| Course | NR 449 Evidence Based Practice |
|---|---|
| Week | 8 |
| Paper type | Dissemination brief (memo) |
| Length | About 840 words, 3 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 449 Week 8
Memorandum
To: Nurse manager and practice council, 4 East Surgical Unit
From: Student Name, RN, practice council member, 5 West Medical Unit
Date: Month Day, Year
Re: What we learned switching peripheral IV locks from heparin to saline, and what you would need to copy
Why You Are Getting This
Your unit still locks peripheral intravenous catheters with heparin flush between doses, as ours did until six months ago. We changed to preservative-free 0.9% sodium chloride for all peripheral locks. This brief is written to help you decide whether the same change would work on 4 East, and it includes what went wrong for us, not only what went well.
The Evidence, in Two Sentences
The question of heparin versus saline for peripheral locks has been settled for decades: a meta-analysis found saline as effective as heparin for keeping peripheral locks patent and preventing phlebitis, at lower cost (Goode et al., 1991). Current national infusion standards recommend preservative-free 0.9% sodium chloride for flushing and locking peripheral catheters (Gorski et al., 2021).
The Result and the Conditions It Came From
5 West is a 32-bed adult medical unit with about 180 peripheral catheters in place on a typical day, where each nurse carries five patients by day and six overnight, with an IV team available on day shift only. We compared three months before the change with the three months after the first month, leaving out the first month as a transition. The rate of peripheral catheters removed for occlusion was 6.1 per 100 catheters before and 6.4 per 100 after, a difference we read as no change. Phlebitis scored 2 or higher on the visual infusion phlebitis scale was recorded in 2.2 and 2.0 per 100 catheters. Heparin flush syringes dispensed to the unit fell from about 4,100 a month to fewer than 50, the remaining ones for central lines. Pharmacy estimates the unit's savings at a little over 1,500 dollars a month in heparin syringes, and the change removed a high-alert medication from routine peripheral use, which our pharmacy counted as a safety gain. These results come from one medical unit with adult patients, an IV team on days and a pharmacy that stocks prefilled saline syringes; a unit without prefilled syringes would face a different workload.
What You Must Copy and What You May Set Yourself
Protected, copy exactly: All peripheral catheters are flushed and locked with preservative-free 0.9% sodium chloride from a prefilled syringe, using the push-pause technique and a positive-pressure or neutral-displacement connector, before and after each use and at least every 12 hours when not in use. Heparin is removed from peripheral locks entirely, including removal of the heparin lock order from the peripheral order set. A partial change, keeping heparin as an option for peripheral catheters, invites the old practice to return.
Adaptable, set for your unit: The flush volume (we use 5 to 10 milliliters depending on catheter use), the education format, who updates the order set, the timing of the switch and whether you track occlusion and phlebitis yourselves or through your IV team. Pediatric and neonatal units and all central lines are outside this change; their practices depend on different evidence.
What Went Wrong First
Three things went wrong in the first two weeks. First, pharmacy removed heparin flushes from the unit's automated dispensing cabinet before the order set was updated, so nurses received heparin lock orders they could not fill, and several called pharmacy at night. The fix was to change the order set first and the cabinet second; do it in that order. Second, float nurses from units still using heparin continued to ask for it and, twice, brought heparin syringes from their home unit. A laminated card on the cabinet and a line in the float orientation sheet solved this within a month. Third, some nurses reduced the flush frequency because saline felt less protective than heparin to them, which was backwards; occlusions rose slightly in week two, then fell once we reinforced the every-12-hours flush at huddles. It took about five weeks before staff described the new practice as normal rather than as extra work.
Who Should Bring This to Your Unit
On our unit, the change moved when two of our most experienced night nurses, not the manager, explained it at huddles and answered questions. We suggest the same on 4 East: ask one respected staff nurse on each shift to present this brief at a huddle, with your pharmacist present for the first session to answer questions about supply. We would be glad to send one of our night nurses to your practice council meeting to describe the first two weeks. Rogers (2003) observed that people adopt new practices faster when the message comes from peers like themselves, and our experience matched that.
What We Would Do Differently
If we started again, we would change the order set before touching the supply, tell float pool leaders a week ahead and reinforce flush frequency in the first week rather than the second. Everything else we would repeat.
References
Goode, C. J., Titler, M., Rakel, B., Ones, D. S., Kleiber, C., Small, S., & Triolo, P. K. (1991). A meta-analysis of effects of heparin flush and saline flush: Quality and cost implications. Nursing Research, 40(6), 324-330. https://doi.org/10.1097/00006199-199111000-00002
Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharpe, E., & Alexander, M. (2021). Infusion therapy standards of practice, 8th edition. Journal of Infusion Nursing, 44(1S), S1-S224. https://doi.org/10.1097/NAN.0000000000000396
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.
What the NR 449 Week 8 assignment asks for
The Week 8 brief has you share the results of an evidence-based change with another unit or audience. The assignment sheet tends to list the purpose and audience, the evidence, the result with its context, what others need to replicate it, lessons learned, how to spread it and APA, often in memo form. Explain why the reader is receiving the brief. Settle the evidence quickly. Give the result with the setting, staffing and supply conditions it came from. Separate the elements that must be copied exactly from those the receiving unit may set. Report what went wrong first and how it was fixed. Say who should carry the message. End with what you would do differently.
How this NR 449 Week 8 example is built
The memo header addresses the 4 East manager and practice council from a 5 West council member. The opening explains that 4 East still uses heparin, as 5 West did until six months ago. The evidence section cites Goode and colleagues and Gorski and colleagues. The result section describes 5 West's beds, catheters, staffing and day-only IV team, compares three months before with three months after a transition month, and reports occlusion, phlebitis and flush supply figures with pharmacy's savings estimate. The protected section requires preservative-free saline from prefilled syringes with push-pause technique. The adaptable section lists flush volume, education and timing. Three early failures include pharmacy pulling heparin before the order set changed. Messengers and lessons close the memo.
Where the points sit in the NR 449 Week 8 rubric
Dissemination brief rubrics in NR 449 generally score clarity of purpose and audience, a concise evidence base, results with context, guidance for replication, honest lessons learned, a dissemination strategy, professional format and APA. Guidance for replication counts most, and the memo earns it by dividing what must be copied from what may be adapted. Results are credited because figures come with the setting and staffing that produced them. The lessons row scores through three early failures and their fixes. Purpose and audience earn points for a memo addressed to a named unit. Dissemination is credited for suggesting experienced night nurses as messengers, with Rogers on diffusion. Goode and colleagues and the infusion standards complete the evidence.
NR 449 Week 8 help from the desk
The most expensive brief is an announcement, a result reported warmly with no conditions, no failures and nothing another unit could act on. Another loss is a result without context, so the reader cannot judge whether it would transfer. Students also skip the protected elements, write to an instructor instead of a unit or leave out who should carry the message. A brief can go to a unit inside the organization; external audiences may need a different format. If your change was never run, present expected results clearly labeled. Who delivers the message matters because people copy colleagues they trust. Send your change and results, and an NR 449 dissemination brief can be written for the unit that needs it.
Get a NR 449 Week 8 example written to your instructions
Send the Week 8 instructions along with the page limit and the material from your earlier weeks, and a custom example is written to that limit and returned inside 24 to 48 hours. The first one is free. Where your workplace requires review before anything internal circulates, that approval is yours to seek.
More NR 449 papers and RN-to-BSN samples
- NR 449 Week 1: Settled Evidence Routine Discussion
- NR 449 Week 2: Night Transfusion Problem Statement
- NR 449 Week 3: Skin Antisepsis Evidence Summary
- NR 449 Week 4: Sedation Trial Stakeholder Analysis
- NR 449 Week 5: Specimen Labeling Barrier Analysis
- NR 449 Week 6: Transfusion Premedication Proposal
- NR 449 Week 7: Chest Radiograph Evaluation Plan
- NR 451 Week 8: Capstone Presentation
- NR 447 Week 8: Relief Charge Leadership Reflection
- NR 446 Week 8: Delegation Course Reflection Paper
- NR 300A Week 8: Independent Study Final Reflection
NR 449 Week 8 questions, answered
Does the brief go outside the organization?
Check your section, since some ask for an internal document and others for a conference abstract or a poster proposal. The reasoning is the same either way. An external version needs more about the setting, because a reader elsewhere knows nothing about your building, and it usually needs approval before anything identifiable leaves an employer.
Should I include results if the change was never run?
Follow the instructions, and most sections here treat this as a proposal rather than a report. Where the change was hypothetical, the brief carries the expected result marked plainly as expected, with its conditions attached. Inventing an outcome and presenting it as measured is the one error in this assignment nobody recovers from.
Why does it matter who delivers the message?
Because adoption follows people more reliably than it follows evidence, which is the argument this whole course has been making. A brief handed to an experienced nurse whose practice the floor already copies moves further than the same brief emailed by somebody with a title. Naming that person is a decision the assignment expects you to defend.
Where can I find a free NR 449 Week 8 sample paper?
This page shows the complete Week 8 memo from 5 West to 4 East on switching to saline locks, with the evidence, results and conditions, what to copy, what to adapt, early failures and three references.
What went wrong first in the NR 449 Week 8 brief?
Pharmacy removed heparin flushes from the unit's dispensing cabinet before the order set was updated, one of three early problems the memo reports along with the fix for each.