Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation

Fall 2018

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Maria G. DeValpine

Tammy Kiser



Background: Detectable lead levels in children’s blood have been associated with increased cognitive difficulties, attention deficits, and poorer academic performance. Children enrolled in Medicaid have higher rates of elevated blood lead levels, yet requirements to test all children at age 1 and 2 who are enrolled in Medicaid are not being met. Nationally, 34% of children enrolled in Medicaid do not undergo proper blood lead level screening. The aim of this project was to increase required blood lead level screening rates for children with Medicaid insurance at a private pediatric practice in the Shenandoah Valley in Virginia.

Methods: The Institute for Healthcare Improvement (IHI) Model for Improvement was used to guide this practice improvement. This model stresses the importance of performing a needs assessment, establishing a baseline, and tracking balancing measures to ensure the intervention has no unintended consequences. A baseline rate of screening was collected by retrospective chart review, a physical review of the clinic was performed, and staff interviews were conducted. The Plan, Do, Study, Act (PDSA) cycle was the used to implement the intervention. Run charts were displayed weekly to show progress.

Intervention: Three cycles of the interventions were run. The first intervention was an inservice to update staff to the current guidelines. Second, an official policy change was enacted, and finally an electronic health record (EHR) flag was employed as a reminder.

Results: The initial assessment revealed that blood lead screenings were not being conducted on 2-year-old children enrolled in Medicaid. Interventions to change the practice and screen 2-year-old children enrolled in Medicaid were designed based on a search of the literature.

The IHI Model for Improvement produced statistically significant improvement (p<0.001) in screening rates of 2-year-old children enrolled in Medicaid. The run charts further illustrated improvement with each intervention.

This project was undertaken in partial fulfillment of the Doctorate of Nursing Practice.



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