NUR 590 Evidence-Based Practice Project Proposal 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.

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).

Setting and Access to Potential Subjects

The project will be implemented in a hospital setting using critically ill patients as the potential subjects. The appropriateness of the setting is attributed to the high number of critically ill patients seen and admitted for further management. Consent will not be sought from the potential subjects. However, approval will be sought from the institution before implementing the project.

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.

Organizational culture is an essential part of implementing change as it mirrors values, mission, and vision and employee perception to adopting new ways of doing things. A decentralized and hierarchical culture where employees get involved in decision-making and has robust values and norms leads to effective implementation of EBP project proposal. The proposed structure enhances employee motivation and diversification. Decentralization improves communication and ensures implementation of new approaches to doing things to enhance quality care (Melnyk & Fineout-Overholt, 2019).  Organizations ready to implement the proposed EBP interventions should focus on patient-centered care and health promotion to save lives in pediatric settings.

The project uses the Organizational Capacity Assessment Tool (OCAT) developed by the United Nations Development Program (UNDP). The tool assesses overall readiness to enhance health interventions in organizations. The tool identifies substantive capacities and strengths that exist and the need for more to attain expected outcomes. Implementing the proposed EBP requires organizations to have capabilities and resources with a superb culture based on their mission, purpose and best values. Threats to readiness include need for resources to implement the project and technologies to reduce HAIs. Teamwork leads to effective flow of information to implement the project and attain expected outcomes.

Organizations that seek to implement the proposed EBP should enhance their patient-handling processes with a focus on improved quality care to reduce infections by better hand hygiene measures and protocols. Data-analysis tool using a collaborative approach will enhance dissemination of evidence to the entire care team. The deployment of Trans-theoretical model will allow the organizations to prepare for change by aligning their interventions with their needs. These include skills’ training and motivation policies to enact changes to focus on solutions (Melnyk & Fineout-Overholt, 2019). The integration of technology is also critical to enhancing organizations’ readiness since it improves gathering of intelligence.

The stakeholders include healthcare professionals in these settings comprising of nurses, physicians and other professionals and the management. External stakeholders comprise of patients and their familiescare (Melnyk & Fineout-Overholt, 2019). Further, the integration of the Project team and management highlights the importance of ensuring that the organization is ready while use of health information technologies like Telehealth leads to better understanding of the underlying issues to enhance patient safety based on existing deployment and their role in enhancing access and quality care.

Timeline

The duration of the project will be one year. The period is adequate to determine the effectiveness of the intervention and revision of strategies.

Budget and Resource List

Changes in clinical processes and systems are needed for the implementation of the project. The existing electronic health records will be integrated to execute the project interventions. The integration will enhance the efficiency of medication processes such as prescription and administration (Sitapati et al., 2017). Organizational processes will change as seen from the use of the new integrated systems. Human, financial, and material resources will be needed in the implementation of the project. Skilled healthcare

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providers, trainers of trainees, and information technology experts are some of the needed human resources. Financial resources will be required for system upgrade, purchase of the required materials and remunerating the participants. The materials that will be purchased for the successful implementation of the project will include writing materials, projectors, integrated health information system, and stationeries. The other cost will gather for the training, coaching and mentoring, data collection and analysis, and presentation of findings to the institutional stakeholders. The estimated budget of the project will be $48000