Develop a comprehensive project plan in relation to your DNP project

Running head: DNP SCHOLARLY PROJECT PLAN

DNP Scholarly Project Plan

School of Nursing, Northern Kentucky University

DNP 806: Program Development, Implementation, & Evaluation

Dr. Teresa Huber & Dr. Julie Joiner

September 4, 2020

DNP SCHOLARLY PROJECT PLAN 2

DNP Scholarly Project Plan

The Doctor of Nursing Practice (DNP) scholarly project is a practice-based project

focused on positively impacting patient outcomes. This paper provides an overview of the

project plan for developing a care-team led patient mobility program. The project plan outlines

the following: Incorporation of evidence-based practice (EBP), measurable goals and outcomes,

key stakeholders, strengths, weaknesses, opportunities, and threats (SWOT) analysis, financial

analysis, methods and instruments, and cultural and learning considerations.

Program Overview and Incorporation of Evidence Based Practice

The purpose of this DNP quality improvement project is to decrease length of stay (LOS)

and increase patient experience after implementing a care-team led mobility program for adult-

geriatric med-surg patients. Prolonged immobility can cause functional decline, increased LOS,

and increased healthcare acquired conditions (HAC) (Jones et al., 2020). Ambulation and

mobility are the most commonly missed care activity, and front-line caregivers are frequently

confused about their role in patient mobility (Teodoro et al., 2016). Implementing a care-team

led mobility program will help to clarify roles, increase mobility, and improve patient

outcomes—particularly LOS and patient experience (Dewitt et al., 2019). The program will also

incorporate an EBP tool at the front-line that helps to guide patient mobility called the Johns

Hopkins Highest Level of Mobility (JH-HLM) tool. This tool has an interrater reliability of 0.99

between physical therapists and nurses (Hoyer et al., 2018).

Measurable Program Goals and Outcomes

The PICOT question for this project is: In adult-geriatric med-surg patients age 18 and

older (P), what is the effect of using a care-team led mobility program (I) compared to not using

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a care team led mobility program (C) on LOS and patient experience (O) over a three-month

period (T)? This PICOT question is integral for defining program goals and outcomes.

Measurable Program Goal and Outcome #1

The first program goal is to decrease LOS by 0.3 days in the med-surg department

performing the quality improvement project. Data will be collected 90-days after implementation

and compared to pre-implementation data. The data used for pre-implementation will include the

previous 6-month average LOS. There are two positive outcomes for meeting this goal. The

organization is positively impacted financially by decreasing patient days in the hospital. Patients

are positively impacted by going home sooner and decreasing their cost for hospitalization.

Measurable Program Goal and Outcome #2

The second program goal is to increase the overall rating of the hospital stay and

likelihood to recommend the hospital by 10% over a 90-day period post-implementation in the

med-surg department performing the quality improvement project. The data for pre-

implementation will include the previous 6-month average score for overall rating and likelihood

to recommend. The organization is positively impacted by meeting this patient experience goal

because it increases reimbursement and patient loyalty. Patients benefit from an improved

experience while hospitalized.

Patient Population

The patient population for this DNP project is adult-geriatric patients age 18 and older

hospitalized in a med-surg department. This patient population and setting was chosen because

adult med-surg departments across the entire hospital system need to improve patient mobility

while also decreasing LOS and increasing patient satisfaction.

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Stakeholders

There are many stakeholders involved in this DNP scholarly project. The primary

stakeholder is the patient who positively benefits from improved outcomes. Other key

stakeholders include nurse leaders, rehab services personnel, care management personnel, front-

line staff, physicians, nurse practitioners, and system-level leaders.

Patients

Patients are the most important stakeholders who participate in the mobility program. This program improves overall patient outcomes and quality of care. Similar mobility programs

have also shown to improve LOS and patient experience (Dewitt et al., 2019).

Nurse Leaders

The nurse manager (NM) and assistant nurse manager (ANM) are the primary leaders

involved with implementing the project because they are the closest to the front-line. It is

important for these leaders to ensure that team members understand their role and the purpose of

the project. The NM and ANM are responsible for collecting data from the Epic analytics system

and the Press Ganey database for monitoring LOS and patient experience.

Rehab Services Personnel

The director of rehab services is a key stakeholder who will help with moving the project

forward at the bedside. The director of rehab services will collaborate and communicate with

front-line leaders and therapists to work with the nursing staff as the project is operationalized.

Care Management Personnel

The director of care management will assist with data management needs. This leader has

access to all LOS data down to the department level. Care management staff who work on the

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nursing unit will be responsible for ensuring the JH-HML assessment is completed daily by front-

line nurses.

Front-line Staff

Front-line staff, particularly nurses and patient care associates, are an important part of

operationalizing the program. The nurses are responsible for completing the JH-HML assessment

and guiding care appropriately. Patient care associates can perform the needed actions, such as

ambulating in the hall, sitting up in a chair, etc. after the nurse has assessed the level of mobility.

This is a practice change that requires adjustment in how nurses perform daily assessments and

delegate tasks.

Hospitalists and Nurse Practitioners

Hospitalists and nurse practitioners need to work with the care team by ensuring patients

have the correct discharge disposition. A majority of ambulatory patients should be discharged

home. Physicians may want to send patients to subacute rehabs even when not warranted—

which increases the LOS. These stakeholders will also have their personal LOS monitored

throughout the project.

System-level Leaders

System-level leaders are important to keep updated periodically throughout the project.

System leaders are needed when the program is disseminated across the entire hospital system.

SWOT Analysis

A SWOT analysis provides an overview of pros and cons that need to be considered. The

strengths and weaknesses identified are considered internal factors and the opportunities and

threats identified are considered external factors (Pearce, 2007). Below explains the SWOT

Analysis. See Appendix A, SWOT Analysis for additional information.

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Strengths

The organization has many strengths that support implementing a care-team led mobility

program. The leadership throughout the hospital supports EBP projects and using the

Institutional Review Board (IRB) to complete projects. The Institute for Nursing (I4N) is another

strength used at the organization. I4N is a system-level department that can assist with planning,

developing, and disseminating the project once proven successful. The level of engagement from

front-line staff is considered high for this organization, and the department conducting the

project has completed EBP projects successfully in the past.

Weaknesses

There are some internal factors that are considered weaknesses. Staff need to understand

the purpose of the project and feel empowered to ask clarifying questions. Potential gaps to

consider related to this project are staff’s ability to interpret statistics, translate knowledge into

practice, and interpret outcomes (Arguelles, 2011). There is also a concern for competing

workloads from both staff and frontline managers who are adjusting to practice changes with the

Covid-19 pandemic.

Opportunities

There are external factors that can positively impact the organization after implementing

the mobility program which include standardization of patient care, improved patient outcomes,

increased financial gains, and decreased costs. Disseminating the program across the entire

healthcare system will ensure that all med-surg patients get the same standard of care. Providing

this level of care can decrease LOS, increase patient outcomes, increase patient satisfaction, and

improve patient loyalty to the healthcare system (Dewitt et al., 2019; Wurmser, 2009).

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Threats

There are some external threats to consider when implementing this project which

include cost constraints, decreased utilization of sub-acute rehabs and nursing homes, and

skewed LOS due to the Covid-19 pandemic. Some leaders may question the cost to train staff

depending on the financial needs during the time of implementation. Alternatives such as virtual

training, on-the-job training, and train-the-trainer can be used to decrease costs. There is a risk

for sub-acute rehabs and nursing homes to question decreased usage from the hospital setting.

Patients will be more mobile and may no longer need sub-acute rehab placement. Finally, there

is a risk that LOS may not decrease as much as desired because the organization is seeing a

higher LOS due to Covid-19.

Financial Analysis

There are financial considerations with implementing this quality improvement project. It

is estimated that virtual training and class training will cost approximately $977.50. This cost is

based on the average hourly wage for both patient care associates and nurses on the department.

Salaried personnel are expected to complete needed training during their regular workday. Other

expenses include print materials such as paper, ink, card stock, etc. that is estimated to be

$150.00. This expense is needed because staff will need quick references and educational

materials to use. The administrative assistant will organize these materials, and the approximate

cost will be $80.80 for four hours of work total for this employee.

The overall cost for implementation of this project is estimated at $1,208.30. The cost

associated with implementation and training is worth the benefits of achieving the goals and

outcomes of the project. Throughout the project the focus will be on financially evaluating the

program using a cost benefit analysis and/or cost-effectiveness analysis (Thomas, 2020). The

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cost-benefit analysis will show that money saved is more than money spent for training. The

cost-effectiveness analysis will show decreased LOS and increased patient experience—which is

financially beneficial for the organization.

Methods and Instruments for Data Collection That Best Fit Project

The Epic analytics system is the method used for collecting LOS data. This data can be

analyzed by hospital, department, and provider. Using this system enables the data to be pulled

from the med-surg department where the quality improvement project is performed. Data can

also be further analyzed by looking at individual providers’ LOS—which could indicate whether

the mobility program is being utilized effectively by providers. The instrument used to collect

monthly data is presented in Appendix B, Data Collection Tools.

The Press Ganey database is used for collecting patient experience data. The data can be

analyzed at the department level to determine if the quality improvement project is positively

impacting the identified categories—overall rating and likelihood to recommend. The data will

be analyzed and reviewed for changes in top-box scores and percentile ranking scores. The

instrument used to collect monthly data is presented in Appendix B, Data Collection Tools.

Cultural and Learning Considerations

There are cultural and learning considerations related to implementing the care-team led

mobility program. From an organizational culture standpoint, it is important to note that the

department where this project will take place has completed EBP projects in the past. The culture

for EBP readiness should be assessed in other departments prior to disseminating the program

across the entire system. Learning considerations for staff include understanding the purpose of

the project and explaining important details such as outcomes data and statistical analyses that

support using the mobility program. Arguelles (2011) explains that common educational gaps

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include statistical analysis, interpretation of data, and translating projects into practice. In order

to overcome these potential learning needs, nurse leaders at the front-line should explain data in

terms staff understand.

There are special needs to consider for patients as well. During the current pandemic, it is

possible that some patients may not tolerate ambulating in the hallways wearing a mask. For

example, patients who have asthma, chronic obstructive pulmonary disease (COPD), pneumonia,

etc. may exhibit activity intolerance when wearing a mask. To alleviate the risk for declining

mobility due activity intolerance related to wearing a mask, these patients can ambulate and

perform mobility exercises in their room.

Conclusion

All in all, this paper provides a comprehensive DNP project plan for implementing and

evaluating a care-team led mobility program. The project plan explains stakeholder roles, a

SWOT analysis, a financial analysis, and data collection methods. This plan will help with

analyzing and evaluating data to support the need for dissemination across the entire hospital

system.

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References Arguelles, C. (2011). Evidence-based practice mentors: Taking information literacy to the units

in a teaching hospital. Journal of Hospital Librarianship, 11(1), 8-22.

https://doi.org/10.1080/15323269.2011.537989

Dewitt, K., Coto, J.A., Carr, L., Ondrey, M., & Petkunas, H. (2019). Ambulation programs:

Decreasing length of stay and improving patient outcomes. MEDSURG Nursing, 28(5),

293-302. Retrieved from

http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=36&sid=98f2858a-e8aa-

4dff-b734-e9cf9dc3e831%40sdc-v-sessmgr02

Hoyer, E.H., Young, D.L., Klein, L.M., Kreif, J., Shumock, K., Hiser, S., Friedman, M.,

Lavezza, A., Jette, A., Chan, K., & Needham, D. (2018). Toward a common language for

measuring patient mobility in the hospital: Reliability and construct validity of

interprofessional mobility measures. Physical Therapy, 98(2), 133-142.

https://doi.org/10.1093/ptj/pzx110

Jones, R.A., Merkle, S., Ruvalcaba, L., Ashton, P., Bailey, C., & Lopez, M. (2020). Nurse-led

mobility program. Journal of Nursing Care Quality, 35(1), 20-26. doi: 10.1097/NCQ.

0000000000000404. Pearce, C. (2007). Ten steps to carrying out a SWOT analysis. Nursing Management – UK,

14(2), 25. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.7748/

nm2007.05.14.2.25.c4343

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Teodoro, C.R., Breault, K., Garvey, C., Klick, C., O’Brien, J., Purdue, T., Stolaronek, A.,

Wilbur, H., & Matney, L. (2016). STEP-UP: Study of the effectiveness of a patient

ambulation protocol. MEDSURG Nursing, 25(2), 111-116. Retrieved from

http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=8&sid=98f2858a-e8aa-4dff-

b734-e9cf9dc3e831%40sdc-v-sessmgr02

Thomas, P. (2020). Developing metrics that support project plans, interventions, and programs.

In J. Harris, L. Roussel, C. Dearman, & P. Thomas (Eds.), Project planning and

management: A guide for nurses and interprofessional teams (3rd ed., pp. 193-220).

Burlington, MA: Jones & Bartlett.

Wurmser, T. (2009). The financial case for EBP. Nursing Management, 40(2),

12–14. doi: 10.1097/01.NUMA.0000345867.84071.fa.

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Appendix A

SWOT Analysis SWOT Analysis of Organization in Relation to DNP Scholarly Project

Strengths

• Leadership supports EBP projects and

IRB process. • Physical therapy and occupational therapy

departments are interested in starting a new mobility program that front-line staff can use.

• Department chosen for Pilot-Study of

DNP scholarly project is well-informed on implementing EBP changes and monitoring patient outcomes.

• Staff within department chosen for Pilot-

Study showed high engagement for making improvements to patient care during recent Employee Engagement Survey.

Weaknesses • Staff understanding that LOS and patient

experience can improve with effective mobility programs (Dewitt et al., 2019).

• Potential educational gaps among staff

related to statistical analysis, interpretation, application of practices, etc. (Arguelles, 2011).

• Competing workloads for staff and

frontline managers to implement mobility program.

• Staff concern for mobilizing and

ambulating patients in the nursing unit considering current pandemic.

Opportunities • Potential for hospital system alignment

with implementing mobility program to improve patient outcomes.

• Improved patient outcomes from DNP

scholarly project can lead to better patient experience, decreased LOS, and increased use of services (Dewitt, et al., 2019; Wurmser, 2009).

• Decreased healthcare costs for patients

who do not have to go to a Nursing Home or Sub-Acute Rehab facility at discharge.

Threats • External organizations such as Nursing

Homes and Sub-Acute Rehabs may lose business when patients ambulate more during hospital stay.

• Cost constraints may require inconsistent

forms of communication and training due to organizational financial needs.

• LOS may be skewed high due to Covid-

19 patients—LOS has increased since pandemic.

• Patient tolerance of wearing personal

protective equipment (PPE) while ambulating outside room.

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Appendix B

Data Collection Tools

Department Specific LOS

Department Month 1 LOS

Month 2 LOS

Month 3 LOS

Baseline Pre-

Implementation LOS

Post- Implementation

Cumulative Average LOS

Department Hospitalist LOS

Hospitalist Month 1

LOS Month 2

LOS Month 3

LOS Baseline

Pre- Implementation

LOS

Post- Implementation

Cumulative Average LOS

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Department Likelihood to Recommend Scores

Department Month 1 Month 2 Month 3 Baseline Post- Top Box & Top Box & Top Box & Pre- Implementation Percentile Percentile Percentile Implementation Cumulative Ranking Ranking Ranking Top Box & Average Top Percentile Box & Ranking Percentile Ranking

Department Overall Rating Scores

Department Month 1 Month 2 Month 3 Baseline Post-

Top Box & Top Box & Top Box & Pre- Implementation Percentile Percentile Percentile Implementation Cumulative Ranking Ranking Ranking Top Box & Average Top Percentile Box & Ranking Percentile Ranking

Qualitative Health Research 2016, Vol. 26(5) 649 –658 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049732316634304 qhr.sagepub.com

Keynote

Introduction to Interdisciplinary Team-Based Mixed Methods Research

We are in the midst of a health care research revolution. Ways of conduct

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