CAPELLA SAMPLE DNP CAPSTONE PROJECT PROPOSALS

Capstone projects for Doctor of Nursing Practice (DNP) degrees are substantive scholarly projects that allow students the opportunity to demonstrate their knowledge and skills attained throughout the program. The goal of the capstone project is to address a problem facing healthcare, focus on improving patient outcomes, and translate evidence into practice. Through these projects, DNP students are able to provide leadership in changing practice and make meaningful contributions to nursing and healthcare.

CAPELLA SAMPLE DNP CAPSTONE PROJECT PROPOSALS

Some common topics that DNP students select for their capstone projects include improving care for chronic illnesses, enhancing patient outcomes, evaluating new models of care delivery, assessing quality improvement initiatives, addressing access issues, reducing healthcare costs, and implementing evidence-based practice changes. The capstone provides the opportunity for the DNP student to design, direct, and influence healthcare in a meaningful way. Here are some sample DNP capstone project proposals in key focus areas:

Reducing 30-Day Readmission Rates for Heart Failure Patients

Reducing 30-Day Readmission Rates for Heart Failure Patients

Project Purpose: The purpose of this project is to reduce 30-day all-cause hospital readmission rates among patients diagnosed with heart failure at Acme Hospital. Heart failure readmissions negatively impact patient outcomes and are costly for the healthcare system.

Background: Heart failure is a chronic condition affecting millions of people in the United States. Approximately 25% of heart failure patients are readmitted to the hospital within 30 days of discharge, often due to non-adherence to discharge instructions and medications, lack of appropriate follow-up care, and exacerbation of symptoms. Acme Hospital's current 30-day readmission rate for heart failure is 29%, exceeding the national benchmark of 24%.

Intervention: This project will implement a transitional care program for heart failure patients at high risk for readmission. The intervention includes a home visit by an advanced practice nurse within 72 hours of discharge, weekly telephonic monitoring for the first month, and coordination of follow-up appointments with cardiology and primary care. Educational materials and instructions will be tailored to each patient's needs and literacy level. Medication reconciliation and adherence support will also be provided by the transitional care nurse.

Outcome Measures: The primary outcome measure is reduction in 30-day all-cause readmission rates for heart failure patients. Secondary outcomes include patient and provider satisfaction scores, adherence to discharge instructions and medications, and costs avoidance from prevented readmissions. Data will be collected via medical record review and surveys.

Analysis: Descriptive and inferential statistics will be used to analyze pre- and post-intervention readmission rates, as well as survey results. A paired t-test will determine if the reduction in readmissions is statistically significant. An anticipated outcome is a reduction in the heart failure 30-day readmission rate to less than 24% at Acme Hospital.

Improving Colorectal Cancer Screening Rates through a Multicomponent Intervention

Improving Colorectal Cancer Screening Rates through a Multicomponent Intervention

Project Purpose: The purpose of this project is to increase colorectal cancer screening rates among eligible patients at three community health centers. Colorectal cancer is the third most commonly diagnosed cancer in the United States but is highly preventable with regular screening. National and state benchmarks for colorectal cancer screening are not being met at these clinics.

Background: Current colorectal cancer screening rates at the three health centers range from 35-45%, falling well below the national Healthy People 2020 target of 70.5% and the state target of 60%. Known barriers to screening include lack of physician recommendation, missed opportunities during visits, and patient perceptions and knowledge deficits. A multicomponent intervention targeting patients and providers has potential to significantly impact screening rates.

Intervention: Interventions will include 1) patient education materials mailed directly to homes of eligible patients, 2) provider reminders and standing orders for screening tests, 3) patient navigation and outreach to schedule examinations, 4) small media incentives for patients completing screening, and 5) performance feedback to clinics on screening rates. Education materials will be culturally and linguistically appropriate.

Outcome Measures: The primary outcome measure is the percentage of eligible patients up-to-date with colorectal cancer screening, as documented in the electronic health record, at baseline and 6 months post-intervention. Secondary outcomes include number ofscreening tests completed and time to exam completion following patient navigation.

Analysis: Descriptive statistics and chi-square analysis will be used to examine screening rates pre- and post-intervention at each health center. The aggregate screening rate across all three centers will also be analyzed for statistical significance using paired t-tests. The goal is to achieve colorectal cancer screening rates of at least 60% at each site.

Implementing an Antimicrobial Stewardship Program

Implementing an Antimicrobial Stewardship Program

Project Purpose: The purpose of this project is to develop and implement an antimicrobial stewardship program (ASP) at Large County Hospital to optimize antibiotic use and reduce antibiotic resistance. Antibiotic overuse and misuse have contributed to a growing crisis of multidrug-resistant organisms infecting hospitalized patients.

Background: Unnecessary or improper use of antibiotics is common in many healthcare settings. Large County Hospital currently does not have a formal ASP. Studies show implementation of ASPs can effectively curtail antibiotic use by 15-25% without negatively impacting patient outcomes. This has potential to decrease health care costs, reduce antimicrobial resistance, and improve patient safety.

Intervention: Elements of the ASP will include 1) appointment of an infectious disease pharmacist as the antimicrobial stewardship lead, 2) development of evidence-based guidelines and clinical pathways for common infections, 3) prospective audit with intervention and feedback on prescribed antibiotics, 4) formulary restriction and preauthorization for certain broad-spectrum drugs, and 5) ongoing provider education. The pharmacist will review culture results and antibiotic use daily then work with physicians to optimize therapy.

Outcome Measures: Primary outcomes are total antibiotic use in defined daily doses per 1000 patient-days and days of therapy per 1000 patient-days. Secondary outcomes include compliance with treatment guidelines, cost savings, rates of Clostridium difficile infection and methicillin-resistant Staphylococcus aureus, and provider satisfaction. Data will be extracted from the electronic medical record and microbiology databases.

Analysis: Interrupted time series analysis with segmented regression will be used to evaluate changes in antibiotic use and resistance after ASP initiation compared to baseline. Descriptive statistics will analyze secondary outcomes. Outcomes will be closely monitored for at least 6 months. The goal is a 10-20% reduction in overall antibiotic use at the hospital.

Improving Blood Pressure Control Rates in Patients with Diabetes

Improving Blood Pressure Control Rates in Patients with Diabetes

Project Purpose: The goal is to increase the proportion of patients with diabetes who have their blood pressure under control (less than 140/90 mmHg) at an outpatient primary care clinic from the current rate of 56% to at least 70%. Uncontrolled hypertension among diabetics increases risk of kidney disease, stroke, heart attack, and death.

Background: National clinical practice guidelines recommend maintaining blood pressure under 140/90 mmHg in patients with diabetes; however, control rates often fall short of quality targets. Barriers to blood pressure control at this clinic include gaps in medication titration, inconsistent lifestyle counseling, lack of self-management support, and limited appointments.

Intervention: A multi-pronged intervention will be implemented, including 1) physician education and reminders for guideline-concordant treatment, 2) group medical visits combining lifestyle counseling and medication management, 3) a nurse case manager to provide telephonic follow-up for uncontrolled patients between visits, 4) home blood pressure monitors for self-monitoring, and 5) personalized goal-setting and barrier identification with each patient.

Outcome Measures: The primary outcome is the percentage of patients with diabetes and blood pressure under 140/90 mmHg, as documented in the EHR at baseline and 12 months post-intervention. Secondary outcomes include changes in systolic and diastolic blood pressure measurements, cardiovascular risk factor control, weight and A1C levels, and medication adherence. Patient satisfaction surveys will also be administered.

Analysis: Descriptive statistics will describe baseline characteristics and McNemar's test will evaluate differences in blood pressure control pre- and post-intervention. Paired t-tests will analyze changes in continuous variables. Covariates such as age, sex, insurance status will be assessed. With a sample size of 200 patients, the project aims to achieve a statistically significant increase of at least 10% in blood pressure control.

Creating a Standardized Handoff Tool for Night Shift Nurses

Creating a Standardized Handoff Tool for Night Shift Nurses

Project Purpose: To address inconsistent nursing handoffs that compromise patient safety and care continuity on night shifts, this project aims to develop, implement, and evaluate a standardized handoff tool for all patient transfers between day and night shift nurses.

Background: Nursing handoffs are vulnerable moments for miscommunication of critical patient information. Without a structured protocol, important details can be missed or forgotten, leading to errors. Research links inadequate handoffs to adverse events such as medication errors, falls, delays in treatment, and increased length of stay. A standardized tool formats important data while allowing for questions.

Intervention: A multidisciplinary team will create a evidence-based handoff tool encompassing each patient's name, room number, diagnoses, procedures, labs/vitals, medications, to-do list for the oncoming shift, lines/drains, code status, and areas of concern. All nurses will be trained to use the new tool which will be pilot tested on two units before hospital-wide implementation.

Outcome Measures: Primary outcomes include night nurses' perception of communication quality using a Likert scale survey and the number of patient-related incident reports during handoffs. Secondary outcomes involve day nurses' perceptions, length of handoffs, and number of call lights requiring nurse response within one hour.