Evidence-Based Practice Project Proposal-Evaluation Plan

Evidence-Based Practice Project Proposal-Evaluation Plan

This intervention plan focuses on implementing a three-hour order set as a standard for treating sepsis patients in an acute care setting. The project is to create awareness regarding the need for early diagnosis and treatment to prevent infection from worsening. The goal is to improve patient outcomes and decrease morbidity and mortality rates. Notably, the primary cause of death due to sepsis is the late diagnosis (Gilbert, 2018). This is to say the condition can be treated if diagnosed early. The intervention plan aims to incorporate the Johns Hopkins Evidence-Based Practice Framework to facilitate sepsis bundled care by promoting a standing order for three-hour sepsis interventions and, having these put into place and administering a knowledge assessment for nurses to be followed up with education and a post-education knowledge assessment. This paper evaluates the effectiveness of the selected evidence-based practice plan and framework.

Expected Outcomes

The PICOT for this implementation proposal is: In adult sepsis patients (P), does sepsis bundled care (I), when compared to routine clinical care (C), reduce hospital mortality rate, reduce admission rates, and reduce the length of stay (O) from the first 24H to discharge (T)? The primary objective is to improve compliance with the sepsis bundled process. The expected outcomes are that serum lactate level, blood cultures, weight-based fluid administration/resuscitation, and antibiotic administration will be ordered as an order set and become a standard for early sepsis intervention, resulting in decreased non-compliance rates of the core measure three-hour sepsis bundles/order set. Education will be provided to nursing staff regarding early recognition of sepsis and the need for bundled care.

Data Collection Methods

The project considered several methods for collecting qualitative and quantitative data, including interviewing, observation, recording, and questionnaires. Data will be collected via chart abstractions, and the CMS sepsis guidelines for the three-hour bundle will be used as an audit tool. Variables, including serum lactate level, blood cultures, weight-based fluid administration/resuscitation, and antibiotic administration, will all be reviewed. Each variable will have a yes or no response option. This will determine if the sepsis bundle interventions were completed per the sepsis bundle order set guideline. Specifically, data abstracted from charts will be audited for compliance with the early intervention, three-hour bundle, before Emergency Department (ED) nursing education. Then, the same data will be abstracted and audited to determine the exact compliance after the instruction. This data will then be examined to conclude if this practice has improved the observance of the core measures before and after all staff education and intervention implementation.

Statistical Test Strategy

A questionnaire completed by nursing staff will be examined using statistical analysis to identify their acknowledgment and comprehension. The questionnaire will be given out before initial staff education. This will help establish a baseline for the ED nurses’ knowledge level. The initial questionnaire will later be compared with the ED nurses’ awareness and understanding after a time frame, post-education, and in-services. A paired-sample t-test is one statistical test that can reach the mean scores for the same group of people on two different occasions. The two requirements for a paired t-test are one categorical independent variable (time) and one continuous, dependent variable (knowledge of sepsis bundles) measured on two different occasions. (Ranganathan et al., 2015, p. 247) This test will be helpful in both looking at the patient’s medical record information to determine improvement and the survey information from the nurses to assess their levels of sepsis education.

Statistical Test Strategy

The sepsis bundled care evidence-based practice project will employ the simple linear regression test analysis strategy in analyzing the collected information. Researchers use this data analysis method to quantify the relationship between a single independent variable and the corresponding dependent variable (Averkam, 2021). Simple linear regression is suitable for this research project because it focuses on one independent and dependent variable. Specifically, the independent variable of the intervention plan is the knowledge and implementation of bundled care. In contrast, the dependent variable is the outcome of sepsis patients. In addition, focusing on specific elements increases the quality and scope of the information collected, making it more reliable in making evidence-based medical conclusions and proper intervention plans study (Holliday, 2019).

Measurement and Evaluation of Outcomes

Outcome measurement and evaluation are crucial in research because they help to determine the effectiveness and achievement of research objectives. Furthermore, outcome evaluation allows researchers to assess the progress of the intervention plan on the target population (CDC, 2021). The sepsis bundled care intervention plan will use the Kirkpatrick model to evaluate the outcomes of the program. According to Kurt (2018), this tool is the most effective for analyzing and assessing educational intervention outcomes. The model follows four evaluation levels, including reaction, learning, behavior, and results in that order. The reaction level observes and measures respondents’ responses to the information to determine their understanding. The evaluation level gauges their knowledge through their participation in the program. The third level analyzes behavior change in response to new data from the program. Lastly, the fourth level evaluates results. In this case, the program will analyze results by determining the number of nurses’ level of knowledge regarding the steps or interventions in the bundled care order.

Alternative Strategies

Even though evidence-based practice programs may have worked in other departments or even with other conditions, they may fail to realize that expected results in other departments vary. For instance, questionnaires may not be an accurate indicator of a nurse’s comprehension or patient outcomes. Therefore, it is necessary to have alternative measures in case the primary intervention plan fails. If creating awareness using the Johns Hopkins Evidence-Based Practice Framework fails to realize expected results, the first alternative is changing the framework by using a more engaging strategy. Additionally, changing the process for presenting information can improve the outcomes. Face-to-face interviews and chart reviews may be more reliable and enhance nursing engagement.

Plans to Maintain, Extend, Revise, and Discontinue the Program

The program will be maintained through regular electronic and in-person communication. The first program will establish a relationship and long-term communication channel that will extend the agenda for the desired period. Revising strategies would include addressing the challenges raised by the respondents. Addressing these challenges will encourage positive responses and change implementation. Furthermore, the revision will involve providing additional information that may have been left out in the first program. The program or plan will be monitored continually and reported to the core stroke committee to monitor compliance and report to ED leadership.

References

Averkam, H. (2021). What is simple linear regression analysis? AccountingCoach.com. https://www.accountingcoach.com/blog/what-is- simple-linear-regression-analysis

CDC. (2021). Types of Evaluation. Centers for Disease Control and Prevention. https://www.cdc.gov/std/program/pupestd/types%20of%20evaluation.pdf

Gilbert, J. A. (2018). Sepsis care bundles: a work in progress. The Lancet Respiratory Medicine. https://www.thelancet.com/journals/lanres/article/PIIS2213- 2600(18)30362-X/fulltext

Holliday, B. (2019). The importance of frameworks and first principles in service design. Medium. https://medium.com/leading-service-design/the-importance-of- frameworks-and-first-principles-in-service-design-feb07e9d08e8

Kurt, S. (2018). Kirkpatrick model: Four levels of learning evaluation. Educational Technology. https://educationaltechnology.net/kirkpatrick-model-four-levels- learning-evaluation/

Ranganathan, P., Pramesh, C., & Buyse, M. (2015). Common pitfalls in statistical analysis: Clinical versus statistical significance. Perspectives in Clinical Research, 6(3), 169. https://doi.org/10.4103/2229-3485.159943

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In 750-1,000 words, develop an evaluation plan to be included in your final evidence-based practice project proposal. You will use the evaluation plan in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Evidence-Based Practice Project Proposal-Evaluation Plan

Provide the following criteria in the evaluation, making sure it is comprehensive and concise:

Review the various data collection tools associated with your selected research design and select one data collection tool that would be effective for your research design. Explain how this tool is valid, reliable, and applicable.

Select a statistical test for your project and explain why it is best suited for the tool you choose.

Describe what methods you will apply to your data collection tool and how the outcomes will be measured and evaluated based on the tool you selected.

Propose strategies that will be taken if outcomes do not provide positive or expected results.

Describe the plans to maintain, extend, revise, and discontinue a proposed solution after implementation.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite a minimum of five peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.