John Hopkins evidence table
When considering the DNP project’s implementation, the project manager will assess potential facilitators and barriers that may impact the project’s implementation. The current setting in which the project will be implemented is founded on the utilization of evidence-based practice to inform clinical practice and policy development. The unit’s culture is open to continuous assessment and evaluation of clinical practices and policies to assure that best practices are implemented by nursing staff. Also, staff buy-in to evidence-based practice and innovation in the clinical setting is present, as the nurse managers have created an environment that enhances nurse’s participation. As a high-performing unit, the DNP project manager will capitalize on these facilitators by allowing the nursing staff to be actively involved in driving this project’s implementation.

In assessing the potential barriers to implementing the DNP project, staffing and patient participation are highlighted. The availability of case managers that have been trained to implement the Project RED toolkit may be limited on the off shifts to include nights and weekends. The DNP project manager will provide training to off-shift charge nurses who may implement the intervention in the case manager’s absence to address this potential issue. Another potential barrier to the implementation of the project may include a lack of adequate participation from patients. To increase the project’s involvement, the DNP project manager will develop a flyer that will highlight the benefits of participation in the project for potential participants. The DNP project manager and the implementation team will address all questions posed by potential participants.

Outcomes

The outcome that will be utilized to assess the impact of the implementation of the Project RED toolkit will be the 30-day readmission rates of patients with a primary diagnosis of congestive heart failure on the unit. The data to assess the outcomes will be abstracted from the 30-day death and readmission data monthly report. The specific data that will be obtained from the report will include the 30-day readmission rates of patients who agree to participate in the study. The readmission data will be reviewed for verification of the admitting diagnosis for the unplanned readmission. The nurse manager will provide the monthly readmission data report to be reviewed by the DNP project manager and the implementation team. The data abstraction will occur 30 days following the completion of the implementation phase of the project. To monitor all toolkit components’ implementation, the DNP project manager will create a checklist completed by the case manager or nurse completing the intervention (Appendix A). The checklist will include the 12 components of the Project RED toolkit that must be implemented.

Appendix A

The Project RED Toolkit Implementation Checklist

· Ascertain need for and obtain language assistance.

· Make appointments for follow-up medical appointments and post-discharge tests/labs.

· Plan for the follow-up of results from lab tests or studies that are pending at discharge.

· Organize post-discharge outpatient services and medical equipment.

· Identify the correct medicines and a plan for the patient to obtain and take them.

· Reconcile the discharge plan with national guidelines.

· Teach a written discharge plan the patient can understand.

· Educate the patient about his or her diagnosis.

· Assess the degree of the patient’s understanding of the discharge plan.

· Review with the patient what to do if a problem arises.

· Expedite transmission of the discharge summary to clinicians accepting care of the patient.

· Provide telephone reinforcement of the Discharge Plan

Thank you for presenting these sections to us. I appreciate that you noted some facilitators that will likely aid in the success of the project implementation. The challenges are quite possible as well. No answer needed

1. Are there other challenges you can anticipate?

2. I am wondering if the extra steps the case managers will lead to potentially significant push-back, perhaps staffing will be a challenges?

3. and maybe you might even find they’ll say it’s out of their scope?

4. If this is the case, how can you gain the support of the leaders ahead of time for example.

For the outcome section, remember this is not a study, so please edit the wording here. Edited already

5. Can you be more specific about the data extraction.

6. For example, from what system,

7. by whom,

8. and at what intervals?

9. And who validates the data?

10. And then can you offer some information about the re-admission rate being an appropriate measure for this intervention?

11. And can you offer more specifics on the formative evaluation of the implementation process?

You are definitely on the right track with this section, you’ll just want to add more detail to each area. NO answered needed