Date of Degree
Fall 2025
Document Type
DNP Scholarly Project
Academic Department
School of Nursing
Degree Type
Doctoral
Degree Name
Doctor of Nursing Practice
First Advisor
Kristie Lowry, DNP, RN
Second Advisor
Jenna Herman, DNP, RN
Abstract
Problem: Baseline audits at a 44-bed critical-illness recovery hospital showed low reliability in two post-PEG practices: (1) pain reassessment within 90 minutes of an intervention and (2) complete PEG-site documentation (skin, drainage, tube position/measurement). Baseline performance averaged 55% and 62%, both of which were below the organization’s 90% benchmark.
Aim of the Project: From May to July 2025 (12 weeks), improve on-time pain reassessment and ensure PEG-site documentation reaches at least 90%, maintaining this level for three or more consecutive weeks; monitor workload to prevent increases in perceived charting time and ensure safety by avoiding a rise in PEG-related events compared to baseline.
Review of the Evidence:
A 2020–2025 review of adult inpatient studies included nurse-led/inclusive strategies (simulation, required-field templates/prompts, audit, and feedback) that reported outcomes for documentation completeness, timely reassessment, or complication detection. Exclusions: pediatric-only, outpatient, non-empirical/commentary, pre-2020, or studies lacking those outcomes. Twelve studies met the criteria.
Project Design:
Unit-based QI across 11 weeks with two PDSA cycles; progress reviewed at the monthly quality meeting. OhioHealth Change Management guided stakeholder engagement, readiness, and reinforcement. Measures included outcome, process, balancing, and safety. Analysis used run-chart rules to detect shifts/trends and summarized the change from baseline.
Intervention: Simulation-based education with a midpoint booster; a required-field documentation template (≤90-minute reassessment and PEG-site elements with prompts); weekly feedback led by the project lead with real-time coaching; visibility boards.
Significant Findings/Outcomes: On-time pain reassessment improved from 55% to 85% (13/23 to 20/23); compliant documentation increased from 62% to 78% (14/23 to 18/23). One minor complication occurred: a brief decline followed by a rebound during a high-census week. Nurse workload remained stable.
Implications for Nursing: Reliability and timeliness improved without increasing workload; the ability to recover during census pressure was demonstrated. Sustainment focuses on leadership visibility, scorecards, automated prompts, and timely feedback. The model applies to similar post-procedure workflows.
Recommended Citation
Cotton, Sherman, "Improving Pain Assessment After Bedside Percutaneous Endoscopic Gastrostomy (PEG) Placement" (2025). Doctor of Nursing Practice (DNP) Scholarly Project. 47.
https://fuse.franklin.edu/dnp-project/47
Rights
CC BY-NC-SA 4.0
