Leadership: Challenges, strategies, and hiccups

My weekly Education has gone well. I haven’t had any challenges or hiccups at this time.  I send the education email on Friday so that the Clinical champion can send it out on Monday. Then the clinical champion sends me a note of confirmation that she received it. If I don’t receive a note of comformation then I send it again to make sure she received it. Then on Mondays she sends me a confirmation when it gets sent out.

I have education for 12 weeks, so I just continue on the current plan. .

Data Collection: Challenges, Triumphs, Initial Data

 

 

In this phase of my project, I don’t have all the data gathered yet.  The last measurement day is November 6 and I hope to collect all the rest of my data at that time. Since the data collection process requires voluntary participation, I am at the mercy of the participants reading the blogs and remembering to appear for the measurements.  My data is a very simple pre and post participation survey.  My biggest concern for the completion of this project is that the number of participants.  While the number of participants for the pre-participation survey wasn’t impressive, I’m even more concerned that the number of participants that will present for the post-participation will be even less.

Challenges:

  • The location of the lunch & learn activities required all participants to walk across campus to arrive at the location. They also had to plan ahead and bring their own lunches.
  • This time of year was super busy with activities outside of my program which conflicted with some of our plans and required that we even change dates of certain activities during homecoming week.

Triumphs:

  • The participants that did sign up have been VERY invested and energetic.
  • Multiple participants were present at the lunch and learn activities
  • Lots of positive feedback from the participants thus far.

Initial data:

  • 27 participants:

Pre-participation survey:

Likert scale ratings from 1-10:

  1. I would rate my knowledge of physical activity as it relates to my health as:

Average rating: 6

  1. I would rate my knowledge of nutrition as it relates to my health as:

Average rating:  4

  1. I would rate my level of physical activity as it relates to my health as:

Average rating: 5

  1. Currently, I would rate my nutrition as it relates to my health as:

Average rating: 4

 

Data Collection; Issues & Triumphs

I have launched the data collection, which is “Survey of attitudes & barriers to the utilization of the 2016 CDC Guideline for Chronic Pain Management with Opioids.”  After an initial 7 weeks of pure anxiety, I was able to switch mid-stream to a survey method of data collection for my project.  Two weeks ago I did send the survey via Survey Monkey to 1600 New Mexico NPs.  To date: 10/18/18, I have received 234 replies.  Not what I have expected, but there is excellent information. I will be wrapping up the survey in the next week or so. Putting at 2.5 weeks. One reminder has been sent out on day five, to do the study.  I have received a few personal emails of individuals that know me from New Mexico, knew this was my project, and were very supportive and excited.  A few of them did not do the survey as they were not NPs that did any form of pain management (they wanted me to know).  So far, the data is >70% family NPs, the most significant response group that has been in practice for 1-5 years. 15% have been adult NPs.  These two groups were my targets.  The rest have been urgent care/ER NPs.  They did not manage chronic pain but were passionate about using the CDC guideline. They did provide Narcan to any patients with an opioid script.

The most significant barrier to using the guideline that I could see was: Not enough time with my patients.  And lack of education on chronic pain management with opioids.

What would help them utilize the guidelines:

1. They want an EMR Template based on guidelines 55.71%;

2. Policy Development that correlates with the CDC Guideline(40%) ( A question which stemmed from lack of organization support)

3. More time with the patient 42.86%

4. Patient Education material 41.90%

5. Education on chronic pain management 34.76%

Over 40% expressed not being comfortable with the guidelines.  Over 30% felt very pleased. And the rest comprised of those that either felt the instructions did not apply to the practice. And there was 1 that did not think the guidelines were helpful.

It will be interesting how this all breaks down statistically. What I did get from this was; they are concerned about this epidemic, and over 90% felt this guideline and using it was extremely important and that this did impact their practice in a big way.

Kay

Data review-Issues, Challenges and trimphs

My initial data was pulled in September. The data was pulled in two weeks. The original project was to have children only, but was concerned if there would be enough patients, so the final project included adults. Adding adults allowed boosting in numbers, I think that it was a positive change, because I am uncertain if i would have had enough patients if I would have just done children.  Adding adults boosted my additional numbers, and will hopefully also boost my final data pull.

My triumph is that the data was able to be collected in two weeks with no difficulty. Additionally was able to obtain all of the data needed.

There have not been any issues thus far with obtaining data or initiating the weekly emails. The facility has been very receptive to the education.

Data collection issues, challenges, and triumphs

My project was implemented on October 1, 2019.  I have not collected any data as of today, October 15, 2019 due to the short amount of time.  There really have not been any major challenges with the exception of the clinic’s EHR program.  The program they are using has ICD-9 diagnosis codes instead of ICD-10 codes.  This should be pose an issue with my project however because my data will be collected using the CPT codes.

Even though I have not started data collection, I have talked with the staff and they said they are giving more pneumonia vaccinations.  That is a win in my corner as that is the goal of my project.  I will begin collection data at the end of the month.  I figure it will be easier on the clinic manager if I asked for data once a month, especially right at this moment and the issues with the ICD codes.

Implementation

Project education was implemented on Monday. On Friday an email with what to send and the educational handouts was attached for easy use.  My clinical champion sent it out on Monday. The education discussed teaching the parents to track patients immunizations to help the parents have a better understanding of the immunization schedule and what is needed when. This will allow parents to have a better understanding and know when they need to come back in.

The providers seem very appreciative of the information and are very excited for new information.

Project Progression and Setbacks

My project of implementing a reminder system into the rural health clinic’s EHR was implemented on October 1st.  My first issue was the fact I was out of town for clinical when it was implemented.  I finally was able to check in with the clinic in person on Friday, October 4th.

I found out the clinic is having issues with the program.  The issue is the program is defaulting to ICD-9 codes instead of ICD-10 codes.  Even though that is an issue for the clinic, I do not think it has any barring to my project.  I attempting to help the clinic manager resolve this issue, but I think it is a program/system issue and she will need to contact the IT department or her sales representative.  The reminder is popping up, however, and the reminder to inquire about pneumonia vaccination status and provide pneumococcal vaccinations is the focus of this project.  When asked about providing pneumococcal vaccinations, the nursing staff reported they have been giving some.  The timing of this project is perfect because it commences during flu vaccination season.

As of right not (knock on wood), I have not had any additional setbacks.  The project is going along perfectly as expected.  I made additional posters to put in the waiting room as they ran out after all the posters were placed in the exam rooms.  Other than that, things are going well.   I am keeping my fingers crossed.

Challenges and Implementation

I did finally submit my project to the FHSU IRB on September 30th. Whew! It had to be in by the 7th of October. Keeping my fingers crossed that I do not have to change much.  Again, the main challenge to date was waiting on the UNM IRB; and I waited for 7 weeks. That is not necessary to put a student through that. If an organization such as the University IRB in New Mexico felt that they would not sign it because; A: I was no longer an employee with UNM, and B: It was not the right form.  Do you not think they would have told someone! A dysfunctional system. Instead; a very diligent Research Director for the College of Nursing kept putting herself self-out there daily to get this signed. She was always dismissed. There is a learning curve here; 1. Communicate; 2. Be ethical ; 3. Be a role-model to others.  I do feel relief, however; just glad to be moving.

I plan to send the surveys out as soon as I get IRB FHSU approval. I would imagine 2-3 weeks should be enough time to get the reviews back. Survey Monkey, does quantify the information some statistical analysis; however, for in depth-review; it will go to FHSU statistician. I have re-worked the theory (Lewins Change); it has been modified to the survey and the change in the structure of this project. I think it is exciting, I do hope the NPs in New Mexico find it helpful to them, make them feel, and be familiar with the, 2016  guideline from the CDC on Chronic Pain Management with Opioids. Each state seems a little different on how Primary Care manages opioids for their patients.  My focus remains in New Mexico. For the most part, they are very progressive in adhering to the guidelines from the CDC. Thanks to an Attorney General that is on top of this epidemic (Hector Balderas).

The next blog will be more organized as I will actually be putting the project together.

10/3/19  UPDATE:  MY PROJECT IS APPROVED! I received my “Exempt” letter today from FHSU IRB. YAY!!!   Kay

Initial Challenges and Adjustments

Initial challenges were the announcements weren’t posted as scheduled and considered to need to be more frequent.  As I mentioned in a previous posting, we adjusted the announcements to run daily and then approved flyers through the IRB.  The flyers were successful.  We had a good turnout for the first lunch and learn.  I know hind-sight, I wish there had been more time to have more interventions and possibly incorporate specific activities outside of learning.  My main goals are for the participants to feel as though they learned something they didn’t know about improving overall health.  I feel like the participants are already excited about participating and have a good grasp of the program.  The participants that keep coming to the on campus activities are a lot of fun and truly enjoy participating.  I have to be comfortable in the fact that the number of participants is fewer than expected but that at least those participating are learning tips to benefit overall health and achieve lifetime goals.  There’s not much I could adjust at this point of the project.  I definitely know the changes I would make to possibly help a future student with a similar project.  I would encourage them not to start at the beginning of the school year and begin during the spring semester instead.  I feel like participation would be greater during that timeframe.  Also I would encourage daily announcements instead of weekly blogs.

Implementation and checkpoints

I initiated my project on August 27 after IRB approval with coordination with my Clinical Champion. I did my retrospective chart review in 2 weeks, which was quicker than I had expected, and then I will begin sending emails weekly to the clinical champion so that she can send it out to the staff on October 7. My timeline was approved by the IRB so have continued with the same timeline, except I completed my retrospective chart review in the first 2 weeks of September, so I didn’t need the fours weeks set out in my timeline. My implementation to this point has gone smoothly.

 

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