NR 583NP Week 5 Implementation Plan Example

Implementation Plan: Tablet PHQ-9 at Check-In Across Four Primary Care Sites, With a Westgate Pilot, the Staffing Arithmetic for the Slow Weeks and a Named Person Who Can Stop It

Student Name

College of Nursing, Chamberlain University

NR 583NP: Informatics for Advanced Nursing Practice

Instructor Name

Month Day, Year

Implementation Plan: Tablet PHQ-9 at Check-In Across Four Primary Care Sites, With a Westgate Pilot, the Staffing Arithmetic for the Slow Weeks and a Named Person Who Can Stop It

Scope, Including What Stays Untouched

In scope: adults aged 18 and over, at all four sites, completing the PHQ-9 on a tablet handed out at check-in when screening is due. Answers flow into the existing flowsheet rows. A positive item 9 sends an immediate flag to the rooming MA and the patient's NP.

Not in scope, and not changing: adolescent screening, which stays with the PHQ-A asked by the MA; the BHC's schedule and referral process; the rest of the MA rooming sequence; the quality report's definitions; and the patient portal, which will not send questionnaires during this project. Writing these down now is meant to prevent the most common rollout argument, which is about what was supposed to change.

Sequence, With the Pilot's Bias Admitted

Pilot: Westgate, weeks 1 to 4, starting 4 January 2027. Westgate was chosen because its site lead volunteered, the BHC is on site four days a week and the front desk ran the two-week trial in September.

Westgate is not representative. It has the most front desk staff per visit, the fewest Somali-speaking patients and a BHC down the hall. If the pilot goes well, that may be because of these advantages. The plan therefore treats Westgate as a test of the technology, not of how the other sites will cope.

Wave 1: Linden Avenue, weeks 6 to 9, chosen next because it has the largest Somali-speaking population and will test the Somali version properly. Wave 2: Eastland and Hilltop together, weeks 11 to 14.

The Staffing Arithmetic

Each tablet hand-off and retrieval adds about two minutes at check-in, measured during the trial. Westgate sees about 60 adult visits a day, of which about 40 are due for screening, so the front desk absorbs about 80 extra minutes a day. In the first two weeks, when staff are slower, I estimate double that, 160 minutes.

Those minutes come from a float front desk staff member, Renee, who covers Westgate's busiest hours (8:00 to 12:00 and 16:00 to 19:00, including the Tuesday and Thursday evening clinics) for weeks 1 to 3. Renee's usual work at Hilltop, insurance verification, moves to the billing office for those three weeks; the billing manager has agreed. At Linden Avenue, with about 70 adult visits a day, the same float covers weeks 6 to 8.

The MAs save about two minutes per screened visit because they no longer read the PHQ-9 aloud. That time is not being taken back by the practice; the site leads agreed it goes to the blood pressure recheck MAs often skip when running late.

Downtime and the Paper Fallback

Each front desk keeps 50 printed PHQ-9 forms in English, Spanish and Somali. If tablets or the network fail, the patient completes a paper form, the MA adds up the answers at the bedside and keys each one into the flowsheet. Any form with a positive item 9 goes from the MA's hand to the NP before the next patient is roomed. The front desk lead checks the stock every Monday.

Training

Training is covered in a separate plan. In short, every front desk staff member and MA at a site completes a 20-minute session in the week before that site goes live, and two trained colleagues per site stay beside the desk through the opening fortnight.

Who Can Stop This

The practice medical director, Dr. Alvarez, can pause the rollout at any site. Each site lead can pause their own site for up to 48 hours without permission. Pausing means returning to MA verbal screening the next morning.

Stop criteria, any one of which triggers a pause: a positive item 9 answer that no clinician reviews before the patient walks out; a tablet answer filed to the wrong patient; median check-in to rooming time more than ten minutes above baseline for three days in a row. I review these daily during the pilot and weekly afterward and report to Dr. Alvarez.

Baselines Taken Beforehand

In the four weeks before each site goes live, I will record: screens completed out of screens due; median check-in to rooming time; time from a positive item 9 to clinician review; and the 30-day contact rate after a positive PHQ-9. The workflow count at Linden Avenue (29 of 34 asked) and the second-quarter data brief (45% contact within 30 days) are early versions of these numbers.

Why the Plan Is Built This Way

Cresswell et al. (2013) list early attention to workload and a plan for problems among the main conditions for successful health IT adoption, and both shape this plan. Sittig and Singh (2010) argue that people, workflow and technology must be considered together; the staffing pages exist because the tablet is the easiest part.

Communication With Patients

Patients will meet the tablet without warning unless the practice tells them. A short notice goes into appointment reminder texts two weeks before each site starts, in English, Spanish and Somali: at check-in you may be asked to answer a few health questions on a tablet. Signs at the front desk say the same. Patients who prefer paper or prefer to answer aloud may ask, and staff record that preference so it is offered again at the next visit. I will count how many patients choose paper in the first month at each site, since a high number would suggest the tablet does not suit that site's patients.

Cost Summary

The purchase, about $14,000 for 16 tablets, stands, cases and the first year's license, is already approved. The added staff cost for the plan is the float front desk time, about 120 hours across Westgate and Linden Avenue, and about 30 hours of my own time for baselines and daily review during the pilot. Ash et al. (2004) describe how information systems can add work in places nobody planned for, which is why the review checks front desk minutes and not just completion.

Risks

The Somali version may need revision after Linden Avenue. Front desk turnover could leave a site with nobody trained on evenings. Patients may hand back an incomplete tablet; the MA then asks the missing items aloud, and I will count how often this happens.

Review

At the end of week 14 I will report to the operations committee on all four baselines, every pause and its reason, and the front desk minutes per visit. The committee then decides whether to keep the tablets, extend them or return to verbal screening.

References

Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112. https://doi.org/10.1197/jamia.M1471

Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association, 20(e1), e9-e13. https://doi.org/10.1136/amiajnl-2013-001684

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085