DNP Project

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Translation
Select the statement that best describes the overall characteristics of the body of evidence from the team’s synthesis and recommendations (Appendix H):
☒ Strong & compelling evidence, consistent results ☐ Good & consistent evidence
What is the level of safety risk associated with the intervention?
☐ High	☒ Low
Translation Assessment Flowchart:
Start Here
Based on the Translation Assessment, select the course of action:
☒ Change is indicated (system or process improvement, or practice), go to Section I ☐ Consider a pilot of the change or further investigation for new evidence, go to Section I. ☐ No indication for change or consider further investigation for new evidence, develop a research study or discontinue project, go to Section II.
Section I: If change is indicated, generate organization-specific recommendations by assessing the best-evidence recommendations for feasibility, fit, and acceptability:
The extent to which the team evaluates and believes that the change is low risk, doable, and can be successfully implemented within a given organization or setting. Feasibility	☒ The change is low risk. ☐ Few, if any, barriers are identified, and the time, effort, and resources to overcome them is reasonable. ☐ Sponsors or leaders share their point of view, endorse and support the change
Compatibility of a change with end-user workflow and consumer expectations; and/or the perceived relevance of the change in addressing the problem and in answering the PICO question within a given practice setting. Fit	☐ The change aligns with unit and/or departmental priorities. ☐ The change is suitable and seems like a good match with end-user workflow. ☒ The change is applicable to the problem and answers the PICO question.
The extent to which stakeholders and organizational leadership perceive the change to be agreeable, palatable, satisfactory, and reasonable. Acceptability	☐ The change aligns with organizational priorities. ☐ The change meets the approval of stakeholders and organizational leadership. ☒ Stakeholders and leaders like and welcome the change and find it appealing.
Organization-specific recommendations:
· Develop Comprehensive Educational Materials: Create detailed literature and data-based educational materials. These materials should include written guides, data charts, and explanatory notes on interpreting blood drug levels, identifying contraindications, ensuring compliance, and assessing treatment efficacy. · Develop Co-Designed Interventions: Utilize collaborative approaches to develop tools and training sessions tailored to specific challenges in mental health care, such as therapeutic engagement and physical monitoring. Engaging staff in co-design ensures the interventions are contextually relevant and fosters greater buy-in and sustained application in practice · Regularly Assess and Update Training Materials: Regularly review and update all training materials to reflect the latest evidence-based practices and guidelines in mental health care. The field of mental health care is continuously evolving, and it is essential to keep training materials up-to-date to ensure staff are using the most current and effective practices. · Incorporate into Orientation: Integrate the educational materials into new staff orientation program. · Implement Comprehensive Staff Education Program: Develop and implement a robust and ongoing staff education program that focuses on interpreting blood drug levels, recognizing contraindications, ensuring patient compliance, and evaluating treatment efficacy. Continuous education is essential for maintaining high standards of care and ensuring that staff are equipped with the latest knowledge and skills necessary for safe and effective medication management in mental health care. · Leverage Existing Technology: Use the organization’s existing digital platforms (e.g., intranet, email, learning management systems) to distribute educational materials and reminders. Ensure that all staff have easy access to these resources. · Foster a Culture of Continuous Improvement and Learning: Cultivate a culture that encourages continuous learning and improvement through regular feedback loops, peer learning sessions, and opportunities for professional development. A culture that values education and improvement will support the ongoing enhancement of staff competencies and ultimately lead to better patient outcomes. · Foster a Positive Safety Culture: Encourage a non-punitive reporting system to address medication errors and support continuous professional development. Emphasizing open communication about errors and learning from them can significantly reduce adverse events, particularly in high-risk environments like mental health wards · Engage Leadership in Supporting Education Initiatives: Ensure that organizational leadership is actively engaged in and supportive of the education and training initiatives. Leadership support is critical for securing the necessary resources, fostering a positive learning environment, and prioritizing education as a key component of patient safety and quality care. · Focus on Multidisciplinary Training: Facilitate interdisciplinary training sessions that bring together pharmacists, nurses, and mental health professionals. Collaborative training enhances communication and teamwork, ensuring consistent application of safe medication practices and holistic patient care
Section II: When a change or pilot is not indicated, what, if any, next steps does the EBP team recommend?

Action Planning
Complete the following activities to ensure successful implementation:
· Secure a project leader · Identify change champions · Consider whether translation activities require different or additional members · Identify objectives and related tasks · Determine dates to complete tasks · Identify observable pre and post measures
Identify strengths that can be leveraged to overcome barriers to ensure the success of the change:
Resources or Strengths	Barriers	Plan to Overcome Barriers by Leveraging Strengths as Appropriate
Strong support from senior leadership	Staff resistance to change	Utilize leadership support to endorse and promote the educational program.
Experienced nurse educators	Time constraints for staff participation	Schedule sessions during shift changes and provide multiple session times to accommodate all staff.



*Which of the following will be affected by this change? ( Select all that apply)*
☐ Electronic health record ☒ Workflow ☒ Policies and/or procedures ☐ Other__________
Identify and secure the resources and/or funding required for translation and implementation: *( Check all that apply)*
☐ Personnel costs ☒ Supplies/equipment ☒ Technology ☒ Education or further training	☒ Content or external experts ☐ Dissemination costs (conference costs, travel) ☐ Other: ____________________

Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals

Translation and Action Planning Tool

Appendix I

Outcomes Measurement Plan
What is/are the goal(s) of the project?	The goal of this DNP project is to increase staff knowledge on interpreting blood drug levels, understanding contraindications, and treatment efficacy. This will majorly be achieved through a structured educational program.	Desired completion date:	Week 11
How will you know if you are successful?	Types of Outcomes	Selected Metrics	Source	Frequency
	☒ Clinical (e.g., vital signs, infection rates, fall rates, adverse events)	Increased knowledge of contraindications and interpretation of blood drug levels is expected to lead to fewer adverse drug reactions and complications among patients.	Pre and post-test assessment scores	Pre and post-intervention
	☒ Functional (e.g., activities of daily living, quality of life, self-medication administration)	Better control of psychiatric symptoms, which may improve the overall quality of life for patients.	Pre and post-test assessment scores	Pre and post-intervention
	☒ Perceptual (e.g., satisfaction, care experience, timeliness of response)	Staff satisfaction with the acquired knowledge.	Satff feedback	Pre and post-intervention
	☒ Process/Intervention (e.g., care coordination, immunization, bereavement support)	Enhanced knowledge in blood drug levels, contraindications, and treatment efficacy should lead to more timely administration of medications.	Pre and post-test assessment scores	Pre and post-intervention
	☒ Organization/Unit-Based (e.g., staffing levels, length of stay, readmissions)	Increased knowledge of interpreting blood drug levels, contraindications, and treatment efficacy	Pre and post-test assessment scores	Pre and post-intervention
High-Level Deliverable	Associated Tasks and Sub-Tasks
		Start Date	End Date	Responsible Party
Develop Educational Materials	· Research and compile literature on interpreting blood drug levels, contraindications, compliance, and treatment efficacy. · Create written learning materials and presentations	Week 2 2024	Week 3 2024	Change agent
Deliver Educational Sessions	· Schedule and organize educational sessions for staff. · Conduct educational sessions using prepared materials	Week 6 2024	Week 7 2024	Change agent
Evaluate Knowledge Gain	· Develop pre- and post-education assessments. · Administer assessments and collect data	Week 8 2024	Week 9 2024	Change agent

See Chapter 11, Lessons from Practice, for examples of completed tools.

Directions for use of the Translation and Action Planning Tool

Purpose:

This tool guides the EBP team through the process of analyzing the best-evidence recommendations for translation into the team’s specific setting. The translation process considers the strength, consistency, risk, fit, and acceptability of the best-evidence recommendations. The team uses both critical thinking and clinical reasoning to generate site-specific recommendations.

Translation Section

What is the overall state of the evidence from the team’s synthesis and recommendations (Appendix H)?

Consult the Synthesis and Recommendations Tool (Appendix H) and record the group’s determination regarding the overall description of the state of the evidence.

What is the level of safety risk associated with the intervention?

Different interventions carry different levels and types of risks. As a group, the EBP team should discuss the potential for harm to patients, staff, or the community associated with the best-evidence recommendations. While other factors, such as monetary risks, may be important, this question refers specifically to dangers related to safety. Select “high” or “low” from the list of options.

Based on the Translation Assessment Flowchart, select the course of action:

Use the Translation Assessment Flowchart to determine the next steps for potential translation. Select the course of action indicated from the flowchart.

If change is indicated, generate organization-specific recommendations by assessing the best-evidence recommendations for feasibility, fit, and acceptability:

The EBP team uses the prompts to assess the feasibility, fit, and acceptability of the best-evidence recommendations to determine the likelihood of suc cessful implementation and to generate recommendations specific to their setting. Feasibility, fit, and acceptability take into account the practice setting’s characteristics such as culture, norms, beliefs, structures, priorities, workflow, and resources. Depending on the setting, organization-specific recommendations may mirror the best-evidence recommendations, differ significantly. or be deemed inappropriate for implementation by the organization. List recommendations for the organization in the space provided in a series of actionable and concise statements. If they differ from the best-evidence recommendations, include information for feasibility, fit, and acceptability-related changes.

Feasibility: The extent to which the team evaluates and believes that the change is low risk, doable, and can be successfully implemented within a given organization or setting.

Fit: The compatibility of a change with end-user workflow and consumer expectations; and/or the perceived relevance of the change in addressing the problem and in answering the PICO question within a given practice setting.

Acceptability: The extent to which stakeholders and organizational leadership perceive the change to be agreeable, palatable, satisfactory, and reasonable.

When a change or pilot is not undertaken, what, if any, next steps does the EBP team recommend?

If the team cannot recommend a change or pilot, record future directions for the project. This might include proposing a research study, waiting until more evidence becomes available, or discontinuing the project altogether.

Action Planning Section

Complete the following activities to ensure successful translation:

This list provides steps to assist the team with completing the practice change(s) associated with their EBP project.

Identify strengths that can be leveraged to overcome barriers to ensure the success of the change:

This analysis allows teams to identify barriers to implementation and potentially mitigate them using inherent strengths and resources. You may find specific challenges that will likely impact the ability to deliver on the action plan. Though these obstacles can get in the way, knowing about them up front is helpful so that you can engage support and create a plan to move forward.

Consider whether or how this change will impact workflows and processes:

This section assists the team in considering the downstream effects of a change. For example, will adjustments need to be made to the electronic medical record to accommodate the change, or will this change impact the workflow of any other staff who have not been considered?

Identify and secure the resources and/or funding required for translation and implementation:

Use this as a guide to consider and plan for financial obligations that may be part of the rollout.

Outcomes Measurement Plan

What is/are the goal(s) of the project?

Record what the team hopes to accomplish by implementing the change(s). These can be high-level statements used to inform the measurement plan and implementation.

Desired completion date:

Record when the team plans to complete the first stage of the project. The team determines the anticipated implementation date and the outcomes data that will be needed to evaluate success. This can be updated throughout implementation to reflect adjustments to the timeline.

How will you know if you are successful?

Use this table to agree upon outcomes the team will collect and analyze to monitor the success of the project. There are different aspects to practice change, and frequently different measures are used to monitor uptake, attitudes, and outcomes. Select as many as the team feels are necessary to gain an accurate picture of ongoing impact. Record the specific metric(s) the team will measure within the outcome categories, how the metrics will be obtained, and how often. Outcomes can be added or changed as the review of the literature is completed and the translation planning begins.

Metrics let you know whether the change was successful. They have a numerator and a denominator and are typically expressed as rates or percentages. For example, a metric for the measure falls-with-injury would be the number of falls with injury (numerator) divided by 1,000 patient days (denominator). Other examples of metrics include the number of direct care RNs (numerator) on a unit divided by the total number of direct care staff (denominator); or the number of medication errors divided by 1,000 orders.

Work Breakdown Structure:

A Work Breakdown Structure (WBS) is a deliverable-oriented prioritized list of the steps needed to accomplish the project objectives and create the required deliverables.

Consider all the categories of work (high-level deliverables) necessary to implement this change. What tasks must be accomplished first for each deliverable to move forward? When must they be completed to stay on track? For example, if a high-level deliverable is needed to implement a protocol, list all tasks to accomplish it. Record when the team must begin and complete the task, and which member(s) are responsible. If possible, list a specific person or role to create ownership of work.

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