Assignment: Uncontrolled Hypertension Project-Initiation: Using the Self Monitored BP Device

Assignment: Uncontrolled Hypertension Project-Initiation: Using the Self Monitored BP Device

Assignment: Uncontrolled Hypertension Project-Initiation: Using the Self Monitored BP Device

Assignment: Developing a Small Nursing Informatics Project for Your Organization, Part 1(UNCONTROL HYPERTENSION)
You will use project management tools and strategies to propose how you would support and potentially implement a small nursing informatics project. While you may not have the opportunity to implement this proposed project, this project will allow you to apply the skills needed and the considerations that are required in deducing how a project of this scope might take place in your nursing practice. To complete this project, you will define a small informatics project that would be beneficial to your healthcare organization or nursing practice. You can discuss this with upper leadership, in your practice or organization, explaining that you will need to design, plan, and propose how to implement and evaluate a small informatics project that can be completed within a 9-week time frame during this course. This project will be completed in two parts.

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TO PREPARE: Addressed each of the bullets with a subtopic, all the references used must have an in-text citation in each paragraph. All Articles MUST BE PEER REVIEWED ARTICLES THAT MUST BE USED AND should come from USA and must be within last four years only that is from 2018 to 2022. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations)

ANSWER ALL THESE BULLET QUESTIONS BELOW WITH A SUBTOPIC

• The introduction and the purpose of this paper should be clear, comprehensive, and well elaborated AND ADDRESSES ALL THE MAIN POINTS OF THE PAPER that is about UNCONTROL HYPERTENSION PROJECT INITIATION: USING THE SELF- MONITOR BLOOD PRESSURE DEVICE at my community health clinic

• Identify and initiate a conversation with a chief medical officer (CMO) at my community health clinic.
• Discuss what you will need to develop Scope and Charter Documents.
• Conduct a SWOT analysis which will provide information for the Scope and Charter. You can use a Word document and insert a table. Overall, the first step for any project, work, or your dissertation, requires a plan: what you will and will not do. That information is defined in a charter and scope.
• Create a visual using the Gap Analysis map of the identified gap, documenting the flow from the point of origin to the destination.
• Identify the gap and analyze the flow or lack of flow of information as the gap in a process. The visual map will include the flow from the point of origin to the destination.
• Create a Work Breakdown Structure (WBS) using PowerPoint slides or another method. Be sure to review the media piece, What Is a Work Breakdown Structure?
• Create a Project Timeline Gantt chart, which defines who is responsible, due dates to start /finish activities. You can find an example on pp. 95–96 of your text, using PowerPoint slides, or another method. Be sure to review the Gantt Charts, Simplified media piece (WILL BE DOWNLOADED TO YOU)
• RACI (responsibility chart) which outlines who will be responsible for which tasks, if working with a team.
• Communication plan – Include documentation of all communications, status reports, changes made, and next steps
• Change management plan – Document all changes as they occur (e.g., meetings moved, revisions of drafts of project, due dates moved due to changes, changes in scope of project, change in team members). An example can be found in the Sipes text on page 106, 108, 138 and on pages 156–157.
• Risk management plan– “Risk Analysis How to Analyze Risks on Your Project,” document the impact of COVID-19 on current processes and potential for change. Be sure to also document how risk may be mitigated if possible. An example can be found in the Sipes text on pages 103–105.
Include a description and application to practice for each of the tools you developed. Include the rationale in your submission. Address the following:
• How and why it was developed and its function (all activities will be identified in the WBS)
• How it will be applied to your project? Is it new technology?
• Who was involved in changes and what are their responsibilities? (This is the stakeholders( THE STAKEHOLDERS; NURSES, NURSE PRACTITIONERS(NPs), chief medical officer(CFO), Medical doctors, IT specialist), leadership(chief Medical director(CMF), end users(Patients) – (use the RACI chart)
• In what way has this changed with the onset of the pandemic, if at all? This might be the gap analysis, change management plan. What were the changes?
• Are health information system/application upgrades scheduled or planned? Why or why not?
• Conclusion should be clear, precise, well elaborated and summarizes the entire paper.(NB HALF A PAGE)
•
• PLEASE THIS TEXTBOOK BELOW MUST BE USED, PLUS EIGHT ARTICLES OR MORE peer reviewed articles that will address all the bullet points above
• Also all the EIGHT or more articles which is peer reviewed must be from 2018 to 2022 published
Sipes, C. (2020) Project management for the advanced practice nurse (2nd ed.). Springer Publishing.

• NB: GANTT CHART ON PAGE 95-96 WILL BE DOWNLOADED TO YOUR WEBSITE
• NB: WILL SEND THE POWERPOINT THAT DETAIL THE HYPERTENSION INITIATIVE

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A Change Initiative to Start Using Self-Monitored Blood Pressure Devices in Clinic Patients with Recalcitrant Uncontrolled Hypertension 

            This change project is taking place in a setting at the community level. The community health clinic is a primary care facility serving an underserved marginalized community of minorities that suffer primarily from lifestyle diseases such as obesity and hypertension. Advanced practice nurses (APNs) by default find themselves filling up the clinician gap that exists at these grassroots primary care facilities since physician numbers are not enough to cater for everyone. Currently, evidence-based practice or EBP is the gold standard for providing care in all healthcare settings. What this means is that any interventions that the APN will use must be anchored on research evidence for efficacy. In other words, the intervention must indeed bring out the outcome that it is expected to bring. In the community health clinic in question, one particular problem has been identified relating to the management of the patients with hypertension. This is the clinical practice gap that needs to be filled. Despite implementation of the use of different medications and lifestyle changes like exercise and diet, it has been determined that these patients are still showing high readings of blood pressure when they come for review (Unruh & Hofler, 2016). The envisaged solution has been determined through clinical inquiry to be the use of a self-monitored blood pressure device that the patient will have with them at all times at home (Twa, 2016). Implementation of this nursing informatics change will involve multiple stakeholders and will adopt a systems approach (Mosier et al., 2019). The purpose of this change paper is to address the implementation of the nursing informatics initiative of using a self-monitored blood pressure device in the home setting.

An Interview with a Colleague (Chief Medical Officer) at the Community Health Clinic

            To get more insight into the nature of the practice gap that seems to exist in the management of the patients with hypertension, it was deemed necessary to interview one of the colleagues at the community health center who is also a clinician. This is the only medical officer working at the clinic whose input and insight would be very welcome given that he has worked at the clinic for a prolonged period of time. What he drew was the confounding contribution that comorbid conditions in these patients have on the management of the hypertension. He particularly singled out type II diabetes and obesity/ overweight as the main culprits (Najafipour et al., 2017). As long as these two comorbidities were still unmanaged, the problem of stubborn high blood pressures would still be witnessed at the clinic. This was his insight which was appreciated.

            According to MacDonald and Pescatello (2018), the prescription of exercise for the management of hypertension is an evidence-based practice or EBP. At this articular community health clinic, this is a practice that is part of the routine clinical practices. However, the fact that high blood pressures are still being witnessed suggests that this intervention is not having the effect that it should be having. Further investigations and consultations however revealed that indeed the hypertensive patients were sticking to their exercise regime and being compliant. That left what happens at home after exercise, medication, and dietary measures as the only grey area to be investigated. Soon it was determined by the quality improvement team that there were gaps in the determination of blood pressure readings when the patients were at home. Unfortunately this was the longest time and therefore it would be appropriate to know what these blood pressure readings are before these patients return to the clinic for review. This is what the focus of this change initiative is going to be about.

Requirements for the Development of the Scope and Charter Documents

            All project managers are aware that projects have set deadlines and budgets that must be stuck to in order for them to be finished successfully. According to Sipes (2020), at the project’s beginning phase, there is normally a project scope statement and a project charter that both describe the project’s purpose as well as its goals and objectives. The project scope statement is the document that will define the project’s boundaries, and it will have a direct impact on the timeframe and resources needed to accomplish the project on schedule and within budget.

            As for the project charter, it is a brief document that provides the necessary authority for the project to go on. It identifies the project manager as well as the project sponsor, and it is typically signed by the company’s top management (Sipes, 2020). The project charter is distributed to the executive directors as well as the departments that will be participating in the project implementation. To effectively develop the project scope and charter documents, the following will be required (Sipes, 2020):  

• Clear designation of the project manager who in this case will be the DNP-prepared APN practicing at the same community health clinic.
• Clear objectives and SMART goals of the project
• A description of the project sponsor and their contribution
• The fiscal, material, and human resources that will be needed for successful completion
• The duration of the project
• A list of the members of the EBP implementation team
• Signed authorization from the organization’s executives giving the project the green light to proceed.

The Project’s SWOT Analysis

            If the project is to have any possibility of success, the project manager must plan strategically and be forward looking. The SWOT analysis undertaken by the project manager and her team is one of the strategic planning techniques. Wang (2019) posits that the SWOT analysis aims to identify the project’s strengths and weaknesses, as well as potential future opportunities and threats. This nursing informatics project falls under the category of data analytics. Analytics requires that a thorough SWOT analysis be performed to determine the issues that will influence the project during and after implementation proper.

            Looking at this project, it has strengths that stand out. An example is the fact that the community health clinic has some of the most experienced DNP-prepared clinicians one can get (McCauley et al., 2020). The other is that the organization’s Board of Directors is in on the change project and is willing to release fiscal resources to bankroll the initiative. The strengths, weaknesses, opportunities, and threats for this project are outlined in the table below.

Table 1

SWOT analysis for the self-monitored blood pressure device (SMBPD) change initiative

Strengths o   Enough money has been allocated by the organization’s executives to cover the budget of the project o   There are DNP-prepared nurses and a physician meaning that the human resources aspect is well covered o   The clinic has a high number of patients coming from the community and so it will not be difficult to get the sample of participants required o   The eClinicalWorks is compatible with the Welch Allyn BP monitoring device. The Healow application also has access to its home BP readings. o   The HealthSnap BP monitoring device has both wifi and Bluetooth and is interfaceable with a smartphone. Home BP readings can be accessed in the HealthSnap portal.

Opportunities o   The effectiveness of this home BP monitoring program employing the two gadgets tested will usher in a new age of highly successful telehealth services for elderly and feeble patients who are unable to travel to a facility on a regular basis. o   Future quality improvement (QI) projects on PB management will be easier to implement thanks to the outcome metrics tracked by the electronic health record (EHR) system or eClinicalWorks.

Weaknesses o   The subjects will require training on how to use the home blood pressure monitoring devices, which will incur additional costs and time. o   A nurse informaticist will be required to give technical competence from a nursing and medical standpoint.

Threats o   Unwanted third-party database access and penetration endangers patient confidentiality and data security. o   Technological obsolescence indicates that this technology will need to be upgraded in a few years, posing a danger to the company’s revenues and bottom line.

A Gap Analysis and Gap Analysis Map for the Identified Clinical Practice Gap

            The gap analysis employed for this change initiative uses a five-step model (Durdag, 2021). A gap analysis is a tool just like a SWOT analysis and they are both aimed at helping fix a problem going into the future. In other words, they are both strategic tools in nature. By using this gap analysis, the nature of the practice deficit will be easier to see and comprehend. This then helps with the efficient and effective implementation of the EBP intervention; which in this case is the nursing informatics change of using self-monitored blood pressure devices.

            To begin the gap analysis, current practice is taken into account. For this initiative, the current practice involves treating hypertension with lifestyle modalities (diet and exercise) as well as medications to complement these two if they are not effective on their own. Step number two involves the ideal state of affairs the way everyone would like it to be. In this case, it is the state of having controlled blood pressure for all the patients with only the occasional high reading once in a while. This step also involves the determination of the evidence-based intervention that will be used to achieve this desired state. In this instance it is the use of the SMBPDs.       

            Discerning the nature of the gap that is being dealt with is the third step in this gap analysis. In this case, it involves what happens with the patient’s BP readings once they are back home. Here it is clear that no one knows what these readings are until the day that they come back again for review. The preparation of a plan to accomplish the desired results or goal is the fourth phase. The goal of this project is to provide patients with a self-monitored blood pressure gadget so they can monitor their blood pressure at home. This manner, if it is found to be raised, they can seek advice from the physician without having to wait until the next appointment. Finally, the fifth stage entails evaluating and tracking the blood pressure measurements’ progress.  

Figure 1

Conceptual map for gap analysis

            By designing a conceptual map of the gap analysis as above, it is easier to visualize and understand the process through which the impending change will be implemented. The conceptual map highlights the relationships and connections that exist between principles and theories. When a conceptual gap analysis map is added to this narrative, it gets simpler and easier to comprehend, and the heart of the program gets simpler.

The Program Work Breakdown Structure or WBS

            The work breakdown structure (WBS) is a visual representation of how a program can be disassembled and subdivided. It is a hierarchical tool that the project manager uses to indicate the project scope and tasks, as well as who’s responsible for what and when (Sipes, 2020). The project manager can utilize the EBS to create a Gantt chart or identify a task’s critical route. A WBS breaks a project into smaller tasks and must be completed before a Gantt chart can be created; since it is the tasks in it that will inform the contents of the Gantt chart. For this particular change initiative, the WBS will look somewhat like the one below.

Figure 2

The phase-based work breakdown structure (WBS) for SMBPDs

Timeline Gantt Chart

Table 2

The project timeline Gantt chart

Task Number	Task Name	Task Duration
1	Project initiation	10 days
1.1	Development of carter	3 days
1.2	Assigning a project manager	3 days
2.1	Define scope	1 days
2.2	Develop schedule	2 days
2.3	Determine cost	6 days
2.4	Assemble project team members	7 days
3.1	Sampling	1 months
3.2	Piloting	2 months
3.3	Implementation	6 months
4	Monitoring	6 months
5	Project closure and handover	1 month

RACI

Table 3

The project responsibility matrix: RACI

PROJECT TASK/ ACTIVITIES	PM/OWNER OF TASK = P = PAUL	APPROVE ACCOUNTABLE/ SIGN-OFF = V = VALERIE	CONSULTED RE: WORK PRODUCT = A = ALEX	INFORMED/ NOTIFIED OF RESULTS = M = MARY
Develop scope	P	V	P	V
Develop charter	M	V	A	M
Team selection	V	I	A	M
Communication plan	V	I	A	M
Risk plan	P	I	A	M
Change control plan	P	M	A	P
Status meetings (twice weekly)	A	C	V	A

The Project Communication Plan 

            Weekly meetings will be held face-to-face and chaired by the project manager as part of the communication strategy. There will also be email communication on matters of the project that will be exchanged with each team member. Another level of communication will be added as a result of this. Airtime will be available for mobile phones, which will be used substantially. For reference in the future, all conversation will be logged and recorded. The nurse informaticist is the custodian of electronic patient information (Sweeney, 2017). She is also responsible for its proper storage and compliance. This is according to the Health Information Portability and Accountability Act (HIPAA) on matters confidentiality and security.

The Project Change Management Plan

            The change management plan will be guided by a suitable change model. In this case this will be the Rogers’ Diffusion of Innovations (DOI) model (Dearing & Cox, 2018). This will ensure that the implementation is scientific and systematic. All adjustments will be recorded when they happen. Minutes will be taken at meetings, for example. Any modifications in delivery deadlines will be documented, and a contingency plan will be implemented in the event of a delay.

  The Project Risk Management Plan

            The concept of risk management refers to the process of instituting measures to prevent adverse outcomes from derailing a project. A befitting example is the Covid-19 pandemic that has left such a great impact on businesses and organizations. The pandemic elicited many of the preventive measures like quarantine, wearing masks, and washing hands. In the event that part of the devices or the electronic platform as a whole fails, there are other backup processes in place. In the event of unforeseen failures or incidents, data is preserved in the cloud as a fall back.

            It is obvious that this project does not use any new technology; instead, it makes use of one that already exists. It was created with the help of vendors, a nurse informaticist, and a system developer. With the commencement of the pandemic, there was little change, but changes had to be made. Upgrades and updates are planned, and according to the contract, the vendor will provide after-sales servicing and technical advice for up to a year.

Conclusion

            Clinical practice must change in response to new knowledge that emerges every day, according to EBP. A clinical issue that has been observed in this case is uncontrolled blood pressure among patients seen at the local community health clinic. The blood pressure levels have remained continuously high despite lifestyle changes and medications. Following a thorough review of the facts, it was determined that using self-monitored blood pressure machines at home would be the best solution to the problem. This entire study has been dedicated to the task of putting these machines to work in the real world.

References

Dearing, J.W. & Cox, J.G. (2018). Diffusion of innovations theory, principles, and practice. Health Affairs, 37(2), 183-190. http://dx.doi.org/10.1377/hlthaff.2017.1104

Durdag, Y. (2021). Gap analysis: 5-step framework guide and template. https://www.grow-force.com/gap-analysis-template/

MacDonald, H.V. & Pescatello, L.S. (2018). Exercise prescription for hypertension: New advances for optimizing blood pressure benefits. Lifestyle in Heart Health and Disease, 115-136. https://doi.org/10.1016/B978-0-12-811279-3.00009-4

McCauley, L.A., Broome, M.E., Frazier, L., Hayes, R., Kurth, A., Musil, C.M., Norman, L.D., Rideout, K.H., & Villarruel, A.M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track. Nursing Outlook, 68(4), 494-503. https://doi.org/10.1016/j.outlook.2020.03.008

Mosier, S., Roberts, D., & Englebright, J. (2019). A systems-level method for developing nursing informatics solutions. The Journal of Nursing Administration (JONA) 49(11), 543-548. https://doi.org/10.1097/NNA.0000000000000815

Najafipour, F., Mobasseri, M., Yavari, A., Nadrian, H., Aliasgarzadeh, A., Abbasi, N.M, Niafar, M., Gharamaleki, J.H., & Sadra, V. (2017). Effect of regular exercise training on changes in HbA1c, BMI and VO₂ max among patients with type 2 diabetes mellitus: An 8-year trial. BMJ Open Diabetes Research & Care, 5(1), 1-8. http://dx.doi.org/10.1136/bmjdrc-2017-000414 

Sipes, C. (2020). Project management for the advanced practice nurse, 2^nd ed. Springer Publishing Company.

Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics (OJNI), 21(1). https://www.himss.org/library/healthcare-informatics

Twa, M.D. (2016). Evidence-based clinical practice: Asking focused questions (PICO). Optometry and Vision Science, 93(10), 1187–1188. https://doi.org/10.1097/OPX.0000000000001006

Unruh, L., & Hofler, R. (2016). Predictors of gaps in patient safety and quality in U.S. hospitals. Health Services Research, 51(6), 2258-2281. https://doi.org/10.1111/1475-6773.12468

Wang, C. (2019). The strengths, weaknesses, opportunities, and threats analysis of big data analytics in healthcare. International Journal of Big Data and Analytics in Healthcare, 4(1), 1–14. https://doi.org/10.4018/ijbdah.2019010101