NR 652 Week 2 Implementation Log Example

Implementation Log Write-Up: Dated Entries From the Committee Vote to the Required Row, and the Three Weeks the January Huddles Consumed

Student Name

College of Nursing, Chamberlain University

NR 652: Healthcare Policy Concluding Graduate Experience II

Instructor Name

Month Day, Year

Implementation Log Write-Up: Dated Entries From the Committee Vote to the Required Row, and the Three Weeks the January Huddles Consumed

The Record

Hours I claim for the practicum and the site's sign-off sheet are my own attendance record and sit separately; this table is the project record.

The Stretches

From 23 November to 4 January, the work moved through governance on schedule. Every step happened on or before the date in the plan, and the only change was the committee's condition, which added a build request.

From 4 to 31 January, the work moved on one unit and stopped on two. The bulletin reached everyone, but the huddle talks, which the plan relied on for nurses to hear about the change from their own managers, happened on Unit A only.

From 2 February to 3 March, the work caught up. Units B and C were briefed, the required row went live and the reports arrived.

The Point Where It Stopped Moving

12 January, when huddles on Units B and C were canceled. Nothing in the project could have prevented it; the huddles are the managers' tool, and the managers needed every nurse on the floor. The plan had no fallback for huddles that did not happen, which is the lesson. A plan that names a channel owned by someone else should also name what happens when that channel is closed, and who decides to use the fallback.

What the Stall Consumed

About three weeks on two units. January's figure, which was meant to be the first clean month after the change and now mixes an educated unit with two that had only a bulletin. And the order of events on Units B and C, where nurses met the policy talk and the required row within days of each other, so their February figures cannot separate the two.

The stall did not consume the policy itself, which took effect on time everywhere, or the required row, which arrived when estimated.

What Was Not in the Plan

Two changes made by others during the period: a discharge lounge that opened on 18 January on Unit C's floor, which moves some patients off the unit before discharge, and two video devices added on 1 February. Both could affect interpreter use at discharge, in opposite directions. Discharge is the moment the benefit of a trained interpreter matters most, since errors there go home with the patient (Karliner et al., 2007), so any change in where discharge teaching happens deserves a line in the log. The log records them because the outcome evaluation will need them.

What the Stall Did Not Change

The committee's condition that the row be made required was met on the estimated date, despite the influenza weeks, because the build sat in an information technology queue unaffected by nursing staffing. The policy bulletin also went out on time. That contrast matters for planning: steps owned by central departments kept their dates, and the step owned by unit managers did not, because it depended on the units having time to spare.

Who Was Told About the Slip

The Nursing Practice Council chair and the coordinator were told on 31 January, when the sign-in check showed no talks on Units B and C. The update memo of 10 February reported it formally. Nobody outside the project had noticed, which is itself a lesson: a slip in education is invisible unless someone counts sign-ins. The counting took about an hour, and without it the January figure would have been read as the policy's effect on all three units.

How the Log Was Kept

Entries were made on the day, from emails, minutes and sign-in sheets, and each row names a role rather than a person. Where an entry depended on someone else's report, such as the sign-in counts, the date the report reached the student is the date recorded. The sign-in sheets stay with the unit managers; the log records only the counts.

What the Write-Up Does Not Say

Whether the amendment worked. The reports are recorded as received; reading them is the outcome evaluation's task.

Fit With Implementation Thinking

Reach and fidelity are implementation outcomes in their own right (Proctor et al., 2011). The log shows that fidelity to the policy was immediate, since the policy took effect on one date, while reach through education was uneven. Contextual factors such as staffing are among the conditions that shape whether changes take hold (Damschroder et al., 2009).

What Changes in the Plan

A fallback for canceled huddles, such as a two-minute recorded message from the manager played at the start of each shift, would have reached Units B and C in January. It is noted for the recommendation document, along with a simpler check: a sign-in count at the end of the first week, so that a missed unit is visible in days rather than at month end.

References

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7