nurse practitioner

Respond to this student’s posting, give a thoughtful response based on the information that she presented:My example of implementing change occurred in a pediatric primary care office many years ago. Despite our lack of knowledge of project management and logic model development at the time, we did seem to follow many of the steps of the logic model described in our readings this week such as including inputs, activities, outputs, and outcomes (W.K. Kellogg Foundation, 2004).

As the sole nurse practitioner in the office with 5 physicians my responsibilities as an employee included not only patient care, but also insurance company reviews of our paper chart documentation (Electronic Medical Records did not exist at the time). The insurance company reviews were important because we had a high percentage of patients in HMO insurance plans. If we were able to document certain elements of patient care in our charts, then the group practice received incentives from the insurance companies. In reviewing charts, it was found that the physicians who were excellent practitioners and followed current guidelines to provide patient care were not documenting properly according to insurance company requirements.

As the project manager, my responsibility as a PNP providing direct patient care needed to be balanced with the role of leader of the change project (Shirley, 2011). By sequencing the tasks of the project and completing the predecessors prior to the successors, we were able to accomplish the tasks in a logical order over a long period of time (Shirley, 2011). We followed an inverted process of contemplating the desired outcomes of the intervention before determining the inputs and outputs as described in the Logic Model for Program Planning and Evaluation article by Paul McCawley (n.d.).

The desired outcome was to utilize a documentation aid/worksheet during well child visits which included all pertinent documentation information required by insurance companies to qualify for incentives for the practice. Another outcome we desired was to standardize anticipatory guidance given at each well child visit according to the current AAP Guidelines. The resources/inputs of the project were human providers, AAP Guidelines (knowledge), CDC recommended immunization table (knowledge), insurance company required documentation, and computer/paper supplies (Wholey, 2011). The activities involved meeting with the physicians to determine important aspects of the documentation worksheets they wanted to include in addition to the insurance company requirements and researching current AAP Guidelines. Another activity was to develop each well child documentation worksheet on the computer based on these guidelines and requirements.

The project was successfully implemented by developing one page worksheets including history, physical, anticipatory guidance, safety, and immunization documentation for each well child visit/sports physical. The factors that heeded the project were that the stakeholders involvement in the development of the documentation aid worksheets were motivated to achieve success due to monetary rewards for improving documentation. The outcome was achieved and the impact was proper documentation of well child visits according to criteria and improved monetary rewards to the practice (Wholey, 2011). An additional impact was provider ease of documentation of evidence-based anticipatory guidance education at each well child visit.
1.Theory of Change Model related to my DNP project

In the literature, lack of epinephrine prescriptions and lack of patient education regarding how to manage allergic reactions was identified as a problem (Kastner et al., 2010).