Plan Proposal Template
The following is a guide to organize your assignment. Please be sure to remove the guiding
questions and comments for each section. You are expected to write in a professional and
academically appropriate manner, including using correct APA style and citations throughout.
Propose a plan, referencing relevant existing and newly created processes, to implement
an intervention to improve quality and safety, and reduce costs in the context of a
chosen health problem.

Introduce a general summary of the project plan that you will be exploring.

Provide a brief context for the project plan.

Identify the specific intervention you are proposing.

Describe how this plan will improve quality, increase safety, and reduce costs associated
with this health problem.

Identify collaborators who will implement your plan.

Discuss how you propose to implement your plan.
Analyze technology within a chosen health care practice context to support a proposed
plan.

Compare and contrast the authors you will cite regarding the impact of technology for
this health concern, discussing pros and cons of the technology you are reading about.

Note whether the authors provide supporting evidence from the literature about this
technology that is consistent with technology you see in your nursing practice.

Include discussion from the literature on barriers to use of this technology and how it is
applied in the context of this patient or population problem.

Describe research studies that present opposing views regarding this technology.
Explain the ways in which existing governmental or organizational policies could impact
the proposed plan.

Cite authors who have written about specific governmental or organizational policies for
nurses to follow when planning care for this patient population.

Discuss research that has tested the effectiveness of these governmental or
organizational policies in improving patient or population outcomes for this health
problem.

Describe current literature on the role of nurses in policy making to improve outcomes,
prevent illness, and reduce hospital readmissions.

Discuss how the literature characterizes ways in which your role as a nurse leader can
help change governmental or organizational policies to improve patient outcomes.
Explain strategies for communicating and collaborating to improve health outcomes with
patients and interprofessional teams.
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Identify the key stakeholders in your clinical practicum environment, including patients,
with whom you plan to communicate.

Describe any surprising experiences you have had while enlisting support and gathering
stakeholder input on needed behavioral or educational changes in this patient or
population to address the identified health concern.

Discuss the benefits of gathering stakeholder input to improve care for this patient or
population.

Identify best-practice strategies from the literature for effective communication and
collaboration to improve patient outcomes in this clinical practicum.
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References
Remember to compile your APA-formatted reference list.
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Assessment 2 Instructions: Plan Proposal
Use a provided template to develop a 3-5 page proposal for an intervention and implementation plan
related to the health problem you defined in the first assessment.
Important: You must complete all of the assessments in order for this course.
For this assessment, you will be designing and planning the implementation for the intervention to
improve the health problem you defined in the first assessment. You will also examine implications of
interprofessional collaboration, technology, and organizational and governmental policies for your
intervention and implementation plans.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course
competencies and assessment criteria:
• Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the
cost of care.
◦ Propose a plan, referencing relevant existing and newly created processes, to implement an
intervention to improve quality and safety, and reduce costs within the context of a chosen
health problem.
• Competency 4: Apply health information and patient care technology to improve patient and
systems outcomes.
◦ Analyze technology within a chosen health care practice context to support a proposed
plan.
• Competency 5: Analyze the impact of health policy on quality and cost of care.
◦ Explain the ways in which governmental or organizational policies could impact the
proposed plan.
• Competency 6: Collaborate interprofessionally to improve patient and population outcomes.
◦ Explain strategies for communicating and collaborating with patients and interprofessional
teams to improve health outcomes.
• Competency 8: Integrate professional standards and values into practice.
◦ Communicate professionally in clear, logically organized writing, using correct grammar,
spelling, and APA style.
Important: You must complete all of the assessments in order for this course.
Professional Context
As a professional nurse, you perform a critical role in solving a host of health care problems. In this
assessment, you will use the literature to plan best-practice strategies to foster positive health outcomes
for your chosen patient or population.
Preparation
Your intervention and implementation plan should be carried out in an interprofessional context, aligned
to your topic, and based on the work you did in the first assessment. You should find collaborators as
soon as possible so you can solicit their feedback about intervention and implementation plans to inform
your approach.
Instructions
Having identified a health problem relevant to your current or future nursing practice and reviewed the
literature to support nursing standards, decision making, and improvement strategies, you should now
plan an intervention to address the chosen health problem based on the research you conducted.
Construct a plausible plan that leverages the best practices and research collected to date as well as
additional research into similar projects that you find in the literature. Be sure to frame your plan within
the context of the health care setting in which you are completing your practicum hours. Incorporate
relevant site-specific processes and policies into your implementation plan.
Use the Plan Proposal Template [DOC] to complete this assessment.
As you develop your plan, be sure to address the following:




Collaboration and communication with patients and colleagues to improve health outcomes.
Governmental or organizational policies that could affect the plan.
Quality and safety improvement strategies.
Technology at the site that could be leveraged.
Scoring Guide Criteria
• Propose a plan, referencing relevant existing and newly created processes, to implement an
intervention to improve quality and safety, and reduce costs within the context of a chosen health
problem.
• Analyze technology within a chosen health care practice context to support a proposed plan.
• Explain the ways in which existing governmental or organizational policies could impact the
proposed plan.
• Explain strategies for communicating and collaborating with patients and interprofessional teams
to improve health outcomes.
Scoring Guide Criteria
• Propose a plan, referencing relevant existing and newly created processes, to implement an
intervention to improve quality and safety, and reduce costs within the context of a chosen health
problem.
• Analyze technology within a chosen health care practice context to support a proposed plan.
• Explain the ways in which existing governmental or organizational policies could impact the
proposed plan.
• Explain strategies for communicating and collaborating with patients and interprofessional teams
to improve health outcomes.
• Communicate professionally in writing that is clear, logically organized, and uses correct grammar,
spelling, and APA style.
Additional Requirements
• Length of submission: Use the provided template. Most submissions will be 3 to 5 pages. You do
not need to include a title page. Be sure to complete the reference page at the end of the
template.
• Number of references: Cite a minimum of 5 sources of scholarly or professional evidence that
support your central ideas. Resources should be no more than five years old.
• APA formatting: Make sure that in-text citations and reference list follow current APA style.
Portfolio Prompt: Remember to save the assessment to your ePortfolio. After you complete your
program you may want to consider leveraging your Portfolio as part of a job search or other
demonstration of your academic competencies.
SCORING GUIDE
Use the scoring guide to understand how your assessment will be evaluated.
VIEW SCORING GUIDE

Plan Proposal Scoring Guide
CRITERIA
NON-PERFORMANCE
Propose an
intervention plan
that references
relevant processes
to improve quality
and safety, and
reduce costs in the
context of a chosen
health problem.
BASIC
PROFICIENT
DISTINGUISHED
Does not propose an Proposes an
intervention plan.
intervention plan that
references relevant
processes to improve
quality or safety, or
reduce costs in the
context of a chosen
health problem, but
not all three.
Proposes an
intervention plan that
references relevant
processes to improve
quality and safety,
and reduce costs in
the context of a
chosen health
problem.
Proposes an
intervention plan that
references relevant
processes to improve
quality and safety, and
reduce costs in the
context of a chosen
health problem. Predicts
one or more plan
outcomes.
Analyze technology
within a chosen
health care practice
context to support a
proposed plan.
Does not identify
technology within a
chosen health care
practice context to
support a proposed
plan.
Identifies technology
within a chosen
health care practice
context to support a
proposed plan.
Analyzes technology
within a chosen
health care practice
context to support a
proposed plan.
Analyzes technology
within a chosen health
care practice context to
support a proposed
plan, comparing
potential costs or
barriers of its use to
benefits.
Explain the ways in
which existing
governmental or
organizational
policies could
impact the proposed
plan.
Does not identify
ways in which
existing
governmental or
organizational
policies could impact
the proposed plan.
Identifies existing
governmental or
organizational policies
that could impact the
proposed plan.
Explains the ways in
which existing
governmental or
organizational
policies could impact
the proposed plan.
Explains the ways in
which existing
governmental or
organizational policies
could impact the
proposed plan. Notes
any possible impact of
policies on plan quality
or cost in particular.
Explain strategies
for communicating
and collaborating
with patients and
interprofessional
teams to improve
health outcomes.
Does not identify
strategies for
communicating and
collaborating with
patients and
interprofessional
teams to improve
health outcomes.
Identifies strategies
for communicating
and collaborating with
patients and
interprofessional
teams to improve
health outcomes.
Explains strategies
for communicating
and collaborating
with patients and
interprofessional
teams to improve
health outcomes.
Explains strategies for
communicating and
collaborating with
patients and
interprofessional teams
to improve health
outcomes. Notes the
relevance or benefits of
the strategies in the
context of the proposed
plan and health care
setting.
Communicate
professionally in
writing that is clear
and logically
organized, with
correct grammar,
spelling, and use of
APA style.
Does not
communicate
professionally in
writing that is clear
and logically
organized, with
correct grammar,
spelling, and use of
APA style.
Communicates in
writing that is unclear
or poorly organized,
and/or contains errors
grammar, spelling,
and/or APA style.
Communicates
professionally in
writing that is clear
and logically
organized, with
correct grammar,
spelling, and use of
APA style.
Communicates
professionally in writing
that is exceptionally
clear and logically
organized, with correct
grammar, spelling, and
flawless use of APA
style.
Problem Identification
Medication Reconciliation to Improve Outcomes among Older Adults
Adverse drug events lead to many deaths in the United States, leading to high costs for
families and hospitals. Research indicates that over 58% of the adverse drug events are
preventable as they are caused by medication errors, misinformation about drugs, and overuse of
medication. The older adults, due to a combination of several illnesses at a time, are at higher
risks for adverse drug reactions (Lavan, Gallagher & O’Mahony, 2016). As the elderly take the
medication for diabetes, hypertension, cardiovascular disease, or antidepressants, some may
completely miss taking one of the drugs, especially after discharge to their homes.
Medical reconciliation is one mechanism that has been applied in practice to reduce
adverse drug events. In medication reconciliation, an accurate list of the patient’s medication is
made with correct names, dosages, and frequency to help a patient know when to take a
particular drug. Since the elderly may not remember all the drugs by name and dosages, the
medication reconciliation document helps them in adherence and follow-up (Lavan, Gallagher &
O’Mahony, 2016). Research has shown that the use of medication reconciliation on admission
and during discharge among the elderly, leads to fewer cases of errors and adverse drug effects.
The overarching goal of medication reconciliation is to improve patient safety by
avoiding cases of adverse drug events. Therefore, through the proper process of reconciliation,
chronic medication can be identified in a continuum of care (Lavan, Gallagher & O’Mahony,
2016). Another goal is to encourage more involvement of the patients in their care by showing
them how to organize their medication and adhere to them. Moreover, medication reconciliation
is part of compliance for accreditation standards to maintain the quality of care given in a
hospital setting (Lavan, Gallagher & O’Mahony, 2016). Therefore, by adopting medication
reconciliation, especially when dealing with the elderly, better outcomes in patient safety can be
expected.
Nurses have an imperative role in ensuring that all patients are safe and are not affected
by issues that can be prevented, such as medication errors. As part of nursing practice, coming
up with methods that can help patients adhere to medication is an essential way of being actively
involved during patient care (Lavan, Gallagher & O’Mahony, 2016). The invention of tools such
as documents for medication reconciliation specific for each patient can help in improving
patient care. With the increasing numbers of geriatric population requiring treatment for chronic
illnesses, nurses have a vital role in using evidence-based methods such as medication
reconciliation in improving patient care.
Literature Review
Rappaport et al. (2017) reported that the need for medication reconciliation had been seen
to increase with age. The use of medication reconciliation can help in the identification of
discrepancies that may contribute to medication errors or adverse drug events. In a past study,
Cullinan, O’Mahony, and Byrne (2016) had noted that the use of medication tools at admission,
especially during history taking, could help in the reduction of errors for older adults. Due to
issues such as polypharmacy and comorbidities, understanding the medication lists of patients
can help avoid mistakes that may result in patient harm. Further, the authors had revealed that the
tools could show the potential of injury to a patient; therefore, allowing nurses to be keener with
a patient, including at discharge. Fredrickson and Burkett (2019), when reviewing the continuity
of medication management for older adults as they transition to residential area facilities,
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emphasized the need for a standard format of medication reconciliation at discharge and
admission at any of the centers. The review had shown that most of the medication errors and
reported adverse drug events had occurred due to poor communication among providers,
multiple prescribers for a patient as well as lack of proper charting of needs of a client.
Medical reconciliation has been applied successfully among pediatrics with chronic
illnesses and admitted to intensive care units. DeCourcey et al. (2017) reported that the use of
standardized tools in medication reconciliation had the potential to lower the cases of unintended
discrepancies in patient medication. However, the study faulted the current tools used, citing
their insufficiency in obtaining an accurate description of drugs in a manner that patients can use
at home. The study suggested a need for better interventions, especially when dealing with
children who may not understand the charts used for medication reconciliation.
The research indicates what is seen in nursing practice as a lack of medication
reconciliation at admission may lead to omissions or missed doses that may harm the patient.
During the patient assessment, history taking of the drugs and at times the right dosages may be
missed since the patients do not have adequate information about their medication (Lavan,
Gallagher & O’Mahony, 2016). Therefore, omitted does or weak interaction of prescribed drugs
could result in patient harm. While some hospitals have standard tools for reconciliation of
medication, some nurses rely on pieces of paper or patient charts to record any medicine that
may be required by a patient. The literature review points to a gap in the care of patients,
especially the older adults who may experience polypharmacy in helping them in the
management of their medication during the transition of care.
Spalla and Castilho (2016) had an opposing view as they proposed the incorporation of
pharmacists in medication reconciliation other than nurses. The explanation was that pharmacists
have better knowledge about drug interactions and can better advise patients on what to note or
avoid when taking certain drugs. Further, since they are knowledgeable on the drug uses, the
doses captured can be accurate and reduce dosage-related errors, which account for the majority
of the unintended discrepancies.
Applying Dorothea Orem’s theory of Self Care Deficit, it is evident that nurses have an
undeniable role in ensuring the safety of patients in their care. The model emphasizes the
identification of patient needs. In this case, the older adults require a thorough assessment of
their knowledge about their condition and education on how to manage the medication upon
discharge(Lavan, Gallagher & O’Mahony, 2016). Therefore, using the tenets of the theory, the
best methods for medication reconciliation can be chosen for older adults who may show specific
deficits with medication management.
Strategies to Improve Patient Outcomes
Steinman et al. (2018) noted that nurses could lead change by providing interventions that
aimed to improve medication management among older adults. The study showed that nurse-led
initiatives were more effective in helping the elderly adhere to medication. A similar study by
Jordan et al. (2019) noted that with nurses as leaders in the monitoring of medicine for older
adults in care homes, the use of practical tools such as adverse drug events profiles helped to
understand the susceptibility of patients to errors. The study revealed that nurses could identify
patients who required more help in medication reconciliation in the care homes through thorough
profile taking. Nurse-led initiatives have often led to positive outcomes for the patients. In
helping older adults’ self-manage diabetes, Azami et al. (2018) revealed how the use of the
nursing process in educating patients led to favorable outcomes. Nurses have a role of
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coordination of care, which can also be applied in this context to help in the reconciliation of
medication for older adults during admission and discharge. In this way, the adverse drug events
can be minimized as patients are part of the care process.
Indeed, the use of patient-centered approaches in care for the elderly has been effective in
the management of several conditions. As patients are made a part of the nursing process, they
have an opportunity to define care and ask questions in case of misunderstanding. Since the
elderly at discharge may not manage their medication correctly, nurses can assist through the
innovation of medication reconciliation tools that would help the clients. The transition of care is
critical for older adults, as it may lead to more errors and patient harm. Hestevik et al. (2019)
showed that coordination of care using family members and visiting of homes helped the older
adults in proper adaptation to home life after discharge. The most significant issue of medication
discrepancies, including missed doses and omitted drugs, can be avoided if the right patient and
family education are given at discharge.
State Board Nursing Practice Standards
In Miami, Florida, the Department of Elder Affairs is concerned about the health and
safety of the older population in the state. An action plan that involves promoting the health
outcomes of the elderly has been laid out to assist practitioners and other stakeholders in dealing
with the geriatric population (Madrigal et al., 2019). Nurses in Florida are bound to the Florida
Nurse Practice Act that requires each of them to have specific competencies that qualify them for
safe patient care. Among the requirements in safety is ensuring that the older adults are at
lowered risk for medication errors and discrepancies that may result to harm (Madrigal et al.,
2019). Although Florida has restricted practice for the nurses, they are allowed to take
specialized roles in-home visits to check on chronic patients after discharge as part of the followup.
It was surprising that while over 22 states have offered full practice authority to nurses,
Florida still maintains the restricted practice. While this may hinder nurses from taking new roles
in private practice to care for elderly patients in clinics, it does not interfere with their mandate to
provide solutions for issues affecting them, such as medication management (Madrigal et al.,
2019). Also, the practice scope allows nurses to make innovations that promote the wellbeing of
the patients. In this context, the use of medication reconciliation tools to help the elderly in the
management of drugs will be associated with reduced risk for adverse drug events.
Nursing ethics is an integral part of the practice that allows one to make informed
decisions when working with a particular population. When dealing with older adults, it is
critical that one aims to maintain the autonomy of the patient while offering help with medical
aspects. Nursing ethics require that one upholds a patient’s confidentiality of medical records
while providing the best optimal care. As I apply the use of medication reconciliation to help the
older adults manage their medication and reduce associated adverse events, promoting autonomy
and fostering self-management would be the best approach.
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References
Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M., Aazami, S., Mozafari, M., & Taghinejad, H.
(2018). Effect of a nurse-led diabetes self-management education program on
glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes
research, 2018.
Cullinan, S., O’Mahony, D., & Byrne, S. (2016). Application of the structured history taking of
medication use tool to optimize prescribing for older patients and reduce adverse
events. International journal of clinical pharmacy, 38(2), 374-379.
DeCourcey, D. D., Silverman, M., Chang, E., Ozonoff, A., Stickney, C., Pichoff, D., … &
Finkelstein, J. A. (2017). Medication reconciliation failures in children and young adults
with chronic disease during intensive and intermediate care. Pediatric critical care
medicine: a journal of the Society of Critical Care Medicine and the World Federation of
Pediatric Intensive and Critical Care Societies, 18(4), 370.
Fredrickson, B. A., & Burkett, E. (2019). Interventions to improve the continuity of medication
management upon discharge of patients from hospital to residential aged care
facilities. Journal of Pharmacy Practice and Research, 49(2), 162-170.
Hestevik, C. H., Molin, M., Debesay, J., Bergland, A., & Bye, A. (2019). Older persons’
experiences of adapting to daily life at home after hospital discharge: a qualitative
metasummary. BMC health services research, 19(1), 224.
Jordan, S., Banner, T., Gabe-Walters, M., Mikhail, J. M., Panes, G., Round, J., … & Medicines’
Management Group, Swansea University. (2019). Nurse-led medicines’ monitoring in
care homes, implementing the Adverse Drug Reaction (ADRe) Profile improvement
initiative for mental health medicines: An observational and interview study. PloS
one, 14(9), e0220885.
Lavan, A. H., Gallagher, P. F., & O’Mahony, D. (2016). Methods to reduce prescribing errors in
elderly patients with multimorbidity. Clinical interventions in aging, 11, 857.
Madrigal, C., VanHaitsma, K., Mogle, J., Fick, D., Scanlon, D., Abbott, K. M., & Behrens, L.
(2019). Validating the care preference assessment of satisfaction tool to measure quality
of care in nursing homes. Innovation in Aging, 3(Supplement_1), S885-S885.
Rappaport, R., Arinzon, Z., Feldman, J., Lotan, S., Heffez-Aizenfeld, R., & Berner, Y. (2017).
The Need for Medication Reconciliation Increases with Age. The Israel Medical
Association journal: IMAJ, 19(10), 625-630.
Spalla, L. D. R., & Castilho, S. R. D. (2016). Medication reconciliation as a strategy for
preventing medication errors. Brazilian Journal of Pharmaceutical Sciences, 52(1), 143150.
Steinman, M. A., Low, M., Balicer, R. D., & Shadmi, E. (2018). Impact of a nurse-based
intervention on medication outcomes in vulnerable older adults. BMC geriatrics, 18(1),
207.
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