| Course | NU813 DNP Project Implementation |
|---|---|
| Unit | Unit 6 |
| Paper type | Protocol deviation memo |
| Length | About 790 words, 5 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU813 Unit 6
Any Visit, Not Just Diabetes Visits: A Protocol Deviation Memo Recording the Medical Director's Week 5 Decision to Widen Eligibility for Standing-Order Foot Exams, the Denominator It Changed and How the Project Will Count
[Student Name]
Purdue University Global
NU813: DNP Project Implementation
Unit 6 Protocol Deviation Memo
[Instructor Name]
[Date]
The health center, staff and figures are composite; dates and counts are bracketed.
Memo Header
To: Medical Director; Clinic Manager, Main Clinic; Clinic Manager, Satellite; DNP Project Faculty. From: [Name], DNP Student and Project Lead. Date: [end of week 5]. Subject: Protocol deviation, eligibility for standing-order foot exams.
What Changed
The approved protocol defined an eligible visit as a scheduled follow-up visit for diabetes by an adult on the diabetes registry whose last documented foot exam was more than twelve months earlier. On [Monday of week 5], the medical director instructed both clinics to offer the exam at any visit by such a patient, including same-day acute visits, nurse visits for blood pressure checks and visits for other chronic conditions. The instruction was given at the provider meeting and confirmed by email the same day.
Why It Changed
The medical director's reasoning was that many patients with open care gaps rarely come for scheduled diabetes visits but do come for acute problems, and that waiting for a diabetes visit would leave them unexamined for another year. In the first two weeks, [38] patients with open gaps were seen at acute or nurse visits at the main clinic and were not offered the exam under the original rule. The reasoning is sound, and the change is likely to help patients. It is nevertheless a deviation from the approved protocol and must be recorded as one.
What It Altered
The change alters the denominator. Under the original rule, the main clinic had about [40] eligible visits a week. Under the wider rule, it has about [58]. Because acute and nurse visits are shorter and patients often come for pressing problems, the exam may be declined or skipped more often at those visits, so the share of eligible visits with an exam could fall even as the number of patients examined rises. Comparing coverage before and after [week 5] without accounting for this would mislead.
More patients will be examined under the new rule, and the percentage may still go down, because the denominator grew faster than the numerator.
The Counting Decision
The project will report coverage in two ways from [week 5] onward. The first, protocol coverage, uses the original denominator of scheduled diabetes visits, allowing comparison with weeks three and four and with the plan. The second, expanded coverage, uses the new denominator of all visits by eligible patients. Both will be charted, labeled and explained in every report. The number of unique patients examined, which does not depend on visit type, will be reported as a third figure, since it is closest to what the change was meant to improve. Implementation research distinguishes the reach of an intervention into its eligible population from how faithfully it is delivered (Proctor et al., 2011), and the three figures together show both.
Effect on the Satellite and on Staff
The satellite clinic will launch under the wider rule from its first day, so it will have no protocol-only period. Its reports will therefore show expanded coverage and unique patients, with protocol coverage calculated for comparison with the main clinic. For medical assistants, the change means more exams to offer, including at visits where patients arrive unwell. Assistants have been told that the exam can be deferred when a patient is acutely ill, and that deferral should be recorded in the flowsheet with a reason, so that deferrals can be counted rather than lost among missed exams.
Risks of the Change
The wider rule could crowd acute visits, lengthen rooming or lead assistants to skip the exam without recording why. The project will watch median rooming time at acute visits and the share of eligible acute visits with a recorded deferral. If rooming time at acute visits rises by more than [five] minutes, the rule will be reviewed with the medical director.
Effect on Fidelity Monitoring
Carroll and colleagues treat coverage as part of adherence (Carroll et al., 2007). The fidelity threshold of [75] percent coverage will apply to protocol coverage, as approved. No threshold will be set for expanded coverage during this project, since there is no baseline for it.
Approval and Reporting
The medical director has reviewed this memo and agrees with the counting decision. Faculty have been informed. The deviation will be reported in the final summary, consistent with guidance that improvement reports describe changes made to an intervention during the project and why (Ogrinc et al., 2016).
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
The Purdue Global NU813 Unit 6 instructions
Unit 6 asks you to record a departure from the approved plan together with the decision it forced. Prompts usually want the original protocol language, the change, the date and authority behind it, the reason, its effect on measurement, and how the project will report results from here on. A memo format of two to four pages is common, addressed to the people who need to know. Faculty expect the deviation to be named as one even when the change helps patients, because an approved protocol is the yardstick for every later figure. The strongest memos decide how results will be counted before any new data arrive, so the decision cannot be shaped by what those data turn out to show.
How the NU 813 Unit 6 example is put together
A standard memo header opens the paper, addressed to the medical director, both clinic managers and project faculty. The next section quotes the approved definition of an eligible visit and states the new one, with the date and how it was confirmed. The reasoning follows, including 38 patients with open gaps seen at acute or nurse visits in two weeks. The effect on the denominator is worked through, with a highlighted line on why the percentage may drop. The counting decision commits to three figures. Effects on the satellite and on staff introduce a recorded deferral. Risks, the unchanged fidelity threshold and approval, citing reporting guidance on describing changes to an intervention, close it.
Where the points sit in the NU813 Unit 6 rubric
Protocol deviation memos in this course are generally evaluated on accuracy of the record, analysis of the deviation's effects, soundness of the reporting decision, and professional form. Accuracy rewards quoting the original protocol and stating the change, its date and its authority without ambiguity. Analysis points go to memos that work out what the change does to denominators, comparisons and staff workload. The reporting decision is judged on whether it preserves comparison with the approved plan and was fixed before new data were seen. Professional form covers a correct memo header, a tone suited to leadership and concise sections. Supporting sources, cited in APA 7, earn the remaining credit when they back a specific point.
NU813 Unit 6 help: mistakes that cost points
Weak memos often describe a helpful change as an improvement and never call it a deviation, which leaves later results without a clear yardstick. Others report only the new denominator, so the weeks before and after the change can no longer be compared. A common error is choosing the counting method after looking at the data, or saying nothing about counting at all. Some memos also forget the staff, who now face more exams at visits where patients arrive unwell. Quote the original rule, state the new one, show what it does to the numbers, commit to reporting both figures before new data exist, and give staff a way to record sensible deferrals.
Get an NU813 Unit 6 example written to your instructions
Quote the protocol line you departed from, say what replaced it, who decided and when, and include the Unit 6 prompt with its rubric. Written from that, the memo places old and new text together, resolves how the measure is counted and leaves approval cells for you. A free first custom sample, returned in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU813 papers and DNP samples
- NU813 Unit 1: Implementation Timeline
- NU813 Unit 2: Fidelity Monitoring Plan
- NU813 Unit 3: Status Report
- NU813 Unit 4: Barrier Analysis
- NU813 Unit 5: Discussion Board Post
- NU813 Unit 7: Midpoint Data Report
- NU813 Unit 8: Site Communication Piece
- NU813 Unit 9: Seminar Reflection
- NU813 Unit 10: Implementation Summary
- NU803 Unit 6: Baseline Data Summary
- NU703 Unit 6: Writing Seminar Reflection
- NU800 Unit 6: Framework Selection, COM-B
- NU713 Unit 6: Disparities Analysis, Heart Failure
NU813 Unit 6 questions, answered
Where can I find a free NU813 Unit 6 sample paper?
This page presents the full NU813 Unit 6 protocol deviation memo, from the header and the change through the reasoning, the altered denominator, the three-figure counting decision, staff effects, risks, fidelity and approval, with three references. A deviation memo for your own project can be requested.
What makes a change a protocol deviation in NU813 Unit 6?
Any departure from the approved protocol counts as a deviation for reporting, even when it helps patients. Here the approved text named scheduled diabetes follow-up visits, so offering the exam at acute and nurse visits departs from it and is recorded as such.
Why could coverage fall after eligibility widened?
The denominator grows faster than the numerator. Acute and nurse visits add many eligible visits, but exams are declined or deferred more often there, so the share examined can drop even while the number of patients examined rises.
How does the memo count results after the change?
It reports protocol coverage on the original scheduled-visit denominator, expanded coverage on all visits by eligible patients, and the number of unique patients examined, all labeled in every report, so earlier weeks stay comparable.
Do I need approval for a deviation in a DNP project?
That depends on your program, your site and any review body involved, and those decisions are yours. Many quality improvement projects need documentation only. The sample records the medical director's agreement and notes that faculty were informed.