EBP: Section F: Implementation Plan

Topic: “Does staffing by nurse-patient ratio vs. the current process decrease falls for LTC patients within three months of implementation?”
In 500-750 words (not including the title page and reference page), provide a description of the methods to be used to implement the proposed solution. Include the following:
Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval form(s) in Topic 5 with the narrative, the consent or approval form(s) should be placed in the appendices for the final paper.
Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, the timeline should be placed in the appendices for the final paper.
Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, the resource list should be placed in the appendices for the final paper.
Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, the instruments should be placed in the appendices for the final paper.
Explain the process for delivering the (intervention) solution and indicate if any training will be needed.
Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, the data collection tools should be placed in the appendices for the final paper.
Describe the strategies to deal with the management of any barriers, facilitators, and challenges.
Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, the budget plan should be placed in the appendices for the final paper.
Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
Upon receiving feedback from the instructor, refine "Section F: Implementation Plan" for your final submission. This will be a continuous process throughout the course for each section.
Don’t forget the title page
Section F: Implementation Plan
This section HAS TO have a reference list of some sort. There is a section in the rubric to count off for not having a reference list, your work needs to be cited. You will have some references that show what actions you want to implement at your facility, make sure you cite the actions.
Setting and Subjects
The project setting is central facility with six community-based outpatient clinics associated with it. The facility has a total catchment of approximately 58 thousand eligible Veterans ranging in age from early 20s to 90+ years. The facility serves a mostly rural area with several areas that do not have internet in the Home Based Primary Care service limits. This is a generic setting. If your population of interest is OR, ER, ICU staff then narrow down to the staff in those units. Not all facilities have satellite clinics, so your facility will have a different reporting matrix to the Leadership.
Timeline I failed to put in the overall time frame here. This paper has maybe 5 appendices that go with it and will be part of the final. However not all items apply to every project. I will give samples, so you can see them. This actual project will have annual reviews because we are planning on changing the culture of the facility and will need to review and address new needs as they come up. Each paragraph mirrors with a time frame, what the content for that time frame is, and explaining what you will do to meet the content. This section is basically an action plan.
This project will take approximately three months of planning. The initial planning phase is finding current research, weighting it, and developing the action plan. The first objective for the team is to develop a questionnaire (Survey Monkey®) to ascertain the staff’s beliefs, skills, and attitudes about EBP (see Appendix A, Questionnaire). Each phase/ stage/ time increment gets a paragraph. Each paragraph needs at least 2 sentences. Print out your PICOT so you can see what you are trying to get at. Step 1 is the lit review, yes, then depending on what your project is, the rest will be a series of steps toward the outcome. So:
The second part of the planning phase, which partially overlaps the first one is developing material to answer the responses to the predicted outcomes of the questionnaire. In other words, the barriers for staff using research are well-documented and researched (Brown, 2015; Correa-de-Araujo, 2016; Ingham-Broomfield, 2015). The EBP Committee has resources already in place for staff to use to overcome the barrier of skills and access, however staff do not use the material. The first step, already taken, was creating a website for the EBP Committee to post the material, which includes tutorials, poster samples, calls for abstracts, and access to the tutorials the central office has developed. Part of this phase is developing the Nurse Manager skills for precepting EBP with their staff. There is a four-module preceptor development course already developed, the nurse managers will have an opportunity to attend workshops presented every Tuesday over the course of four weeks, two hours per module. In these sessions the managers will participate in all the skills development they will need to facilitate their staff.
The third phase, at approximately six months will be the maturing and support phase of the project. The team will present lunch and learns and other educational presentations at the nursing break rooms. Additionally, there are presentations designed for the community clinics, and continuing education offerings developed. The direct care staff will be facilitated developing abstracts on what they are working on to the local and regional conferences (see Appendix D, Timeline).
Solution Process and Resources resources include what you will need to move the project from planning to implementation. If your project is changing care processes, the staff are already getting paid to do patient care, they should (!) have some sort of ongoing education on care delivery initiatives so those costs are not part of resources. New equipment (with a $ amount you research) and, in this example, the poster printing either will or will not cost something. If your project involves posters, then either say it will or will not, they are a resource you need to know you need to move forward with the project. If it is a turning bed with magic wheels, then you need the cost of the thing and juxtapose that $ amount with either patient injury cost or staff injury costs (off OSHA or AHRQ) …. Let leadership know there is a financial gain to adopting your project. Make it easy for them to say yes. Not all resources apply to each project.
The process for this project is to first get Institution Review approval. Then send the questionnaire to the union for approval prior to sending it out. During this time, the team will continue to meet weekly for planning and development. The educational material will all be reviewed prior to submitting for Continuing Education Units. None of these steps take any funds, they are all free within the healthcare system and Survey Monkey ® Basic is free (see Appendix A, Questionnaire).
Costs will be incurred with travel to the community clinics and materials for handouts and advertising. These will be nominal if the team coordinates with other trips to the clinics. It costs approximately $40.00 for printing and laminating posters. Some of the posters have already been printed.
Additional costs later, when staff are submitting for funds to go to conferences will range from $20.00 each for the local conferences to $400.00+ for the regional or national conferences. There will be the cost of salaries during administrative time away from patients while the nurses are in learning sessions or away at conferences (see Appendix E for the Budget and Resources). Part of the development for this project is getting agreements from the staff submitting for reimbursement to bring back educational material and provide learning presentations for other staff.
Solution Methods and Instruments for Data Collection
Your measurement instruments may be staff sick leave, or times from door to diagnosis, or reduced readmission rates. Your metric will be what dictates how you find out if the project is successful. If you are working on a sepsis protocol, a survey on staff beliefs won’t give you the door to discharge time with the new protocol. If you are working on a safety intervention, your outcome will be reduced whatever injury …. and so your metric has to measure that outcome.
The methods are outlined above, the instrument for measuring the outcome about staff beliefs is the survey, which will be anonymous and voluntary, and sent out before any active interventions are implemented. The only action that has been taken to date is getting a website established off the main Nursing Service intranet site. The team will move the educational material from the current folders to the public folders after the EBP Committee decides on a layout for the resources.
The other measurement instrument is the spreadsheet the EBP Committee currently has for tracking staff abstract submissions. This spreadsheet is the basis of quarterly reports to the Nursing Quality Council. The information in it is the title of the presentation, name of the presenter, the conference, date of abstract submission, date of acceptance, and whether the presenter is a novice or has presented before (see Appendix F, Presentation Tracking).
The results of the questionnaires and the Presentation Spreadsheet will be kept in the EBP Committee shared folder on the facility intranet. This site is restricted to specific staff who are eligible for access to it. Additionally, the number of conference participants is reported in both the EBP Committee minutes and the Nursing Quality Council minutes, so those data are aggregated and public information.
Facilitators, Barriers, and Challenges
These elements depend on your domain and your PICOT, for a safety product, facilitators are actually your CEO or Executive Leadership because they will save $. Barriers may be staff attitudes, however, whether they believe in a safety thing or not, if it is the facility policy there needs to be some sort of sequential reprimand set up. Challenges are also dependent on what the project is.
Facilitators for this project include the Nursing Executive Leadership and the members of the team. There has recently been an increase in EBP development from the Central Office and the facility Director has approved the Nursing Service to pursue Pathway to Excellence ® designation. This award is given only if the nursing staff is actively involved with EBP as a process and as a care delivery methodology.
Challenges and barriers include all the previously stated barriers for EBP development including time and skills (Brown, 2015; Correa-de-Araujo, 2016; Ingham-Broomfield, 2015). The team feels, with executive support, these barriers can be overcome.
Maintenance
Maintaining the program will include annual re-surveys to evaluate new challenges for staff. As time progresses, barriers will change, and new action plans will need to be developed. Another challenge for maintenance is staff turnover through promotions or retirement. The subject matter experts in EBP will not be a resource for novice users. The hope is that new nurses coming to the facility will have the basic EBP development skills from their academic work and the facility team will only need to enculturate them to the local processes. This project uses a multi-pronged approach; top down (executive level), middle (training mid-level managers as preceptors), and bottom up (new hires who had EBP in their academic work) for spreading EBP throughout the system.
In the context of maintenance, if your project has a potential for failure, put your thoughts on how to salvage it have it terminated. Safety equipment should be a success, if it isn’t then I would look at user adherence to the protocols and get a bigger stick/carrot to get staff buy in.
page break for the references