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Implementation Plan
Obtaining research approval
The approval process will start from the department level. This entails conducting a comprehensive discussion on the project, its idea, its rationale and its economical relevance to the healthcare system and the patient’s outcomes. The support and corrective criticism from the department will be of significant improvement to this capstone project. The Administrative support and approval is particularly important because it influences the changes within the organization (Black et al. 2014).
To start with, key stakeholders will be identified. This includes representative from the staffing pool, patient population, the departmental managers, clinical operations director, research nurse scientist and the Chief nursing officer. This team is important as they will play integral role of evaluating the data collected, evaluation of the proposed strategy in providing additional strategic solutions that may seem feasible.
The research nurse scientist will brief the key stakeholders by outlining the research idea in respect to the negative impact to the healthcare system and to the patient’s safety. The clinical relevance of the proposed solution to the problem will also be discussed. The questions asked will be answered and re-evaluated further in order to obtain the clinical relevance.
It is most likely that the stakeholders will not support the research idea, so I will avoid overwhelming the key stakeholders with ideas and instead, I will let them to participate actively to enable them reach their approval without any coercion or biasness (White et al. 2013).
After obtaining approval from the departmental level, I will consult the IRB to seek permission to carry out the research of human subjects. Seeking approval from the university ethics body is important because they ensure that the investigation content is legal, valid and ethical. This is because before approving the study, the appropriate protocol is followed, consent forms are filled and that ethical issues arising on HIPAA or data security plans are sorted out appropriately (Black et al. 2014).
Description of the healthcare problem
CHF is a chronic disease that affects approximately 5.8 million people in the USA. In addition, a further 670,000 are diagnosed with CHF annually. The large fraction of the people diagnosed with CHF is geriatric population. The average readmission days are within 30 days after hospital discharge. Approximately 25% of the patients diagnosed with CHF are readmitted shortly after they have been discharged from the hospital.
This is because of the patients are ill-prepared when discharged from the hospital, and they end up getting frustrated and confused. The poor education is attributable to the low nursing ratio and inadequate patient-physician interaction period. Despite the guidelines established on the importance patient education to avoid readmissions, the most effective strategy of education is still unknown (Black et al. 2014).
Proposed solution
The traditional classroom training as begun to shift towards a more contemporary appropriate approaches such as integration of skill based and interactive kinds of education. The patient education is increasingly shifting towards these trends whereby there is gradual incorporation of audiovisual and interactive technology based method of education.
The use of mobile and electronic platforms in this generation is paramount in order to improve the patients plans as it helps the healthcare providers to conduct ongoing educational needs that are beyond the inpatient setting through interaction and communication of needs for nurses (White et al. 2013).
The aim the capstone project is to explore if deploying the standardized patient education programs lowers the incidences of exacerbations, emergency visits and re-hospitalization. The proposed solution is the integration of technology to educate patient from the time they have been admitted and after they have been discharged using telemonitoring, telephone coaching and patient follow up assessment. The proposed solution aims to reduce the emergency visits and readmission rates by 80% (Black et al. 2014).
Rationale for proposed solution
Poor education is the leading cause for high rates of admission among the patients diagnosed with CHF. With the increased advancement of technology, there is numerous opportunities which can be used to address and improve the preventive measures. Therefore, using the teach back system to educate the geriatric population on the factors that are associated with exacerbation of CHF is an effective strategy.
This is even better in that the integration of the new electronic tablet based platforms will help train the patient to help them have a smooth transition of care, and to pre-discharge gaps of patient education, thus reduce the readmission rates which are estimated to consume approximately $26 billion annually, and wher $17 billion of it could be prevented. As all research points out, the inadequate patient education is the contributing factor (White et al. 2013).
Literature review
Approximately 20-50% of geriatric patients diagnosed with CHF undergo readmission in 2 weeks -90 days after they have been discharged. Research indicates positive impact of post discharge care in reducing the re-hospitalization rates and in improving patient’s quality of life (Adib-Hajbaghery, Maghaminejad, & Ali, 2013).
There has been a substantial increase on the number of hospital readmissions of patients diagnosed with CHF. There have been a considerable number of state-level variations in the discharge of skilled nursing facilities. However, there is limited information on hospital level variation of SNF rates and its association with increased re-admission rates. Some research studies was conducted by evaluating the data obtained from fee charges of Medicare patients who had a principal diagnosis of CHF indicated that shortage of skilled nurses resulted to an increase in readmission rates ( Chen et al., 2012).
Despite the fact that guidelines on the importance patient education to avoid readmissions have been established, the most effective strategy of education is still unknown. One study conducted to explore if the teach back method of patient education aids in reduction of readmission rates found that teach back method of education reduced readmission rates by 8.4 %. The study concluded that the teach back method is an effective teaching method as it helps the patients retain the information for significantly longer time than patients who had been taught using briefer teaching (White et al. 2013).
Another study conducted by Vedel and colleagues indicated that integration of Transitional care reduced the readmission rates by 8-29%. The paper concluded that high intensive training which involves the combination of telephone coaching, telephone follow up and clinical visits reduced readmission risk effectively. Therefore, it is highly recommended that that the healthcare providers should integrate these interventions in their healthcare facility (Vedel & Khanassov, 2015).
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Implementation logistics
The implementation process involves these 3 main aims including a) establishment of the value of the telephones and iPads mode of delivering education to the geriatric population, b) formulation of the responsibilities and competencies required by the team members for smooth running of activities and c) to develop the procedures and process of device protection, storage, safety and software maintenance. The main aim of implementation process is to ensure that staff competency is maintained high (Sawyer et al., 2016).
The approach of implementing comprehensive transition patient education among the geriatric population will begin from shared governance perspective. I am well aware that despite providing supportive evidence of integrating technology when delivering patient education during and after discharge, implementation of the evidence based change will be faced with challenges such as lack of adequate implementation support and insufficient time.
To address these issues, the research team will use the monthly briefing sessions to establish an environment that supports the implementation of modernized patient education program. This involves taking steps to ensure that the staffs have the tools and adequate tome to incorporate the evidence based practice into the existing work flows (Black et al. 2014).
In this context, the first step , the department based committee leaders from the quality improvement department will identify staff who will engage in “ transition patient education care using telemonitoring and telephone coaching role” champions. These champions will participate in preliminary training session with the research nurse scientist in order to make them gain an understanding on what is expected of them, and their responsibility of developing a cohesive work groups with the other staff members.
These champions selected will lead the other team members through the implementation process using a comprehensive and structured approach that includes communication of the value of the project, staff training on work flow and the approach of integrating change into the organization’s culture (Sawyer et al., 2016).
This kind of involvement is important as it helps the leaders and staff to become supportive throughout the implementation process. The messages staff obtain from the leadership contributes to adoption or rejection of the proposed change. Positive message from the management brings out a culture of adoption which is instrumental in securing the front line nurses perception of the benefits of their involvement during the implementation process (Black et al. 2014).
Resources needed for the implementation
The resources needed for successful implementation of this project is in terms of human resource, monetary resources and the time resources. This projected is expected to take approximately 6 months. During this period, the staff will be educated on the processes as well as the standard procedure for safe care of the electric devices to avoid patient contamination, and on the storage of these devices including the charging instructions and infection control measure. This is to ensure that each of the nurse champions receives comprehensive but simple instructions on the best strategies to educate the patients using the technology and teach-back strategy (Sawyer et al., 2016).
During study evaluation, the data will be collected using survey tests and questionnaires in order to establish a baseline of patient’s knowledge, which will be applied to evaluate the outcome of the intervention. The technologies that will be integrated include laptops, iPads and internet. The data collection will be done by two people. The estimated cost of operations is approximately $ 200,000 (White et al. 2013).
References
Adib-Hajbaghery, M., Maghaminejad, F., & Ali, A. (2013). The Role of Continuous Care in Reducing Readmission for Patients with Heart Failure. J Caring Sci., 2(4), 255-267. Retrieved from http://dx.doi.org/10.5681/jcs.2013.031
Black, J., Romano, P., Sadeghi, B., Auerbach, A., Ganiats, T., & Greenfield, S. et al. (2014). A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition – Heart Failure (BEAT-HF) randomized controlled trial. Trials, 15(1), 124. Retrieved from http://dx.doi.org/10.1186/1745-6215-15-124
Chen J, Ross JS, Carlson MD, Lin Z, Normand SL, Bernheim SM. et al.(2012). Skilled nursing facility referral and hospital readmission rate after heart failure or myocardial infarction. Am J Med. 125(1):100. e1–9.
Sawyer, T., Nelson, M., McKee, V., Bowers, M., Meggitt, C., & Baxt, S. et al. (2016). Implementing Electronic Tablet-Based Education of Acute Care Patients. Critical Care Nurse, 36(1), 60-70. Retrieved from http://dx.doi.org/10.4037/ccn2016541
White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquivel, J. (2013). Is “Teach-Back” Associated With Knowledge Retention and Hospital Readmission in Hospitalized Heart Failure Patients?. The Journal Of Cardiovascular Nursing, 28(2), 137-146. Retrieved from http://dx.doi.org/10.1097/jcn.0b013e31824987bd
Vedel, I. & Khanassov, V. (2015). Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis. The Annals Of Family Medicine, 13(6), 562-571. Retrieved from http://dx.doi.org/10.1370/afm.1844
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