Date of Award

5-14-2019

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Nola A. Schmidt

Abstract

The American College of Cardiology (ACC) and the American Heart Association (AHA) (2013; 2016), as well as the American Diabetes Association (ADA) joined forces to create clinical practice guidelines (CPGs) recommendations for healthcare providers (HCPs) to follow with the aim of preventing cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality in the United States. The Centers for Disease Control (2017a) estimates CVD costs 325 billion dollars annually. Although CVD has an astronomical cost associated with it, CPG adherence continues to be an issue among HCPs and improvement is warranted. The purpose of this EBP project was to alter standard practice among HCPs, with the aim of improving adherence of CPGs through prescribing a statin and/or aspirin among patients who have been diagnosed with dyslipidemia, hypertension (HTN), and/or type 2 diabetes mellites (T2DM) and have a 10-year atherosclerotic cardiovascular disease (ASCVD) risk factor of greater than or equal to 7.5%, thereby potentially preventing primary CVD in these at-risk patients. The sample size (N = 3) included one physician and two nurse practitioners who have prescriptive authority. Kotter’s change model was used as the theoretical framework and the Promoting Action on Research Implementation in Health Services (PARiHS) model as the evidence-based practice model used to guide this project. An extensive literature search was performed, which generated 10 pieces of evidence that met the inclusion criteria for this EBP project. The interventions for this project included a multi-modal approach that included four strategies: (a) education, (b) computer-generated paper reminders, (c) visual cues and (d) feedback. A cross tabulation Chi-square analysis was used to determine the effectiveness of the four intervention strategies for improving adherence by HCPs with prescribing statins and/or aspirin for the primary prevention of CVD in at-risk adult patients. Results showed HCPs prescribed according to the CPGs for 59.4% (n = 139) of the patients. A combined statistically significant improvement between all phases of this EBP project for compliance showed (X2 = 6.887, df = 2, p = 0.032).

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