Date of Award

Summer 2022

Project Type


College or School




Program or Major


Degree Name

Master of Science

First Advisor

Pamela Kallmerten


Background: Screening and monitoring growth throughout childhood and adolescence, as well as providing the necessary education on positive lifestyle choices is vital in combating the childhood obesity epidemic. Counseling children on the importance of nutrition and physical activity also helps to prevent numerous comorbid conditions associated with obesity. The United States. Preventive Services Task Force recommends that healthcare workers screen for obesity at least annually in all patients 3-17 years of age, as well as offer lifestyle counseling regardless of Body Mass Index ranking.

Aim: The aim of this quality improvement project was to improve the current percentage of pediatric patients with up-to-date documentation of Body Mass Index percentile and proof of receiving counseling for both physical activity and nutrition. Specifically, this project aimed to increase child BMI screening and counseling rates at a federally qualified healthcare facility from 49% to the agency goal of 60% by July 30th, 2022.

Interventions: A root-cause analysis was performed by completing an initial chart audit of 176 patient charts. After analyzing the audit results it was determined that the most common error was failure to document providing patient education on physical activity and nutrition. This information was then used to develop an educational presentation for clinical staff to learn about the measure and how to properly document patient counseling in the Electronic Medical Record. A focus group was then conducted to understand the current barriers staff face with meeting the measure, and receive feedback on ways to improve. The two providers with the lowest compliance rates were given additional education on documenting the measure and at-the-elbow support was provided.

Results: The data revealed that the educational intervention had not been effective in improving compliance rates of the measure. By the end of June 2022, the percent compliance rate had actually decreased to 46%. During the focus group staff expressed concerns about not having enough time to complete education, along with having their patients present annually for physical exams.

Discussion: Screening pediatric patients for obesity, in addition to providing the appropriate education for implementing healthy lifestyle habits is vital for growth and development. As the results have shown the educational intervention to be unsuccessful, a different approach should be taken in the future to help improve compliance.

Implications for the CNL: Focusing on the role of the CNL, healthcare technologies were used to obtain and evaluate data regarding the quality of patient-centered care. Leadership and communication skills were utilized to strengthen interprofessional partnerships, which served as vital during the implementation phase. The necessary steps taken throughout this project has emphasized the roles of the CNL as a lifelong learner, continuously striving to improve the quality of healthcare.