HCA 499 Module 6 Implementation Plan Example

From Recommendation to Routine: Implementing a Heart Failure Discharge Bundle

Student Name

Health Care Administration Program, Aspen University

HCA 499: Senior Capstone

Instructor Name

Month Day, Year

From Recommendation to Routine: Implementing a Heart Failure Discharge Bundle

A good recommendation fails without a good implementation plan. Implementation turns an idea into daily practice: who does what, when, with what tools and how problems are caught early. This paper presents the plan Dana developed for putting a three-part heart failure discharge bundle into daily use on a single medical unit.

The Bundle

The bundle has three parts. First, no heart failure patient goes home until a visit within the next week is on the calendar. Second, a pharmacist reviews medications with the patient and family before discharge, using teach-back for new or changed medicines and daily weights. Third, a unit nurse calls the patient within 48 hours to check symptoms, weight, medications and the appointment.

Why a Bundle

Its design follows trial evidence that readmission programs work better when they combine several parts and involve several kinds of staff (Leppin et al., 2014), and it targets the first two weeks, when most of the hospital's readmissions occurred. Early follow-up is supported by national heart failure data linking it to lower readmission (Hernandez et al., 2010).

Workflow

When a heart failure patient is expected to go home within 48 hours, the case manager places a follow-up order through a new order set. The cardiology clinic scheduler books a reserved slot within seven days and enters it in the record. The pharmacist completes the medication review on discharge day. At discharge, the nurse confirms the appointment and a backup phone number. A call list is generated each morning for patients discharged the previous day.

Timeline

The table shows the implementation steps.

Roles

The sponsor removes barriers and communicates support. The unit manager leads staff and monitors daily. Case managers initiate scheduling. The clinic scheduler books appointments. Pharmacists complete medication reviews. Nurses make calls and document them. Dana coordinates, tracks measures and leads improvement cycles. The cardiologist advisor handles clinical questions.

Electronic Record Changes

Informatics built an order set that triggers the follow-up request, a pharmacist review task and a discharge checklist item. A daily report lists heart failure patients discharged the previous day with phone numbers and appointment dates. A structured call note records the call outcome, symptoms, weight and any escalation.

Training

Training for each role took 30 minutes and used the actual screens and a practice call script. Nurses practiced asking about weight gain and swelling and when to escalate to the cardiology nurse line. Pharmacists practiced teach-back. A one-page quick reference was posted at each workstation.

Communication

The sponsor announced the pilot at a unit meeting, explaining the readmission data and why the bundle was chosen. Weekly updates shared progress, such as the share of patients leaving with appointments. Staff were invited to report problems through the unit manager or directly to Dana.

Improvement Cycles

The team used plan-do-study-act cycles. In week five, data showed that only 60% of patients were reached by phone within 48 hours, often because calls went unanswered. The team added a second call attempt in the afternoon and a text message option. By week eight, reach rose to 82%.

Anticipating Staff Stress

Workflow redesign can raise engagement but also stress. Lean redesign research in primary care offers a caution: teams felt more engaged afterward, yet burnout and stress also climbed, most of all in clinics beyond the pilot (Hung et al., 2018). The plan addressed this by adding pharmacist time rather than shifting all new work to nurses, checking in with staff weekly and removing a redundant discharge form.

Barriers and Responses

Barriers included late-afternoon discharges that left little time for pharmacist review, weekend discharges without pharmacist coverage and clinic slots filling with other patients. Responses included starting reviews the day before expected discharge, a weekend nurse-led review with pharmacist follow-up call, and protecting reserved slots until 48 hours before each clinic day.

Sustainability

For the bundle to last, it was built into the order set, job descriptions and new staff orientation, not left to individual memory. The unit manager added bundle completion to the monthly quality dashboard.

Patient Materials

The team created a one-page discharge sheet in plain language listing the follow-up appointment, medications with changes highlighted, daily weight instructions and a phone number to call after any quick weight gain the care team defined for that patient. Pharmacists used it during teach-back, and patients took it home.

Monitoring During the Pilot

During the pilot, the unit manager reviewed a short daily list of heart failure discharges and checked whether each had an appointment, a pharmacist review and a scheduled call. Missed steps were followed up the same day. Daily attention in the first weeks kept the new process from slipping.

Engaging Physicians

Hospitalists and cardiologists were briefed at their meetings and asked to support the order set. The cardiology advisor encouraged colleagues to accept reserved follow-up slots. Physician support signaled to nurses and pharmacists that the bundle was a priority, not an optional extra.

Contingency Plans

The plan included contingencies: if the order set was not ready, case managers would use a paper checklist; if the clinic could not provide a slot within seven days, primary care follow-up would be booked instead; if the unit was short-staffed, the charge nurse would assign calls to the next shift. Contingencies keep a pilot running when parts fail.

Documentation Standards

Each bundle component has a documentation standard: the appointment appears in the discharge summary, the pharmacist records the review and teach-back result, and the nurse uses a structured call note. Consistent documentation makes evaluation possible and ensures the next clinician can see what happened.

Conclusion

The implementation plan turned the recommended bundle into specific workflows, roles, record changes, training and communication, with improvement cycles to fix problems early. Anticipating staff stress, removing barriers and building the bundle into routine systems increased the chance that it would work and last beyond the pilot.

References

Hernandez, A. F., Greiner, M. A., Fonarow, G. C., Hammill, B. G., Heidenreich, P. A., Yancy, C. W., Peterson, E. D., & Curtis, L. H. (2010). Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA, 303(17), 1716-1722. https://doi.org/10.1001/jama.2010.533

Hung, D. Y., Harrison, M. I., Truong, Q., & Du, X. (2018). Experiences of primary care physicians and staff following lean workflow redesign. BMC Health Services Research, 18, Article 274. https://doi.org/10.1186/s12913-018-3062-5

Leppin, A. L., Gionfriddo, M. R., Kessler, M., Brito, J. P., Mair, F. S., Gallacher, K., Wang, Z., Erwin, P. J., Sylvester, T., Boehmer, K., Ting, H. H., Murad, M. H., Shippee, N. D., & Montori, V. M. (2014). Preventing 30-day hospital readmissions: A systematic review and meta-analysis of randomized trials. JAMA Internal Medicine, 174(7), 1095-1107. https://doi.org/10.1001/jamainternmed.2014.1608