Feb 23, 2024 NUR 590 Project Implementation
NUR 590 Project Implementation
NUR 590 Project Implementation
Do you foresee any issues with the proposed implementation of your project? Identify a strategy to help create or sustain a higher level of readiness to change with your organization and discuss how current research or literature will be used to ensure that change is based on current evidence.
As with any project implementation its best to envision any potential issues before they arise. Therefore, I anticipate a few potential issues with the proposed implementation of my project. The first foreseen issue identified for the proposed implementation of my evidence-based project are financial concerns and will continue to be an ongoing concern. I was able to identify a couple of strategies to help with the financial concerns including executive leadership engagement in the process. Being fully transparent with the executive leadership team regarding the implementation plan including cost and methods of saving will aid in gaining their support. Another financial strategy would be to develop a team of subject matter experts/educators on the Physician Orders for Life-Sustaining Treatment (POLST) program utilizing the system Respecting Choices Model within the system. With the development of the program within the system there will be a reduction in further cost to outside resources.
The second foreseen issue is a lack of clinician buy in to the program and change management. In order to address this area education, engagement, and communication are necessary strategies. The education will include up-to-date best practices, refresher courses, audit, and review. The engagement strategies include ensuring confidence in their work, standardized workflow, ensuring collaboration and stakeholder involvement. The communication strategies include ongoing updates on education and engagement opportunities, events, current POLST literature, and development of newsletter.
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The third foreseen issue is lack of quality of the POLST process and order sets. Quality of the work is a multifactorial problem; in that it relies heavily on the first two foreseen issues. “The quality of POLST documentation is only as good as the conversations that precede it” (Abbott, 2019, p. 297). Therefore, if there is a lack of financial support or clinician buy in, ultimately leading to a reduction in POLST quality.
Research on POLST implementation is actively being reviewed and updated therefore in order to ensure that my proposed evidence-based practice proposal is based on current evidence it’s necessary to regularly search for the most up-to-date literature.
NUR 590 Project Implementation Reference
Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine, 73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021
The only issue I see with the proposed implementation of my project is allowing both nurses and patients the time to get used to the implemented process. Most organizational change initiatives fail because we apply strategies that are not tailored for the structure of the concerned organization. I work at the VA in Lancaster and our structure is a healthy one. Changing a healthy structure requires trust, clarity, and integrity. Employees are accountable for what they do. If they need skills, they can get trained or ask support to their managers. Anyone in the organization, not only managers, is likely to ask questions like: “When will you be ready?” or “Have you tested the quality of your realization?” Everyone is accountable to their colleagues. Here are the guidelines to follow to identify the most appropriate change approach.
It decomposes the movement from the current state to the future state in five steps (Cavarec, 2014):
· Formulate change
· Plan change
· Implement change
· Manage transition
· Sustain change
Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles (Silver et al., 2016).
Investments in new clinical practices do not stop with their developers; enormous effort and resources are directed to introducing new clinical knowledge to healthcare organizations. These investments include mobilizing human resources through the establishment of knowledge brokers, evidence-based practice committees or teams and identifying opinion leaders and champions who will support the practice excellence (Virani et al., 2009).
NUR 590 Project Implementation Reference
Cavarec, Y. (2014). Increase your organization readiness to change. Paper presented at PMI® Global Congress 2014—North America, Phoenix, AZ. Newtown Square, PA: Project Management Institute.
Silver, S. A., McQuillan, R., Harel, Z., Weizman, A. V., Thomas, A., Nesrallah, G., Bell, C. M., Chan, C. T., & Chertow, G. M. (2016). How to Sustain Change and Support Continuous Quality Improvement. Clinical journal of the American Society of Nephrology : CJASN, 11(5), 916–924. https://doi.org/10.2215/CJN.11501015
Virani, T., Lemieux-Charles, L., Davis, D. A. & Berta, W. (2009). Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then? Healthcare Quarterly, 12(1), pp 89- 96
I do foresee issues with the proposed implementation of my project, including financial difficulties. My project focuses on the importance of continuous CPR during defibrillation. For many decades the focus of CPR was identified in order of importance; airway, breathing, circulation. Recently the American Heart Association announced that circulation would overtake as the number one priority during cardiopulmonary resuscitation (American Heart Association., n.d.). This means that early and continuous high quality compressions are seen to improve circulation and perfusion during CPR to help increase patient outcomes. Clark et al., 2019 reports that interruptions in chest compressions greater than 10 seconds have been associated with adverse outcomes: “previous literature has associated shorter peri-shock pause times with greater odds of survival and longest pause during chest compressions with lower odds of survival” (Clark et al.,2019). Getting not only nurses but also physicians onboard with the new evidence based practice poses a huge barrier in implementation. It is very difficult to change people’s ways of practice, especially if they have been practicing for an extended period of time. This will require a large amount of education and support from leadership and clinical education to encourage the staff to buy-in to this new practice. In addition, the research I collected identified that ECG devices and the LUCUS device were found to be the most beneficial to perform continuous compressions during defibrillation in simulation studies. These devices are extremely expensive and may not be an option, nor an opportunity for small rural community hospitals. In this instance, those small community hospitals will be unable to deliver the most up to date evidence based practice care to patients due to the inability to afford the equipment needed. THis is not just a barrier to the implementation process but also a barrier in providing the most quality care to the patient.
I would utilize The Organizational Readiness to Change Assessment (ORCA) tool to assess the organization’s readiness, capacity, and strength to change and implement this project. For a project this size, I believe this tool would be able to assess all areas of change to determine if the organization is a good fit for the project and vise versa.
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American Heart Association . (n.d.). CPR Facts and Stats. cpr.heart.org. https://cpr.heart.org/en/resources/cpr-facts-and-stats.
Clark, L. R., McDannold, R., Mullins, M., & Bobrow, B. (2019). Pause Duration During Manual CPR is Associated With Survival and Favorable Neurological Outcome in All-Rhythm OHCA. Circulation, 140(Suppl_2), A458-A458.
The first issue with every proposed implementation of many projects is that people avoid change due to fear of failure to adapt to the new system, losing the comfort zone and lack of confidence in the choice, or maybe a previous bad experience when workflow changes. Lack of communication might be another problem that makes the project fails. I should be more vigilant with this problem with effective communication, timely and transparent methods of communication to ensure that all stakeholders are involved in the process ((Project.2021). The availability of a workforce is another problem. For project success, it is vital to assess the available workforce to determine if additional staff and skillsets are required to complete the project. As a leader, ensure that the project stakeholders are on the same page and have a clear vision by inviting them to the project plan to shape and provide feedback actively.
An evidence-based approach involves an ongoing, critical review of research literature to determine what information is credible, and what policies and practices would be most effective given the best available evidence. It also involves rigorous quality assurance and evaluation to ensure that evidence-based practices are replicated with fidelity and that new practices are evaluated to determine their effectiveness( nicic.gov).
Projects: (2021). 9 Project management Challenges and How to Overcome them. https://kissflow.com/project/project-management-challenges.
National Institute of Corrections. (n.d). Evidence-based Practices (EBP). https://nicic.gov/projects/evidence-based-practice-ebp.
From an institutional standpoint, I do not foresee any issues with implementing my EBP Project because the nurses are already engaged in patient education and have the resources to implement the project. However, patient compliance and adherence may prove to be problematic. According to Pan et al (2019), noncompliance with treatment regimens is primarily responsible for uncontrolled blood pressure among patients diagnosed with hypertension.
Before implementing change, organizations need to assess readiness for change. Therefore, it is imperative that organizations analyze systems, processes, and more importantly people when conducting change readiness. As cited in Borges & Camila (2020), 70% of organizational change fail due to lack. of employee adoption of the changes. Change readiness assessments can aid in facilitating change by collecting quantitative and qualitative data measurements about where readiness gaps may exist.
Once the change readiness assessment has been conducted, data summarized and reviewed, and issues addressed, change can be initiated. John Kotter’s 8 Step Change Model would be most appropriate because it involves establishing, maintaining, and sustaining change. Kotter’s model states that organizational change is vital to be successful (Kuo & Chen, 2019). The eight steps of change in Kotter’s model are: create urgency, organize a guiding team, develop a clear and concise vision and strategy, communicate the vision, utilize empowerment to remove obstacles or barriers, create short-term victories, build on the change, and cement changes in culture (Kuo & Chen, 2019).
NUR 590 Project Implementation References
Borges, R., & Camila, A. Q. (2020). Understanding the individual’s reactions to the organizational change: A multidimensional approach. Journal of Organizational Change Management, 33(5), 667-681. doi: http://dx.doi.org.lopes.idm.oclc.org/10.1108/JOCM-09-2019-0279
Kuo, Y. L. & Chen, I. J. (2019). Facilitating a change model in age-friendly hospital certification: Strategies and effects. PLOS One, 14 (4). https://doi.org/10.1371/journal.pone.0213496
Pan, J., Wu, L., Wang, H., Lei, T., Hu, B., Xue, X., & Li, Q. (2019). Determinants of hypertension treatment adherence among a Chinese population using the therapeutic adherence scale for hypertensive patients. Medicine, 98(27), e16116. https://doi.org/10.1097/MD.0000000000016116
As with any change there is stress on an organization or staff in the process of the change, even good change causes stress to staff as their process is changed moving them out of their comfort zone (Ost et al., 2020). In every population from nursing to the janitor, change has moments of unacceptance, In my project of teaching a new practice change from EBL to QBL I foresee change stress and pushback, due to lack of trust in this new process. Utilizing assessment tools such as a SWOT analysis to address readiness is the first step to understand where the population of a EBP project is ready to accept(Renalt, 2021). Once barriers are identified one can start to formulate a plan to address those barriers and to navigate around them by removing barriers, acceptance of a change is made easier.
Transformation or change is a large problem area in an organization, Implementing or using a change management tool such as ADKAR also will help in the success of a project. ADKAR is an acronym with the following meanings, A= starting with awareness, presenting the issue, why it is a problem or why they should be a change. D= creating desire or want to become engaged in the process, creating a desire of the how this will improve practice and outcomes. K= giving knowledge or improving knowledge in the process, through providing the research for staff to understand. A= abilities, or assessment of abilities of the nurse involved, do they have the tools, understanding, equipment needed. Finally, R= reinforcement or circling back to address issues that arose in the process after development and re-enforcement of usage of a practice(Pawl & Anderson, 2017).
As the leader of a project understanding there may be pushback, self-awareness is another area needed for assessment and creating a support system around oneself when “hiccoughs” happen, a process has a lot of push back. Assessing or understanding your emotions and the intellectual intelligence of those you are leading, or teaching will help you to stay focused and look for solutions.
Ost, K., Blalock, C., Fagan, M., Sweeney, K. M., & Miller-Hoover, S. R. (2020). Aligning organizational culture and infrastructure to support evidence-based practice. Critical Care Nurse, 40(3), 59–63. https://doi.org/10.4037/ccn2020963
Pawl, J. D., PhD, RN, OCN, CNE, & Anderson, L. S., PhD, RN. (2017). The use of change theory to facilitate the consolidation of two diverse Bachelors of science in Nursing programs. Nursing Outlook, (65), 233–239. Retrieved May 4, 2021, from
Renalt, V. (Ed.). (2021). SWOT analysis: Strengths, Weakness, Opportunities and Threats. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/swot-analysis/main
Evidence-based practice (EBP) implementation involves actualizing ideas or best practices established by providers through their research. The implementation process entails several aspects that must be followed systematically to integrate a best practice identified in the research. In this case, the implementation plan focuses on the use of Fall TIPS (tailoring interventions for patient safety) as a bundled care approach to reduce and prevent the occurrence of falls among hospitalized adult patients in medical-surgical units by 20% within six months. Studies and evidence from the Agency for Healthcare Research and Quality (AHRQ) (2021) show that the Fall TIPS toolkit optimizes patient and family efforts in reducing falls. The implementation plan focuses on different aspects of executing the intervention for effective patient care quality delivery and outcomes. The purpose of this paper is to describe the implementation plan of the EBP project propose by exploring the different components of the plan, from setting to timelines and resources, methods and instruments as well as the interventions of the delivery process and barriers.
Setting and Access to Potential Subjects
The project’s setting is the medical-surgical ward with patients who are susceptible to falls due to their health status. The medical-surgical ward provides services to patients recovering from surgical procedures and a majority are susceptible to falls because of being weak. Patients in the unit will all be potential subjects (Barber, 2018). However, only those who will provide their informed consent voluntarily will be part of the subjects. The consent will be critical as it demonstrates their free will to be part of the project to reduce falls.
Timelines
The implementation timeline will be six months. The timeline will have different aspects that include creating an inter-professional collaboration team comprising all providers including nurses, nurse managers, and physicians. The initial week will be about planning and project requirement identification as well as the selection of research design. Nurse training will also happen in the first week on various aspects of the evaluation of the project. The entire activities and components of the time are in the appendix section of the paper.
Resources Required
Effective implementation of an evidence-based practice (EBP) project requires access to and availability of required resources. The EBP project will require resources from organizational leaders and managers as well as sufficient financial resources to implement Fall TIPs as an intervention in the facility to reduce falls (DeNisco, 2019). Human resources for the project will entail nurses, and trainers on the Fall TIPS as a bundled care approach and management. Financial resources for the project will be critical to facilitate training, purchase of required materials and equipment, especially technologies, and installation of the various components of the Fall TIPS. Nurses will require resources to produce informational sheets, enter key data on patients’ health status in electronic health records, and communicate within the setting.
Qualitative or Quantitative Design in Collecting Data and Effectiveness
The project will use a qualitative approach to collect data and perspectives from participants. Falls remain a critical health issue because the Center for Medicare and Medicaid Services (CMS) describes them as never events implying that facilities cannot be compensated for resources used in fall prevention efforts. Using a qualitative design is essential as it allows researchers to deploy techniques that include interviews, focus groups, observation, and literature through systematic review (DeNisco, 2019). The qualitative method would be effective for the proposed project as providers will implement a host of interventions that include fall risk assessment, safe ambulation, safe toileting, effective staff communication, early warning, and patient education. The use of different interventions means that providers will collect data, thoughts, experiences, and perspectives from patients and offer education or awareness information on the best strategies to address falls. Observation of the effects of each intervention would also be tabulated and focus groups will be established to implement certain aspects to assess the overall effectiveness of the Fall TIPS.
The proposed EBP project proposal focuses on reducing and preventing patient falls in the medical-surgical unit among adults. Through these interventions, providers will work collaboratively with all healthcare workers, patients, and their families to reduce the burden of falls by customizing the interventions based on patient needs (Dykes et al., 2018). As such, the project would be effective as it will help improve the quality of care for these patients, improve understanding of the efficacy of each intervention, and allow organizations to get reimbursement from CMS for quality improvement by reducing patient falls.
Monitoring Methods and Instruments
The project will have different methods and instruments or tools to monitor overall results for patients and the medical-surgical unit and the nurses. The team will use an audit tool and a patient satisfaction survey during the implementation process. The satisfaction survey will involve the research participants giving their opinions and perspectives on the overall efficacy of the different interventions. For instance, participants will identify an intervention that is suitable to their condition (Rebekah & Ravindran, 2018). The audit tool will assess the overall level of implementation of the different approaches and those that work for certain types of patients based on their conditions. Through these tools, stakeholders will evaluate the common effects of the Fall TIPS in improving patients’ overall mobility during their stay in the unit.
Intervention Delivery Process
Delivering the intervention will entail having an inter-professional team comprising different healthcare workers in the medical-surgical unit, especially nurses and other specialty nurses like anesthetists and those specializing in areas like ambulation, and data. The intervention will include having staff training on all aspects of the Fall TIPS, developing approaches to safe toileting, effective communication, and patient education. Patients and their families will get the education and know the possible signs of falls, and learn to use bed alarms where necessary, while nurses will learn and apply risk assessment approaches to the issue to ensure effective implementation.
Stakeholders Needed to Implementing the Plan
Stakeholders play a crucial role in the implementation of evidence-based practice project proposal since they offer resources, input, and feedback, collaborate to have a common goal and implement the recommended intervention to improve the quality of care and patient outcomes. The project will require a host of stakeholders, especially internal (Heng et al., 2020). These would include nurses, nurse leaders and managers, project team and trainers, patients and their families, organizational management, and health information technology vendors. The nurses, nurse leaders, and managers will implement the different parts of the Fall TIPS intervention while the project will be in charge of all actions, activities, and timelines for effective deliverables (Tang, 2019). Patients and families will be the beneficiaries of these interventions and will require knowledge as well as skills to improve their gait, mobility, and overall functioning. The organizational management and leaders will offer the resources needed to implement the project and support it.
Aspects of the Implementation Plan: Barriers, Challenges, and Proposed Strategies
The entire success of this EBP project proposal will rely on how stakeholders, especially the project manager, and team, handle different components of the initiative. The EBP implementation will encounter barriers that include resistance to change, limited resources, the need for organizational leaders’ support, and insufficient knowledge and skills by nurses on Fall TIPS (Pop et al., 2020). As such, the project will require facilitators who include organizational leaders and managers, nurse leaders, and change champions who will motivate others to accept the use of Fall TIPS as a bundled care approach to reduce and prevent falls in the medical-surgical unit.
The management and project team should take an active role and integrate all stakeholders in the project. This requires effective communication and the application of models like Lewin’s change theory for employees to accept and embrace change. The integration and involvement of all nurses will ensure that the project attains its intended purpose. Again, predictable timelines would be critical for the success of this project.
Feasibility of the Project
The feasibility of the Fall TIPS intervention is high based on its cost-benefit analysis and approach. The cost incurred in implementing the intervention will be estimated and evaluate overall benefits that will accrue to patients and healthcare organizations, especially the medical-surgical unit (Tang, 2019). Based on the cost of implementation and the associated benefit compared to the effects of falls, the facility and unit will implement the Fall TIPS to reduce and prevent falls while improving the quality of care offered to patients.
Conclusion
Implementing this proposed EBP project to reduce and prevent falls in the medical-surgical unit will be critical to improving the quality of care offered to patients. Through the elaborate stages, stakeholders will assess the overall positive effects of the Fall TIPS intervention to reduce falls and improve the quality of life and patient outcomes. The implementation will focus on ensuring that all healthcare providers in the facility participate and develop a common goal to improve care provision. The Fall TIPS framework will help the unit reduce fall rates and improve the overall quality of care and patient satisfaction.
NUR 590 Project Implementation References
Agency for Healthcare Research and Quality (AHRQ) (2021). Fall TIPS: A Patient-Centered
Fall Prevention Toolkit. https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips/index.html
Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.
(2019). The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls. Nurse Leader, 17(4), 365-370. https://doi.org/10.1016/j.mnl.2018.11.006
Barber, B. (2018). Research on human subjects: Problems of social control in medical
experimentation. Routledge.
DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:
Essential Knowledge for the Profession. Jones & Bartlett Learning.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital
falls prevention with patient education: a scoping review. BMC Geriatrics, 20, 1-12. DOI: https://doi.org/10.1186/s12877-020-01515-w
Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a
comprehensive bundled intervention for ED fall prevention. Journal of emergency nursing, 46(2), 225-232. DOI: 10.1016/j.jen.2019.11.010.
Ratnapalan, S. (201
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