NU803 Unit 10 Sustainability Plan, Resource Nurse Example

Four Hours a Month, Still Only Requested: A Sustainability Plan Handing a Steroid Hyperglycemia Routine on Two Composite Medical Units to a Diabetes Resource Nurse, With Routines Built Into Documents Staff Already Use

[Student Name]

Purdue University Global

NU803: Change Management and Clinical Data Analysis

Unit 10 Sustainability Plan

[Instructor Name]

[Date]

The units, roles and figures are composite; hours, dates and thresholds are bracketed.

What Must Be Sustained

Three things must continue after the project ends: afternoon checks for patients on qualifying steroids, at or above [80] percent of eligible days at each check time; escalation of qualifying episodes with a scheduled insulin response in at least [70] percent; and hyperglycemic monitored days at or below the implementation median of [15.5] per 100. Low-glucose days must stay near the baseline of about [1.1] per 100.

Why Sustainability Needs Its Own Plan

Improvements in clinical practice often fade after implementation support ends. A systematic review of clinicians' adherence to guidelines over time found that adherence frequently declined, and that sustained adherence was associated with factors including integration of the practice into routines, ongoing monitoring and feedback, and the continued involvement of people responsible for it (Ament et al., 2015). A review that developed a definition of sustainability treated it as more than keeping a program running: the program or its parts continue after implementation support ends, the behavior change persists, benefits keep flowing, and adaptation along the way is expected (Moore et al., 2017). These units have already seen what happens without such a plan: a memo adding afternoon checks four years ago faded within six weeks.

Principle 1: Put the Routine Where Work Already Happens

Every part of the routine will live in a document staff already use rather than in a new one. The order-set trigger already generates checks automatically, and informatics has agreed to extend it to the cancer-care and emergency admission order sets by [month]. The technicians' daily assignment sheet now prints steroid-triggered checks with their times beside diabetic checks, so the sheet itself tells technicians what to do. The escalation script is embedded in the paging template. The lunch-wave timing agreed in implementation is written into the unit's break schedule, signed by both nurse managers. Nothing depends on a poster or a memo.

A routine written into the assignment sheet survives staff turnover; a routine written into a memo survives only as long as someone remembers the memo.

Principle 2: Give the Routine an Owner

The change agent, a DNP student on the hospitalist team, will step back at the end of the project. Ownership will pass to a day-shift diabetes resource nurse on 4 North, who has agreed to serve and who already answers colleagues' questions about insulin. The role needs [four] protected hours a month to review the monthly data, audit a sample of escalations and bring problems to the nurse managers. Those hours have been requested in the next budget cycle but not yet approved. If they are not approved, the fallback is to fold the review into the clinical nurse specialist's existing monthly quality time, which would work but with less attention.

Principle 3: Keep the Data Moving Without Extra Work

The point-of-care testing coordinator already sends a monthly glucometer report to nursing leadership. The plan adds three lines to that report: afternoon check completion by check time, hyperglycemic monitored days per 100 and low-glucose days per 100. The script that produced the project's figures will be handed to the coordinator, who will run it monthly. Run charts will continue on the huddle board, updated monthly rather than weekly.

Triggers for Action

The diabetes resource nurse will act when any of four conditions appears. Afternoon checks fall below [70] percent for two consecutive months at either time. Hyperglycemic monitored days rise above the implementation median for three consecutive months. Low-glucose days exceed [3] per 100 in any month. Or the trigger coverage measure shows a qualifying order route without checks. Each trigger leads to a named action: a huddle review with technicians, an audit of escalations with the hospitalist director, a pharmacy review of NPH suggestions, or an informatics ticket.

Principle 4: Anchor the Change in the Culture

Kotter argued that changes last when they become "the way we do things around here," and that leaders must show people how the new approaches have improved performance (Kotter, 1995). The monthly run chart on the huddle board does that, and the units' quarterly recognition will include a mention of the steroid glucose routine when targets are met. New staff will learn the routine in orientation, where it has been added to the glucose management module.

Spread

The community hospital's medical unit has asked about the bundle. Spread will begin only after [six] months of sustained results on 4 North and 4 South, and will use the same documents, adapted to that hospital's order sets.

Timeline

Handover of ownership: week [14]. First monthly report with added lines: month [four]. Review of the sustainability plan by the nurse managers: month [nine]. Decision on spread: month [ten].

References

Ament, S. M. C., de Groot, J. J. A., Maessen, J. M. C., Dirksen, C. D., van der Weijden, T., & Kleijnen, J. (2015). Sustainability of professionals' adherence to clinical practice guidelines in medical care: A systematic review. BMJ Open, 5(12), Article e008073. https://doi.org/10.1136/bmjopen-2015-008073

Kotter, J. P. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73(2), 59-67.

Moore, J. E., Mascarenhas, A., Bain, J., & Straus, S. E. (2017). Developing a comprehensive definition of sustainability. Implementation Science, 12, Article 110. https://doi.org/10.1186/s13012-017-0637-1