Evidence-Based Practice Proposal Section E: Implementation Plan

Setting

The proposed EBP project will be implemented in the WellMed Medical Management unit of the Managed Care Organization that serves around 50 000 clients. The implementation will involve clinical nurse coding consultants, nurse practitioners, and clinical nurse leaders working in the organization. The participants will give their consent to take part in the implementation process. The actual sample population will constitute 60 healthcare staff. These healthcare officials will specifically implement the continuous glucose monitoring (CGM) strategy while taking care of elderly patients with type 1 diabetes mellitus (T1DM) in the organization. The proposed project aims to decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions in the long-term. The researcher will obtain approval from the management before implementing this project.

Time

This evidence-based project will be implemented in 8 weeks. In week 1, the researcher will focus on the formation of a multidisciplinary team (MDT). The training of the implementation team members is the major activity that will be conducted in week 2. All the team members will be equipped with the knowledge required to implement the organization’s proposed change. The members of the MDT team will spend week three gathering the relevant literature and synthesizing it. Week 4 will be utilized to pilot the change in practice. This exercise is important since it will help the participant identify any potential barriers that are likely to hinder the implementation process. Additionally, project facilitators will be pointed out in this week. Actual implementation will be conducted from week five to week five. During this period, medical staff will utilize the continuous glucose monitoring (CGM) strategy while attending to elderly patients with type 1 diabetes mellitus (T1DM). A clinical nurse leader will release the results to the nurse administrators. Finally, the implementation team will spend week 8 to evaluate the overall process results and identify any changes that should be made.

Resources

Various resources are required to enhance the implementation process. Primarily, human resources will be utilized in the implementation of this evidence-based project. External quality improvement trainers will be hired. They will work together with the internal improvement team and the implementation team to create awareness and train the healthcare staff. According to Lavallée et al. (2019), a team of the multidisciplinary team will be required to enhance the implementation process. This team will comprise of nurse practitioners, clinical nurse leaders, and clinical nurse coding consultant. Nurse practitioners will be involved in managing the health status of elderly patients with T1DM during the implementation process. According to Nikitara et al. (2017), nurse practitioners take care of people with diabetes. Clinical nurse coding consultant will provide complete diagnostic data that has been properly coded. Clinical nurse leaders will assign responsibilities to clinical nurse coding consultants and supervise them to ensure that they are adhering to the proposed strategy’s components. Specifically, the leaders will ensure that the continuous glucose monitoring (CGM) strategy will be utilized while taking care of elderly patients with type 1 diabetes mellitus (T1DM) in the organization. The collaboration of these specialists will reduce the rate of severe hypoglycemia, which requires

emergency medical treatment. According to Wang et al. (2017), types, 1 and 2 diabetes are associated with most severe hypoglycemia cases.

Methods and Instruments

A satisfaction survey and an audit tool will be utilized by the author to collect data. Primarily, a satisfaction survey will be used to assess the care provided to elderly patients with T1DM. The rate of overall satisfaction of the patients and their experience will be based on the collected data. Additionally, the implementation team will utilize the audit tool to gather data about effective interventions in every individual patient. Specifically, the tool will focus on the components of the continuous glucose monitoring (CGM) strategy. The outcomes will be based on hypoglycemic events, glycemic control, and hospital readmissions. Besides, the implementation team will utilize the audit tool to determine participants’ compliance with the proposed intervention. According to Van der Nest et al. (2017), the audit tool is utilized to enhance internal audit functions.

Data Collection Plan

Data will be required to enhance the implementation process. The implementation team will utilize a questionnaire for monitoring the entire exercise. The questionnaire containing close-ended questions will be given to the participants who will handle them back to the implementation team after filling them. This type of questionnaire will be preferred since they reduce the chances of collecting irrelevant data. According to Desai and Reimers (2019), close-ended questionnaires direct the participant on the information to provide, thus limiting irrelevant data.

The Management of Facilitators, Barriers, and Challenges

The implementation process’s success will be determined by how the implementation team will manage facilitators and barriers. Management is the key facilitator of this project. Therefore, the management should be informed about the proposed EBP project and its benefits to individual patients and the entire organization. Additionally, the implementation team should address the critical barrier, which is the participants’ attitude. Most healthcare staff consider the change as time consuming and expensive process. This barrier can be addressed by informing them about the benefits of the proposed change. According to Qaseem et al. (2015), the implementation team should document every component of the project to convince the participants. Finally, the team will enhance the success of the implementation process by addressing the challenge of finances. According to Stedman et al. (2020), a healthcare organization should invest in strategies for managing type 1 diabetes (T1DM) if the benefits are higher than the cost.

The Feasibility of the Implementation Plan

The implementation of the proposed EBP project is cost-friendly. The cost that will be incurred by the organization is relatively low since it has already adopted the use of computerized charting. Thus, documenting patient care will not require extra cost. However, the organization will incur the cost of hiring external quality improvement trainers. These specialists will work together with quality improvement trainers to create awareness about the participants’ proposed project. Specifically, they will emphasize the project’s benefits, thus triggering the participants to take part during the implementation process.

Maintenance Plan

The author and the implementation team will collaborate with the management to develop the project if it meets the expected outcomes. Continuous glucose monitoring (CGM) will be considered as an effective strategy for enhancing the care of elderly patients with type 1 diabetes mellitus (T1DM) in the organization. On the contrary, some adjustments will be made if the project fails to meet some of the expected outcomes. The project will not be implemented at all if it meets none of these outcomes.

References

Desai, S. C., & Reimers, S. (2019). Comparing the use of open and closed questions for Web-based measures of the continued-influence effect. Behavior research methods , 51(3), 1426-1440.

Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2019). Preventing pressure ulcers in

nursing homes using a care bundle: A feasibility study. Health & social care in the

community, 27(4), e417-e427.

Nikitara, M., Constantinou, C. S., Andreou, E., & Diomidous, M. (2019). Nurses’ role and the facilitators and barriers in diabetes care: A mixed methods systematic literature review. Behavioral Sciences, 9(6 ), 61.

Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention

of pressure ulcers: a clinical practice guideline from the American College of

Physicians. Annals of internal medicine, 162(5), 359-369.

Stedman, M., Lunt, M., Davies, M., Livingston, M., Duff, C., Fryer, A., … & Heald, A. (2020). Cost of hospital treatment of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) compared to the non-diabetes population: a detailed economic evaluation. BMJ Open, 10 (5), e033231.

Van der Nest, D. P., Smidt, L., & Lubbe, D. (2017). The use of generalized audit software by internal audit functions in a developing country: A maturity level assessment. Risk Governance and Control: Financial Markets & Institutions, 7 (4-2) , 189-202.

Wang, H., Donnan, P. T., Leese, C. J., Duncan, E., Fitzpatrick, D., Frier, B. M., & Leese, G. P. (2017). Temporal changes in the frequency of severe hypoglycemia treated by emergency medical services in types 1 and 2 diabetes: a population-based data-linkage cohort study. Clinical Diabetes and Endocrinology, 3(1), 7.

Evidence-Based Practice Proposal – Section E: Implementation Plan

In 1,000-1,500 words, provide a description of the methods to be used to implement the proposed solution. Include the following:

1. Describe the setting and access to potential subjects. If there is a need for a consent or approval form, then one must be created. Although you will not be submitting the consent or approval forms in Topic 5 with the narrative, you will include the consent or approval forms in the appendices for the final paper.

2. Describe the amount of time needed to complete this project. Create a timeline. Make sure the timeline is general enough that it can be implemented at any date. Although you will not be submitting the timeline in Topic 5 with the narrative, you will include the timeline in the appendices for the final paper.

3. Describe the resources (human, fiscal, and other) or changes needed in the implementation of the solution. Consider the clinical tools or process changes that would need to take place. Provide a resource list. Although you will not be submitting the resource list in Topic 5 with the narrative, you will include the resource list in the appendices for the final paper.

4. Describe the methods and instruments, such as a questionnaire, scale, or test to be used for monitoring the implementation of the proposed solution. Develop the instruments. Although you will not be submitting the individual instruments in Topic 5 with the narrative, you will include the instruments in the appendices for the final paper.

5. Explain the process for delivering the (intervention) solution and indicate if any training will be needed.

6. Provide an outline of the data collection plan. Describe how data management will be maintained and by whom. Furthermore, provide an explanation of how the data analysis and interpretation process will be conducted. Develop the data collection tools that will be needed. Although you will not be submitting the data collection tools in Topic 5 with the narrative, you will include the data collection tools in the appendices for the final paper.

7. Describe the strategies to deal with the management of any barriers, facilitators, and challenges Evidence-Based Practice Proposal – Section E: Implementation Plan

8. Establish the feasibility of the implementation plan. Address the costs for personnel, consumable supplies, equipment (if not provided by the institute), computer-related costs (librarian consultation, database access, etc.), and other costs (travel, presentation development). Make sure to provide a brief rationale for each. Develop a budget plan. Although you will not be submitting the budget plan in Topic 5 with the narrative, you will include the budget plan in the appendices for the final paper.

9. Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

I live in el Paso, Texas

I work in a Managed Care organization. I look at Hierarchical Condition Category coding (HCC codes) and proper documentation for accurately diagnosing and reimbursement. More specific, I work for WellMed Medical Management. I am a clinical nurse coding consultant.

I have been working my papers around diabetes, elderly with Type 1 diabetes and continuous glucose monitor

PICOT question

In elderly patients with type 1 diabetes mellitus (T1DM), how does continuous glucose monitoring (CGM), when compared to the traditional self-monitoring of blood glucose (SMBG) levels decrease hypoglycemic events, improve glycemic control, and reduce hospital readmissions or admissions in the long-term Evidence-Based Practice Proposal – Section E: Implementation Plan