Now that you have completed your proposal, please review it and check off each of the following requirements:
_____ Your project is ready to go, as soon as you receive IRB approval and funding from DAISY
___ _____ Your project is an Evidence-based Practice Project (EBP), not a Quality Improvement project (QI)
_____ Your Purpose statement contains the patient population matching The DAISY Foundation's mission, clinical problem, evidence-based intervention or practice change and desired outcome.
_____ Your Team includes staff nurses in project leadership roles, change agent(s) and an EBP expert as a mentor.
_____ Your Background describes why this is a priority for patients/families and the organization.
_____ Your Background describes a synthesis of the evidence establishing the need to address the clinical issue (e.g., cited prevalence of the clinical problem), the benefit of the intervention, and expected impact on process and outcome indicators. Evidence is cited that is current and comprehensive. If a practice guideline is part of the evidence synthesis you include a brief summary of the strengths and limitations as identified by your critique (e.g., using the AGREE Instrument - link to http://www.agreetrust.org/ or http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II-Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf). If a practice guideline is used, you include a synthesis of more recent evidence (including research and EBP) that has been reported subsequent to the date of the evidence review within the guideline.
__ _____ Your EBP Process Model provides direction for project development and planning. Commonly-used models include the Iowa Model, Johns Hopkins Model, or another model used in your organization.
_____ Your Proposed change describes the procedure for the use of the evidence-based practice being introduced such that any nurse reader would be able to use the procedure as intended. Please see the sample EBP proposal for ideas when describing the desired practice, timing within patient encounters (e.g., week 4 of radiation therapy) and use of tools to engage patients and clinicians.
_________ Your Implementation Plan describes a multi-faceted approach to engage clinicians and patients in use of the practice change. Do not limit implementation to education of clinicians, as additional implementation strategies will be needed. Consider a reinfusion plan along with a plan to promote initial adoption.
_____ Your Process evaluation is included in the evaluation plan and describes the key process measures/indicators including a general definition (e.g., patient activity practices will be collected by interviewing patients to self-report the frequency and time spent walking, gardening, household chores, work, and other forms of physical activity over the past week), how data will be collected, planned data analysis and reporting. Examples of process measures include clinician knowledge, clinician feedback on implementation tools, clinical practices used by clinicians, patient knowledge or patient health behaviors. Preliminary data may be helpful but is not required.
_____ Your Outcome evaluation is included in the evaluation plan and describes the key outcome measures/indicators including a definition (e.g., patients will be asked to rate their fatigue on a 0-10 scale using Brief Fatigue Inventory (used with permission, The University of Texas MD Anderson Cancer Center, 1997), how data will be collected, planned data analysis and reporting. Examples of outcome measures include patient symptoms related to cancer or cancer treatment. Preliminary data may be helpful but is not required.
_____ Your Attachments include ALL the tools to assist the clinician in engaging patients to participate in the practice change.
_____ Your Attachments include ALL the tools used for data collection.
_____ Your Attachments include all letters granting permission for use of tools
_____ Your Attachments includes a timeline that uses the format described above. It includes the steps of the EBP process following development of the tools supporting the practice change (i.e., Copying of patient materials, copying of data collection tools, staff training about practice change, core group work to promote adoption of the practice change, reinfusion plans, monitoring progress, data collection, data entry, data cleaning and analysis, Interim and Final Reports to The DAISY Foundation, etc.)
_____ Your Attachments include a budget for materials and tools needed to engage patient in the practice change, train clinicians and complete the evaluation. You have used the format described above.
_____ Your Attachments include one addressing IRB approval (with the consent) or determination that the project is not human subjects research.
_____ Your Attachments includes the letter of agreement with The DAISY Foundation, signed by you and your CNO or other administrative leader.
___ Your Attachments includes the list of references cited within the application.
___ Your Attachments include the CV of the applicant and EBP mentor.