Date of Conferral

9-17-2026

Date of Award

9-17-2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Margaret Harvey

Abstract

Chronic heart failure (HF) remains a leading cause of avoidable hospital readmissions and emergency department visits due to delayed recognition of early symptom exacerbation between routine outpatient encounters. This doctoral quality improvement project evaluated whether the implementation of an evidence-based, nurse-led remote patient monitoring (RPM) standard operating procedure (SOP) improved early identification of symptom exacerbation compared to standard episodic care among adult heart failure patients (NYHA Class II–III) in an outpatient primary care setting over a 10-week period. Guided by the Plan-Do-Study-Act (PDSA) framework, an evidence-based clinical practice guideline (CPG) and escalation protocol were developed and appraised by a 3-member expert review panel using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Across six evaluated domains, the guideline achieved a mean scaled domain score of 90.20%, demonstrating high methodological quality and clinical rigor. Implementation of the standardized workflow yielded a 92% nursing protocol adherence rate, 100% staff proficiency following ADDIE-based onboarding, and a 30% reduction in 30-day all-cause hospital readmissions compared to historical baseline data. These findings demonstrate that structured daily biometric telemetry paired with proactive nurse triage effectively bridges the outpatient care gap, enhances nursing autonomy, and optimizes clinical resource utilization. Scaling this nurse-led surveillance model supports health equity and positive social change by ensuring continuous, accessible care coordination for homebound and socioeconomically disadvantaged chronic disease populations.

Download

Included in

Nursing Commons

Share

 
COinS