DNP project

Please insert your project objectives from DNP Project I here.

OBJECTIVES

1. To design and implement a collaborative nursing transition protocol among case management care coordination departments.

2. To educate the providers on the new Transition of Care Protocol.

Section I

Contextual elements considered important at the outset of introducing the interventions. (Note: You will use this outline to complete your section 1 project proposal for DNP Project II)

SQUIRE Criteria

Please outline project plan details

Context

Project setting

· Practice type

· Practice location

· Practice size

· Use of EHR

· Organization

· Ann Arbor, Michigan

· 500 employees and serves more than 50,000 multiethnic patients. Serving Medicaid patients of all ages primarily elderly

EHR QNXT are used for documentation and also used by analyst to pull high readmission rate and paid claims- a report that show cost and readmission rate within 30 days of discharge from acute setting.

Population of Interest

· Direct population of interest (generally staff that will be educated or similar)

· Indirect population of interest (usually the patient population you hope to indirectly impact)

· Registered Nurses from the Care Coordination (CC) and Case management (CM) departments.

· There are 60 Care coordinators and 15 case managers

Stakeholders

· Permission to complete project at site

· Affiliation agreements, if necessary

· Identification of key stakeholders and their role in the DNP Project

· Yes

· No

· Stakeholders

· Administration: This stakeholder group includes the Care managers, Care Coordinators, Utilization Management Managers, Directors and Vice president (VP)

- Their primary role will be to provide Approvals, human resources, and social support to the DNP student and nurses to ensure the project’s success.

For instance, the VP will approve the project at the practicum site, while the CC and CM managers will help mobilize nurses to participate in the project.

· Nursing Staff: Nurses from CC and CM departments are the primary stakeholders in the project.

-They will receive education on Transition of Care Protocol on how to better care for diabetic members transitioning from Acute to Community settings.

I would meet routinely with utilization management director, case managers and the care coordinating managers for feedback and consultation.

Section II

Description of the intervention(s) in sufficient detail that others could reproduce it.

Specifics of teams involved in the work.

Review your project objectives for this section. What tools do you need to accomplish your project objectives?

.

SQUIRE Criteria

Please outline project plan details

Interventions

Interventions

Describe planned interventions in sufficient detail that it could be reproduced. (Use the timeline and write a few sentences to briefly describe your approach to your QI project. The full timeline does not need to be included in the paper but your general plan for intervention should be. (Note, data collection and analysis will be done during section 3)

Week 1

· Gather data regarding readmission rates for DM patients readmitted with 30 days of discharge from acute setting. Data will be collected 4 weeks prior to implementation

· Administer pretest

· Staff training- Will have 3 days of training broken down into 2 one-hour sections a day to accommodate staff schedule.

· Provider knowledge Evaluation using a posttest with a passing grade of 80%

· -Group Remediation will be competed for staff members with less than 80%

Week 2- Week 4

· Implementation of the protocol/Go live

· Be present to support staff. Observe compliance answer questions that might arise during implementation

· Start a retrospective audit of discharged patients to see if participants are compliant with protocol.

· Audit will be done by checking if provider assessment and documentation tool was used and in Patient’s chart

Week 5

· Project success will be measured by comparing readmission rates for DM patients 4 week prior and 4 weeks post project implementation.

Tools

Describe each tool that will be necessary for achieving your objectives and carrying out interventions of the QI project. Include the following information:

· Who will develop the tool (will you use an existing/established tool or develop your own)?

· 2) How will the tool be validated (was it validated by a previous study, or will you seek expert consultation through stakeholders and the project team)?

· 3) If using an established tool, do you need to seek permission to use the tool? From who?

Note that every project will have different tools. Examples are provided below.

· Protocol/Policy

· Pre-Post Education Test/Questionnaires

· Educational Presentation/handouts

· Published Tools (Obtain Permission)

· Chart Audit Tool

· Provider assessment and documentation template a guide for provider documentation and gauge for compliance with Transition of Care .

Tool will be Self-developed and validated by expert consultation through stakeholders and the project team will be sought for validation.

Transition of care protocol

PowerPoint presentation and theoretical framework graphics for staff training

· Tool will be Self-developed and validated by expert consultation through stakeholders and the project team will be sought for validation.

A pre-post education test questionnaire will also be utilized to gauge providers attitudes and knowledge of the TOC protocol.

Tool will be Self-developed and validated by expert consultation through stakeholders and the project team will be sought for validation.

.

Appendices

All tools need to be completed and placed in the appendices by the final due date for this section. Appendices should be listed in the order they appear in your paper. Use this section to plan out the order that you will list your appendices in your paper.

Additional appendices that should be included:

· Permission to complete project at the site

· IRB materials where applicable from the project site

· IRB determination form for TUN

· Graphic of any models/theories/frameworks being used in the project (where appropriate)

· Letter from project site (No affliation needed)

· Theoretical Framework graphic

· Transition of care protocol

· PowerPoint presentation

· A pre-post education test

· Provider assessment and documentation template

Section III

Approach chosen for assessing the impact of the intervention (s)

Approach used to establish whether observed outcomes were due to the intervention (s)

SQUIRE Criteria

Please outline project plan details

Study of Interventions/ Data Collection

Procedure for collecting data and plans for maintaining confidentiality during this process.

Common data collection approaches to consider:

· Chart review done using specific ICD codes at pre-implementation and then 5 weeks post implementation to evaluate outcomes and/or compliance.

· Participant surveys before and after implementation or pre-implementation and then 5 weeks post implementation.

· EHR data on 4 weeks prior to readmissions will be at baseline and 1-week post-implementation to facilitate statistical analysis.

· Data will be collected using readmission report and stored on an excel spreadsheet. All member identifiers will be removed

· The results will show the project’s impact on DM patients.

· Pre and post-test will be completed by participating providers to determine improvements in knowledge, attitudes, and compliance with TOCs

Ethics/ Human Subjects Protection

Explain how you will conduct ethical and confidential implementation.

· Discuss IRB process- note TUN doesn’t require IRB for QI projects- in week 10, you will submit an IRB determination form to demonstrate you have a QI project.

· Does your project site require IRB or QI Committee oversight? If so, define IRB process for the site.

· Benefits/Risks for participants

· Compensation for participants

· Recruitment methods (how will you get people to your training?)

· EHR data on 30-day readmissions will not contain patient identifiers like their names, Medicaid ID, address to ensure confidentiality.

· Data analyses will be conducted using a password-protected computer that only the DNP student can access.

· Data will not be disclosed to the public or third parties

· Project site does not require IRB or QI committee oversight

· The questionnaire will not collect provider and facility-specific information like their names and staff number.

· Participants will be informed that no compensation will be offered for participating in the project before the study commences

· Participation will be voluntary and free. 

· Nurses in the case management and care coordination department will benefit from the quality improvement DNP project as it would enhance their skills on TOC and educate them on how to achieve better care outcomes for DM patients

Risks

Loss of privacy and confidentiality.

However, all mitigation strategies will be utilized.

· There will be no compensation for participants

Measures/Plan for Analysis

· Appropriate statistical analysis tests chosen and decision justified.

· Discussion of assumptions to be addressed and specific process for analysis included

· Will you hire a statistician at the site to complete your analysis?

· (Note, in week 3 you will complete a statistics worksheet and submit to a TUN statistician and they will approve or redirect your plan for statistical analysis)

· SPSS statistics software. Will help to run data in a simpler manner as compared to entering the data.

Fisher’s exact test. It is more accurate when dealing with a small sample size as compared to other tests such as the chi-square test and the G-test of independence.

· Assumptions:

Add assumptions of the Fischer’s test

Introduction

Project Site

Organization

Project Mentor

Project Purpose

Reduce readmission rates for patients diagnosed with diabetes to reduce health care costs for that population.

Project Question

how does the use of a TOC protocol (I) compared to?

the current practice without TOC protocol (C) reduce the readmission rates for patients.

diagnosed with DM (O) within 4-5 weeks (T)?

Project Timeline

The purpose of this timeline is to keep you and the project team on track during the implementation phase which will occur in DNP Project III. Intervention or project timeline should be clearly described. Time to carry out implementation, collect data, and evaluate the project should be clearly delineated. Please plan out the activities you will be performing each week during the implementation phase. Please set actual concrete dates for any training, interventions, data collection, and/or data analysis.

Week 1

Dates: (please obtain from course announcements. Week 1 should correlate with the first week of DNP Project III unless special permission is granted to implement early.)

·  Nov. 3–9

· Data collection

· Debriefing the clinical staff, Interpretation of findings

·

· Administer Pretest

· Training / and Presentation

· Provider knowledge Evaluation using a posttest with a passing grade of 80%

-Group Remediation will be competed for staff members with less than 80%

Week 2

(Nov. 10–16)

· Implementation of the protocol/Go live

· Be present to support staff. Observe compliance answer questions that might arise during implementation

· Start a retrospective audit of discharged patients to see if participants are compliant with protocol.

Audit will be done by checking if provider assessment and documentation tool was used and in Patient’s chart

Week 3

(Nov. 17–23)

· Implementation of the protocol/Go live

· Be present to support staff. Observe compliance answer questions that might arise during implementation

· Start a retrospective audit of discharged patients to see if participants are compliant with protocol.

Audit will be done by checking if provider assessment and documentation tool was used and in Patient’s chart

Week 4

(Nov. 24–30)

· Implementation of the protocol/Go live

· Be present to support staff. Observe compliance answer questions that might arise during implementation

· Start a retrospective audit of discharged patients to see if participants are compliant with protocol.

Audit will be done by checking if provider assessment and documentation tool was used and in Patient’s chart

Week 5

(Dec. 1–7)

· Evaluation of project/Analysis/ Dissemination of findings

Weekly Summary

Clearly and succinctly summarizes project status and discussion includes any updates to the project timeline.

DO NOT COMPLETE THIS NOW- SAVE THIS FOR DNP PROJECT III

Week 1

Week 2

Week 3

Week 4

Week 5