The Force Field Analysis Essay Paper

The Force Field Analysis Essay Paper

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The Force Field Analysis (FFA) Paper provides strategic project planning to evaluate the Driving and Restraining Forces that influence project implementation and Recommendations to Minimize the Restraining Forces. This results in an adjustment of the project and is summarized within the conclusion of the paper. The FFA analysis is a narrative paper (and includes the FFA Model), no longer than 4 pages (excluding title page & and the table appendix)The Force Field Analysis Essay Paper.

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Introduction

This Force Field Analysis (FFA) paper conducts a critical evaluation of the main driving and restraining forces that influenced the project implementation process and provides evidence-based recommendations to minimize the restraining forces. The project was implemented at Mt. Sinai West, a full-service medical center with a 24/7 Emergency Department (ED), situated in New York, the United States.  The main purpose of the project was to reduce unnecessary ED visits and unplanned hospital admissions among cancer patients through implementation of an evidence-based high-risk patient management HEART (High ED/Admission Risk Therapy) team protocol for adult oncology patients receiving multimodal cancer therapy at the identified organization. The main goal of the project included: to employ the HEART protocol for enhancing the capacity of the multi-disciplinary team to enhance the capacity of the emergency department at the facility to employ evidence-based recommendations for reducing potentially-avoidable ED visits and hospitalizations by 20% amongst patients receiving multimodal cancer therapy. With regards to objectives, the DNP project was implemented with the core intention of ensuring improvements in nurse recognition and early detection of risk factors for unplanned ED visits in adult oncology patients receiving multimodal cancer therapy and achieving improvements in the nurse knowledge of high-risk patient assessment and symptom management. In relation to the measurable outcomes, strong emphasis was placed on ensuring increased staff understanding of cancer-related high-risk adverse effects; a 20% reduction in ED visits for patients receiving multimodal cancer therapy; earlier detection and management of oncologic complications; reduced the financial burden associated with ED visits for patients and agency; close monitoring of high-risk patients; and the establishment of clear practice guidelines on managing cancer treatment-related adverse effects.

An Overview of Force Field Analysis

Initially introduced by Kurt Lewin, Force Field Analysis is a widely applied problem-solving technique for identification and analysis of the driving (positive or facilitating forces) and restraining (negative or resisting forces) factors with the core intention of enabling a positive change (Shafaghat et al., 2021; Hussein et al., 2022l; Mak & Chang, 2019). Assigning of weight to each of the identified problem is highly instrumental in determining or measuring the perceived impact, and planning for clear interventions to either strengthen or weaken the specified forces in the context of change management planning (Gaivoronskaya et al., 2021;

Astafeva et al., 2021). Similarly, the quantifying the forces and visually representing their respective strengths forms the basis on each to think and act on the problem situation with the core aim of analyzing the problems and identifying working solutions (Gałązka-Sobotka et al., 2020; Farh et al., 2020; Cordell & Thompson, 2019). The next part of this narrative text shall identify those forces that affected the implementation of the HEART Team protocol at Mount Sinai West.

Driving and Restraining Forces

During implementation of the DNP project, a myriad of inhibiting and inducing forces came into play. As shown in appendix 1, the cards that indicate the key driving factors are placed above the line whilst those on restraining forces are kept below. Each of the identified forces as assigned a score through the placement of a numerical number to denote the extent of the effects of each of the force on the actual implementation of the High ED/Admission Risk Therapy (HEART) team protocol. The maximum score for a given force was 5. Clear depiction of the various problems and the use of a score allowed those involved in the actual implementation of the project to gain a better understanding of the specific forces and to actively participate in the force field analysis.

Implementation of the HEART Team protocol

As can be seen in appendix 1, based on the scoring, “nursing staff training”, “reduction in ED visits for patients with receiving multimodal cancer therapy”, “early detection and management on cancer treatment-related adverse effects”, and “ensuring close monitoring of high-risk patients (score=5) and “providing assistance by supporting the multi-disciplinary oncology team”, “establishing practice guidance on managing treatment-related adverse effects”  and “reducing unnecessary ED visits and unplanned hospitalizations” and “reducing ED visits related financial burden for patients and agency” (score=4). The total score for the first category of driving and restraining forces was 32. On the other hand, the restraining forces with high strength included “inadequate training of staff”, “not enough understanding of the need for SCP”, “lack of understanding of cancer treatment-treatment high-risk signs and symptoms”, and “lack of standardizes tool for early intervention for high-risk patient symptom management” (score=5). Moreover, a number of restraining forces including “the lack of clear guidance in managing high-risk patient management”,  “inadequate Quality Improvement (QI) team to participate in the SCP” were also identified and analyzed (score=4). On the other hand, “staff resistance” (score =3) was the weakest restraining force experienced during the implementation of the HEART team protocol at Mount Sinai West. The total score for this category of restraining forces was 31. In relation to the evidence-based recommendations, it was observed that a set of ideas including “the provision of education for nursing staff on cancer treatment high-risk signs and symptoms”, “development of clear guidance with using checklist for high-risk patient management”; “development of educational materials for staff education” and “creation of a rapid decision algorithm to initiate early interventions to reduce ED visit rates” were the strongest driving forces (score =5)The Force Field Analysis Essay Paper. On the other hand, the second category of driving factors included “establishment of a QI team including a clinical team and supportive care team”  (score = 4) also emerged as strong driving forces in support of the implementation of the HEART team protocol at the identified healthcare organization. Furthermore, “holding of monthly QI meetings to request staff input and related feedback” was the weakest force to project implementation (score = 3). The total score of this category of driving and resisting forces to change toward implementation of the evidence-based intervention stood at 31.

Discussion

Implementation of the HEART team protocol was primarily informed by the greater need to reduce unnecessary ED visits and unplanned hospital admissions amongst high-risk cancer patients at Mount Sinai West, New York. Adoption of this evidence-based intervention was influenced by a myriad of driving and restraining forces that proved instrumental in supporting successful change management planning (Hammond & Hammond, 2019). Equally, the core findings from the field force analysis may encourage project stakeholders and policymakers and members of the multidisciplinary team to create suitable plans inside and outside the identified healthcare setting with the core intention of amplifying the practical benefits of the HEART team protocol (Xu et al., 2021)The Force Field Analysis Essay Paper. In the field force analysis, some of the opposing forces can be categorized as both restraining forces and driving forces on the path to change and this is largely based on their implications on the change process. In the present paper, seven key factors in favor and against the change toward implementation of the HEART team protocol at Mount Sinai West. In this context, the presence of these similar key factors is deemed to be a driving force, and their weakness or absence is categorized as a restraining force with relation to the implementation of the evidence-driven project (Crawford, 2018). These findings indicates that having a better understanding of these two groups of conflicting forces may significantly help to identify and respond to some of the growing list of organizational problems, goals and needs regarding the HEART  team protocol implementation. As such, the centrality of the FFA is based on the fact that the implementation team was able to come up with practical and tangible solutions to tackle the specific problems, demands and needs that characterized the project implementation process.

Conclusion

In this paper, FFA was employed to identify and analyze the driving forces and restraining forces that shaped the achievement of the set change objectives. Precisely, the provision of proper staff training, development of clear guidelines, holding of monthly meetings, development of educational materials for staff, development of a rapid decision algorithm, and the establishment of a multi-disciplinary QI team emerged as the strongest driving forces in favor of successful implementation of the HEART team protocol. Strong emphasis was placed on transforming the restraining forces into driving forces as the fundamental basis for attaining the measurable outcomes and achieving the set goals and objectives. Combined, the findings from the field force analysis forms a useful basis for identifying and analyzing both the driving and restraining forces, and adopting practical solutions/interventions to the distinct problems and needs associated with the project implementation process The Force Field Analysis Essay Paper.

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References

Astafeva, O. V., Zhatikova, D. V., & Osipova, I. A. (2021). Study of the impact of driving and restraining factors on ensuring the development sustainability of the bicycle market in Russia. Proceedings of the International Scientific-Practical Conference “Ensuring the Stability and Security of Socio-Economic Systems: Overcoming the Threats of the Crisis Space”. https://doi.org/10.5220/0010698300003169

Cordell, A., & Thompson, I. (2019). Force Field analysis. The Procurement Models Handbook, 168-170. https://doi.org/10.4324/9781351239509-51

Crawford, S. M. (2018). Multidisciplinary team working contributes to lung cancer survival. BMJ, k1904. https://doi.org/10.1136/bmj.k1904

Farh, E., Seada, A., & Baker, A. (2020). Factors affecting implementation of nursing services accreditation standards in port-said general hospitals. Port Said Scientific Journal of Nursing, 7(4), 82-97. https://doi.org/10.21608/pssjn.2020.123969

Gaivoronskaya, T. V., Vermennikova, L. V., Chabanets, E. A., & Rykova, A. A. (2021). Force Field analysis and K. Lewin’s change model as leverages of “Lean University” principles in student environment. Kuban Scientific Medical Bulletin, 28(1), 152-165. https://doi.org/10.25207/1608-6228-2021-28-1-152-165

Gałązka-Sobotka, M., Frączkiewicz-Wronka, A., Kowalska-Bobko, I., Kelm, H., & Szymaniec-Mlicka, K. (2020). Identification of forces driving and restraining the implementation of HB-hta in Poland. Polityka Społeczna, 557(8), 18-27. https://doi.org/10.5604/01.3001.0014.377

Hammond, J., & Hammond, D. (2019). Multidisciplinary work, multidisciplinary team. Oxford Textbook of Inpatient Psychiatry, 49-56. https://doi.org/10.1093/med/9780198794257.003.0006

Hussein, M., Pavlova, M., & Groot, W. (2022). An evaluation of the driving and restraining factors affecting the implementation of hospital accreditation standards: A force field analysis. International Journal of Healthcare Management, 1-9. https://doi.org/10.1080/20479700.2022.2084810

Mak, A. H., & Chang, R. C. (2019). The driving and restraining forces for environmental strategy adoption in the hotel industry: A force field analysis approach. Tourism Management, 73, 48-60. https://doi.org/10.1016/j.tourman.2019.01.012

Shafaghat, T., Rahimi Zarchi, M.K., & Imani-Nasab, M. (2021).Force field analysis of driving and restraining factors affecting the evidence-based decision-making in health systems; comparing two approaches. Journal of Education and Health Promotion, 10:419. DOI: www.10.4103/jehp.jehp_1142_20

Xu, M., Zhou, L., Zheng, L., Zhou, Q., Liu, K., Mao, Y., & Song, S. (2021). Sonodynamic therapy-derived multimodal synergistic cancer therapy. Cancer Letters, 497, 229-242. https://doi.org/10.1016/j.canlet.2020.10.037 The Force Field Analysis Essay Paper

Appendices

Appendix 1: Using Field Force analysis to analyze the status of project implementation

Force Field Analysis Paper

The Force Field Analysis (FFA) Paper provides strategic project planning to evaluate the Driving and Restraining Forces that influence project implementation and Recommendations to Minimize the Restraining Forces. This results in an adjustment of the project and is summarized within the conclusion of the paper. The FFA analysis is a narrative paper (and includes the FFA Model), no longer than 4 pages (excluding title page & and the table appendix)The Force Field Analysis Essay Paper.

Grading Criteria: This assignment is worth 10 points.

2 points: In the introduction, clearly describe the organization and how you went about doing a FFA analysis. Discuss project purpose, goals, objectives, and measurable outcomes that will help you know what you aim for.

4 points: The narrative text section evaluates the driving and restraining forces and opportunities/recommendations to strebgthen project implementation, staff capacity and readiness. There is information that helps match the organization’s resources and capabilities to the competitive environment in which it operates. Identify the key internal and external factors that are important to achieving the organization’s objective or individual. The FFA analysis provides a model of the Table in weighted form; and the narrative text should provide an integrative summary of each point, explaining the rationale.

2 points: Write a conclusion summarizing the major driving and restraining forces despite project adjustments. Give your conclusion, making recommendations based on the FFA findings that would positively influence organizational readiness and capacity.

2 points: FF Analysis Table.

Resources

https://asq.org/quality-resources/force-field-analysis

https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/force-field-analysis

https://www.coursera.org/lecture/change-management/3-2-force-field-analysis-LvGVW?utm_source=link&utm_medium=page_share&utm_content=vlp&utm_campaign=top_button

Introduction

This Action Plan aims to address the implementation of an evidence-based high-risk patient management HEART (High ED/Admission Risk Therapy) team protocol for adult oncology patients receiving multimodal cancer therapy at Mount Sinai West Hospital, New York, in the United States. The action plan will describe the set goals and objectives; project plan; team structure, roles and responsibilities; needs; methodology; and timeline. The plan is divided into numerous sections that touch on the agency assessment, background and significance of the problem, need/gap assessment, what will be done, who will do it, why it will be done, how it will be done, and completion target The Force Field Analysis Essay Paper.

Agency Assessment

Implementation of the HEART team protocol seeks to reduce unnecessary Emergency Department (ED) visits and unplanned hospital admissions among cancer patients at Mount Sinai West, New York. Precisely, Mount Sinai West is a full-service medical center with a 24/7 emergency department. The facility has 511 inpatient beds and offers comprehensive, individualized treatment plans for patients with all types and stages of cancer. Cancer care at Mount Sinai Health System reflects a collaborative, multi-disciplinary approach grounded in outstanding patient clinical care and research. Some of the key oncology areas of focus include surgical oncology, medical oncology, bone marrow transplantation, radiation oncology, clinical research and clinical trial, and other innovative cancer therapies.

Background and Significance

Background

Cancer is currently ranked as the second leading cause of death in the United States. Recent years have witnessed a significant rise in the rates of emergency department (ED) visits and unplanned hospitalization by oncology patients due to a myriad of health concerns, including treatment-related emergencies (e.g., chemotherapy complications), symptoms-related complications, among others (Hubler et al., 2022). The official launch of measure OP-35 (OP refers to Outpatient) by the Centers for Medicare and Medicaid Services marked a key development toward achieving a reduction in chemotherapy-related expenses as a result of the rising rates of ED visits and unplanned hospitalization among cancer patients receiving outpatient therapy (Alsuhebany et al., 2021). Smith and Carlson (2021) explained that the measure OP-35 requires healthcare facilities and departments to monitor as a quality measure outcome the rates of hospitalization, ED visits, and re-hospitalization for cancer patients and survivors within 30 days of chemotherapy treatment for preventable symptoms (e.g., fever, sepsis, pneumonia, emesis, dehydration, diarrhea, anemia, nausea, pain, and neutropenia) or chemotherapy toxicities. As a claims-based measure, the OP-35 is considered to be an important measure through which the facility’s ED can achieve quality reporting by collecting and sharing ED visits and hospital admission rates for cancer patients. The OP-35 also encourages healthcare facilities to implement clear clinical guidelines aimed at supporting the integration and promotion of evidence-based interventions to treat and prevent adverse side effects and complications of chemotherapy (Neugut & Bates, 2021)The Force Field Analysis Essay Paper.

At Mount Sinai West Hospital, implementing the OP-35 measure will become a valuable starting point for developing facility-specific reports on the list of treatment-related complications experienced by cancer patients receiving outpatient chemotherapy that lead to a potentially preventable ED visit or hospitalization. As a treatment assessment model, the HEART team protocol is primarily informed by measure OP-35 since it is designed to reduce unnecessary ED utilization and inpatient admissions with the core intention of improving therapeutic benefits for patients with cancer reducing health care costs and ultimately attaining shared savings (Smith & Carlson, 2021).

The HEART team protocol is capable of enabling the multidisciplinary team to identify high-risk patients and collect relevant information and data that can be used to prevent unplanned ED visits and hospitalizations. These findings indicate that the incorporation of the HEART team protocol into clinical practice carries the greater potential to contribute to improvements in the management of cancer-treatment-related emergencies and in the health and patient care outcomes (Bueno et al., 2020; Hubler et al., 2022). The strong emphasis during the implementation of the HEART team protocol must be placed on ensuring the continuity of cancer care, and implementation of patient-centered, and evidence-based treatment plans during the treatment and completion of the treatment course (Dufton et al., 2022)The Force Field Analysis Essay Paper.

Significance

ED crowding is becoming a pertinent healthcare problem in the United States and worldwide (Dufton et al., 2022). With the significant increase in the number of cancer-related ED visits, the adoption of effective evidence-based approaches across different care environments and populations can help to minimize ED and unplanned hospitalization among cancer patients and survivors, thus contributing to improvements in oncology complication management and coordination of active treatment and follow-up care (Nene et al., 2021). The specific, measurable, achievable, relevant, and time-bound (SMART) decision-making algorithm and the high-risk nursing assessment checklist can guide oncology nurses and other healthcare providers in predicting and managing adverse effects of cancer treatment in order to prevent unplanned ED visits and hospital admissions (Lee et al., 2021). Other empirical findings indicated that incorporating the HEART team protocol into routine clinical practice could boost the management of complications and adverse events associated with multimodal treatments (Teggart et al., 2022). The HEART team protocol can significantly reduce adverse health outcomes associated with unplanned hospitalization and ED visits, including exacerbated exposure to infections, high costs of care, and reduced quality of care (Gallaway et al., 2021). Moreover, the HEART team protocol provides an evidence-based, multi-disciplinary team approach to enable improvements in managing and treating high-risk cancer patients and survivors (Teggart et al., 2022)The Force Field Analysis Essay Paper. Hass et al. (2021) established that the active involvement of a supportive oncology team and other key healthcare practitioners across the care continuum for cancer patients and survivors may help to improve their management, reduce the risk of oncologic complications, and improve coordination of care.

Needs Assessment

Although unplanned ED visits and lengthy hospital stays are common occurrences for cancer patients who receive chemotherapy, there is currently a lack of comprehensive guidelines to inform the need for rapid access to appropriate care among patients with cancer (Lee et al., 2021). Equally, the absence of Oncology Nursing Guidelines and standardized Oncology Clinical Practice Guidelines for this patient population has greatly undermined the provision of holistic, patient-centered to cancer patients and survivors who are at risk of experiencing unplanned ED visits. Other gaps in practice include the unclear roles of nursing practice, which contributes to the growing rates of unplanned ED visits and hospitalizations (Jairam et al., 2019)The Force Field Analysis Essay Paper. At Mount Sinai West, a range of multimodal cancer therapy is provided at the Radiation Oncology Department to patients with different types of cancer. However, the facility recorded 14 unplanned emergency department visits in 2022, representing about 35.89% of ED visit rates. The high rates of unplanned ED visits at the facility necessitate the greater need for implementation of the High ED/Admission Risk Therapy (HEART) team protocol as the fundamental basis for reducing the ED visits among people with cancer.

PICOT question

The proposed quality improvement project is based on the PICOT question; “For adult cancer patients receiving multimodal (chemotherapy and radiation) treatments (P), does the implementation of a High ED/Admission Risk Therapy (HEART) team protocol (I), compared to traditional practice (C), reduce ED visits within 30 days of completion of chemotherapy by 20% (O) during a three-month pilot period (T)?”

The DNP Project Plan

The Institute of Medicine introduced the importance of Clinical Practice Guidelines (CPGs) to establish trustworthy standardized guidelines for each practice (IOM, 2013). However, most evaluated oncology clinical practice guidelines were not meeting the IOM expectation (Reames et al., 2013)The Force Field Analysis Essay Paper. The CMS measure OP-35 suggested using guidelines to integrate and promote evidence-based interventions to prevent and treat common side effects and complications of chemotherapy (CMS, 2022). However, current existing guidelines from the National Comprehensive Cancer Network (NCCN), American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO), and Oncology Nursing Society (ONS) guidelines focus on each cancer diagnosis and treatment-specific guidelines and symptom-focused guidelines. There are no specific management and surveillance guidelines for oncology patients receiving multimodal cancer therapy. Hence, the DNP project will aim to improve nurse recognition and early detection of risk factors of unplanned ED visits in adult oncology patients receiving multimodal cancer therapy.

The intervention will be conducted by implementing evidence-based High ED/Admission Risk Therapy (HEART) team protocol. Developing SMART (specific, measurable, achievable, relevant, and time-bound) decision-making algorithm. Implement a High-Risk nursing assessment checklist and multidisciplinary HEART team building.

The Expected outcome will be that the nurses will be able to detect and implement interventions for high-risk patients early. The nurses understand the use of the developed high-risks nursing assessment tool. The well-trained oncology nursing workforce is one of the critical aspects of nursing practice to perform patient-centered and evidence-based practices, which is essential for high-quality care (Ferrell et al., 2013). A multidisciplinary team approach with oncology social workers and nutritionists will reduce cancer care disparities. Individuals’ psychosocial and socioeconomic needs will be assisted within the HEART team collaboration (Haas et al., 2021). Also, the high-risk patient will be referred to the HEART team, including a weekly NP-led symptom management clinic for close monitoring. Eliminating unwarranted ED visits will promote positive patient outcomes, low cost of care, and improve the quality of life for oncology patients (Mason et al., 2013)The Force Field Analysis Essay Paper.

The DNP project will meet the DNP essential VII expectation that interprets health promotion and risk reduction/illness prevention for individuals and families (Zaccagnini & Pechacek, 2021). The DNP project approaches patient-centered care and multidisciplinary collaboration with individuals’ needs and symptom management to reduce treatment-related unplanned ED visits and admission rates.

Team Structure, Roles, and Responsibilities

A multidisciplinary care team will be deployed to undertake a range of roles, tasks, and responsibilities to significantly reduce the high incidence of multimodal cancer treatment-related ED visits and unplanned hospital admissions at Mount Sinai West Hospital. Regarding team structure and composition, the multidisciplinary team will be tasked with implementing the HEART team protocol. It will comprise the DNP student, RN champion, hospital leadership, MD champion, nursing staff, and the supportive oncology team (nutritionist, social worker, agency community mentor). Some of the critical roles and responsibilities assumed by the multidisciplinary team will include building the HEART team, holding biweekly HEART team meetings, providing educational sessions on evidence-based high-risk patient early detection and management, project implementation, data collection, and analysis, continuing point of care coaching, and collaborating with the coordination organization for efficient communication, evaluation, and feedback. Other key responsibilities will include dissemination of project findings and holding discussions on sustainability and feasibility of further studies to contribute to knowledge creation, policymaking, field practice, and theory development The Force Field Analysis Essay Paper.

Need of the DNP project

Implementation of the HEART team protocol at Mount Sinai West Hospital will be done for a number of key reasons. First, Research has shown that the emergency department is fundamental in oncologic care. Lash et al. (2017) established that the prevalence of cancer in the United States and globally is rapidly increasing, and this has contributed to the exponential growth in the acute care needs of cancer patients, including ED care. Similar sentiments are shared by Haas et al. (2021), who found out that while cancer patients account for about 4% of the total ED visits, close to two-thirds of these ED visits result in hospitalization, thus exposing the patient to an increased risk of morbidity and death. Young et al. (2020) argued that increased patterns of cancer-related ED use reflect a sophisticated interaction of individual and contextual factors, including patient characteristics, provider behavior, health policies, and health system features. Gallaway et al. (2021) indicated that the emergency department is emerging as a critical portable used to support the continuum of cancer management and tackle acute illness issues associated with cancer and its treatments. Caterino et al. (2019) confirmed that while significant advances in oncology treatments have helped to improve health and patient care outcomes, they equally present new adverse effects and a growing list of cancer treatment-related emergencies. Taberna et al. (2020) identified some of the symptoms-driven issues behind the high rates of ED visits among cancer patients, and they include gastrointestinal tract and respiratory issues, chronic pain, nausea, vomiting, high fever, neurologic problems, injury, bleeding, and psychological disturbances. Hubler et al. (2022) noted that patients with progressive cancer are more likely to make frequent ED admissions, indicating that palliative care management and post-treatment requirements are not sufficiently fulfilled. However, a huge knowledge and practice gap exists for offering optimal cancer care and support in the emergency department.

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Secondly, the HEART team protocol will be implemented as an evidence-based intervention to reduce the adverse events associated with the increased ED visits at the facility’s ED. Numerous guidelines from the National Comprehensive Cancer Network, the American Society of Clinical Oncology, the Infectious Diseases Society of America, the Oncology Nursing Society, and other professional entities recommend a set of evidence-based recommendations aimed at reducing the many of the complications and side effects associated with cancer treatments (especially chemotherapy) (Gallaway et al., 2021). Young et al. (2020) insisted that providing patient-centered and effective outpatient care can prove highly instrumental in curbing potentially avoidable ED visits and hospitalization for some cancer-related issues and contributing to improving cancer patients’ care and quality of life. Selby et al. (2019) insisted that frequent ED visits by people with cancer can have detrimental effects on cancer patients and survivors under various treatments, including radiotherapy and chemotherapy. Notwithstanding the adverse effects behind the increased ED visits, the elimination of unnecessary ED visits among patients with various types of cancer can contribute to improvements in the quality of health-related life, reduced cost of care, and enhance the management of symptom-driven issues (Caterino et al., 2019)The Force Field Analysis Essay Paper.

How the DNP Project Will Be Done

Methodology

The Plan-Do-Study-Act (PDSA) model will guide the implementation of the proposed evidence-based project. First, recruiting team members to form the HEART team protocol will provide an opportunity to develop a multidisciplinary team with different experts and practitioners (e.g., physicians, nursing teams, clinicians, nutritionists, and social workers) with experience in cancer-related concerns. Secondly, practical implementation of the HEART team protocol will be carried out by the team members based on their assigned duties and responsibilities. Thirdly, a comprehensive assessment of the project will be conducted to determine the effectiveness and efficacy of the HEART team protocol with the attainment of the set goal and objectives. Lastly, improvements in current results based on the findings from monitoring and evaluation will assist in reinforcing the integration of best practices into clinical practice and in tackling some of the barriers and concerns that are behind the growing ED visits and hospitalization among patients with various types and stages of cancer during diagnosis, active treatment, and end of life.

The HEART team protocol will be implemented as an evidence-based intervention that is centered on the following algorithm for high-risk patient management and utilization of the assessment tool with weekly ED visits. Oncology nurses will detect high-risk patients’ medical conditions early on by using a checklist and will need to initiate an early intervention for the patient. A supportive oncology team will be deployed to cater to the patient’s psychosocial needs and make referrals to social work and oncology nutritionist teams for early intervention and support needs. The holding of a 4-week course weekly nurse practitioner-led (NP-led) symptom management clinics will help to meet the following targets to reduce rates of unplanned ED visits and hospitalization following patients’ post-completion of intensive multimodal cancer therapy. Patients who completed multimodal cancer therapy have the advantage of close monitoring and toxicity management by NPs to avoid unplanned ED visits and hospital admissions The Force Field Analysis Essay Paper.

The DNP Project Timeline

The proposed evidence-based project plan will be developed, implemented, and evaluated over the next three semesters. Each team member of the multidisciplinary team will assume a set of responsibilities, tasks, and deliverables as follows: DNP Student and Community Agency Mentor (identify the gap in practice, planning, and mentorship) were conducted between July 2022 to the end of August 2022. The DNP Student, leadership, and mentor (meeting with nursing/medical directors to discuss the adoption of high-risk patient management algorithm) were conducted during July, August, September, October, November, and December of 2022 and will continue to be conducted in February, March, April, and June 2023. The DNP student nursing leadership (Meeting with the nursing manager to discuss using high-risk nursing assessment tool in weekly On-treatment Visits) was performed in October, November, and December of 2022, and it will be continued in March, April, and June of 2023. The DNP Student will meet with Registered Nurses for a pre-educate nursing team survey in May 2023. The DNP student will meet with the nursing team and educate nursing them on the HEART algorithm and high-risk patient assessment checklist in May and June of 2023. The HEART team building will be established, including the DNP student, MDs, Nursing Manager, RNs, Social Workers, and Nutritionist, in May and June of 2023. The DNP project will be implemented in June, July, August, and September. The HEART team bi-weekly meeting will be held by the DNP student, HEART Team, RN champion, and MD champion in June, July, August, September, and October of 2023. The Post-Implementation RN survey will be conducted in October of 2023. The DNP student will collect and analyze data in October and November of 2023. The DNP project aims to be completed in November. The DNP Student will conduct evaluation and feedback with the faculty, senior leadership, and mentor in November and December of 2023. The DNP student will undergo dissemination of the project and manuscript completion in 2024. The DNP student and senior leadership will discuss the sustainability of the project and assessment of further studies to be conducted in 2024. The Force Field Analysis Essay Paper

Conclusion

The findings presented in this action plan indicate the roadmap for the development, implementation, and evaluation of the proposed evidence-based project to address, predict and prevent these unplanned emergency visits and hospital admissions by providing acute symptom management, additional monitoring, and outpatient therapeutic interventions in the acute phase after patients complete multimodal cancer therapy. The CMS measure OP-35 will be integrated with the project to meet the quality and criteria to meet the national benchmark. Close monitoring of these cancer patients and survivors through implementations of the HEART team protocol can prove highly instrumental in identifying and responding to some of the cancer treatment-related risk factors, causes, and effects associated with multimodal cancer treatments and preventing unnecessary ED visits and hospital admissions. Some key aspects covered in the project include the enhanced provision of acute symptom management, adoption of outpatient therapeutic interventions in the acute phase after patients complete chemoradiation, additional monitoring and follow-ups in the NP-led symptom management clinic. Reducing ED visits and hospitalizations can help cut down the heavy financial burdens associated with cancer care and contribute to superior health and patient care outcomes for these high-risk patient populations. As an assessment tool, the HEART team protocol will act as an evidenced-based intervention. The protocol is primarily tailored to address measure OP-35 and to contribute to a significant reduction in ED visits and unplanned hospitalization by 20% for adults receiving multimodal cancer therapy at Mount Sinai West Hospital.

References

Admissions and Emergency Department (ED) Visits for Patients Receiving Outpatient Chemotherapy. Centers for Medicare and Medicaid Services Measures Inventory Tool. (n.d.). Retrieved December 7, 2022, from https://cmit.cms.gov/cmit/#/MeasureView?variantId=2090§ionNumber=1

Alsuhebany, N., Brown, J., Echave, J., Elquza, E., Babiker, H. M., Abraham, I., & McBride, A. (2021). Evaluation of Emergency Department (ED) visits by oncology patients: A running comparison to admissions and ED visits under the CMS op-35 ruling. Journal of Clinical Oncology, 39(15_suppl). https://doi.org/10.1200/jco.2021.39.15_suppl.e18683

Bueno, M., Stevens, B., Barwick, M. A., Riahi, S., Li, S. A., Lanese, A., & Isaranuwatchai, W. (2020). A cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol. Trials, 21(1), 1-11.

Cancer disparities. National Cancer Institute. (n.d.). Retrieved December 7, 2022, from https://www.cancer.gov/about-cancer/understanding/disparities

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