LEARN HOW TO TRANSLATE THE EVIDENCE ​(APPLY)
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So you have gathered and evaluated all this information, now what do you do with it?
According to the Evidence-based Practice Model, your next step should be to conduct a 
​pilot project.

What is a Pilot Project?
 A pilot project involves the implementation of the intervention on a small-scale to test its effectiveness and identify barriers. Usually, a pilot project would take place your unit with the approval of your patient care manager and nursing director. If a pilot project proves to be successful on your unit, the hospital may decide to implement the new evidence-based practice as a hospital-wide policy.
Forming Project Teams
An important part of the implementation process is having an engaged project team. Most nursing units at Ellis have a unit-based forum (UBF), a shared decision-making body. The UBF consists of staff nurses and educators from your unit, and they can help implement evidence-based nursing projects in your clinical area. You can utilize your UBF as  part your project team. They can help you plan how to carry out a project on your unit and what resources may be needed. You may also want to include team members from other disciplines if they are major stakeholders in the project, for example, Pharmacy.

Plan~do~study~Act: The PDSA Cycle


One easy way to implement an evidence-based pilot project is to follow the PDSA cycle.  The Plan-Do-Study-Act model of improvement was developed by the Associates for Process Improvement. The model consists of three questions which guide the project, and a four-part process for implementing change.

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The Questions
 There are three questions that will help guide your evidence-based improvement project:
  1. What are we trying to accomplish?
  2. How will we know a change is an improvement?
  3. What change can we make that will result in improvement?​
​The answer to the first question should be your clinical concern from the "Ask" phase of the EBP process. The third question, "What change can we make that will result in improvement?", will be the evidence-based practice that you discovered in the "Acquire" and "Appraise" part of the process. The second question, "How will we know a change is an improvement?", involves deciding what project metrics will indicate success. What's your goal? If your clinical concern was about hand hygiene compliance among health care workers, you might say your goal is to increase their compliance rate to 75% within 3 months.  

For more information on measuring project success, go to the Institute for Healthcare Improvement website.
Plan
The planning stage of the PDSA cycle involves developing the change or test you will be implementing. This can be done with the input of your project team.
You will want to consider the following questions:
  • What steps will be needed to put the change into place?
  • Who will be responsible carrying out pdsa  each step?
  • What resources will be needed?
  • What is the timeline for implementation?​
  • How will you measure progress?
  • How and when will you inform the team of the project progress?
It may also be helpful to collect baseline data at this point, so you have something to measure your outcome data against. 
Do
Once you have a clear plan of how to carry out your project plan, you can begin implementing. Be sure to communicate expectations and deadlines to each person who is involved in the implementation. Effective team communication is important to ensuring project success. Also, you should be collecting data related to your project metrics. 
Study​
Once the change is implemented and you've collected data, you will need to study or analyze it using the measures of success you developed in the "Plan" phase as a comparison. Did the results show what you expected? What did you learn while doing the project? What were the barriers you faced in implementation? What worked for your team? What didn't work? 
Act
After analyzing the results, you can Act on them. The action phase may involve one of three outcomes:
  1. You decide to make an adjustment to the change, based on the outcomes of your pilot. You'll start the PDSA cycle at the "Plan" step again.
  2. You decide not to carry out the change elsewhere, and end the project.
  3. You decide to implement the change on a larger scale if the pilot project has been successful. At this point, the project team may need to start the PDSA cycle again, or involve some project management tools to gain institutional support if the project will be more complicated and require more resources. (See below for project management tools.)
PDSA Resources
Reference:
Institute for Healthcare Improvement. (2017). "How to Improve." Available       from: http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx 

Project Management

For more complex projects, or to implement a hospital-wide change that is based on the results of your pilot project, you may need to utilize project management tools. Below are some simplified resources, developed with the advice of a project manager, that you can use for your project. 
Planning Your Project
Below is a handy project charter worksheet that you can download to help you with the project planning process. It will help you organize your plan to help make the project implementation easier. You and your mentor can work on this together.
Project Charter Elements
  1.  Problem Statement- This is similar to your PICO clinical question. 
  2. Results of the Problem- Why is a change in practice needed?  Collecting baseline data may be necessary before completing this section. Baseline data collection can be as simple as noting the number of events on your unit related to the issue you are trying to solve within a given time period. Include a summary the literature you have found supporting the evidence-based change you are hoping to effect.
  3. Goal - The desired outcomes of your pilot related to your clinical question.  How will you know the change in practice has successful? These must be SMART goals (Specific, Measurable, Achievable, Relevant, and Time-bound).  
  4. Project Scope- Where will your project begin and end? What should be included? (For example, including only patients on a specific unit with a specific medical condition.) What assumptions are you making?
  5. ​Project Summary- Briefly describe your pilot project in a clear manner so that others can easily tell what you intend to do.
  6. Team Members- Who is working on this project with you? Who will be helping you to implement this project?
  7. Project Stakeholders- The project stakeholders are the people who will be affected by the project. This might include patients, families, nursing staff, and other healthcare workers.
  8. Timeline- When will the project start? How long will this project take?
  9. Key Milestones- These are the steps you must take to implement the project. For each action item, you will need to specify the person or persons responsible for completing it, and the date when the action must be completed by.

By utilizing a project plan template, like the one above, you are ensuring that have a concrete plan for how to proceed in implementing your evidence-based improvement project. This will help you keep track of what should be happening during the implementation, and allow you and the other team members to have some level of accountability to your timeline. 
Communications  Plan
You will need to develop a communications plan for your project. The communications plan will detail your approach to informing stakeholders about the project and its progress.

You will want to divide your plan into sections for each group of stakeholders, and include the following elements for each group:
  • Manner of communication (holding or attending a meeting, sending an email, publishing an update on the intranet)?
  • Frequency of communication (daily, weekly, monthly, at the project close)?
  • What information will be included in the communication?
  • Who is responsible for the communication for this stakeholder group?
Developing a Budget
If your project plan includes the purchase of supplies or equipment, and/or requires staff time outside of their normal duties, you will need to develop a simple budget to submit along with your project charter and communications plan.

Below is a template that you can use to help develop your budget.
Getting Approval
 Before you kicking off your project, you'll need to get approval ​your nursing director, and possibly even the vice president of nursing. Your mentor and patient  care manager can help facilitate bringing your project charter and communications plan to the attention of leadership to get the needed approvals. 
Kick-off Meeting
After you've gotten approval from leadership for your project, you'll want to host a project kick-off meeting. At this meeting, you will provide a high-level overview of the project, including:
  • Project Background
  • Project Goals
  • Project Timeline
  • Project Milestones
  • Any Action Items Needed from Stakeholders

For more information about developing a PowerPoint presentation for this meeting, consult the presentation resources in the Disseminate section.
Running the Project

Role of the project Lead or Manager

If you become the project lead, you will be responsible for overseeing the day-to-day operations of the project.

This may involve:
  • fielding questions from team members and stakeholders,
  • troubleshooting issues that arise during implementation,
  • ordering project-specific supplies, 
  • coordinating communications to the team and scheduling meetings, 
  • managing the budget
  • and monitoring project outcomes.​​

For more information on Project Management, consult the following resources:
You'll also want to hold regular meetings with your project team to monitor project progress.
Here are some resources on keys to having successful meetings:
Project Wrap Up
After you have finished implementing the pilot project, and collecting your data, you will want to share the results of your evidence-based project.

There are two main ways that you will share your results:
  1. Internally- report-out meetings with stakeholders and assessment of results of your project.
  2. Externally- with other professionals at other institutions

internal report-out

Stakeholder Meetings Pointers:
  • You will want to hold a meeting to share the results of your project with stakeholders once your project is finished.
  • You should share the barriers and limitations of your project, as well as the outcomes and successes.
  • Be sure to leave time for questions.
  • Also make sure to recognize the efforts of your project team.

Leadership Meetings: 
  • You will want to share the results of your project with nursing leadership.
  • If your pilot project was successful, you will want to work with leaders in the affected service lines about spreading the project to other areas of the hospital.
  • Your EBP mentor will be a good resource to work with to come up with a plan to move the project forward, and to help you schedule meetings with the appropriate leaders.

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External Dissemination

Please proceed to the Disseminate section to learn more about sharing your EBP project results with other professionals.
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