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DQ: Do you foresee any issues with the proposed implementation of your project?

DQ: Do you foresee any issues with the proposed implementation of your project?

NUR 590 Topic 2 DQ 2

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.

This article reviews patients’ actions reflected by carrying out medication lists to diminish information loss from health care settings and identifying support for patient safety. The study reveals priorities for improving medication safety in primary care by addressing incomplete medication reconciliation. The strength of the study is reflected by the empowerment and confidentiality inspired to patients by involvement in medication management, increasing their dignity and self-esteem level, evidencing a form of resilience in nursing practice. Patient-held medication lists may be helpful for information transfer in emergency situations when communication is altered. Patient-held medication lists assist with taking medications, reordering, monitoring health care conditions, or tracking the efficiency of medications. The weakness of the study is reflected by possible disconnections between the information needs by health care professionals and the information being kept by patients who carried medication lists. Another limitation of the study is interviewing more females than males who carried a medication list, and the procedure suggests that more females carry a medication list than males and may reflect an inaccurate practice (Garfield et al., 2020).

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.

DQ: Do you foresee any issues with the proposed implementation of your project?

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.

Reference

Abbott, J. (2019). The POLST paradox: Opportunities and challenges in honoring patient end-of-life wishes in the emergency department. Annals of Emergency Medicine73(3), 294–301. https://doi.org/10.1016/j.annemergmed.2018.10.021

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DQ: Do you foresee any issues with the proposed implementation of your project?

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).

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Implementing the evidence-based practice of early ambulation in post-surgical patients can be associated with several challenges. Implementing the evidence-based practice of early ambulation in post-surgical patients requires addressing issues such as resistance to change, resource allocation, staff training, and workflow modifications. These issues need to be anticipated and managed to ensure successful implementation. Healthcare organizations often need more support from healthcare providers, who may be comfortable with traditional practices or skeptical about the benefits of early ambulation. Ensuring that staff members receive appropriate education and training is essential to facilitate the practice change.

Employing change management principles is vital to create and sustain readiness for change. Communicate the benefits of early ambulation to all stakeholders, emphasizing patient outcomes, reduced complications, and improved recovery times. Leadership support and involvement are crucial in providing necessary resources and fostering a culture of change. A multidisciplinary team comprising representatives from different departments involved in post-surgical care(Lavin & Ida,2022). This team can collaborate to develop protocols, guidelines, and training programs for early ambulation.

Reviewing recent research studies, systematic reviews, and clinical practice guidelines to gather evidence supporting the benefits of early ambulation in post-surgical patients to ensure that the change is based on current evidence (Bramer,2018). This will provide a foundation for the implementation plan.

Bramer, W. M., de Jonge, G. B., Rethlefsen, M. L., Mast, F., & Kleijnen, J. (2018). A systematic approach to searching: an efficient and complete method to develop literature searches. Journal of the Medical Library Association : JMLA, 106(4), 531–541. https://doi.org/10.5195/jmla.2018.283

Lavin, J. M., & Ida, J. B. (2022). Quality Improvement Methodology. Otolaryngologic clinics of North America55(6), 1301–1310. https://doi.org/10.1016/j.otc.2022.07.008