Developing An Implementtaion Plan

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I desire to have this project get approved to implement it in the identified hospital. I intend to use the following procedure to have it approved and gain support from the organization’s leadership. First, I will understand the approval process of the organization. It will include getting a clear understanding of the processes and procedures the organization uses to approve new projects. It is intended to position the project with the vital funding and executive decision makers. The second is to determine the need for change concerning the organization’s vision and strategic plan. Here I will have to provide detailed information on how the project will contribute towards achieving the organization’s objective for it to get revenue allocation. After that, I will identify the key influencers and align with them. I will explain to them how the project will benefit each of the audience to prevent any instance of resistance from the stakeholders but to gain their support. I will inform them that they will be getting regular reports to keep them on the same page. I will have a clear and detailed understanding of the project and the involved stages of implementation to communicate to the stakeholders the correct information when getting the approval. For, instance, I will have estimates of the cost of integrating MEWS into EHR, the timeline for completing the project as well as its rationale. I will also have information regarding the required support from the management to have them brought on board when implementing the project. I will have a projected outcome from the project when completed for the stakeholders to buy in the idea. Some of the expected outcomes include the reduced hospital stay among the patients, improved disease diagnosis among others. All this will lead to the final stage of getting the approval from the executive decision makers of the organization. Once the project has been approved, I will get funding and the necessary support from the stakeholders to implement it. I will, however, provide a precise mapping of the outcomes from the project on a regular basis for the management to remain focused on it.

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General wards are characteristics with many patients admitted with minor ailments but requiring close monitoring as well as those transferred from the Intensive Care Units (ICU). In most cases, only a few nurses get assigned to monitor the progress of the patients. This causes a lot of fatigue as some are expected to work extra hours to meet the demands of the high number of patients getting admitted to the wards leading to their burnout. It such cases, it becomes difficult to identify the necessary philological changes among the patients which signify subtle changes which when addressed in advance can lead to early treatment. A significant number of patients are even forgotten increasing the risk of their conditions getting exacerbated. Traditionally, the physiological change scores such as temperature and blood pressure which are determinants of deteriorating conditions among the admitted patients in the general wards are only carried out by the trained medical staff, and most occasions occur once on admission. Evidence indicates that subtle but vital sign changes such as the level of consciousness and respiratory changes start 6 to 8 hours before a patient can start manifesting recognizable deterioration (Mathukia et al. 2015). Due to understaffing of nurses on the general ward and the irregular examining of the physiologic changes in patients that play a critical role in illustrating whether the patients’ conditions are deteriorating, the patients are put in increased risk for unplanned admissions to ICU, inpatient cardiac arrests, and even death. There is, therefore, need to bridge that gap to improve the outcomes and satisfaction for the hospitalized patients in general war.

The proposed solution to the above problem is the implementation of a Modified Early Warning Scoring (MEWS) system in an electronic health record (EHR) to decrease the risk of deterioration in patients on a general ward during hospitalization. MEWS is a physiologic scoring system “that uses temperature, blood pressure, pulse, respiratory rate and level of consciousness with each progressive higher score triggering an action.” (Mathukia et al., 2015). The MEWS system will be added to the EHR of patients on general wards and will be visible to nursing when logged in to a patients chart. A score will be automatically calculated based on the patient’s vital signs and documented level of consciousness and then updated automatically each time new documentation of either occurs. This score will be visible to nursing on both their homepage and each patient’s record when opened. A flowsheet will also be made available in the EHR to prompt the nurse to varying interventions required based on the score calculated. Those interventions range from increasing frequency of vital signs and notification of the charge RN to initiating a rapid response team (RRT).   Through the application of the MEWS system, it is possible to identify those patients with higher risk for deterioration allowing for early interventional measures. Evidence indicates that MEWS can be an essential tool in facilitating prompt communication between nursing and medical staff whenever the changing condition of the patient becomes apparent in the electronic chart. Once the MEWS identifies the patients at risk of deterioration, the healthcare professionals can examine the cause and further address the it accordingly. It, however, requires the healthcare workers to have proper training on how to interpret the results that will MEWS. Its usage will be regular, unlike the traditional approach where examination occurs once on admission.

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Early intervention and treatment of the patients in the general ward lead to better outcomes. Failure to accord the patient promptly and effective treatment breach one of the policies of National Patient Safety Agency which recommends that any patient admitted to a hospital should get the right and safe treatment. The relatives and associates should also get the assurance that in case of deterioration the patient will get prompt treatment (Cherry & Jones, 2015). As an early warning system, MEWS is an essential risk management tool that when implemented will reduce deterioration among the in-patients. The nurses can use the tool to monitor how the patients are experiencing (Quarterman et al. 2005). In case of a sudden decline, the nurses can improve their conditions through a clinical care.

Previous studies from the review of the literature prove that MEWS is a vital system recommending it for implementation. For instance, Mathukia et al. (2015) attempted to investigate how the recognition of clinical changes along with appropriate early interventions can help in preventing adverse outcomes among them being cardiac arrest and death. They implemented MEWS in an Academic Community Hospital in Easton that had no ICU wards. Upon the implementation of MEWS, the number of RRTs increased, while the rate of Code Blues decreased and an associated decline in overall mortality. Mathukia et al. (2015) recommended that a widespread use of MEWS would improve patient outcomes. Mullany et al. (2016) noted that the unrecognized deterioration of patients in hospital wards leads to adverse outcomes for the patient among them being cardiac arrest, unplanned admission to ICU or even death. The underuse of the escalation process and the current calling criteria that are operational is infective leading to patient’s clinical deterioration. They, therefore, conducted a study at the Prince Charles hospital among the hospitalized patients to determine the effect of the introduction of a rapid response system on process and outcome measures. The findings suggested that a low MET dose connected with enhanced hospital mortality when joined with a MEWS together with a means of improving communication (Mullany et al. (2016). They recommended the use of MEWS along with a properly designed escalation system to improve results with a low MET activation rate to minimise the consumption of resources allocated for the MET providing unit.

Page, Blaber & Snowden (2008) believed that MEWS could be essential in alleviating the particular needs of the acute hospital and further would lead to positive outcomes for the patients in the general wards. They piloted a nursing tool consisting of a colour-coded observation chart and response algorithm to back the nurses in the critical ill wards. They aided in identifying in advance the conditions of the patient and alerting rapid response concerning the deteriorating patients. It was conducted in two general wards, one 30 beds and the other 41 in an Australian private hospital. The findings showed that MEWS is a valuable tool in enhancing the work of ward nurses in the care of patients with critical illness and the system would be stretched to other wards (Page, Blaber & Snowden, 2008). They recommended adapting MEWS to all the Australian hospitals to provide the ideal care for patients with critical illnesses.

Cherry & Jones (2015, 09) noted that MEWS chart was outstanding at alerting the nursing and other medical staff about the patients with deteriorating conditions. They recommended that when used correctly, MEWS would assist in alerting the nursing staff and guiding the medical staff to take the most appropriate action for the patient (Cherry & Jones (2015, 09).

The following logistics will be employed during implementation. The first will be integrating the people and roles. I will evaluate the type of change to determine the best architecture for integrating the resources and the change management. I will define the roles, responsibilities and relationships of all the participants considering the existing organizational structures as well as the culture. All this is intended to prevent resistance by creating better expectations and fostering a better working relationship by establishing who will do what. The initiation of the project will be done by the top management of the organization to obtain so that all other staff can offer their support. I will create proper awareness to prevent resistance from the staffs who will be directly involved in working with the new system to assess the physiological changes of the patient. I will develop a program for training the involved staff on how to use MEWS once integrated with the EHR. Educating them will enhance efficiency and acceptance. Kyriacos et al. (2014) noted that experience among the clinicians, education, the nurse-patient ratios and the hospital setting play a critical role in the implementation of MEWS system. I will be present and involved to oversee the implementation process together with selected leaders of the organization. Involvement will inculcate the required seriousness of the project in the organization.

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There are particular resources required during the implementation as discussed below. When educating the staff, I will require specific educational materials among being the following. I will need pamphlets, handouts and posters containing the information on the procedures and process of using the new system. I will require PowerPoint presentations to illustrate the basics of the MEWS, how it works, its significance and how it integrates with EHR to improve on the examining deterioration among the patients. Assessing the effectiveness of the project is critical to examine whether it is feasible to implement in all other wards and other hospitals and also to assess the knowledge of participants at baseline after intervention. I will use the following tools for assessments; questionnaires, surveys and pre and post-tests. The MEWS software for integrating with EHR is required. The costs anticipated for this project are those associated with the acquisition of the software, educating the staff printing or producing educational materials. Other costs will relate to gathering and analyzing data, before, during and after the implementation. There will be those related to the staff who will be involved in initiating this project within the organization, overseeing its progress as well as evaluating the change.

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  1. Cherry, P. G., & Jones, C. P. (2015). Attitudes of nursing staff towards a Modified Early Warning System. British Journal of Nursing, 812-818.
  2. Kyriacos, U., Jelsma, J., James, M., & Jordan, S. (2014, 01). Monitoring Vital Signs: Development of a Modified Early Warning Scoring (Mews) System for General Wards in a Developing Country. PLoS ONE, 9(1). doi:10.1371/journal.pone.0087073
  3. Mathukia, C., Fan, W., Vadyak, K., Biege, C., & Krishnamurthy, M. (2015). Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital. Journal of community hospital internal medicine perspectives5(2), 26716.
  4. Mullany, D. V., Ziegenfuss, M., Goleby, M. A., & Ward, H. E. (2016). Improved hospital mortality with a low MET dose: the importance of a modified early warning score and communication tool. Anaesthesia and intensive care44(6), 734-741.
  5. Page, M., Blaber, I., Snowden, P. (2008). Implementing a modified early warning system for critically ill patients in an acute private hospital. CONNECT: The World of Critical Care, 6(3), 57-64.
  6. Quarterman, C. P., Thomas, A. N., Mckenna, M., & Mcnamee, R. (2005, 04). Use of a patient information system to audit the introduction of modified early warning scoring. Journal of Evaluation in Clinical Practice, 11(2), 133-138. doi:10.1111/j.1365-2753.2005.00513.x
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