Sue & Bill Gross School of Nursing

Background: A significant concern contributing to morbidity and mortality among perioperative population is Surgical Site Infections (SSIs) compromising patient safety, readmissions and healthcare cost. In Same Day Services (SDS), variation in preoperative hygiene education and documentation created opportunities to improve workflow, standardize nursing practice and support reliable patient optimization prior to surgery. Purpose/Aims: The purpose of the Doctor of Nursing Practice (DNP) quality improvement (QI) was to implement a nurse-driven preoperative optimization bundle to improve workflow consistency, strengthen chlorhexidine gluconate hygiene (CHG) education and promote standardized documentation among SDS nurses. Methods: The QI project was implemented over a four-week period at a Magnet designated hospital ambulatory SDS within the perioperative department in Orange County, California. The intervention consisted of staff education, laminated patient centered educational materials, a QR linked digital toolkit, nurse champion support and an Epic SmartPhrase utilization among eligible preoperative encounters along with a pre/post survey findings related to nurse confidence, workflow clarity and feasibility. Findings: A total of 34 of 42 preoperative nurses received education on the optimization bundle, achieving 80.9% staff education reach. SmartPhrase usage increased across the implementation phase, reflecting improved documentation consistency among preoperative encounters meeting inclusion criteria. Post-implementation survey findings demonstrated an increase perceived workflow clarity and viability of using the standardize bundle in practice from 42% at baseline to 80% after implementation. Improvement was also observed in nurse confidence and consistency of CHG education practices. Conclusion: A nurse-driven preoperative optimization bundle supported more consistent preoperative education and documentation practices in SDS. The QI initiative highlighted the role of nursing leadership in translating evidence-based perioperative practices into sustainable improved workflow processes. Continued reinforcement, electronic medical record (EMR) integration and leadership guidance may further strengthen adoption and long-term sustainability.

Purpose: To improve comprehension and self-efficacy about post-operative care in older adult patients after their Mohs surgery, using multi-faceted education tailored to the individual. Methods: This quality improvement project used a pre- and post-intervention design, following the guidance of the Johns Hopkins EBP Model. The intervention consisted of revised written instructions tailored to the learning needs of older adults, an educational video, electronic health portal access to all materials for home review, and involvement of caregivers in teaching—in addition to standard verbal instruction. Written materials were refined iteratively with provider and clinical team input. A 10-item paper survey assessing knowledge and self-efficacy was administered at the post-operative visit. Primary outcomes consisted of patient knowledge and self-efficacy about post-operative care after Mohs surgery. Secondary outcomes assessed patient preference for educational method, material readability, and clinical team adoption of the intervention. Outcomes from a pre-intervention group were compared with those from a post-intervention group surveyed three weeks after implementation, using descriptive and inferential statistics. Results: Mean knowledge scores increased by approximately 8% following the intervention, although the difference was not statistically significant. Median self-efficacy and readability ratings remained high and unchanged, with identical medians and percentile ranges across groups. Preference for written and verbal instruction were greatest after implementation, highlighting the critical role of verbal instruction in guiding supplemental material use. Clinical team and provider engagement in design and the iterative revision of materials enhanced intervention fidelity and sustainability. Conclusion: A multi-faceted, tailored approach to education of older adults is a feasible, cost-effective strategy to improve post-operative understanding among older adults undergoing Mohs surgery. Continued refinement of materials and evaluation may further improve outcomes.

Delayed recognition of patient deterioration in acute care settings is associated with increased morbidity, mortality, unplanned transfers to higher levels of care, and failure to rescue. Early warning systems, such as the Modified Early Warning Score (MEWS), provide standardized criteria to identify at-risk patients and facilitate earlier escalation of care, including activation of the Rapid Response Team (RRT). Despite evidence supporting MEWS, staff awareness and consistent utilization remain variable, highlighting the need for targeted education and structured implementation. This quality improvement project aimed to enhance early recognition of patient deterioration and improve outcomes in a Level II trauma center observation unit in Southern California. The intervention included standardized staff education on MEWS scoring and escalation protocols, reinforcement of MEWS use and RRT activation, and provision of MEWS reference tools. During the 7-week implementation period, MEWS use and adherence were evaluated through periodic audits to ensure accurate scoring and appropriate RRT activation. Primary outcomes, including RRT activations, code blue events, and transfers to higher levels of care, were collected from the electronic medical record. Nurse confidence in recognizing and escalating patient deterioration was assessed using pre- and post-intervention surveys. Implementation fidelity was monitored through periodic chart audits. Post-intervention survey results are pending. Anticipated outcomes include increased RRT activation, improved nurse confidence, and a reduction in adverse events. Findings from this quality improvement project support ongoing implementation, with integration of MEWS into the electronic medical record currently in progress and expected to be implemented hospital wide.

Purpose: To develop and implement a Structured Handoff from the operating room (OR) to pediatric cardiovascular intensive care unit (CVICU) to improve interdisciplinary team participation, completeness and timeliness of handoff information, and team satisfaction at a Southern California Children’s Hospital. Background: Ineffective handoffs have been identified as the 3rd most common cause of medical error and posing a significant threat to patient safety. Hand-offs from the OR to the pediatric CVICU represent one of the most demanding care transfers and, if inadequate, may result in loss or unreliable information and adverse events. Despite the Joint Commission recognition as an important patient safety goal, some centers have not incorporated handoff standards among their interdisciplinary teams. Methods: An Evidence Based Practice (EBP) methodology guided development of the handoff tool using current literature and unit-specific workflows. The tool was refined through staff and provider feedback and implemented over 14 weeks. Data collection occurred across three phases: pre-intervention, intervention, and post-intervention. Each phase included a minimum of 4 direct handoff observations assessing the outcome measures of timeliness of report, team member presence, and completeness of information. Staff satisfaction surveys were administered both pre- and post-intervention to evaluate satisfaction with the handoff report. Outcomes: Out of 33 surgical cases during 14-week implementation, 30 Handoff Forms were completed reporting a 91% utilization. Use of the form improved team participation (pre-85.7 vs. post-92.7%; 7.2% ↑), documentation accuracy (pre-83.5% vs. post-87.4%; 3.9% ↑) and staff satisfaction (pre-67% to post-80%; 13% ↑) with current handoff procedure. However, timeliness of report was longer (pre-12.3 minutes vs. post-25.5 minutes; 13.2 minutes↓). Ongoing challenges reported qualitatively in the post-survey were distractions in post-operative tasks and variability in adherence to handoff report process. Conclusions: This project demonstrated successful use of a EBP standardized handoff report form for patients transferred from the OR to the pediatric CVICU. Use of the form improved team participation, documentation accuracy, and staff satisfaction. While implementation resulted in longer report times, this was likely due to higher surgical complexity. Clinical Implications: This form can be adapted for other surgical units to drive system-wide, sustainable, interdisciplinary tracking.

Critical care nurses are exposed to high-acuity, emotionally demanding environments that contribute to elevated stress and burnout. Burnout is associated with emotional exhaustion, decreased job satisfaction, increased turnover, and potential negative impacts on patient safety and quality of care. Although mindfulness-based interventions (MBIs) have demonstrated effectiveness in reducing stress and improving resilience, their implementation in inpatient critical care settings remains limited. The purpose of this Doctor of Nursing Practice (DNP) quality improvement (QI) project was to implement and evaluate an 8-week MBI to reduce stress and burnout while improving Keyword: mindfulness among critical care nurses in an intensive care unit (ICU), and to assess feasibility and acceptability, poster, DNP Scholarly Project Poster 2026 This project utilized a pre- and post-intervention QI design guided by the Johns Hopkins Nursing Evidence-Based Practice Model. The intervention consisted of an 8-week mindfulness-based stress reduction program (MBSR), delivered via weekly 5–10 minute guided electronic sessions (e.g., diaphragmatic breathing, mindful movement, gratitude reflection, and visualization). Participants were encouraged to practice mindfulness independently two to three times weekly. Outcome measures included burnout, perceived stress, and mindfulness, assessed using the Modified Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS), and Mindful Attention Awareness Scale (MAAS) at baseline, Week 4, and Week 8. Feasibility was evaluated using recruitment, retention, attendance, time burden, and participant feedback. Data were analyzed using descriptive statistics and non-paired samples t-tests. A total of 63 critical nurses enrolled, with 47 completing the intervention (74% retention). Burnout decreased from moderate at baseline to low levels post-intervention. Perceived stress declined from moderate (M = 20.1) at baseline to low levels (M = 7.5) at Week 8. Mindfulness increased from moderate (M = 3.16) at baseline to high levels (M = 5.26) post-intervention. Feasibility outcomes demonstrated strong engagement, high completion rates, and positive participant feedback, supporting acceptability within a high-acuity environment. Findings suggest that a brief MBI is both feasible and effective in reducing burnout and stress while enhancing mindfulness among critical care nurses. The findings support the integration of low-burden mindfulness strategies into nursing workflows as a scalable, evidence-based intervention to improve nurse well-being, reduce burnout in critical care settings, and guide broader organizational wellness initiatives.

Purpose: This Doctor of Nursing Practice (DNP) quality-improvement (QI) project evaluated the impact of a peer-led certification workshop on the perceived value of specialty certification among medical-surgical and telemetry (MST) nurses and assessed certification engagement and barriers. Background: Specialty certification for registered nurses (RNs) is associated with improved patient outcomes, professional satisfaction, and career advancement. Despite these benefits, certification rates remain <1% among MST nurses at an acute care community hospital, compared to the average 51% in Magnet hospitals and 34% in non-Magnet hospitals. Barriers such as lack of time, limited confidence, and insufficient access to resources persist despite institutional support, including books, certification reimbursement, and a $500 incentive. Methods: This pre-post QI project was conducted at a community hospital in California. MST nurses were invited to attend a 1-hour Zoom workshop covering test-taking strategies, test anxiety management, and practice questions facilitated by volunteer peer staff nurses. Pre- and post-intervention surveys assessed certification interest, confidence, barriers, and the validated Perceived Value of Certification Tool (PVCT). An 8-week follow-up survey evaluated engagement towards certification. Results: Mean PVCT scores increased from 36.7 (pre, n=16) to 41.6 (post, n=11) (p = 0.01, Hedges’ g = 1.14). Common pre-intervention barriers included lack of time (69%) and fear of failure (50%). All post-intervention participants (n=11) reported the workshop as useful and were satisfied with the peer-led format. At 8-week follow-up (n = 7), all participants reported plans to pursue certification within six months and engaged in certification-related activities, including obtaining study materials (100%), researching eligibility (80%), enrolling in a review class (80%), joining a study group (60%), and meeting with a mentor (20%), reflecting progression from intention to action. Conclusion: The peer-led certification workshop increased the perceived value of certification and promoted engagement in certification activities. Peer-led educational interventions represent a scalable strategy to enhance certification readiness, but should be accompanied by complementary organizational efforts to address system-level barriers.

Background: Based on the BOOST II study and Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) guidelines, evidence indicates that brain tissue oxygen (PbtO₂) monitoring in severe traumatic brain injury (TBI) patients results in lower mortality and improved Glasgow Outcome Scale-Extended Scores. A large academic hospital's neurocritical care unit lacks standardized PbtO₂ monitoring protocols for TBI patients despite clinical recommendations for invasive intraparenchymal catheter monitoring. Purpose: This project aimed to implement PbtO₂ monitoring in severe TBI patients and assess its impact on mortality, Glasgow Coma Scale (GCS), hospital, and ICU length of stay. Additional goals included promoting provider and nursing knowledge of PbtO2 monitoring and ensuring sustainability through policy development. Methods: This evidence-based practice project was a pre- and post-intervention design which included the implementation of a brain tissue oxygen (PbtO₂) monitoring protocol adapted from the BOOST III trial in adult severe traumatic brain injury patients. Inclusion criteria included patients with a GCS <8 admitted to the neurocritical care unit with staff education tailored by role. Outcomes including mortality rates, length of stay, and GCS scores were compared between pre- and post-implementation cohorts using retrospective chart review and non-paired t-tests over an 8–12-week period. Results: No statistically significant differences were found between the pre and post groups on any outcome measure. The study was substantially underpowered across all variables, warranting further investigation with adequately powered samples. Conclusions: This evidence-based practice project examined outcomes before and after implementation of PbtO₂ brain tissue oxygen monitoring across two independent patient cohorts (PRE, n=20; POST, n=7). Although descriptive trends favored the POST group — including lower mortality (42.9% vs. 50.0%), shorter lengths of stay among survivors, and higher GCS on arrival — no statistically significant differences were found on any outcome measure. These null findings are largely attributable to the small number of participants in the POST group. Additionally, baseline differences in injury severity between groups introduce potential confounding that limits direct comparison. These results should not be interpreted as evidence against the utility of PbtO₂ monitoring, but rather highlight the need for larger, prospective studies.

Survival-to-hospital discharge rates remain low for outside-hospital cardiac arrest (OHCA) in the U.S. largely due to delays in activating the American Heart Association (AHA)’s chain of survival for adult OHCAs. There is a growing need to equip non-medical volunteers in parish communities to respond effectively to medical emergencies during worship services. Literature indicates that bystander-initiated CPR achieves outcomes comparable to physician-initiated CPR. Chest-compression only CPR for bystanders has been shown to yield similar survival rates to conventional CPR with ventilation, making it a viable alternative for bystanders. The project was guided by the Johns Hopkins Evidence-Based Practice Model/Framework. The project occurred at a local non-denominational church in Southern California. Sixteen volunteers included adult and adolescent (12+) Parish volunteers. The intervention included a 2-hour in-person didactic and hands-on practice session provided by a registered nurse, utilizing the American Heart Association’s Hands-Only CPR and AED training with a live feedback mannikin device. Pre- and post-intervention surveys measuring willingness and knowledge of CPR-AED use were collected before and immediately after using the validated Factors Influencing Community Willingness to Perform Cardiopulmonary Resuscitation and Use AED (FIXED) questionnaire. Sixteen participants (n=6 males and n=10 females) of which two (12.5%) are students, four (25%) are working in healthcare-related careers, ten (62.5%) are working in non-healthcare related careers. A 20% increase in pre- and post-intervention surveys was shown in the willingness domain, specifically for the slightly more, moderately, and extremely confident points of the FIXED questionnaire tool utilized. There is also an increase in intention to conduct CPR in a stranger, elderly, child, and family member. A total score of ≥14 (out of 18 questions) is reflective of a participant's “good” grasp of CPR-AED use knowledge defined as ≥75%. The pre-intervention participants’ “good” knowledge score was 0% (0 of 16 participants), whereas the post-intervention “good” knowledge score was achieved by 81.25% (13 of 16) of the participants. Overall, the primary and secondary outcomes were achieved as evidenced by the overall improved willingness and knowledge of CPR/AED use. The project site acknowledges the positive outcomes and has agreed to continue bi-annual comprehensive CPR/AED training to encourage knowledge retention and continual improvement of willingness to conduct bystander CPR/AED during a cardiac arrest emergency. Future data will be collected from the 6-month intervention training.

Introduction

Hypertensive disorders of pregnancy (HDP) are associated with increased maternal morbidity and long-term cardiovascular disease (CVD) risk. Despite recommendations for early postpartum blood pressure (BP) monitoring and cardiovascular risk counseling, postpartum education regarding HDP and future CVD risk remains inconsistent. This quality improvement (QI) project aimed to implement and evaluate feasibility of a standardized multicomponent educational bundle designed to improve patient knowledge of long-term CVD risk and accurate BP measurement techniques and to ensure patient access to a BP cuff at home.

Methods           

This QI project was implemented on postpartum inpatient units at an academic medical center. The intervention included a brief educational video, printed educational handouts, interactive counseling, and a BP measurement return demonstration checklist. Educational content focused on HDP-associated cardiovascular risk, follow-up recommendations, concerning signs requiring medical evaluation, and home BP measurement technique. Participants completed pre- and post-intervention surveys assessing knowledge related to CVD risk and BP monitoring technique. Other measures included patient satisfaction, completion of BP return demonstrations, and confirmation of patient access to BP cuffs.

Results

Postpartum patients diagnosed with HDP participated in the project (n=7). Most patients demonstrated increased awareness and knowledge following implementation of the educational bundle. 86% of patients reported improved awareness regarding the relationship between HDP and future CVD risk. Knowledge scores related to CVD risk improved in 71% of patients, with mean scores increasing from 31 to 45 out of 100 post-intervention. Knowledge regarding accurate BP measurement technique improved in 57% of patients, with mean scores increasing from 66 to 83 out of 100 post-intervention. 58% of patients reported they were likely or very likely to recommend the educational bundle to others, and all patients confirmed access to a BP cuff at home. Implementation findings highlighted the importance of workflow integration, stakeholder engagement, and timing of education delivery.

Implications and Conclusion

This QI project demonstrated that a standardized multicomponent educational bundle is a feasible approach to improving inpatient postpartum HDP education. The intervention supported patient understanding of long-term CVD risk and BP measurement technique. This project may help inform future refinement and sustainability of standardized postpartum HDP education processes.

Background and Significance

Vietnamese Americans experience disproportionately high rates of T2DM. Diabetic patients experience healthcare costs 2.6 times higher than healthy patients, as it leads to complications such as heart disease, stroke, kidney failure, and amputations. Culturally appropriate health education has been shown to significantly improve glycemic control and diabetes knowledge among ethnic minorities. The purpose of this quality improvement project is to enhance type 2 diabetes mellitus (T2DM) education for Vietnamese-speaking patients by integrating culturally and linguistically tailored education materials into a digital platform and handouts within a busy clinic workflow.

Method

This project was implemented at an endocrinology clinic for 10 weeks. All providers (3 nurse practitioners) and medical assistants (4 MAs) were invited. The intervention included a bilingual diabetes education website and bilingual handouts covering key diabetes self-management information. Educational content was written at a fifth to sixth-grade reading level and includes visuals, case examples, and videos. These resources were part of the new clinic workflow where bilingual educational handouts and website flyers are handed out by MAs upon check in and providers encourage patients to review the available materials. All MAs and providers receive training on the new workflow and educational materials prior to implementation.

MA’s consistency was measured weekly by the percentage of patients receiving educational materials. Providers’ consistency was measured weekly by their self-report percentage of patients receiving recommendation to review educational materials. Patient engagement was defined as reading handouts, reviewing the website, and willingness to follow the recommendations, and was measured through surveys embedded in the website. The project lead conducted site visits to monitor progress and ensure consistent implementation. Data was analyzed using descriptive statistics, with all information de-identified and securely stored in accordance with institutional and clinic policies.

Results

All 4 MAs and 3 NPs participated. Total 72 patients had clinical encounters during implementation (n=72). MA’s consistency was 41.7% (n=30). It varied significantly from 0% to 100%. Provider consistency was initially low (0–25%), improved during Weeks 6–7 (76–100%), declined again during Weeks 8–9, and partially improved in Week 10 (51–100%).

Of 30 Vietnamese patients receiving materials, 16.7% accessed the website (n=5), with highest views in community resources, diet, and exercise content. Video engagement could not be tracked due to technical difficulty. No blog comments were left. Only one patient completed the survey, limiting evaluation of willingness to follow recommendations.

Despite having reported barriers of time constraints (71.4%) and forgetfulness (28.6%) from participants (n=7), 85.8 % participants rated the workflow as easy to neutral.

Conclusions

The project demonstrated that culturally and linguistically tailored materials like online materials can be successfully integrated into routine clinical workflows and delivered to patients.