NU480CL Unit 8 Capstone Progress Memo Example

One Aim on Track, One Behind: A Progress Memo to the Preceptor and Course Faculty on the Goals Screen Piloted on a Composite Short-Stay Hall, Reporting 84 Percent Screened and Five of Twelve Conversations, With a Remedy for the Lagging Aim

[Student Name]

Purdue University Global

NU480CL: Four Spheres BSN Capstone Practicum

Unit 8 Progress Memo

[Instructor Name]

[Date]

The facility and figures are composite and bracketed; the remedy described requires approval that has not yet been given.

Memo

To: [Preceptor], [course faculty] From: [Student], NU480CL Re: Progress on the admission goals screen, week [seven] of [ten] Date: [date]

Verdict

Aim 1, screening within [48] hours: on track, [84] percent over the last three weeks against a target of [90] percent. Aim 2, a recorded goals talk for positive screens ahead of the first team care meeting: behind, [five] of [12], [42] percent against a target of [75] percent.

Screening on Track

Before the change, evening admissions accounted for most missed screens. Since evening arrivals moved to next-morning screening by the day nurse, weekly completion has been [78], [85] and [89] percent. On the run chart the rise starts the same week as the change, which suggests the change, rather than chance, explains it (Langley et al., 2009).

Conversations Behind, and Why

I reviewed the seven positive screens without a documented conversation. [Three]: the conversation happened but was not documented in the new template; one was recorded in a progress note, two only in the social worker's notes. [Two]: the family could not attend before the care plan meeting. [One]: the patient declined. [One]: the notification was missed by the attending, before the social worker was copied in. So the gap is partly real and partly a measurement problem. The two families who could not attend are a real gap; the three undocumented conversations are not, and fixing the first needs a different remedy from fixing the second.

Three of the seven missing conversations were not missing at all; they were written in places the measure did not look.

Remedy Needing Approval

1. Accept social worker notes and progress notes that meet a short definition of a goals conversation, so the measure finds conversations that happened. This needs the quality committee's approval of the definition.

2. Offer the goals conversation at the social worker's existing family meeting, held within [72] hours of admission, rather than as a separate meeting. This needs the director of nursing's and medical director's agreement, since attending clinicians would join when possible rather than lead every conversation.

3. Count declined offers separately, as an offer made, rather than as a failure. Respecting a patient's choice not to discuss goals now is part of good practice (Bernacki & Block, 2014).

What Faculty Should Know About the Data

The screening figures come from the admission assessment and are reliable. The conversation figures depend on where notes are written, which is why the measurement fix matters. Weekly counts are small, so a single family's availability moves the percentage noticeably; the run chart smooths this better than any single week.

What I Am Not Proposing

I am not proposing to lower the target. If the remedies are approved and the rate stays below [75] percent, the final report will say so.

Risks

Accepting notes from several places could count weak conversations. The definition will require three elements: the patient's understanding of their illness, what matters most to them and a plan or next step recorded.

The Log as Bracketed Rows

Week [5]: admissions [9]; screened [8]; positive [4]; conversations [1]. Week [6]: admissions [10]; screened [9]; positive [5]; conversations [2]. Week [7]: admissions [9]; screened [8]; positive [3]; conversations [2].

Effect on Staff

Evening nurses have said the change removed a task at their busiest time. Day nurses report the screen takes about [four] minutes. The social worker says the extra notifications fit into meetings she was already holding, though she has asked for a shared list so she can see which families are still waiting.

Next Steps

Seek approvals this week; apply the definition to all positive screens since week three; continue weekly run charts; report in the final synthesis.

What I Have Learned So Far

A target can fail because the process is weak or because the measure is looking in the wrong place. Checking each missing case by hand showed which was which, and that check took two hours that changed the whole plan (Weissman & Meier, 2011).

Reply

Preceptor: ______ Faculty: ______

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