NURS-FPX 9100: Defining the Nursing Doctoral Project Project Charter Part 1 Project Name Implementing Evidenced Based Palliative Focused CHF Protocol for Advance

Practice Clinicians in Long-Term Care
Project Site Optum-United Health Group
Contact at site Name with credentials: Adrienne Peart APRN, NPC, Clinical Service Manager.
Organizational Email:
Phone Number:
Preceptor Name with credentials: Lora Crowe, Ph.D., Senior Clinical Service Manager.
Email:
Phone Number:
Executive Sponsor The executive sponsor is Adrienne Peart APRN, NPC, a Clinical Service Manager at Optum. The reason for selecting the sponsor is the extensive experience in handling patients with complex health needs. The manager also coordinates efforts by advanced practice clinicians and monitors outcomes to ensure that the services provided match patients’ needs and expectations.
Gap Analysis Optum Health is a subsidiary of the United Healthcare Group responsible for providing healthcare services to those who are insured by United healthcare insurance products.

Therefore, the strategic priorities of Optum health reflect the corporate mission and core values that align with the broader United Health Group (UHG) vision of improving customer experience by making healthcare work better for everyone by helping people live healthy lives.  The strategic priorities of UGH-Optum health for 2021 include expanding access to preventative care services to 85% of its customers by the year 2030, shifting 55% of outpatient surgeries to a high-quality, cost-effective setting by the year 2030, and closing 600 million gaps in care for customers by 2025 (UHG, 2020). Undoubtedly providing affordable, quality, safe, and effective patient care set precedence and is the number one priority of UHG. Achieving high-quality outcomes, lower costs, and improved consumer and physician satisfaction, driven by our high-performing local care practices.

UHG focus on the efficiency and profitability of the services provided by the organization.
Ten patients with heart failure with reduced ejection fraction diagnoses were selected, reviewed, and compared with AHA guidelines. None of the charts audited had ARNI (angiotensin receptor-neprilysin inhibitor) known as Entresto is part of the AHA recommendation for management of heart failure with reduced ejection fraction. Four patients with African American (AA) heritage are not on Hydralazine and only one patient was one SGLT2i as indicated by the guideline (Heidenreich et al., 2022). All ten charts reviewed had full code status indicating a lack of understanding of disease trajectory and recommendations.

Evidence to Support the Need The lack of use of an evidenced-based protocol for Advanced Practice Clinicians (APCs) limits them from proactively managing patients with CHF at risk of reduced ejection fraction in long-term care (Mechler & Liantonio, 2019). Even though some patients are managed by a cardiologist and have echocardiograms, evidenced based palliative focused CHF protocol may not be readily available to the APC at skilled nursing facilities. The gaps undermine the workforce’s abilty to deliver patient-centered and holistic care to patients with complex health care needs (Ryan et al., 2021). Therefore, managing the polypharmacy and CHF regimen calls for adequate knowledge and expeirncing in using the American Heart Association (AHA) guidelines  on managing cardiovascular conditions.
PICOT In advanced practice clinicians in complex care management at Optum (P) implementation of CHF palliative care protocol (I) compared to No heart failure protocol (c) to measure APC compliance with CHF protocol for patients in long-term care (O) within 10 weeks(T)

Project Aim The aim is to streamline Advanced Practice Clinicians’ use of palliative care protocols for CHF patients at Optum. The project seeks to enhance the implementation of AHA guidelines for Advanced Practice Clinicians (APC) handling members with NYHA class IV heart failure in long-term care. The guidelines will strengthen adherence to evidence-based CHF protocols adopted to protect patients from severe complications and premature deaths. The intervention will address gaps in using evidenced-based protocols for APCs to proactively manage members with CHF with reduced ejection fraction in long-term care.

Part II
Stakeholders
Stakeholder Identify the key stakeholders for your project. Think of key stakeholders (internal and external). This might include patients/clients, families, community leaders and organizations, health agencies, and systems within the organization. List between 3-4 potential stakeholder members

Initials or fictitious names Title, Role, or Affiliation. Connection to the project. Potential impact (how affected). Contribution to the project. Barriers or anticipated challenges if any
L.C Senior clinical service manager Internal stakeholders with knowledge of compliance gaps in the advanced care setting. The manager g