Nursing Research Utilization Project Proposal: Poster Presentation in Reducing Pressure Ulcers

Running head: HEALTH CARE CHANGE PROJECT MATRIX

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HEALTH CARE CHANGE PROJECT MATRIX

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Objective:

To reduce the incidence of newly acquired pressure ulcers development in California Health Medical Center (CHMC) to 10% within six months of implementing the new evidence-based protocol.

Objectives

Content

Describe the methods to be used to implement the proposed solution

An electronic system to document pressure ulcer risk assessment and incidence will be created within the hospital’s current electronic medical record system, EPIC.

The system facilitates recording pressure ulcer incidence that would trigger wound consult nurses to provide timely advice on and validation of the categories of pressure ulcers.

Staff charge nurses will conduct pressure ulcer assessments in admission. Instead of documenting in paper form, they will directly record these findings on an initial risk assessment electronic form and simultaneously make an e-referral to the wound consult nurse if a patient has a pressure ulcer that is a stage 2 or higher.

Having an electronic pressure ulcer risk and incidence form for each patient allows various healthcare professionals and members of the interdisciplinary team to have secure access to reliable and current information in real-time (Plaskitt, Heywood, and Arrowsmith, 2015).

Develop a plan for implementing the proposed solution

Per Wager et al (2009), it is crucial that a team is organized that serves “to plan, coordinate, budget, and manage all aspects of the new system implementation” (p. 244). A team will be assembled to gain much-needed support for the program. This implementation team is vital in engaging various stakeholders in providing support and commitment to the project. The team members include charge nurses, wound consultant nurses, quality improvement nurses, an MD champion and department managers from areas such as education, equipment and information technology (IT) and administration.

An immersion event will be launched to inform and engage all staff members in the project. The event will allow necessary information to be disseminated, share goals and desired outcomes as well as the rationale behind the project.

Shedenhelm et al (2010), states that providing education through a variety of methods allows training to be received well for recipients with diverse learning styles. Furthermore, ongoing training should be developed and advertised through educational newsletters and emails that provide education reminders and other important information. Shedenhelm et al (2010), also emphasizes provision of multiple opportunities through multiple sites locations at varied times increases turnout. Furthermore, each nursing units will be provided pressure ulcer training bundles that including competencies will be presented.

Regular communication with various constituent groups such be conducted and a means for reporting problems and issues should be established. According to Bebow (2011), having a structure and well-planned communication provides all involved with a roadmap of what to do, when to do it, and how it will be accomplished. During the system implementation, the flow of communication will need to be multi-directional: upward, downward, and horizontally.

Wager et al (2009) also emphasize the importance of evaluations in minimizing the effects of a project failure. Evaluating is an on-going process throughout the entire implementation. "No matter how well the system was designed and tested, errors and problems will be detected, and changes will need to be made" (Wager et al, 2009, 266).

An on-going assessment and evaluation of the status of the project will be conducted. Barriers will be identified and plan to eliminate barriers will be tested.

Incorporate a theory to develop the implementation plan and explain how it is used to develop the plan.

Reinforcement theory suggests that individual behavior may be changed through reinforcement or punishment. Rewards, in this case, are used to reinforce behavior while penalties are used to discourage unwanted behavior. Extinction can also be used, as a means of preventing the occurrence of behavior. The theory states that organization readiness for change is a multilevel contrast. Each nurse and management need to be adequately involved and be willing to portray actions aimed at supporting change and rewards are to be used as a form of motivation. The theory recommends the need to ensure that end users and front line staff are not sidelined in this process. Per reinforcement theory, there is a need to incorporate reward systems, simultaneous staffing, and workflows to facilitate various effective decision-making routines. In applying reinforcement theory, providing positive feedback and recognition to nurses and units that have successful completion of risk assessment tests can be used. Furthermore, performance scorecard that shows decreased pressure ulcers rates can provide visual reinforcement of achieved outcomes as compared to national average or previous data. Scorecards can also be used as reinforcement to administrative stakeholders to garner continued support and provision of resources to the project.

Identify resources needed for the proposed solution’s implementation and how you plan to gather and incorporate them.

Resources needed for the proposed solution include administrative support as well as educational materials and training. The program will also require a change in workflow, using assessment tool and documenting it in the electronic format instead of paper. These resources will be available by engaging administration and upper management by adequately involving designing, planning, and change implementation. With the availability of these resources, the change initiative will be successful, and the project will be appropriately introduced in the entity for maximum effectiveness. On-going communication with an avenue for feedback and multi-way communication will be available. There is a need to inform all the personnel of the change in advance to provide a clear direction and is engage actively in the project (Cummings, 2002).

Describe outcome measures aligned with planned outcomes

The expected result of the change implementation in California Health Medical Center (CHMC) is to have a reduction in the incidence of newly acquired pressure ulcers development from the current rate of 15% to 10% in all patients in the hospital within six months. This outcome measure is supported by Plaskitt, Heywood and Arrowsmith’s study in 2015 which showed a decreased incidence rate in hospital-acquired pressure ulcers after it implemented an electronic system that recorded harm events and documented initial pressure ulcer risk assessment.

Discuss the feasibility of the implementation plan.

Literature supports the need to have this plan implement in efforts to reduce pressure ulcer rates in California Health Medical Center (CHMC). Support and buy-in from stakeholders are guaranteed as the project aligns with the hospital's commitment to providing excellent quality of care to the patients it serves. Many resources needed are in the form of staff education and time needed to provide training. While the project will need up-front costs, successful implementation will yield a great return on initial investment. The risks of not implementing a sound pressure ulcer reduction plan in CHMC is too high, creating pain, impaired function, infections, increased hospital days, and rise in expenses.

CHMC will receive CMS performance-based incentives, and the program will lead to safe patient outcomes that equate to long-term, efficient use of CHMC’s resources in the use of less pressure ulcer supplies, expensive treatment, and extensive staffing workload, significantly reducing later costs (Mallah, Nassar, & Badr, 2014).