Date of Award

Spring 5-16-2016

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Maryellen Roberts, DNP

Committee Member

Jane Dellert, Ph.D

Committee Member

Melissa Hess

Abstract

There is a strong need for healthcare providers to improve the quality of care, which benefits not only patients but the whole population. Due to the increasing cost of health insurance, society is forced to bear the cost of poor care for patients. The Institute of Medicine (IOM) stunned the nation in 1999 with, “To Err is Human: Building a Safer Health System” which reported that between 44,000 and 98,000 people die each year from preventable medical errors (IOM, 1999). Since then there has been a move in the direction of accountability and quality care for patients. This change has had a large impact on the importance of continued competency. A culture of excellence first begins with the power of knowledge.

In 2003 the IOM introduced the core competencies for health professionals that include; working in interdisciplinary teams, provider patient-centered care, employing evidence-based practice, use of informatics and applying quality improvement (Greiner, Knebel, & Institute of Medicine, 2003). This DNP final project was to implement a competency based course to improve quality care for patients who have Intrathecal Baclofen Therapy (ITB) and Intrathecal Pain Therapy (ITP). The intrathecal pump therapy has been used for many years and if not done effectively complications can be fatal.

Programming errors, administering incorrect medication concentration/dosage and pump and catheter malfunctions can place the patient at risk for over/under dosage as well as withdrawal symptoms (Bhimani, 2008). This project addresses these crucial issues as well as implements an educational tool to prevent human error and equipment malfunction. The significance of this project is to demonstrate that there are currently little data in the area of best practice for this specialized therapy. According to Stetkarova, Yablon, Kofler, & Stokic, (2010) a standardized data collection and complication-reporting procedure along with appropriate training should be implemented in centers offering ITB treatment. This project is comprised of a learning manual containing various topics. The topics include: how the pump works, the various modes available for the delivery of medication, the different patient populations, patient education, and assessment of patients. The manual discusses the refill procedure, programming procedures, risk and complications, medications, and formulas with calculations. There is a mandatory examination for healthcare providers to take at the completion of the course.

The learning manual was developed by using information from intrathecal pump manufactures, current policies at the home care agency, and other reliable sources. An extensive review of the data was performed to develop the learning manual and an exam which was part of the project. The examination consisted of 100 questions. The desired outcome of the project is a passing score of 90% on the examination with the allowance of the healthcare provider to retake the exam after remediation.

The significance of this project is to improve the quality of care delivered to patients that use intrathecal pump therapy. The idea of a learning manual and exam for competency for intrathecal pump therapy was conceived since there was little data available. This extensive course covers many pertinent areas with regard to intrathecal pump therapy. The clinical significance is that many complications can occur with intrathecal therapy such as; infection, pocket refill, under or overdosing of medication, and other life threating complications. The implemented methodology was rolled out to this national home care agency consisting of a competency course manual and final examination.

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