NUR 590 Description of the methods to be used to implement the proposed solution

NUR 590 Description of the methods to be used to implement the proposed solution

NUR 590 Description of the methods to be used to implement the proposed solution

Evidence-Based Practice Proposal – Section E: Implementation Plan

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 Description of the methods to be used to implement the proposed solution 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.

370. (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. (2019). 37 Leading and managing change in healthcare organizations. BMJ

Leader, 3(Suppl 1), A14-A14. http://dx.doi.org/10.1136/leader-2019-FMLM.37

Rebekah, G., & Ravindran, V. (2018). Statistical analysis in nursing research. Indian Journal of

Continuing Nursing Education, 19(1), 62.

Tang, K. N. (2019). Change management. In Leadership and Change Management (pp. 47–55).

In 1,000-1,500 words, 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 forms in Topic 5 with the narrative, you will include the consent or approval forms 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, you will include the timeline 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, you will include the resource list 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, you will include the instruments in the appendices for the final paper.

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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, you will include the data collection tools 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, you will include the budget plan in the appendices for the final paper.

NUR 590 Topic 4 DQ 1

Explain whether you would select a qualitative or quantitative design to collect data and evaluate the effectiveness of your evidence-based practice project proposal. Identify which data collection tool you would specifically use and explain why this design is best for your evidence-based practice project proposal.

My PICOT: In patients with a central line (P), does use of a central line care bundle (I), when compared to no use of a central line care bundle (C), lead to lower central line associated blood infection (CLABSI) rates (O), over the course of three months (T)?

Careful identification of study intentions and meaningful data collection is an essential piece in the evidence-based practice study design process. Though daunting, statistics “play a key role in health and human related research… statistical analysis assists in arriving at right conclusions which then promotes generalization or application of findings to the whole population of interest in the study,” (Rebekah & Ravindran, 2021, p 62). My PICOT intervention aims to reduce the rate of CLABSI occurrence over the course of three months. This quantitative evaluation leads me to design a quantitative evidence-based practice study that considers the numbers and rates of CLABSI occurrence and whether or not implementing a standard bundle will effectively reduce these. Additionally, statistical analysis is essential to give meaning and a story behind a great deal of numbers, with ultimate positive impact on patient popultaion outcomes (Rebekah & Ravindran, 2021). Inferential statistics allow for statistical analysis of data collected to then draw conclusions from specific interventions or scenarios.

My PICOT data collection does not require an intermediate or advanced statistical software. Instead, I would use an Excel document to collect information on a randomized control trial approach to patient information, whether or not the intervention of a central line care bundle was implemented or not, and if CLABSI rates were seen to be decreased compared to those without use of a central line care bundle. This would need to be done with access to patient health records in EPIC, to review documentation as well as nurse interventions actually being performed with this patient group. Using basic excel formulas, analysis is able to be performed on this somewhat simple comparison (Rebekah & Ravindran, 2021). I anticipate the largest challenge will be identifying those who will participate in the study, and if it can be done in a randomized fashion.

NUR 590 Description of the methods to be used to implement the proposed solution References

Rebekah, G. & Ravindran, V. (2021). Statistical analysis in nursing research. Indian Journal of Continuing Nursing Education, 19(1), p 62-69.

In the evidence based research project I am proposing, observing the effect that education has on physical health changes such as weight loss in order to decrease obesity rates may be best suited in a quantitative research design. This is because collecting body measurements would include physical number categorizing as well as identifying nutritional amounts in meals could be an important factor in evaluating if certain types of educational content are more effective than others (Metzgar & Nickols-Richardson, 2016). In order to collect quantitative data for the research project, the best data collection tool I believe would provide sufficient data for evidence based practice would be through survey. Surveys would be the most realistic option as my project setting would be set within the education department working with outpatient and public avenues (Lallukka, Pietilaeinen, Jaeppinen, Laaksonen, Lahti & Rahkonen, 2020). Controlled environments would cost too much resources to sustain and surveys that would include questions about changes in measurements what what type of foods being consumed within the time frame would provide data that can show direct correlation with less cost making them more efficient. However I would only distribute surveys for evaluation for those who have actively been contacted to participate in the project instead of using national surveys or general public ones.

NUR 590 Description of the methods to be used to implement the proposed solution References:

Lallukka, T., Pietilaeinen, O., Jaeppinen, S., Laaksonen, M., Lahti, J., & Rahkonen, O. (2020). Factors associated with health survey response among young employees: a register-based study using online, mailed and telephone interview data collection methods. BMC PUBLIC HEALTH, 20(1). https://doi-org.lopes.idm.oclc.org/10.1186/s12889-020-8241-8

Metzgar, C. J., & Nickols-Richardson, S. M. (2016). Effects of nutrition education on weight gain prevention: a randomized controlled trial. Nutrition Journal, 15, 1–13. https://doi-org.lopes.idm.oclc.org/10.1186/s12937-016-0150-4

Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

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