Date of Graduation

Spring 5-22-2015

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Elena Capella

Second Advisor

Enna Trevathan


The purpose of the project was to improve the management of patients with rib and or sternal fractures in a 413 bed Level I Trauma Center. The pathway included best practice guidelines paired with clinical expertise to reduce Intensive Care Unit (ICU) readmissions, costs, complications and length of stay (LOS). Analysis of the data revealed 55% of ICU readmissions were due to respiratory causes. The timeline guided the creation, deployment, and evaluation of the project over a two phase, one and one half year period. Methods included analysis of the data, meetings with lead team members to define the scope of the problem and identify processes. Lastly, the pathway, Pain, Inspiratory Capacity, and Cough (PIC) score board, patient and family handout, timeline and educational plan for staff was created using power point presentations, handouts and visual aids. Currently, actions in the timeline are up to date and the revised educational plan will be carried out over four weeks from May 17, 2015 through June 15, 2015; implementation will begin on June 15th, 2015. Evaluation of outcomes, ICU readmission rates and length of stay days, will be carried out one year from implementation. As a CNL, I recommend additional PDSA cycles be implemented based on the data, if needed, frequent rounding to ensure enrollment of patients and adherence to the pathway, and incorporating the PIC score and team goals into daily team rounds.