Document Type

DNP Project

Publication Date


Degree Name

Doctor of Nursing Practice

Faculty Advisor

Constance Glenn DNP, APRN, FNP-BC, CNE

Practice Mentor

Alexander Deluca MSN, RN



Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating lung condition, and a leading cause of readmission following an acute exacerbation. The Centers for Medicare and Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP) determines reimbursement penalties to hospitals when patients admitted with acute exacerbation of COPD are readmitted for any reason within 30 days of discharge. A regional medical facility (MF) identified 30-day readmission rates for COPD patients as a key improvement metric. Several gaps in the standardized care of patients with COPD on a pulmonary-focused medical-surgical unit (MSU) identified by key unit stakeholders provided impetus for this project.

Project Goals

  1. Identify best practice strategies to reduce all-cause 30-day readmission rates in patients with COPD.
  2. Educate staff on the evidence-based COPD clinical pathway at MF
  3. Implement a checklist-based standardized nurse-driven COPD protocol.
  4. Examine 30-day readmission rates and barriers to care metrics for patients COPD over a period of 12 weeks.


Staff on MSU were educated on the COPD inpatient clinical pathway located in EPIC and evidence-based best practice for patients with COPD. A gap analysis of barriers to care was performed and a nursing COPD bundle checklist was developed to guide and standardize the care of this population. Each patient with a history or diagnosis of COPD admitted to MSU received a daily COPD checklist. Nurses on the unit were asked to refer to the checklist to check off each intervention in the care bundle performed. Completed checklists were returned to the Project Leader for data analysis upon patient discharge. Pre - and post-intervention 30-day all-cause readmission rates were compared along with key COPD driver and mobility data.


A total of seven checklists accounting for 14 patient-days were utilized and collected over the one-month pilot period. Patients had their mobility assessed on 13 days (93.00%), were ambulated out of bed on 12 days (85.71%) and received COPD-specific patient education on 12 days (85.71%.). Of the three patients on supplemental oxygen, two had home oxygen requirements assessed via blood oxygen saturation readings (SpO2) while ambulating. Total mobilizations trended down over the pilot period while the rates of effective mobilization trended up. Post-intervention COPD readmission data was not available at the time of the project’s conclusion due to the lag in software data publication.


While it was proposed that the 30-day all-cause readmission rate will decline, results from this 30-day pilot study concluded prior to the data becoming available. This project showed that a nurse-driven COPD care bundle is potentially an effective way to standardize care resulting in reducing 30-day patient readmissions for the COPD patient.


A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.

Creative Commons License

Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.

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