​JOHN HOPKINS NURSING EBP Translating into practice PHASE

Step 12: Determine fit, feasibility, and appropriateness of recommendation(s) for translation path
Step 13: Create action plan
Step 14: Secure support and resources to implement action plan
Step 15: Implement action plan
Step 16: Evaluate outcomes
Step 17: Report outcomes to stakeholders
Step 18: Identify next steps
Step 19: Disseminate findings

Step 12: Determine fit, feasibility, and appropriateness of recommendation(s) for translation path

How do we determine fit, feasibility and appropriateness of recommendations from the evidence to our setting?

According to Dang and Dearholt (2017), the main questions that you should be considering are:
  1. "Can this practice change be implemented given the current organizational infrastructure?"
  2. " What additional actions and resources are needed?" 
  3. Would this change improve clinical outcomes, patient or staff satisfaction, the cost of care, or unit operations?
  4. Are the findings in the evidence consistent?
  5. How applicable are the findings to your practice setting?

More guidance for this process can be found on Appendix H: Evidence Synthesis and Recommendation Tool. 
References
Dang, D., & Dearholt, S. (2017). Johns Hopkins nursing evidence-based practice: model and guidelines. 3rd ed. Indianapolis, IN: Sigma Theta Tau International.

​Step 13: Create action plan

What is an action plan?

An action plan is a detailed plan of how you will carry out a project and reach your objectives. It includes the who, what, where, and when of your project. There are several different models for creating an action plan, but they all share elements in common. They each consist of steps needed to accomplish a goal, a timeline of when those steps will be accomplished,  and who is responsible for each of the steps. 

​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.

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

Step 14: Secure support and resources to implement action plan

​Step 15: Implement action plan

​Step 16: Evaluate outcomes

​Step 17: Report outcomes to stakeholders

​Step 18: Identify next steps

Step 19: Disseminate findings

Dissemination

​There are three main methods for disseminate your EBP findings:
  1. Posters,
  2. Presentations, and
  3. Publications.
Below are some resources to help you with each method of dissemination. (Hint: The red underlined words are direct links to the resources.)

RESOURCES FOR POSTERS

Posters are an easy, clear method of presenting your evidence-based practice findings for other nurses. Many professional nursing organizations hold poster sessions at their annual meetings. ​​​

Abstracts

After choosing which professional conference would be a good fit for your poster, you will need to submit an abstract to their selection committee. Happell (2007) provides some guidance for nurses in preparing abstracts.
  • Happell, B. (2007). Hitting the target! A no tears approach to writing an abstract for a conference presentation. International Journal of Mental Health Nursing, 16, 447-452. Doi:10.1111/j.1447-039.2007.00501.x ​

PLANNING YOUR POSTER

​Once your  abstract has been accepted by the conference, the next step is to begin planning your poster. Sherman (2010) has created a guide for nurses on creating effective conference posters.
  • Sherman, R. (2010). How to create an effective poster presentation. American Nurse Today, 5(9), 13-15.

​POSTER TEMPLATES

Free poster templates are  available in PowerPoint format online to enter your poster information into. Below are a number of sites on which you can find free templates. You will need to download the file to your computer and then open it in PowerPoint to enter in your content. 
For technical support in using these templates, please reach out to the librarian at library@ellismedicine.org.
​
After you create the poster in PowerPoint, you will need to have it printed. There are a number of online sites that can print them for you from the PPT file, or you can reach out to the marketing/graphic arts team for assistance.

​RESOURCES FOR PRESENTATIONS

​Another method of disseminating your research findings is to make a presentation. Many professional conferences invite presentations from researchers. Typically, these presentations take the form of a PowerPoint presentation. Again, you'll need to submit an abstract for your presentation to a selection committee.
You may want to include the following sections in your PowerPoint:
  • Title Page- Name of your project, your name, your organization
  • Objectives- A brief list of information that the audience will learn from your presentation
  • Background- Why did you do this project? What was your PICO question?
  • Literature Review- What were the key points you learned from conducting a review of the literature?
  • Methodology/Implementation- How did you apply the evidence in your setting?
  • Results- What did you find?
  • Discussion- Why were these findings important? How well do these findings translate to other settings? Do you have any recommendations?
​​Below are some resources to help you develop  an effective speech and presentation materials.

RESOURCES ON PUBLICATION AND WRITING

If you decide you'd like to submit your research findings in the form of an article to a journal, below are a number of books that can help guide you through the writing process. Keep in mind, each journal has its own formatting and publication requirements. Be sure to refer to the journal's guidelines for submitting articles.
  • Sredl, D. (2015). Writing for Publication : Easy-to-follow Template Guides for Nurses and Allied Health Professionals. New York: Nova Science Publishers, Inc.  Available through EBSCO e-Books.​
  • Oermann, M. H., & Hays, J. C. (2016). Writing for Publication in Nursing, Third Edition. New York, NY: Springer Publishing Company. Available through EBSCO e-Books.
  • Saver, C., & Sigma Theta Tau, I. (2014). Anatomy of Writing for Nurses, Second Edition. Indianapolis, IN, USA: Sigma Theta Tau International.  Available through EBSCO e-Books. 

Additionally, if you need assistance in identifying an appropriate journal to submit your article to, would like someone to proofread your writing, or need help with citations- please reach out to the librarian at library@ellismedicine.org. ​
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