Project pressure ulcer reduction Running head: HEALTH CARE CHANGE PROJECT MATRIX 1 HEALTH CARE CHANGE PROJECT MATRIX 4 Health Care Change Project Matrix Objective: To reduce the incidence of newly acquired pressure ulcers development in California Health Medical Center (CHMC) to 10% within six months of implementing the new evidence-based protocol. Objectives Content Describe the methods to be used to implement the proposed solution An electronic system to document pressure ulcer risk assessment and incidence will be created within the hospital’s current electronic medical record system, EPIC. The system facilitates recording pressure ulcer incidence that would trigger wound consult nurses to provide timely advice on and validation of the categories of pressure ulcers. Staff charge nurses will conduct pressure ulcer assessments in admission. Instead of documenting in paper form, they will directly record these findings on an initial risk assessment electronic form and simultaneously make an e-referral to the wound consult nurse if a patient has a pressure ulcer that is a stage 2 or higher. Having an electronic pressure ulcer risk and incidence form for each patient allows various healthcare professionals and members of the interdisciplinary team to have secure access to reliable and current information in real-time (Plaskitt, Heywood, and Arrowsmith, 2015). Develop a plan for implementing the proposed solution Per Wager et al (2009), it is crucial that a team is organized that serves “to plan, coordinate, budget, and manage all aspects of the new system implementation” (p. 244). A team will be assembled to gain much-needed support for the program. This implementation team is vital in engaging various stakeholders in providing support and commitment to the project. The team members include charge nurses, wound consultant nurses, quality improvement nurses, an MD champion and department managers from areas such as education, equipment and information technology (IT) and administration. An immersion event will be launched to inform and engage all staff members in the project. The event will allow necessary information to be disseminated, share goals and desired outcomes as well as the rationale behind the project. Shedenhelm et al (2010), states that providing education through a variety of methods allows training to be received well for recipients with diverse learning styles. Furthermore, ongoing training should be developed and advertised through educational newsletters and emails that provide education reminders and other important information. Shedenhelm et al (2010), also emphasizes provision of multiple opportunities through multiple sites locations at varied times increases turnout. Furthermore, each nursing units will be provided pressure ulcer training bundles that including competencies will be presented. Regular communication with various constituent groups such be conducted and a means for reporting problems.

1. Project pressure ulcer reduction
Running head: HEALTH CARE CHANGE PROJECT MATRIX
1
HEALTH CARE CHANGE PROJECT MATRIX
4
Health Care Change Project Matrix
Objective:
To reduce the incidence of newly acquired pressure ulcers
development in California Health Medical Center (CHMC) to
10% within six months of implementing the new evidence-based
protocol.
Objectives
Content
Describe the methods to be used to implement the proposed
solution
An electronic system to document pressure ulcer risk
assessment and incidence will be created within the hospital’s
current electronic medical record system, EPIC.
The system facilitates recording pressure ulcer incidence that
would trigger wound consult nurses to provide timely advice on

2. and validation of the categories of pressure ulcers.
Staff charge nurses will conduct pressure ulcer assessments in
admission. Instead of documenting in paper form, they will
directly record these findings on an initial risk assessment
electronic form and simultaneously make an e-referral to the
wound consult nurse if a patient has a pressure ulcer that is a
stage 2 or higher.
Having an electronic pressure ulcer risk and incidence form for
each patient allows various healthcare professionals and
members of the interdisciplinary team to have secure access to
reliable and current information in real-time (Plaskitt,
Heywood, and Arrowsmith, 2015).
Develop a plan for implementing the proposed solution
Per Wager et al (2009), it is crucial that a team is organized that
serves “to plan, coordinate, budget, and manage all aspects of
the new system implementation” (p. 244). A team will be
assembled to gain much-needed support for the program. This
implementation team is vital in engaging various stakeholders
in providing support and commitment to the project. The team
members include charge nurses, wound consultant nurses,
quality improvement nurses, an MD champion and department
managers from areas such as education, equipment and
information technology (IT) and administration.
An immersion event will be launched to inform and engage all
staff members in the project. The event will allow necessary
information to be disseminated, share goals and desired
outcomes as well as the rationale behind the project.
Shedenhelm et al (2010), states that providing education
through a variety of methods allows training to be received well
for recipients with diverse learning styles. Furthermore,
ongoing training should be developed and advertised through

3. educational newsletters and emails that provide education
reminders and other important information. Shedenhelm et al
(2010), also emphasizes provision of multiple opportunities
through multiple sites locations at varied times increases
turnout. Furthermore, each nursing units will be provided
pressure ulcer training bundles that including competencies will
be presented.
Regular communication with various constituent groups such be
conducted and a means for reporting problems and issues should
be established. According to Bebow (2011), having a structure
and well-planned communication provides all involved with a
roadmap of what to do, when to do it, and how it will be
accomplished. During the system implementation, the flow of
communication will need to be multi-directional: upward,
downward, and horizontally.
Wager et al (2009) also emphasize the importance of
evaluations in minimizing the effects of a project failure.
Evaluating is an on-going process throughout the entire
implementation. "No matter how well the system was designed
and tested, errors and problems will be detected, and changes
will need to be made" (Wager et al, 2009, 266).
An on-going assessment and evaluation of the status of the
project will be conducted. Barriers will be identified and plan
to eliminate barriers will be tested.
Incorporate a theory to develop the implementation plan and
explain how it is used to develop the plan.
Reinforcement theory suggests that individual behavior may be

4. changed through reinforcement or punishment. Rewards, in this
case, are used to reinforce behavior while penalties are used to
discourage unwanted behavior. Extinction can also be used, as a
means of preventing the occurrence of behavior. The theory
states that organization readiness for change is a multilevel
contrast. Each nurse and management need to be adequately
involved and be willing to portray actions aimed at supporting
change and rewards are to be used as a form of motivation. The
theory recommends the need to ensure that end users and front
line staff are not sidelined in this process. Per reinforcement
theory, there is a need to incorporate reward systems,
simultaneous staffing, and workflows to facilitate various
effective decision-making routines. In applying reinforcement
theory, providing positive feedback and recognition to nurses
and units that have successful completion of risk assessment
tests can be used. Furthermore, performance scorecard that
shows decreased pressure ulcers rates can provide visual
reinforcement of achieved outcomes as compared to national
average or previous data. Scorecards can also be used as
reinforcement to administrative stakeholders to garner
continued support and provision of resources to the project.
Identify resources needed for the proposed solution’s
implementation and how you plan to gather and incorporate
them.
Resources needed for the proposed solution include
administrative support as well as educational materials and
training. The program will also require a change in workflow,
using assessment tool and documenting it in the electronic
format instead of paper. These resources will be available by
engaging administration and upper management by adequately
involving designing, planning, and change implementation.
With the availability of these resources, the change initiative
will be successful, and the project will be appropriately
introduced in the entity for maximum effectiveness. On-going
communication with an avenue for feedback and multi-way
communication will be available. There is a need to inform all

5. the personnel of the change in advance to provide a clear
direction and is engage actively in the project (Cummings,
2002).
Describe outcome measures aligned with planned outcomes
The expected result of the change implementation in California
Health Medical Center (CHMC) is to have a reduction in the
incidence of newly acquired pressure ulcers development from
the current rate of 15% to 10% in all patients in the hospital
within six months. This outcome measure is supported by
Plaskitt, Heywood and Arrowsmith’s study in 2015 which
showed a decreased incidence rate in hospital-acquired pressure
ulcers after it implemented an electronic system that recorded
harm events and documented initial pressure ulcer risk
assessment.
Discuss the feasibility of the implementation plan.
Literature supports the need to have this plan implement in
efforts to reduce pressure ulcer rates in California Health
Medical Center (CHMC). Support and buy-in from stakeholders
are guaranteed as the project aligns with the hospital's
commitment to providing excellent quality of care to the
patients it serves. Many resources needed are in the form of
staff education and time needed to provide training. While the
project will need up-front costs, successful implementation will
yield a great return on initial investment. The risks of not
implementing a sound pressure ulcer reduction plan in CHMC is
too high, creating pain, impaired function, infections, increased
hospital days, and rise in expenses.
CHMC will receive CMS performance-based incentives, and the
program will lead to safe patient outcomes that equate to long-
term, efficient use of CHMC’s resources in the use of less
pressure ulcer supplies, expensive treatment, and extensive
staffing workload, significantly reducing later costs (Mallah,
Nassar, & Badr, 2014).

6. References
Bebow, G. L. (2011). The CEO's role in small and rural
hospitals' EMR implementation.
Frontiers of Health Services Management, 28(1), 31-4.
Retrieved from
http://search.proquest.com/docview/892261324?accountid=
458
Cummings, T. (2002). Organization Development and Change.
New York, NY: John Wiley and Sons.
Mallah, Z., Nassar, N., and Badr, L. (2014). The effectiveness
of a pressure ulcer intervention program on the prevalence of
hospital acquired pressure ulcers: Controlled before and after
study. Applied Nursing Research, 28, p. 106-113. Retrieved
from http://dx.doi.org/10.1016/j.apnr.2014.07.001
Pittman, J., Beeson, T., Kitterman, J., Lancaster, S. and Shelly,
A. (2015). Medical device–
related hospital-acquired pressure ulcers. Development of
an evidence-based position
statement. Journal Wound Ostomy Continence Nurse,
42(2), 151-154.
DOI: 10.1097/WON.0000000000000113

7. Plaskitt, A., Heywood, N., & Arrowsmith, M. (2015). Recording
pressure ulcer risk assessment
and incidence. Nursing Standard (2014+), 29(46), 54.
doi:http://dx.doi.org/10.7748/ns.29.46.54.e10013
Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health care
information systems: A practical
approach for health care management. San Francisco, CA:
John Wiley & Sons, Inc.
Nursing Research Utilization Project Proposal: xxxxx
Name
Evidence-Based solution
Extension
Revision & Termination
Communication & Feedback
dissemination
Overcoming Barriers
References
Image: Ohio State University, 2013
http://stars.csc.ncsu.edu/project/all/#sthash.R692Wh8S.dpbs

8. Image: Page, 2010
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A goal of Standing Strong is to provide ongoing programs,
including advanced Standing Strong classes along with an
individual maintenance goal to reduce falls and increase regular
physical activity in older adults (Page, 2010). Standing Strong
will maintain a successful project solution through the Safety of
Senior Act of 2007. Several method will allow the successful
maintenance of this project solution. Safety of Senior Act of
2007 authorizes the Secretary of Health and Human Services to
oversee and support a national education campaign focusing on
reducing falls among older adults and preventing repeat falls;
and award grants, contracts, or cooperative agreements to
design and carry out local education campaigns (Govtrack,
2008). Conducting research funded by the Safety of Senior Act
of 2007 will allow continual maintenance of Standing Strong
through facts that support this project solution. Through

9. research conducted will allow for improvements in the
identification of older adults who have a high risk of falling;
along with improving data collection and the analysis to
identify fall risk and protective factors (Govtrack, 2008). The
dissemination of proven, effective fall prevention intervention
from research will maintain a successful project solution
(Govtrack, 2008). These methods and specific plans will
maintain a successful project solution.
Plans to extend Standing Strong to other communities and
facilities will include financial support from the Safety of
Senior Act of 2007. Extension will support this project solution
is effective in the reduction of falls in older adults in the
communities through physical exercise and education. The act
will aid in continual research to implement, and evaluate the
most effective approaches to reduce falls among high-risk older
adults living in communities (Govtrack, 2008). Extension of
this solution will be done by the design, implementation and
evaluation of fall prevention programs using proven
intervention strategies along with carrying out a multistate
demonstration project (Govtrack, 2008). The multistate
demonstration project include several communities adopting the
Standing Strong program with results from the implementation.
This plan will also include reports to Congress on the effects of
falls on health care costs and the most effective strategies for
reducing associated health care costs related to falls in older
adults in the communities (Govtrack, 2008). Documented
effectiveness of this project solution will serve as a marketing
tool for other programs similar to Standing Strong. Page (2010)
the Safety of Senior Act of 2007 will provide new opportunities
for communities to implement evidence based fall prevention
programs as well as for researchers to investigate the translation
of the program for widespread dissemination.
Revisions of an unsuccessful project solution starts with

10. analyzing the reviews and comments about the project. When
analyzing, look for consistency in comments and the problems
that are identify. This will allow the focus of the revision. Once
this revision topic is chosen seek an expert opinion. The
Program Officer should be contacted to discuss the possible
revisions. Reassessments of the proposed solution and
components that need revision will be completed. Decisions on
whether the project is important and relevant; once this decision
is made continue the project solution revision or move on
(Piechowski, 2010).
Terminating the proposed solution of Standing Strong will be
done with termination by extinction. These are projects brought
to an end often before completion because they are
unsuccessful, fail to meet end-user objectives, are superseded
by technical advances that make the project obsolete, or because
cost escalations destroy economic viability of the project
(Project Man, 2015). Expectations to end the project abruptly
should not occur. Administration closure and processes within
the organization should be made to end the project properly. A
final report will be drafted along with dissemination of lesson
learned (Project Man, 2015). Lesson learned will allow the
team to overview everything and prevent the termination from
happening again. Administrative closure will involve bringing
to completion of all internal aspects of the project concerning
team members, management, stakeholders, financials, and
equipment (Project Man, 2015). This will ensure that all loose
end are brought to an end. The first step should begin early in
the process and it will include contacting the team members and
managers to prepare them for the termination. Two important
actions should include the managers determining the team
members’ next assignments and the project manager
communicating staff-members performance to the resource
manager (Project Man, 2015). These steps will allow proper
termination of the unsuccessful solution through termination

11. through extinction.
Standing Strong will disseminate evidence through community
meetings. Even though there are many ways to disseminate
information like handouts, oral presentation, and social media;
community meetings were the most appropriate for this setting.
Presenting this information can be challenging due to the
variety of audience members. Before making this presentation,
it is important to collaborate with the community leaders about
culturally sensitive information of potential participants of the
meeting (Mazurek Melnyk, 2011). Presenting to a mixed
audience can be difficult but it is best not to use abbreviations;
all acronyms should be defined. There should be ample time for
questions and answers during the presentation as well as an
allotted time for questions after the presentation. The use of
slides and corresponding handouts are useful in keeping
participants engaged and focused on the presentation (Mazurek
Melnyk, 2011) pp. 367).
Feedback will help to strengthen the proposed study and
facilitate the professional growth of the investigator (Mazurek
Melnyk, 2011). The Safety of Senior Act of 2007 committee
will act as a reviewer for the proposed solution resulting in
possible funding for the project. Reviewers typically judge the
significance of a project whether it addressed an important
problem or extends what is known in the area (Mazurek Melnyk,
2011). Feedback from the reviewer can include supportive or
non-supportive feedback in regards to the proposed solution.
Mazurek Melnyk, (2011) Feedback can include comments such
as the literature does not capture the entire body of information
on the selected concepts; the argument for why an intervention
in this particular population is needed is not strong; or it is not
clear how this study or project builds on prior work in the area
(pp. 465). Feedback will be considered carefully and the
proposed solution will be altered accordingly.

12. Communication is vital to the success of a proposed solution.
Communicating the project and its results to external
professional groups Involving individuals will facilitate their
buy-in and commitment to the project (Mazurek Melnyk, 2011
pp. 286). Clear and effective communication to external
profession groups such as community centers and senior living
facilities will facilitate communication.
There are several barriers that may affect the project solution
but there are ways to overcome those barriers. Exercise
programs similar to Standing Strong are proven effective in the
research setting but are difficult to disseminate and implement
in the community (Page, 2010). It is pointless and useless to
have an evidence based program that is only effective on paper
and unsuccessful in communities. Several issues and barriers to
deliver fall prevention programs in senior centers including
space, staffing and recruitment of participants (Page, 2010). A
major issue is replicating the research into the communities to
aid in the reduction of falls among older adults. The plan to
overcome these barriers will include the use of RE-AIM which
was developed to enhance the interpretation of research into the
communities. RE-AIM is a strategy to evaluate an evidence
based program’s success in the community through variables
including reach, effectiveness, adoption, implementation and
maintenance (Page, 2010). Reach as many targeted individuals
that are 49 years old and older without severe cognitive
impairment; retaining these individuals throughout the program
(Page, 2010). Effectiveness is reaching the goals of Standing
Strong to reduce falls and fall related injuries as well as
improving physical activities. Adoption is used as the steps
necessary to get started with the program before it is actually
implemented (Page, 2010). This step includes ordering supplies,
developing a schedule for the classes and education component
while training the staff members. Implementation ensure the
fidelity of the program including the program schedule,

13. instructions and qualified physical and occupational therapist
(Page, 2010). Maintenance is providing ongoing programs while
the continual reduction of falls while increasing physical
activity among the participants. The overall goal of the RE-AIM
framework is to encourage program planners, evaluators,
readers of journal articles, funders, and policy-makers to pay
more attention to essential program elements including external
validity that can improve the sustainable adoption and
implementation of effective, generalizable, evidence-based
interventions (Ohio State University, 2013).
1
TEMPLATE DESIGN © 2008
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Fall Prevention Program: xxxxx
name
Falls in the Hospital Settings
The Evidence-based Fall Prevention Program
Methods and Plan to Maintain Fall Prevention Program
Methods and Plan to Extend the Fall Prevention Program
Methods to Revise a Unsuccessful Program
Methods and Plan to terminate an Unsuccessful Program
Plans for feedback
Plans for communicating the Project & Results
Barriers in the Hospital Setting
References

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