NU813 Unit 3 Status Report Example

Seventy-One of 118, and a Box Still Taped Shut: A Status Report Three Weeks After Standing-Order Diabetic Foot Exams Began at a Composite Community Health Center's Main Clinic

[Student Name]

Purdue University Global

NU813: DNP Project Implementation

Unit 3 Status Report

[Instructor Name]

[Date]

The health center, clinics and figures are composite; counts and dates are bracketed.

Where the Project Stands Against the Timeline

The main clinic launched as planned in [week 3]. The standing order was approved by the board quality committee in [week minus 2], the flowsheet went live in [week minus 1], and training was completed for [11] of [12] medical assistants; the twelfth, on leave, will be trained on return. The referral agreement with the podiatry practice was signed [three] days before launch.

The satellite clinic has not launched. Its [six] monofilaments and tuning forks were backordered by the supplier and are now expected in [week 6], a week after the planned launch. Training at the satellite was completed on schedule, so the site can start as soon as the equipment arrives.

Screening at the Main Clinic

In the first three weeks, [118] visits were made by adults with diabetes who had an open foot-exam care gap. A completed foot exam was recorded in the flowsheet at [71] of them, [60] percent. By week, the figures were [19] of [37], [24] of [40] and [28] of [41], rising each week. [Six] patients declined, most often because of time or difficulty removing footwear. In the remaining visits the exam was not offered, usually because the flag was missed at huddle or the patient was roomed by a float assistant.

Fidelity

Content adherence, the share of completed flowsheets with every required element, was [84] percent, below the [90] percent threshold. The element most often missing was vibration testing with the tuning fork. The nurse educator observed [28] exams; monofilament technique was correct in [26]. Median added rooming time was [3.5] minutes.

Carroll and colleagues' framework treats content and coverage as parts of adherence and quality of delivery as a moderator (Carroll et al., 2007); on those terms, coverage is rising, content is close to target but short, and quality is good.

Early Findings, Without Conclusions

Of the [71] patients examined, [9] were classified by providers as high risk, with loss of protective sensation, deformity or a history of ulcer. Referrals were placed for [7]; the other [2] already see a podiatrist. None has yet reached the [30]-day point for measuring whether they were seen. [Two] patients had an active foot problem found at the exam, a callus with bleeding beneath it and a nail infection, and were treated the same day.

Two patients had foot problems found and treated that day, which matters to them and proves nothing yet about the project.

These early findings are reported as counts. Implementation outcomes such as adoption and fidelity can be tracked early, while effects on patients take longer (Proctor et al., 2011), and guidance for reporting improvement work cautions that early results should be described with their context and without overstating what they show (Ogrinc et al., 2016), and three weeks at one clinic is far too little to judge whether the project changes foot outcomes.

What Has Already Shifted

Three things have changed from the plan. The satellite launch will be at least a week late. The tuning fork element is being missed often enough that the nurse educator will review vibration testing at the next huddle. And float assistants, who were not in the training plan, room patients on about [one] day in five; they will be added to training. None of these changes the design.

Issues Log

Four issues were logged in the first three weeks, each with an owner and a status. First, the care-gap flag did not appear on the huddle sheet for patients seen as walk-ins; informatics is adding walk-ins to the report, due [week 5]. Second, two exam rooms lacked a chair low enough for patients to reach their feet comfortably; operations ordered step stools, which have arrived. Third, one provider asked assistants to skip the exam for patients over [80]; the medical director clarified that the standing order applies to all adults with diabetes, and the provider agreed. Fourth, the podiatry practice's first return report arrived by fax rather than through the electronic referral system; the practice has been asked to use the system, and in the meantime the clinic manager scans faxed reports into the chart.

Supplies and Costs to Date

Spending is on plan. Monofilaments and tuning forks for the main clinic cost $[616], and the satellite's order of $[231] will be charged on delivery. Training used [22] paid staff hours. Informatics time for the flowsheet was absorbed within the department's work, as agreed. No additional costs are expected before the midpoint.

Next Two Weeks

Satellite launch when equipment arrives; tuning fork review at the main clinic; training for float assistants; the first [30]-day checks on referrals. The next report is due at the end of [week 6].

References

Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, Article 40. https://doi.org/10.1186/1748-5908-2-40

Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2016). SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. BMJ Quality & Safety, 25(12), 986-992. https://doi.org/10.1136/bmjqs-2015-004411

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7