of HIT which increases outcomes and supports the MHS Quadruple Aim.
2019:
Title: "Impact of a Reward Efficiency, Set Priorities, Empower Teams (RESET) Pilot Program in Family Medicine Clinics"
Purpose: Comparative analysis of a RESET-based pilot program to the usual state using metrics of provider burnout, access to care, and PCM continuity in a Family Medicine clinic.
Impact: A locally developed RESET-based program has the potential to reduce provider burnout while still meeting and potentially improving Patient-Centered Medical Home and Defense Health Agency metrics of access to care and PCM continuity.
2020
Improving Rates of Pediatric Vaccinations (NP)
Title: “The Effect of Same-Day Vaccination Adherence Rates For Pediatric Patients Age 0-5 Years” (LT Scott, LCDR Steadman)
Purpose: Implement an evidence-based physical reminder or “golden ticket” intervention to improve vaccine adherence rates
Impact: During this post-implementation phase, 52 patients requiring immunizations. Of these, 37 patients received same-day immunizations, a 71% adherence rate (excluding influenza) and significant increase from current facility rates. Increasing vaccinations rates will address HEDIS measures and ensure soldier and family wellness.
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.
Overall 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
Project: To develop, implement and evaluate the effectiveness of a Continuous Respiratory Monitoring (CRM) Curriculum for ward staff at NMCSD, ultimately with the goal of improving knowledge and confidence among ward staff caring for patients at risk of respiratory depression.
Impact: Data show the CRM curriculum increased ward staff knowledge and confidence levels when providing care to patients at risk for respiratory depression at NMCSD.
2018:
Title: Intraoperative Anesthesia Handoff Checklist: A Tool to Improve Communication
Purpose: To evaluate a standardized intraoperative handoff checklist and its impact on communication among anesthesia trainees during patient turnover at Naval Medical Center San Diego.
Impact: Using Intraoperative Anesthesia Handoff Checklists handoff checklists during care transitions improves efficiency, effectiveness, and communication.
2019:
Title: "Pharmacological Approaches to Postoperative Nausea and Vomiting Prevention"
Purpose: Implement a PONV practice guideline identifying key risk factors with a suggested algorithm for prophylactic treatment to increase adherence to PONV evidence-based practice among anesthesia providers at NMCSD.
Impact: There was an increased staff awareness of evidenced-based PONV recommendations and potential cost savings with a decrease in rescue antiemetics utilized.
2020
Patient Education in Obstetrics (RNA)
Title: "Educating Parturients in Labor Analgesia" (LT Sternbaum, LT Parker, LT Nevonen, LT Paul)
Purpose: Use a multimodal approach to provide patient education through the implementation of a video to improve and standardize epidural education and consent process
Impact: Providing a video tool improved knowledge and satisfaction and addressed NMCSD’s “Guiding Principles” and the MHS Quadruple Aim of providing “Better Care.”
Practice Guideline to Reduce Opioids (RNA)
Title: "Implementation of an opioid-sparing guideline in the post anesthesia recovery unit" (LT Sternbaum, LT Balazs, LT Bautista, LT Moore)
Purpose: Use an opioid-sparing guideline to reduce opioid administration and improve postoperative pain management in the post-anesthesia care unit.
Impact: The guideline did not decrease opioid administration but it did directly increase awareness and administration of non-opioid adjuncts in the PACU.
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.
Overall 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:
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.
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:
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.
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.
Title: Barriers to Remifentanil Use for Labor Analgesia: A Process Improvement Initiative
Purpose: Purpose of this project was to remove barriers to the appropriate use of patient-controlled intravenous administration remifentanil in laboring patients at Naval Medical Center Portsmouth.
Impact: Patient Controlled Intravenous Administration of Remifentanil (PCIAR) is safe and effective for labor pain in women who are ineligible for neuraxial analgesia.
2019:
#1 Title: "Implementation of Video-Based Weight Loss Education in Primary Care"
Purpose: Develop and implement a video-based educational offering in Primary Care to increase awareness of weight loss programs that is sensitive to known time constraints and facilitates provider-patient dialogue.
Impact: Video-based education was well-received in the Primary Care setting and aligns with VA/DOD Clinical Practice Guideline recommendations for obesity management.
#2 Title: "An Evaluation of the Caregiver Occupational Stress Control Program at Naval Medical Center Portsmouth"
Purpose: The primary purpose of this DNP project was to determine the impact and effectiveness of the CgOSC program at Naval Medical Center Portsmouth.
Impact: Results from this project can strengthen local and regional leadership’s efforts in promoting systematic measurements for the impact and effectiveness of the CgOSC program.
#3 Title: "Residual Neuromuscular Blockade (RNMB) Educational Project for Post Anesthesia Care unit (PACU) Nurses"
Purpose: Increase the knowledge and confidence of PACU staff in their ability to recognize and manage RNMB.
Impact: Implementation of this training video to PACU staff across the MTFs can lead to decreased costs, enhanced patient outcomes, and improved customer satisfaction.
2020
Documentation Workflow and Intake Processes Evaluation (NP)
Title: “A Needs Assessment of the Documentation Intake in Military Primary Care” (LCDR Hervey, LCDR Horne)
Purpose: Identifying evidence-based recommendations to decrease provider documentation burden.
Impact: Documentation burden (68 percent of providers surveyed report spending 2-4 hours after normal work hours) could be reduced by training support staff to complete preliminary documentation. Addressing challenges of extensive or incomplete documentation could decrease provider workload and increase the length of time for provider- patient interaction.
Title: Antidepressant Medication Adherence in Patients Diagnosed with Depression* (LT Moore, LCDR Nguyen)
Purpose: The primary purpose of this DNP project was to determine if adult patients with depression who receive additional education and support intervention during antidepressant initiation, sustain medication adherence at 6 weeks?
Impact: Initiating the use of an antidepressant educational pamphlet along with supportive follow-up phone calls is helpful in maintaining medication adherence and is linked to depression severity improvement by as much as 85%. Enhancing medication adherence improves service member functioning and thus contributes to enhancing military readiness.
Improving Obstetrical Patient Warming (RNA)
Title: "Implementation of a conductive fabric warming mattress to maintain normothermia in Cesarean Deliveries" (LCDR Bokan, LT Camp, LT Nagle)
Purpose: To implement a conductive fabric warming mattress during scheduled Cesarean deliveries to maintain perioperative normothermia.
Impact: Maintaining normothermia during cesarean deliveries supports the MHS Quadruple Aim of providing better care and becoming a high reliability organization.
Screening tool for postsurgical chronic pain (RNA)
Title: "Risk factors for persistent post-surgical pain: Implementation of a risk assessment questionnaire" (LT Beasley, LT Blais, LT Garcia, LT Tio)
Purpose: To improve the identification of preoperative patients at risk for persistent postsurgical pain.
Impact: Improved identification of patients at risk for persistent postsurgical pain which can lead to improved healthcare outcomes, increased patient satisfaction, and decreased costs which contribute to the Military Health System Quadruple Aim.
2017:
Title: Early Perinatal Loss and Its Implications on Women's Mental Health
Purpose: Evaluate, develop, and implement clinical practice guideline for psychological management of women experiencing miscarriage at DGMC's women's health clinic.
Impact: The clinical practice guideline standardized psychological management of women after miscarriage and increased their support services.
2018:
Title: Mental Health Stigma Reduction: Piloting the LINKS Anti-Stigma Program
Purpose: Pilot-study of the LINKS evidenced-based anti-stigma program to measure outcomes and determine efficacy in the target population (military mid-level leadership).
Impact: Implementing the LINKS Mental Health Stigma Reduction program reduced MH stigma, enhancing military readiness, reducing risk, and improving mental health outcomes.
2019:
#1 Title: "Postvention Program for Clinicians after Loss of a Patient to Suicide"
Purpose: After providing education on the impact of patient suicide on providers, assessed the perceived need for clinician-focused suicide postvention guidelines at an Air Force MTF.
Impact: 95.24% of participants reported that a clinician-focused postvention program would be helpful. A future pilot study could lead to implementation of postvention guidelines across the MHS and ultimately foster a culture of support and clinician readiness in the aftermath of patient suicide.
#2 Title: "An Evaluation of Utilization of Enhanced Recovery After Surgery Protocols at Travis AFB"
Purpose: Evaluate the utilization of Enhanced Recovery After Surgery (ERAS) protocols for Total Hip Arthroplasty and Total Knee Arthroplasty surgeries at David Grant Medical Center, Travis AFB, CA. Make recommendations to the perioperative team for implementation and barrier resolution.
Impact: Increased provider and nursing knowledge of the benefits of ERAS protocols to improve patient outcomes, reduce postoperative complications, and decrease length of stay, costs, and readmissions.
2020
ERAS Protocol for Total Joints (RNA)
Title: "Implementation of an Enhanced Recovery After Surgery (ERAS) protocol for orthopedic total joint arthroplasties" (Maj Anderson, Maj Crissman, Capt Haines)
Purpose: To evaluate the implementation of a standardized ERAS order-set compared to a standard order set on order set utilization.
Impact: The ERAS order set creation and implementation had no significant impact on practice change DGMC although it aimed to improve recovery after 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.
Overall 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.
2018:
Title: Improving Success Rate of the Adductor Canal Block (ACB) by Standardizing Technique
Purpose: Standardizing technique of the adductor canal block to improve the success rate of peripheral nerve blocks for knee and leg procedures.
Impact Standardizing techniques used in Adductor Canal Block (ACB) did not improve block success rate, but did reduce local anesthetic use while maintaining the same level of success.
2019
Title: "Achieving High Reliability in High-Level Disinfection of Flexible Endoscopes at Walter Reed National Military Medical Center"
Purpose: Implement an evidence-based audit process for program evaluation of high level disinfection in support of HRO goals: quality, safety, and continuous process improvement.
Impact: Overall improvement of 5.5% with implementation of 22 system/process initiatives and 28 practice improvements, impacting over 135 areas and enhanced quality, safety, and continuous process improvement related to HLD processes across the organization.
2019:
Title: "Achieving High Reliability in High-Level Disinfection of Flexible Endoscopes at Walter Reed National Military Medical Center"
Purpose: Implement an evidence-based audit process for program evaluation of high level disinfection in support of HRO goals: quality, safety, and continuous process improvement.
Impact: Overall improvement of 5.5% with implementation of 22 system/process initiatives and 28 practice improvements, impacting over 135 areas and enhanced quality, safety, and continuous process improvement related to HLD processes across the organization.
2020
High Reliability in High-Level Disinfection Education Programs Evaluation (AGCNS)
Title: “Evaluation of Flexible Endoscope Reprocessing Training and Education Programs” (MAJ Knight)
Purpose: Evaluation of existing flexible endoscope reprocessing training and education programs (FERTEPs) compared to evidence-based practice guidelines result in the identification of a comprehensive program for use across DHA
Impact: Implementation of a standardized HLD FERTEP by the DHA is projected to impact 424,944 patients and 700 reprocessing personnel while preventing 8,799 HAI’s and saving the enterprise $84,991,600.00 dollars annually.
Education of clinical students (RNA)
Title: "Implementation of a Neuraxial Task Trainer during the didactic phase of the registered nurse anesthesia program at the Uniformed Services University" (LCDR Patterson & Capt Wilson)
Purpose: To compare a video and task trainer with the current method of using a watermelon (green grocer method) on level of comfort.
Impact: A training program that encompasses visual training (video) with a task trainer is more effective in increasing a student's level of comfort to place neuraxial anesthesia prior to attempts in clinical practice.
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.
Overall Impact: Sustained usage and improved outcomes translates to safer anesthetics besides increased patient satisfaction.
2019:
Title: "Evaluation of Cricothyroidotomy Training During a 'Can’t Intubate, Can’t Ventilate' Scenario"
Purpose: Determine how the implementation of standardized, hands-on cricothyroidotomy training affects the competency and proficiency of student registered nurse anesthetists (SRNA) in performing this skill.
Impact: Cricothyroidotomy training will result in increased competency and provider readiness, a better experience of care, decreased per capita cost for the Military Health System, and improved health outcomes.
2020
Emergency Preparedness (RNA)
Title: "Perioperative emergency manuals for low-incidence high-risk events" (Capt Abraham and Maj O’Donnell)
Purpose: To compare the Stanford Emergency Manual and safety training to current practices on adherence to critical management steps in a malignant hyperthermia training scenario.
Impact: The project did not show a statistically significant improvement in adherence to best practice, it did result in two structures simulations of malignant hyperthermia in the operating room and post anesthesia recovery units training databases for future use and training.
2020
Title: Evaluation of Primary Care Provider Adherence to the VA/DoD 2016 Clinical Practice Guideline (CPG) for Major Depressive Disorder (MDD) and Patient Outcomes”(Major Briones, Jessup & Capt. Clark Spesard-Langield)
Purpose: Assessing provider adherence to the VA/DoD Depression CPG and its links with depression severity outcomes
Impact: The current process evaluation identified adherence gaps, patterns, site, and provider-specific adaptations along with recommendations for further sustainment of the CPG. These improvements can contribute to better patient outcomes and improved readiness in service members.
2020
Battlefield Acupuncture and Low Back Pain Management (NP)
Title: “Battlefield Acupuncture in the Management of Non-Traumatic Low Back Pain in Service Members” (MAJ Birkle, MAJ Brown, CPT Prince, CPT Cossa, MAJ Gibbons)
Purpose: Does battlefield acupuncture provide improved medical readiness when compared to current practice?
Impact: Providing education on the CPG and BFA expands provider knowledge and safely and promotes BFA as an effective, efficient and highly appropriate pain management technique. Administration of BFA improves ADSM readiness and reduces duty limiting profiles and CNS depressant medication prescriptions.
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.
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.
2020
Identifying impact of genetic education on provider prescribing practices (NP)
Title: “Pharmacogenetic Testing Education Effect on Psychiatric Prescriber Genetic Testing Practices” (MAJ Peterson, MAJ Flynn)
Purpose: An educational and awareness toolkit intervention to increase psychiatric provider awareness of pharmacogenetic testing
Impact Pharmacogenetic testing is an effective tool to maximize early medication management for and results in improved stability increased readiness of the force. When compared with prescribing medication to treat MDD without testing, pharmacogenetic testing is a cost-efficient method that provides greater patient-centered care for soldiers.
2018:
Title: Incivility in the Workplace: An Evidence-Based Practice Pilot Project
Purpose: Assess workplace incivility among perioperative nurses in an MTF and implement an evidence-based intervention consistent with findings.
Impact: Identifying sources of uncivil behavior can guide intervention strategies and promote workplace civility.
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: "Trigger Films in Nurse Anesthesia Education"
Project: This TSNRP-funded project developed a difficult airway trigger film, and evaluated its effect on student nurse anesthetist performance in a simulated difficult airway situation.
Impact: Students demonstrated improvements in time to make critical decisions in the difficult airway scenario, thus resulting in students who are better prepared to manage can’t intubate/can’t ventilate situations in clinical practice.
The USU Archives preserves and provides access to the USU theses, dissertations, and Doctor of Nurse Practice (DNP) projects on its web site. The public can discover these full text materials through search engines like Google or by visiting the USU Archives web site directly, select "Browse All" in the Theses/Dissertations collection, then on the left hand side of the navigation column, sort by Degree --> DNP
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