NU712 Unit 10 QI Sustainability Plan Example

After the Student Leaves: A Unit 10 Sustainability Plan That Keeps an Insulin Discharge Bundle Working and Changing

[Student Name]

Purdue University Global

NU712: Quality Improvement and Interprofessional Collaboration for the Doctoral Nurse

Unit 10 Sustainability Plan

[Instructor Name]

[Date]

The hospital, units, scores and people are composite and illustrative; the frameworks, tool and studies cited are real.

Why Sustainment Needs Its Own Plan

Improvements often fade once the people who drove them move on. Wiltsey Stirman et al. (2012), pooling 125 studies that followed new programs past their launch, found that many did not define sustainability at all, about half relied on self-report and, among the few that measured it rigorously, only a small number reported full sustainment; partial continuation was common. A bundle with five components is especially exposed to partial continuation. The pen might still go home early while the check-in quietly stops, and the overall rate would erode without anyone deciding to drop anything.

Assessing Capacity Now

Malone et al. (2021) developed the Clinical Sustainability Assessment Tool from concept mapping with clinicians and researchers and tested it with 286 clinicians. Its 35 items cover seven areas: whether staff and leaders are engaged, whether stakeholders beyond the unit are, how ready the organization is, how well the practice fits daily work, how staff were trained to deliver it, whether its results are tracked and whether it is shown to work. Items are rated from 1, little or no extent, to 7, a great extent.

Twenty-six staff on 5 West and 6 West completed the tool in the bundle's thirteenth month. Domain means were highest for engaged staff and leadership, 5.8, and outcomes and effectiveness, 5.6. They were lowest for monitoring and evaluation, 3.9, and organizational readiness, 4.1, with workflow integration in between at 4.7. Comments explained the low scores: staff knew the DNP student tracked the numbers but did not know who would after the project, and two nurses wrote that the bundle "lives in one person's spreadsheet."

A bundle that lives in one person's spreadsheet ends when that person's course ends.

Owners for Every Part

The first step is to move every part of the bundle from the project to a permanent owner, so that nothing depends on the student.

Supervised self-injection and the written plan. Owner: the unit nurse educators, through annual competency validation for all medical-surgical nurses and orientation for new hires.

Pen by the first insulin day. Owner: the pharmacy department, through the discharge prescription check that now includes pen type and needle size, and the prior authorization step started at the first insulin order.

Follow-up by day three. Owner: the diabetes education service, through the text follow-up queue, with a written coverage plan for the educator's absences.

Class seat or virtual class. Owner: outpatient diabetes education, which already reports class attendance to the ambulatory leadership.

Readiness flag and dashboard. Owner: the quality department, which adds the bundle's measures to the monthly nursing quality report and stratifies them by payer, age group and distance.

Building the Bundle Into Routine Systems

Ownership alone fades when owners change. The plan therefore puts each part into a system that runs without anyone remembering it. The bundle becomes a nursing policy, reviewed every two years like every other policy. Its components become required fields in the discharge navigator, so the record will not complete a discharge on new insulin until the readiness flag is answered. The insulin order set carries the pharmacy prior authorization prompt. Annual competencies include the supervised injection. The text follow-up runs on the hospital's existing messaging contract, budgeted in the diabetes service's operating budget rather than in a grant.

Planning for Change, Not Stillness

The traditional view treats sustainment as keeping an intervention exactly as it was tested and expects benefits to fall as it moves away from the original. Chambers et al. (2013) challenge both assumptions. Their dynamic sustainability framework expects interventions to keep being refined through continued learning and problem solving, with attention to how well the intervention fits a changing practice setting and its wider context, and it looks for improvement over time rather than decline.

The bundle's setting will change. New insulin products will reach the formulary; payer rules for pens will change; a new version of the electronic record is planned for 2028; the hospital may add a virtual nursing service. A bundle frozen at its 2026 form would fit less well each year. The plan therefore separates the bundle's core functions, which stay, from its forms, which may change.

Core functions. The patient performs an injection with supervision before discharge; the patient leaves with a plan in plain language; the patient has the device and supplies in hand; someone checks on the patient within three days; the patient is connected to ongoing education.

Adaptable forms. Which device is taught, how the plan is written, whether follow-up is a text, a call or a video visit and whether education is a class or a virtual session.

Any unit may change a form through a PDSA cycle reported to the bundle review; a change to a core function requires the nursing quality committee.

Monitoring and Triggers

Because monitoring and evaluation scored lowest, it gets the most detailed plan. The quality department will report the all-components measure and the 30-day return rate monthly to each unit council, and quarterly by payer group to the nursing quality committee. Three triggers prompt action. If the all-components rate on a unit stays under 80 percent for two months running, the unit champion and educator review ten charts within a month. If the return rate rises above 12 percent for a quarter, the committee reviews the bundle's delivery and the population served. If any payer group's all-components rate falls ten points below the hospital rate, the pharmacist and educator review the access steps.

Handoff Timeline

In NU804, the quality analyst begins producing the dashboard in parallel with the student. In NU806, the analyst takes over production while the student checks it. One month after the project ends, the CSAT will be repeated on the pilot units and the first spread units. Targets for the second assessment are 5.0 or higher for monitoring and evaluation and for organizational readiness. A one-year review of the bundle's measures will be presented to the chief nursing officer by the nursing quality committee chair, not by the student.

Risks to Sustainment

Educator turnover is the largest risk, since one person holds much of the knowledge; the plan requires a second trained educator from the outpatient service. Budget pressure could cut the messaging contract; the business case from the leadership course, updated with the bundle's results, goes to finance with each budget cycle. Policy fatigue could reduce the bundle to a checkbox; the bundle review and the transition questions keep attention on whether patients are actually ready.

Conclusion

The bundle's first year depended on a student who watched every number. Sustaining it means giving each part an owner, embedding each part in policy, records, competencies and budgets and fixing the weakest domains the CSAT found, monitoring and readiness. It also means accepting that the bundle will change. Keeping its five core functions while letting units adapt the forms, with triggers that call for review, is how the hospital can keep the bundle working long after the DNP project ends.

References

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8, 117. https://doi.org/10.1186/1748-5908-8-117

Malone, S., Prewitt, K., Hackett, R., Lin, J. C., McKay, V., Walsh-Bailey, C., & Luke, D. A. (2021). The Clinical Sustainability Assessment Tool: Measuring organizational capacity to promote sustainability in healthcare. Implementation Science Communications, 2(1), 77. https://doi.org/10.1186/s43058-021-00181-2

Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, 17. https://doi.org/10.1186/1748-5908-7-17