Date of Graduation

Winter 12-13-2019

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Juleah Walsh


At a large, community-based pediatric hospital in Southern California, a quality improvement project commenced with a goal to improve patient outcomes by decreasing length of stay and pain levels, while increasing toleration of feeds. Implementing a standardized guideline would ensure safe practice across the continuum and allow providers to use a systematic tool for postoperative care, including nursing care interventions and medications. The Root-Cause-Analysis tool was used to assess the microsystem and determine the contributing factors to the identified problem. A SWOT analysis was then performed, followed by a plan to collect data from all pediatric cleft palate procedures performed at the hospital within the last year. The data collected included all necessary actions that took place upon patient’s exit from surgery. Patient exclusion criteria included PICU admits and those with cleft palate repair resulting from injury. The patients that fell within the exclusion criteria were excluded due to the increased risk and complications that these conditions bear. Considerations for care guideline use include: congenital abnormalities of the heart, brain, or gastrointestinal system as well as those with hematology or oncology conditions and developmental delays. Research was then performed on the patient information found from chart audits, in order to verify the best practices following postoperative cleft palate repair. Ultimately, research on the impact of care guidelines on postoperative cleft palate repair versus physician preference yielded a recommendation for the development of standardized care guidelines, however, the results showed that additional steps are needed to evaluate the results of this implementation on length of stay, pain levels, and time of first tolerated feed.