NUR5053 Module 6 sustainability and spread plan example

After the Red Tags Come Off: A Plan to Hold Confirmed Feeding Tube Placement on One Neuroscience Unit and Spread It to Three More

Student Name

American College of Education

NUR5053: Quality Improvement and Safety

Module 6 Assignment

Instructor Name

December 1, 2026

Where the Project Stands

The project followed through this course began with a safety culture appraisal on a 30-bed neuroscience step-down unit, a composite, traced a harmful feeding tube event to its system causes, mapped the failure modes of the whole placement process and chartered a project whose aim is that no first feeding begins until the radiologist's reading of the placement film is on file. At the time of writing, four consecutive weeks have reached 100% on that measure, against a baseline median of 81.5%. By the rules applied in Module 5, two more weeks above the median will confirm a real shift.

The change behind those weeks is fragile. It rests on a red paper tag on the feeding pump, on the attention of a project team that meets every week and on a clinical nurse specialist who checks every record on Monday morning. Each of these will end or fade. A result that depends on a tag and a team is a pilot, not a new process, and this plan is about the difference.

What Sustaining Means Here

Moore et al. (2017) reviewed 24 published definitions of sustainability and combined them into five elements: after a defined period, the program or its activities continue to be delivered, the changed behavior of individuals is maintained, the program and behavior may adapt over time, and the program continues to produce benefits. Their definition is useful because it separates continuing to do something from continuing to get the result, and a unit can manage the first while losing the second.

For this project, sustainment will be judged at 12 and 24 months after the aim is met, on three tests. The process measure stays above 95% with no week below 80%. Guided placement for high-risk patients stays above 80%. And the change has been adapted as needed without losing its core, which is that no feeding begins through a tube whose position has not been confirmed on a filed result. Wiltsey Stirman et al. (2012), reviewing 125 studies, found that few programs were sustained in full when sustainment was measured rigorously, and that partial continuation was common, so the plan assumes some parts will erode and decides in advance which parts cannot be allowed to.

Hardwiring What Can Be Hardwired

The strongest way to sustain a change is to make the old way impossible, so the plan converts every part it can from a behavior into a system feature. The paper tag will be replaced in January 2027 by the forcing function first recommended in the root cause analysis: the enteral nutrition order will not release to the pump workflow until a placement result is filed, and the imaging status will distinguish acquired from read. The informatics team has scheduled the build, and the tag will stay in use until the electronic version has run for four weeks without a failure.

The three-question risk screen will become a required field on the placement order, so it cannot be skipped. The radiology priority category for feeding tube films will be written into the radiology department's own policy rather than the unit's, because a policy owned by the department that must follow it lasts longer than one that another department wrote. The rebuilt placement competency will join the unit's annual competency cycle and new hire orientation, with guided placement training scheduled so that at least two trained nurses are on every shift.

Ownership and Monitoring After the Project

The project team will disband when the aim has been met for eight weeks. Responsibility then passes to the unit's practice council, which already meets monthly and includes staff from all shifts. The weekly chart will move to monthly reporting on the unit's quality board, and the monthly figure will also appear on the nursing division's patient safety dashboard, where the director reviews it with other units' results. The audit of records will step down from every record to a random sample of ten a month once the forcing function is live, since the system itself will then prevent most failures.

The plan also names signals that will bring the team back together. Any feeding started through a misplaced tube, any month below 90%, a rise of more than an hour in the night balancing measure or a change to the electronic record that touches the order set will trigger a review within two weeks. Chambers et al. (2013) argue that sustainability should be treated as continued learning and adaptation to a changing context rather than as a fixed protocol that can only drift downward, and these triggers are how the unit will notice when the context has changed around it.

Spreading the Change

Spread is planned in three phases. The neuroscience intensive care unit comes first, because its patients carry even higher risk, its nurses asked to join and it shares the same radiology service. The two medical units that place the most feeding tubes come second, three months later. Hospital-wide adoption follows only after both phases have held for six months.

Greenhalgh et al. (2004), in their review of how innovations spread in service organizations, found that adoption depends partly on the innovation's own attributes: whether users see a clear advantage over current practice, whether it fits their values and ways of working, how hard it is to learn, whether a unit can test it briefly before committing, and whether other staff can watch it produce results. The plan uses those attributes to decide what travels and how. The forcing function spreads without persuasion, since it lives in the shared order set and will reach every unit when it is built. Guided placement is more complex and needs trained staff and devices, so each receiving unit will run its own small test first and adapt the risk screen to its patients. The step-down unit's run charts, and the story of the two misplacements, will be shared with each unit because a visible result persuades more than a policy memo. Each receiving unit will name a nurse champion who spends a shift with the step-down unit's trained nurses before its own test begins.

The receiving units will not be asked to copy the step-down unit's process exactly. They will be asked to keep the core, that feeding waits for a filed result, and to adapt the rest, reporting what they changed.

Conclusion

Over six modules, one unreported near miss led to an appraisal, an event review, a failure analysis, a chartered project, a measurement plan and now a plan to keep and share the result. The project's own history shows why the order of that list matters: each step existed because the one before it found something the unit could not see. The gain will last only if the parts that depended on attention become parts that depend on design, and if the unit that owns the change keeps watching the data after the project team has gone home.

References

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8, Article 117. https://doi.org/10.1186/1748-5908-8-117

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Moore, J. E., Mascarenhas, A., Bain, J., & Straus, S. E. (2017). Developing a comprehensive definition of sustainability. Implementation Science, 12, Article 110. https://doi.org/10.1186/s13012-017-0637-1

Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, Article 17. https://doi.org/10.1186/1748-5908-7-17