NU298 Unit 2 Capstone Problem Statement Example

One Unit, One Kind of Order, One Number and One Deadline: A Capstone Problem Statement Narrowing Unnecessary Fasting on a Composite 30-Bed Medical Unit Until It Can Be Measured, With a PICOT Question and a Balancing Measure

[Student Name]

Purdue University Global

NU298: Capstone

Unit 2 Problem Statement

[Instructor Name]

[Date]

The unit and baseline figures are composite and bracketed; published figures are from the cited studies, and any change requires the provider, anesthesia and unit leadership.

Three Narrowings, Shown

From "patients go hungry in hospital" to fasting before procedures, because procedures cause most fasting orders on medical units (Sorita et al., 2017). From all procedures to those done with moderate sedation or imaging with contrast, the largest group on this unit. From fasting in general to fasting from clear liquids, because national anesthesia guidance permits clear fluids up to roughly two hours ahead of most sedated or contrast procedures (Joshi et al., 2023), so this is where the gap between practice and evidence is largest.

Baseline, With Its Sources

A four-week review of the unit's records found [62] fasting orders for procedures. Median time from last clear liquid to procedure start: [13.5] hours. Procedures canceled or postponed after a full fast: [12] of [62], about [19] percent, in line with the one in five reported in a study of medical inpatients (Sorita et al., 2017). Median procedure start time: [1330].

PICOT

In adult medical inpatients awaiting procedures with sedation or contrast (P), does a nurse-driven clear-liquids-until-two-hours protocol with a procedure-time confirmation call (I), compared with routine nothing-by-mouth-after-midnight orders (C), reduce the median clear-liquid fasting time (O) over eight weeks (T)?

Thirteen and a half hours without water for a test that begins after lunch is not caution; it is habit.

Why Clear Liquids, Not Food

Solid food carries a longer recommended fast, and changing it involves more parties. Clear liquids are where the evidence is strongest, the risk is lowest and the patient's distress is most immediate, since thirst and low blood pressure follow fluid restriction faster than hunger does. Starting with clear liquids lets the unit test the process before taking on anything harder.

Significance From Arithmetic

At about [15] procedure fasts a week and an average excess of [11] hours of fasting from clear liquids beyond what guidance requires, the unit produces about [165] patient-hours of unnecessary thirst every week. Each canceled procedure means the fast is repeated the next day.

The Measure That Guards the Change

Primary measure: median clear-liquid fasting time. Balancing measure: any procedure delayed or canceled because a patient was not fasting long enough, and any aspiration event reported during sedation. If shorter fasts led to delays or aspiration, the change would be stopped.

Deadline

Results are reviewed at eight weeks, against the baseline median.

References

Joshi, G. P., Abdelmalak, B. B., Weigel, W. A., Harbell, M. W., Kuo, C. I., Soriano, S. G., Stricker, P. A., Tipton, T., Grant, M. D., Marbella, A. M., Agarkar, M., Blanck, J. F., & Domino, K. B. (2023). 2023 American Society of Anesthesiologists practice guidelines for preoperative fasting: Carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration: A modular update of the 2017 American Society of Anesthesiologists practice guidelines for preoperative fasting. Anesthesiology, 138(2), 132-151. https://doi.org/10.1097/ALN.0000000000004381

Sorita, A., Thongprayoon, C., Ratelle, J. T., Bates, R. E., Rieck, K. M., Devalapalli, A. P., Ahmed, A., & Kashiwagi, D. T. (2017). Characteristics and outcomes of fasting orders among medical inpatients. Journal of Hospital Medicine, 12(1), 36-39. https://doi.org/10.1002/jhm.2674