Nursing Assignment Acers

Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Applying Model/Framework for Change: Evidence-Based Practice Model

The selected model to facilitate the implementation of my sepsis bundled care evidence- based practice is the John Hopkins Evidence-Based Practice Framework. The framework focuses on addressing clinical problems to identify and apply the most appropriate course of action and interventions utilizing a user-friendly tool to guide changes at individual and group levels (Vera, 2020). The model aligns with my evidence-based practice, which aims to implement changes to reduce the length of stay, morbidity, and mortality, leading to improved patient outcomes. The primary contributor to most mortality in sepsis patients is late diagnoses, which reduces treatment efficacy (Gilbert, 2018). The goal is to create sepsis awareness and encourage timely detection and intervention to reduce adverse outcomes and mortality. Sepsis care bundles describe a brief and straightforward set of evidence-based practices during change implementation to improve patient outcomes when applied together. Being a problem-solving approach, the John Hopkins framework’s relevance to my evidence-based practice will facilitate changes by solving a clinical problem that results in illness and even death.

Evidence-based practices are essential in clinical decision-making processes that follow a problem-solving approach that facilitates changes into better and researched methods. Therefore, it incorporates proven scientific evidence to ensure a smooth and effective transition. To ensure the desired transition, the model or framework used should provide specific procedures and guidelines. The John Hopkins Evidence-Based Practice Model follows three steps during the change program. The three-implementation phase includes practice question, evidence, and transition (OHSU, 2021). The first step entails developing and refining the implantation question and the team that will create the change. In particular, the first phase involves:

  • Identifying the existing health
  • Determining the purpose of the change.
  • Assembling the tools and a team that will facilitate the

The second phase, the evidence step, involves searching, appraising, and synthesizing internal and external sources for evidence (OHSU, 2021). The most appropriate technique used to retrieve the best available evidence is answering the PICO question (Howe & Close, 2016). During this phase, change managers identify the most reputable and reliable research sources, such as books, medical websites, and research journals. Appraisal involves critical analysis of the available evidence to identify the strongest and the best quality evidence that suits the PICO question. Additionally, the practice question prepares change implementers before undertaking the transition. The last step is the transition itself which involves creating and implementing an action plan, evaluating outcomes, and distributing the findings to the relevant people in the health facility (OHSU, 2021). This phase entails implementing the change by allowing team members to undertake their specific roles to facilitate the changes. The evidence-based practice tool provides necessary guidelines to be followed to ensure cohesion and effective changes.

Each of the three stages of the John Hopkins Evidence-Based Model is essential in my sepsis bundled care evidence-based practice. In the first phase, I would formulate my practice question regarding the health need and develop an expert team to help implement the transition. In addition, I would brief the team about the healthcare need and convince them that there is a need to seek better approaches. Specifically, I intend to enhance awareness of the sepsis condition to improve diagnosis and early treatment to save lives. In the second phase, the evidence stage, I would ask my team members to search for evidence from research-based journal articles online and from library databases to identify a wide range of information supporting our initiative.

ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERS

Then, we will analyze the information gathered to select the most appropriate sources. At this point, we will be ready to apply our evidence-based practice theoretical framework to implement the initiative. In the third phase, I would create an implementation plan by assigning roles to change facilitators, then a regular evaluation of the progress and sharing the findings with relevant authorities in our facility.

The figure below is a concept map illustrating the John Hopkins Evidence-Based Model and applying it to the sepsis bundled care evidence-based practice.

  • Phase 1: Development and refinement of the practice question and creating a team to facilitate the implementation.
  • Phase 2: Searching, analyzing, and synthesizing evidence from reliable sources.
  • Phase 3: Creation and implementation of the initiative through assigning roles and evaluating change outcomes.

I feel the John Hopkins Evidence-Based framework is most appropriate for my evidence- based practice change implementation process. It follows a systematic approach that will facilitate the change implementation.

References

Benchmark

SUBMIT ASSIGNMENT Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Requires LopesWrite

Points

100

Rubric

View Rubric

Status

Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

ORDER NOW FOR CUSTOM-WRITTEN, PLAGIARISM-FREE PAPERS

Upcoming

Assessment Description

Applying a model or framework for change ensures that a process is in place to guide the efforts for change. In 500-750 words, discuss the model or framework you will use to implement your evidence-based practice proposal project. You will use the model or framework you select in the Topic 8 assignment, during which you will synthesize the various aspects of your project into a final paper detailing your evidence-based practice project proposal.

Include the following:

  1. Identify the selected model or framework for change and discuss its relevance to your project.
  2. Discuss each of the stages in the change model/framework.
  3. Describe how you would apply each stage of the model or theoretical framework in your proposed implementation.
  4. Create a concept map for the conceptual model or framework you selected to illustrate how it will be applied to your project. Attach this as an appendix at the end of your paper.

Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.

You are required to cite minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing

1.2 Apply theoretical frameworks from nursing and other disciplines to make decisions regarding practice and health-related problems at the individual and population level.

NUR 590 Course

Week 3 Participation

Points

20

Status

Upcoming

Assessment Description

There is no description for this assessment.

Resources

Collapse All

Advanced Practice Nursing: Essential Knowledge for the Profession

Read Chapter 6 in Advanced Practice Nursing: Essential Knowledge for the Profession.

View Resource

Evidence Based Medicine: Levels of Evidence

Read “Evidence Based Medicine: Levels of Evidence,” by the University of Illinois/Chicago’s Library of the Health Sciences at Peo

… Read More

http://researchguides.uic.edu/content.php?pid=232200&sid=1921074

A Test of the ARCC Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes

Read “A Test of the ARCC Model Improves Implementation of Evidence-Based Practice, Healthcare Culture, and Patient Outcomes,” by

… Read More

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=121082056&site=ehost-live&scope=site&custid=s8333196&groupid=main&profile=ehost

Iowa Model of Evidence-Based Practice: Revisions and Validation

Read “Iowa Model of Evidence-Based Practice: Revisions and Validation,” by Buckwalter et al., from Worldviews on Evidence-Bas

… Read More

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=123692132&site=ehost-live&scope=site&custid=s8333196&groupid=main&profile=ehost

Use of Evidence-Based Practice Models and Research Findings in Magnet-Designed Hospitals Across the United States: National Survey Results

Read “Use of Evidence-Based Practice Models and Research Findings in Magnet-Designed Hospitals Across the United States: National Sur

… Read More

https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=142632269&site=ehost-live&scope=site

Evidence-Based Practice in Nursing and Healthcare : A Guide to Best Practice

Read Chapter 14 and review Chapter15 in Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice.

… Read More

View Resource

Critical Appraisal Tools

Read “Critical Appraisal Tools,” located on the Centre for Evidence Based Medicine (CEBM) website.

https://www.cebm.ox.ac.uk/resources/ebm-tools/critical-appraisal-tools

Study Designs

Review “Study Designs,” located on the Centre for Evidence Based Medicine (CEBM) website.

https://www.cebm.ox.ac.uk/resources/ebm-tools/study-designs

Worksheet for Using Practice Guidelines

Study “Worksheet for Using Practice Guidelines,” from the “Evidence Based Medicine Toolkit,” by Buckingham, Fisher, and S

… Read More

http://www.ebm.med.ualberta.ca/CPGWorksheet.html

Guidelines and Measures

Study “Guidelines and Measures,” located on the Agency for Healthcare Research and Quality website.

https://www.ahrq.gov/gam/index.html

Star Model

Explore the Star Model resources, located on the UT Health San Antonio School of Nursing website.

https://www.uthscsa.edu/academics/nursing/star-model

Nursing Best Practice Guidelines

Investigate the Nursing Best Practice Guidelines page of the Registered Nurses Association of Ontario (RNAO) website.

http://www.rnao.org/Page.asp?PageID=861&SiteNodeID=133

Updating the Stetler Model of Research Utilization to Facilitate Evidence-Based Practice

Read “Updating the Stetler Model of Research Utilization to Facilitate Evidence-Based Practice,” by Stetler, by Nursing Outlo

… Read More

https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0029655401478390. Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Benchmark – Evidence-Based Practice Proposal Final Paper

Grand Canyon University NUR-590

Abstract

You can read this proposal to see how the organizational culture and readiness assessment were taken into account. You will get knowledge of the issue that Medication Assisted Therapy (MAT) with Cognitive Behavioral Intervention (CBI) is required in correctional facilities due to the high rate of problems from Substance Use Disorder (SUD), such as overdose deaths and emergency calls connected to overdoses. The altered model that may be used with an implementation plan and how it can be evaluated will be described, along with the offered solutions.

Keywords: Medication Assisted Therapy (MAT), Cognitive Behavioral Intervention (CBI), Substance Use Disorder (SUD)

Benchmark – Evidence-Based Practice Proposal Final Paper Section A: Organizational Culture and Readiness Assessment

Utilizing the Medication-Assisted Treatment for Opioid Use Disorder Self-Assessment Checklist, it is determined that the organization readiness level is high. There is so many of the processes in place such as, it has been decided which components of MAT will be provided internally and which patients will be referred to external providers. There are also engaged clinicians and staff that understand the benefits and importance of offering MAT services in our practice. There has also been a basic understanding of the elements of implementation and have an implementation plan to integrate MAT services into our practice. Some of the identified barrier are the cultural change and staff buy in. In the clinical setting in which we provide care include an interdisciplinary team that also include correctional officers. Their view on healthcare in general is different from that of the medical field so getting their buy in is essential to a successful program. It will take a lot of education to get the correctional officers to see the impact of drug use and the benefits of treatment not just during the patient incarceration but after incarceration once these patients are released and the effects it could have on recidivism. Getting someone in their leadership to buy in will help to get others to buy in. Areas that were low included the staffs understanding that addiction is a chronic disease with biological, psychological, and social aspects, which is a part of needing to change the culture in the correctional setting. We will have to develop a plan to support staff through continuing education, clinical supervision, and consulting resources that will educate on addiction. There was a high score in regard to operational systems and workflows. An example is the development of methods to identify opioid use disorder, including a protocol to incorporate standardized screening tools into the patient workflow. Overall, the readiness assessment shows that we are progressing in the right direction for the project.

Section B: Proposal/Problem Statement and Literature Review

The California Department of Corrections and Rehabilitation (CDCR) has experienced a 54% increase in Emergency Department transports and hospitalizations related to drug overdoses and a 160% increase in overdose between 2014 to 2017 (Kelso, 2018). Substance use disorders have now been recognized as a chronic health condition, like diabetes or hypertension, and require long term treatment as like any other chronic health condition. Patients that have a substance use disorder has often been viewed as drug seeking, manipulative, hopeless, selfish, and as people who lack the desire to change (“Substance use disorders,” 2019). There needs to be a cultural change within CDCR that deals with substance use disorders in correctional primary care settings, changing the stigma associated with substance use disorders, and recognizing that medicated assisted therapy along with cognitive behavioral therapy can be beneficial and successful for the treatment of substance use disorders.

There has been significant data that has shown there is a significant increase in opioid related death in the first two weeks after a patient in released from prison (SAMHSA, 2019). In the past the standard treatment for addiction was mental health counseling. This approach did not consider the way that opioids have altered the brain through continued use or that addiction is also a medical condition. Medicated assisted therapy along with cognitive behavioral therapy through evidence-based research, is beginning to become a more widely accepted treatment by providers. As the healthcare system continues to progress in this area of treatment and advances are made in the development of medications to treat addictions, we can help those make the necessary changes while incarcerated that will help these individuals after release and hopefully reduce recidivism in the process.

Section C: Solution Description

In January 2016, the Center for Disease Control (CDC) reported there was a significant increase in the drug overdose death rates, it doubled from the year 2000 to 2014, from 6.2 to 14.7 per 100,000 people. The California Correctional Health Care System (CCHCS), which is the health care provider for the California Department of Corrections and Rehabilitation (CDCR) has seen the same rise in the drug overdose rate over the last eleven years, the rates range from a 5.3 per 100,000 inmate in 2007 to 22.5 per 100,000 inmates in 2016 (Kelso, 2018). To help decrease the overdose death and treatment the substance use disorders as a chronic condition, the proposed solution is to treat those who want to be treated with Medicated- Assisted Therapy (MAT) in combination with Cognitive Behavioral Therapy (CBI). The evidence-based practice MAT is the use of FDA-approved medications, in combination with counseling and behavioral therapies (CBI), to provide whole-patient care approach to the treatment of substance use disorders (SAMHSA- Substance Abuse and Mental Health Services Administration, 2019).

There has been evidence that shows the MAT program is clinically effective with a significant reduction for the need of an inpatient detox service. The MAT program also includes a comprehensive, individualized program that include medication and behavioral therapy. There is also support services that can be offered to address patient’s needs. So, to expand on the solution the CDCR and CCHCS should implement a drug treatment program that will focuses on:

  • reducing opioid overdose deaths within CDCR
  • improving the continuity of treatment for inmates coming into and leaving CDCR
  • developing a voluntary Substance Use Disorder Treatment (SUDT) program, that identifies SUD as a chronic disease and will manage it as a chronic condition with a complete care program, that will include MAT

The MAT program with CBI is lined up and consistent with what is currently being offered in the community. The Drug Medi-Cal (DMC) program offers SUD treatment services to Medi-Cal beneficiaries and this program is operated through contracts between the Department of Health Care Services and the counties (“DHCS,” 2020). The services being offered in the community include MAT with medications that would be included in the correctional setting, suboxone and methadone and they also are provided naloxone. Naloxone is a great medication that will provide emergency rescue for people at risk of overdose. MAT treatment has been proven to be the gold standard of SUD treatment. There is evidence that it is effective in decreasing the risk of overdose. MAT in communities is also provided with CBI. Other services being offered in the communities that can be helpful with linking correctional patient to upon release are counseling, care management, care coordination between SUD services and physical health, mental health, and social services (Hernandez-Delgado, 2019).

The expectation for starting SUD treatment in the correctional setting has many beneficial outcomes. SUD can be treated with long-term medical care with behavior modification treatments, the treatment has the same effectiveness that is similar to other chronic disease treatments. MAT has positive benefits such as increased retention in treatment programs, reduced illicit opiate-use, decreased craving, and improved social functioning (Kelso, 2018). By providing access to care for behavior and medication therapies for SUD during incarceration, and then linking them to community resources when it’s time to be released, has been shown to reduce recidivism and overdose risk and increase function such as maintaining employment (Kelso, 2018).

The methods to be used to achieve this goal is by setting it up in stages of implementation. First, we must prepare for change by identifying a project champion, developing an implementation team, getting buy-in from leadership and staff at all levels, assessing the current procedures and policies, and developing the goals and action steps. Next we must plan and design the program by determining which medications to offer, which program model is best, decide who should be eligible for MAT, determine the program’s capacity, develop a diversion protocol, and also decide on what recommendations will be used for counseling. Then we need to develop the staff by providing staff training, developing the care teams, identify the appropriate staff-to-patient ratios and also provide ongoing staff supervision and support. We will also need to decide on the treatment model. We need to decide on the where and when MAT services will take place, determine which medications to offer and dosages, establish screening protocols to determine eligibility, develop guidelines for ongoing care, develop protocols related to drug testing, protocols for special populations, and protocols for program discharge and release. The care coordination and linking patient to services once released will also need to be done. This can be done by connecting patients to health insurance coverage, coordinating care with community providers, providing linkages to social services and recovery supports and also by providing education and resources to prevent opioid overdose. Audit will also have to be done to determine if the program is efficient and effective so we will need to identify who will conduct monitoring and evaluation activities, identify key metrics to monitor progress and evaluate impact, and also develop a plan for monitoring and evaluation. By implementing this program we will provide greater opportunities to ensure dependability, effectiveness and efficiency for SUD treatment which will save the state and communities financial burden from opiate related deaths and hospitalizations, and it will promotes positive outcomes such as safer work environments in correctional setting, reduction of recidivism, and safer communities and healthier patient population. Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Section D: Change Model

The model selected that I would use as a framework for my project is the Iowa Model. The Iowa Model will help guide the process for my project with how to operate in an evidence- based manner, it teaches how to introduce the topic, then shows how to develop and evaluate evidence-based practice. The Iowa model focuses on organization and collaboration with the use of research, along with other types of evidence. It allows the focus to be on knowledge and problem-focused triggers, it leads staff to question current nursing practices and whether care can be improved through the use of current research findings (Doody & Doody, 2017). I believe this model is relevant to my project because the framework is geared at promoting quality care based on evidence-based practice. My project is geared at a quality care program that can be implemented in correctional institutions that will treat patient with Substance Use Disorders (SUD) as a chronic health conditions, the program will offer Medicated Assisted Therapy (MAT) and Cognitive Behavioral Intervention (CBI). Current practice and biases have been to look at SUD as a personal choice when research shows SUD are caused by a chemical brain dependency and it requires long term treatment, as someone with Diabetes or Hypertension.

The stages of the Iowa Model are to select a topic, then form a team, next you need to retrieve your evidence, after you gather your evidence you need to grade it, you will then need to develop the EBP standards, so that next you can implement the EBP, then the final step is to evaluate your project implementation. When you select your topic, you want to consider the priority of the problem and the impact, how it can contribute to improving care, the availability of data, and the commitment of staff. You need to be careful with the team selection as they are responsible for development, implementation, and evaluation. A team member from every discipline, along with management should be included with interested stakeholder. There also needs to be written policies, procedures and guidelines that are based on evidence. Then when getting your evidence together is should be pulled from electronic databases like Cinahl, Medline, Cochrane, other sources of evidence such as the National Institute of Health and Clinical Excellence (NICE) and Quality Improvement and Innovation Partnership (QIIP) (Doody & Doody, 2017). The next step is to grade the evidence, in this step the team addresses the quality of the research. The research question will have an influence on the research methodology, and this influences the way the data is collected and how it is analyzed. The development design of the EBP standards will be based on the studies and it will be tailored to what the benefits and risks to the patients were. This will set the practice standard guidelines, assessment, actions, and the treatment (Doody & Doody, 2017). Evidence-based practice should be a patient centered approach. Written policy, procedure, and guidelines that are evidence-based will be considered during the implementation phase. Direct care providers, the organization stakeholders, and leadership need to behind the changes for implementation to be successful.

There are many factors that can affect the implementation, so support and value need to be there for the integration of evidence into practice. Evaluation is the final process and it is essential to see if the study shows value and contributes to the evidence-based practice. An audit with feedback during the process of implementation is important, success cannot be achieved without support from the frontline leaders and the organization. The evaluation will show how the program had impacted the patient population and this can only be assessed with actual change occurring and if it had the desired effect.

The topic of my project was selected based in the impact SUD has had on my patient population in the correctional setting. There is a need to implement a quality-based program for treating this population. All the steps identified above will help guide me through the steps forming the team that will be best suited to gather and analyze the best-practices identified. It will help to develop the evidence-based practices to formulate our policies and procedures. With the stakeholder, management, leadership, and all other disciplines behind the project this program can be successfully implemented.

Section E: Implementation Plan

Many correctional institutions across the United States deals with the same issue the California Department of Corrections and Rehabilitation (CDCR) deals with and that is the issues of illegal drug use within the facilities. There has been an increase in the death rates related to drug overdoses over the past eleven years. The rates in the CDCR were 5.3 per 100,000 inmates in 2007, and now in 2016 is has risen to 22.5 per 100,000 in 2016 (Kelso, 2018). Between 2014 and 2017, there has been an increase of Emergency Department send outs and hospitalizations related to drug overdose of 54 percent and these inmate patient are two-and- a half times more likely to die from an overdose (Budget Change Proposal, 2017). There is also a significant increase for patients with a Substance Use Disorder (SUD) that they are 45 times more likely to die within the first two weeks of release from prison of an overdose. The patient population that this project will focus on is the inmate patients within the CDCR institutions.

Due to the increasing number deaths related to overdoses and the high number of hospital emergency send outs there is a need for implementation of a Medicated Assisted Therapy Program (MAT) in combination with Cognitive Behavioral Intervention (CBI). Due to the fact the patient population is in a prison there are special considerations that need to be looked at. This patient population is considered a vulnerable population, there are regulations federally governed due to their ability to make an informed and voluntary decision to participate in research is compromised (Research with Prisoners, 2020). Patients will be required to sign a consent for treatment as they would in the community prior to initiating treatment.

This project deals with many different entities within CDCR and there are also community partners that needs to be included in the care coordination. There are 35 institutions within CDCR that will require the program to be implemented. This project will need to be implemented in phases. Phase 1 will take approximately six months, this will include making sure the available staff is hired such as headquarter staff, supervisory staff, the addiction medicine providers, all institution supervisory registered nurses (RNs), Licensed Clinical Social Workers (LCSWs), and nurse consultants for the program. Phase 2 will take six months also.

This phase will also require hiring staff such as the headquarter administrative and analytical support staff, pharmacy staff, laboratory staff, RN institution staff for the program. After all the staff have been hired in phase 2 this phase will also include starting the screen and assessments for patients that will be releasing within 15-18 months, this allows time for the patient to be on the program for at least a year prior to releasing. The last phase is phase 3 which should take approximately twelve months. This will include statewide implementation at all 35 institutions with continued screening and assessment with the implementation of MAT program with CBI. Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

There are many resources that will be required to be implemented this project as it is a large-scale project. There are many entities within CDCR that will be a part of the collaboration to develop, implement, and operate this comprehensive program. In order for this to be implemented there will be additional resources needed for this to be successful. The hires needed for the different CDCR entities will include 99 positions for California Correctional Healthcare Services (CCHCS), CDCRs Medical Providers, another 201 positions for CCHCS Nursing Services, 5 positions for Division of Rehabilitative Programs (DRP), and 126 positions for the Division of Adult Institutions. This program will require changes in the processes that are being followed at this time. There will be new clinical tools being used but before any of these changes can be implemented there has to be training and education provided.

CCHCS uses a clinical risk classification system, registries, that will help identify if our patient population is receiving the most appropriate care to serve their needs. By developing a system that pulled information technology that could automate the clinical risk classification system it has proven to improve patient care results by 18 percent (Budget Change Proposal, 2017). Once this program has been implemented, we will be able to monitor the progress by use of the registries that can be built to track specific data that is pertinent to monitor the program.

It will be important to be transparent with all staff involved in the implementation of this program. Staff need to be on board. Education and training will have to be done before implantation to allow staff time to process the changes and also time to ask questions. It will also be important to provide the staff with the why, the why this program is important for this patient population. So, providing the time for a mandatory on the job training that will discuss SUD as a medical condition. There is a great video done by Dr. R. Corey Waller “Addiction Neuroscience 101” that explains the addiction and the effects (Waller, n.d.). This video would be a great way to engage staff, get them to see addiction as not a person personal choice but as a chronic condition that requires long term medical treatment.

The data collection will be monitored by the Quality Management (QM) team. The way CCHCS sets up there HQ staff is there is a specialty nurse consultant group over every healthcare discipline, such as mental health, pharmacy, medical, nursing, there will be a nurse consultant group created for this program also and it will include each discipline also. The QM team will develop what to include on the registry that will capture the data needed to monitor the processes such as identifying patients that will be releasing within twelve months and identify patient that have had recent over doses. Other things that will need to be captured is the once screened for a SUD they will move on to another screening that goes in to detail about which drug is being abused and whether or not they meet criteria for MAT with CBI or just CBI. We will have to track appointments and compliance dates, medication management, making sure appropriate labs are being tracked. This can all be done by utilizing the registries. There will also be a team at each institution that will consist of a supervising RN (SRN), resource RN, and an analyst to track the data locally and then there will be the nurse consultants at HQ tracking all the institutions as a whole.

There are going to be many challenges as this program gets implemented. To try to mitigate some of those challenges we will need to make sure to choose the correct people for this program. There will be so many new positions for this program which will give the opportunity for those who believe in the project to apply. The management has the opportunity to pick those that are enthusiastic and who want to be a part of this program. This will help when the staff hired can go out and get others on board to understand the benefits of this program.

The implementation of this project has been proven to be successful in other states. Rhode Island was one of the first two states to develop a MAT program in their correctional institutions in 2016. They developed a process of screening their patient population with protocols to provide treatment medications such as methadone, buprenorphine, or naltrexone. Then they also partnered with community partners to ensure that patient was able to continue treatment after release, their program was fully operational by January 2017 (Greene et al., 2018). There will be a significant budget needed to implement a project of this magnitude but at the same time it will also save the state so much money on the death related to overdoses and the ED send outs related to SUDs. To get this project up and running it will take approximately $70 million for the general fund, then for 280 positions additional positions will require $160 million that will include salaries and benefits to continue hiring for all 35 institutions it will require addition staff to be hired in the next few years 2021-22, another 150 positions for a total of 430 positions which will require $164 million for the continuation of the MAT program.

For the program to be successful there will have to be continuous monitoring, meetings, and discussions regarding what is working and what does not. These meeting will have to include the multidisciplinary team members and all stakeholders. Three will need to weekly conference with the local level staff also to give a two-way communication to allow for changes to be discussed and also for questions to be asked. There needs to be a multidisciplinary approach when developing all the workflows, policies and procedures and local level staff need to be included since they are the ones doing the job and will have valuable insight. This project has so many benefits if it successful by our patient population releasing in in better health from being in treatment. It lessens the rates of communicable diseases, STIs, and can reduce recidivism rates.

Section F: Evaluation of Process

Monitoring the data and evaluating the program is an important part to ensure the programs outcomes and impact are understood. There are data monitoring tools and evaluation plans that can be utilized to track the activities of the Medicated Assisted Therapy (MAT) program. There are program metrics that should be tracked that can identify and help resolve issues faster, help there be a better understanding of the daily activities and also to identify the service impact over a period of time (Mace et al., 2020). Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

Outcome measures of the evidence-based project can evaluate if the objectives have been achieved. Evaluation of the outcome measures can start with information that is already being collected and easily pulled, such as medical data that is documented in the electronic health records. The goals of the metrics should be in collaboration with all stakeholders. Useful metrics are the ones that can help streamline feedback and accountability that will show the successes and ways to improve. For correctional MAT programs monitoring the data that tracks how well the program is being given and the outcome will show if the objectives are being achieved. If measures or metrics are chosen correctly it will help with strategic analysis and improvement. A main purpose for monitoring the data is to identify and resolve issues early (Mace et al., 2020). It is important to place attention on just a few key metrics that will be of value and can be addressed. In the correctional settings data across the continuum of care should be collected also. It should include data related to screening, treatment, and pre-release planning. Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

The outcomes that will be measured and evaluated are the identification of Substance Use Disorders and the treatment in the prisons. Then screenings of the inmate patients will be data that is collected with those who test positive identified for needing further assessment. The next measure to track is the those being offered the program and the initiation of treatment. Another measure to track is for those that complete the program and also tracking if coordination of care upon release was done.

If outcomes were not positive some strategies that can be taken to make improvement is to have multidisciplinary meetings with all stakeholders involved to review and address changes that need to be made. An important step to take is to evaluate the arear with negative results. If it was an issue with the methods used, it may require some adjustments. If there was nothing wrong with the method, then continue to monitor the data and share it with the stakeholders that can utilize the data so adjustments can be made when needed.

The implications for this practice are needed because those with SUD in the correctional setting have a difficult time and it can be overwhelming when they transition back into the communities. Data has shown that within three months of release, 75 percent of people with an opioid use disorder experience a relapse (Berg, 2019). There is also data that newly released inmates are 10 and 40 times more likely to die of an overdose than the public with the first two weeks of release.

Appendix 1

Appendix 2

KEY COMPONENTS OF MAT PROGRAMS IN CORRECTIONAL SETTINGS

  • Preparing for Change

Identify a project champion. Develop an Implementation Team.

Obtain buy-in from leadership and staff at all levels. Assess current procedures and policies.

Develop goals and action steps. Monitor progress.

  • 2.  Program Planning and Design

Determine which medications your facility will offer. Determine which program model is best for your facility. Determine who should be eligible for MAT.

Determine your program’s capacity. Develop a diversion protocol.

Determine your program’s recommendations for counseling.

  • 3.  Workforce Development and Capacity

Provide staff training.

Develop a care team.

Identify appropriate staff-to-patient ratios. Provide ongoing staff supervision and support.

  • 4.  Delivery of Treatment

Determine where and when MAT services will be delivered.

Determine which medication formulations to offer. Develop dosage guidelines.

Establish screening protocols to determine eligibility. Develop guidelines for ongoing care.

Develop protocols related to drug testing. Develop protocols for special populations.

Develop protocols for program discharge and release.

  • 5.  Care Coordination and Linkages to Services Post-release

Connect patients to health insurance coverage. Coordinate care with community providers.

Provide linkages to social services and recovery supports. Provide education and resources to prevent opioid overdose.

6.  Data Monitoring and Evaluation

Identify who will conduct monitoring and evaluation activities. Identify key metrics to monitor progress and evaluate impact. Develop a plan for monitoring and evaluation.

  1. Funding and Sustainability Assess existing resources. Determine program needs. Identify funding

Appendix 3

Budget Request Summary

Total Positions: 431.0

Total Salaries and Wages: $40,379 Total Personal Services: $60,886 Operating Expenses and Equipment General Expense: 705

Printing: 247

Communications: 460

Postage: 118

Insurance: 14

Travel: In-State 597

Training: 131

Facilities Operation: 2051

Utilities: 37

Consulting and Professional Services- External: 154 Consulting and Professional Services- Interdepartmental: 59009 Information Technology: 156

Non-Capital Asset Purchases- Equipment: 769 Other: 39483

Total Operating Expenses and Equipment: $103,931 Total Budget Request: $164,817

References – Benchmark – Evidence-Based Practice Proposal Project: Framework or Model for Change

mersin escmersin esc