NU480CL Unit 4 Capstone Project Charter Example

Ninety Percent Screened, Seventy-Five Percent Talked With: A Project Charter for a Nurse-Completed Goals Screen on a Composite Rehabilitation Hall, Fixing a Sponsor, a Scope With Named Exclusions, Measures and the Approvals Still to Be Obtained

[Student Name]

Purdue University Global

NU480CL: Four Spheres BSN Capstone Practicum

Unit 4 Project Charter

[Instructor Name]

[Date]

The facility, people and baseline are composite and bracketed; the charter is a student capstone document, and approvals listed as pending have not been obtained.

Project Title

Asking Early: A Nurse-Completed Goals Screen at Admission to the Short-Stay Rehabilitation Hall.

Sponsor and Team

Sponsor: director of nursing, who controls the admission form and staff education time. Clinical lead: the student, under the preceptor's supervision. Preceptor: the hall's nurse manager. In my words, her role is to approve each step before it reaches staff, to open doors I cannot open and to tell me when an idea will not survive the evening shift. Partners: the social worker, the contracted palliative nurse practitioner, two evening charge nurses and the medical director.

Problem

In the baseline month, [4] of [15] admissions with features of serious illness had a documented goals-of-care conversation within the first week. Most such conversations happened only after a decline or a return to hospital.

Aim and Targets

Over [eight] weeks, nurses will complete a three-item screen for [90] percent of short-stay admissions within [48] hours of arrival, and [75] percent of patients who screen positive will have a documented goals conversation before their first care plan meeting, usually held on day [five] to [seven]. Both targets come from the baseline. Screening is a new task embedded in an existing form, so high completion is realistic. Conversations depend on clinicians and families and on time, so their target is lower.

A target that the screen alone could meet would be too easy; the second target depends on what happens after the screen, which is where the project can fail.

The Line Around the Screen

In scope: all short-stay rehabilitation admissions to the [36]-bed hall during the eight weeks. Out of scope: long-term care residents, patients admitted directly to hospice, patients with a documented goals conversation in the [30] days before admission, and readmissions to the hall within [seven] days. Out of scope as actions: prescribing changes, decisions about code status and any change to therapy plans. The screen prompts a conversation; it decides nothing.

Measures

Process: percent of admissions screened within [48] hours, from the admission form. Outcome: percent of positive screens with a documented goals conversation, using a new note template, before the first care plan meeting. Counted but never targeted: palliative consultations requested and patients who change their plan of care. These are reported, not targeted, because a good conversation can lead to any choice, including continuing full rehabilitation (Bernacki & Block, 2014). Balancing: any patient or family complaint the screen provokes; evening admission completion time, to check the screen is not delaying assessments.

Timeline

Weeks 1 and 2: approvals, form change, staff education. Weeks 3 to 10: screening and conversations; weekly run charts. Week 11: synthesis and recommendation to the sponsor. Run charts allow changes to be dated and their effect watched over time (Langley et al., 2009).

Risks and Responses

Evening nurses skip the screen during busy admissions: keep it to three items in the existing form and review completion weekly. Families hear "palliative" as "dying": introduce the screen as a routine goals question and prepare a reply for nurses. Conversations stall waiting for the nurse practitioner: route positive screens to the attending clinician and social worker first, as hospital screening models recommend for wider coverage (Weissman & Meier, 2011).

Approvals Still to Be Obtained

Director of nursing: change to the admission form. Medical director: notification of attending clinicians. Information technology: new note template. Quality committee: data review. None of these is obtained yet; the charter will be revised if any is refused.

The Screen Itself

The three items, any one of which makes the screen positive, are: the admitting nurse would not be surprised if the patient died within a year; the patient has a serious illness with two or more hospitalizations in the past six months; or the patient's function on a standard performance scale is at or below [50] percent. A positive screen triggers a notification to the attending clinician and the social worker, with a request to offer a goals conversation before the first care plan meeting. The nurse does not discuss prognosis; she records the screen and tells the patient that the team will be checking in about goals, as it does for many patients.

Why These Targets and Not Others

A target for palliative referrals was considered and rejected, because it would reward steering patients toward a particular choice. A target for readmissions was rejected because the screen cannot plausibly change them in eight weeks. The two targets chosen measure what the project can actually do: ask the question and make sure someone follows up.

What Would Make Us Stop

If families raise more than [three] concerns in a week, or if evening admission assessments take [15] minutes longer than baseline, the team will pause, review the wording and decide whether to continue.

Communication Plan

Brief staff at the [0645] and [1845] huddles in week two; post a one-page guide; report weekly results at the hall's staff meeting.

References

Bernacki, R. E., & Block, S. D. (2014). Communication about serious illness care goals: A review and synthesis of best practices. JAMA Internal Medicine, 174(12), 1994-2003. https://doi.org/10.1001/jamainternmed.2014.5271

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Weissman, D. E., & Meier, D. E. (2011). Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the Center to Advance Palliative Care. Journal of Palliative Medicine, 14(1), 17-23. https://doi.org/10.1089/jpm.2010.0347