Near-infrared light device implementation in pediatric intravenous cannulation

Purchasing and Implementation of a Near-infrared Light Device Project Management Plan

Executive Summary

The project idea was generated by the need among RNs for a better IVC procedure. Having some knowledge of using the near-infrared light device, I was able to generate this project idea and find support for it from the project sponsor. The project will deliver the purchase of near-infrared light devices to assist RNs in IVC work in the Pediatric Ward so as to boost quality of care for patients. The total funding for the project is $25,000 but less than half of that will be needed to fund the project. The project will be steered by the project manager Isilda Luis and the project sponsor will be Tonya Tochi, the Nursing Unit Manager. Risks to completion include running out of time before a complete review of the outcomes can be measured and not finding enough time to ensure that all RNs receive adequate training with the device. Project management activities will include monitoring team members, organizing groups within the team, assessing outcomes, receiving reports and communicating with RNs and the project sponsor. The expected outcome of this project is to increase quality care for patients in the Pediatric Ward by making the IVC procedure less painful and traumatic for young patients. Their improved experience in the Ward will help to improve the feelings of job satisfaction among RNs in the Ward and contribute to the department’s overall well-being in the long run.

Table of Contents
1. Overview 3
1.1 Purchasing and Implementation of a Near-infrared Light Device. 3
1.2 Project Background 3
2. Scope 3
2.1 Aim 3
2.2 Objective(s) 4
2.3 Outcome(s)/Benefits 4
2.4 Output(s) / Deliverables 4
2.5 Assumptions 4
2.6 Constraints 5
3 Work Breakdown Structure, Schedule / Milestones 5
3.1 Timeline estimation 5
4 Project Management Office Structure 6
4.1 Governance Structure 6
4.2 Project Sponsor/Steering Committee 7
4.3 Project Manager 7
4.4 Project Team 7
4.5 Working Parties/Groups 8
4.6 Reporting Requirements 9
5 Stakeholder Management & Communication Management Plan 9
6 Human Resources and Cost Management Requirements 10
6.1 Budget and Expenditure 10
7 Risk Management Plan 10
7.1 Quality Management 11
8 Project Closure & Outcome Realization 12
9 Appendices 13

Project Purchasing and Implementation of a Near-infrared Light Device: Project Management Plan – Version 1 Page 2 of 13
1. Overview
1.1 Purchasing and Implementation of a Near-infrared Light Device.
1.2 Project Background
Intravenous cannulation (IVC) is performed to more than 70% of children admitted to hospital. One third of them require multiple attempts to achieve successful cannulation (Joshi et al. 2017). Clinical staff working at the Paediatric Ward is responsible for IVC insertion. A current problem that clinicians often face is multiple venepuncture attempts to achieve successful cannulation. This can result in prolonged procedural pain, increased parental and child anxiety, delayed treatment and clinician frustration. Cannulation is challenging because children’s veins are thin and difficult to palpate and visualize and clinicians are largely dependent on their proficiency and on their visual and tactile senses (Dougherty 2008; Park et al. 2016). This validates the need for a near-infrared light device to assist locate and delineate veins (Chapman et al. 2011). The benefits of this device are increased success in finding veins; it is safe, non-invasive, portable and simple to use; consequently, it promotes patient-centred care and better patient outcomes.

2. Scope
This project seeks to accomplish the purchase of a near-infrared light device by April 2018 and successfully see its implementation by nurses. The work needed to accomplish this task is: 1) the proper budgeting of funds to ensure the device is purchasable, 2) training of nurses to ensure the device is used appropriately, and 3) measurement of implementation of device by nursing staff to ensure staff is using the device effectively. Research will need to be conducted to identify the cost of the device, and the staff will need to be organized and informed about the device through familiarity with tutorials that will be accessed by the staff at the appropriate time. Measurement methods will also have to be identified in order to assess the effectiveness of the implementation of the device’s usage.

2.1 Aim
This project aims to purchase a near-infrared light device by April 2018 and successfully see its implementation by nurses.
2.2 Objective(s)
1.This objective will ensure greater quality of care for young patients receiving the IVC post-implementation of device usage by April 2018
2.This objective will ensure greater accuracy of nurses in executing the IVC on patients by April 2018.
3. This objective will ensure that the nursing staff has access to near-infrared light devices to assist in proper IVC by April 2018 and that staff is trained in how to use the devices.
2.3 Outcome(s)/Benefits
Near-infrared light devices will facilitate proper IVC. They will be used to identify blood vessels up to 10 mm deep by projecting an image of the veins on the skin, assisting clinicians in the identification, assessment and patency of veins and their preservation because it provides a clear image of the patient’s blood vessels. This will benefit patients by causing them less trauma (proper IVC will be achieved more easily with the assistance of the devices), and nurses will feel more confident about their work as a result. Improved quality of care will be the ultimate outcome.

2.4 Output(s) / Deliverables
In order to achieve the outcome, the near-infrared devices will have to be purchased after allocating appropriate resources from the budget for the purchasing. Nurses will have to be trained in their usage so that they can be implemented on the floor effectively. Measurements will have to be devised in order to assess the effective implementation of the devices on the floor and to assess the improvement in quality care as the overall result. A schedule will need to be developed to allocate time and work towards the achievement of this objective.
2.5 Assumptions
It is assumed that the near-infrared light devices will be available for purchase within the timeframe of this project and that nurses will be able to schedule the appropriate training sessions so as to allow for implementation of the devices in a timely manner. It is further assumed that the budget will allow for the purchase of these devices and that their implementation will promote greater quality of care. Finally, it is assumed that this project will be able to be completed and that the administration will sign off on the purchasing of the devices.
2.6 Constraints
This work must be accomplished by the deadline of the project. Likewise, there may not be sufficient funding for the project, which could result in delay of the projection’s accomplishment. A further constraint is that work schedules and nurses calling off work or calling in sick may slow down the training process, which could lead to poor results following the measurement of the implementation of the device’s usage on the floor. The schedule will have to be maintained as closely as possible to ensure a successful outcome for this project and the budget will have to be carefully analysed to ensure that the devices may be purchased.

3 Work Breakdown Structure, Schedule / Milestones
3.1 Timeline estimation

The Project Sponsor is Tanya Tochi, Nursing Unit Manager. The Project Manager is Isilda Luis, Registered Nurse, Paediatric Ward [ full-time]. The project manager will oversee the completion of the project and report to Tanya. The Work Breakdown Structure (WBS) will consist of the following elements: The project team will be required to research the purchase of near-infrared light devices and obtain all the data on availability, best in class, and cost. This data will then be compiled into a presentation that concludes with a recommendation for an appropriate device model for the nursing staff. The team will have to coordinate with the budget department to ensure that the purchase of the devices will be possible. The team will then have to make the purchase and receive the product. The team will also have to oversee their training on how to use the devices, utilizing Internet video tutorials and practice training sessions. The measure of quality care will have to be implemented using a brief survey of patients to assess whether this technique has received a favourable outcome. The milestones will be achieved with the completion of each individual task, assessed by interview via daily reporting to the project manager:
· Task 1: the researching of products.
· Task 2: the compilation of data.
· Task 3: the presentation of data.
· Task 4: coordinating with budget.
· Task 5: the conclusion and recommendation made on a product to purchase.
· Task 6: making the purchase.
· Task 7: tutorial training.
· Task 8: receiving and implementing the devices.
· Task 9: measuring project outcomes using the survey method.
· Task 10: making adjustments if necessary.
The timeline for this project is to have completion finished by April 2018. This timeline is sufficient for the project, as it essentially allows for 1 week for each milestone to be reached, with some leeway afforded in either direction (for advancing or for taking extra time if needed for any one milestone).
4 Project Management Office Structure
4.1 Governance Structure

Project Organizational Structure is hierarchical with the project manager overseeing the project team, the team itself divided into groups tasked with performing specific functions throughout the project.
Governance will be conducted through coordinated efforts of the project manager and the project sponsor. The Project Sponsor Committee will be driven by the Project Sponsor in conjunction with the administration to which she reports. The Project manager will monitor the achievement of milestones through daily interviews with project team members. Working groups will be formed from the project team, and reporting requirements will consist of daily reporting to the project manager and the project manager’s bi-weekly reporting to the project sponsor, with the project sponsor reporting to the committee on a monthly basis.





Figure 1: Governance Structure for the Near-Infrared Light Device Purchasing Project

4.2 Project Sponsor/Steering Committee
The project sponsor Tonya Tochi is the Nursing Unit Manager and will be responsible for overseeing the entire project.
4.3 Project Manager
The project manager will be Isilda Luis, RN in the Paediatric Ward. The project manager will coordinate with the nursing team and report to the project sponsor on milestone achievement and assessment along the way. The Project Manager delivers the defined project outputs listed above and will manage the day-to-day aspects of the project, resolving planning and implementation issues, budgeting, and monitoring and reporting progress through coordinated efforts with the team members.
Nominee: Project Manager: Isilda Luis, Registered Nurse, Paediatric Ward [full-time]
4.4 Project Team
Nominee(s): [Christine Carter], [Registered Nurse], [Paediatric Ward] – [full time]
[Kim Robinson], [Clinical Nurse Educator], [Paediatric Ward] – [part time]
[Marilyn Limuaco], [Registered Nurse], [Paediatric Ward] – [full time]
[Mary Flannigan], [Registered Nurse], [Paediatric Ward] – [full time]
[Cris Solano], [Registered Nurse], [Paediatric Ward] – [full time]
[Kylie Reader], [Registered Nurse], [Paediatric Ward] – [part time]
[Clara Kong], [Clinical Nurse Specialist], [Paediatric Ward] – [part time]
Project Sponsor: Tanya Tochi, Nursing Unit Manager
Project Manager: Isilda Luis, Registered Nurse, Paediatric Ward [ full-time]

4.5 Working Parties/Groups
Christine Carter and Kim Robinson will be tasked for finding appropriate tutorials for the education of the nurses on how to use the infrared-light devices and to ensure safety and effective implementation of the devices on the floor.
Marilyn Limuaco and Mary Flannigan will be responsible for coordinating with budget (Reference group) and ensuring that the devices recommended can be purchased with the available funds.
Cris Solano and Kylie Reader will research the devices and formulate the conclusion of which models to purchase based on coordination with Marilyn Limuaco and Mary Flannigan. They will also coordinate with Christine Carter and Kim Robinson so that this time knows which models will be used so as to prepare for the appropriate training exercises and tutorials.
Clara Kong is a Clinical Nurse Specialist in the Paediatric Ward and is part-time only, so will be used as a consultant in this project and her role will be to reach out to the manufacturers and sales team of the device selected in order to ensure that its applicability is what the nursing staff is looking for in this project.
Every team member will be tasked with measuring through survey post-implementation of the device usage. Patients will be asked a question regarding the IVC and whether they found the technique to be satisfactory.

4.6 Reporting Requirements
Team members will report to the project manager on a daily basis and the project manager to the project sponsor on a bi-weekly basis.
5 Stakeholder Management & Communication Management Plan
Key stakeholders in this project are the RNs in the Paediatric Ward, who will be using near-infrared light devices to assist with IVC work.
The communication framework that will be used for this project will be focused on RNs on the nursing floor as they are the clinicians who will be tasked with utilizing the near-infrared light device. Communicating with the RNs on the floor will be the task of the project manager and sponsor and their method of communication will be face-to-face, in-service, and the RNs will be met with during shift meetings that will be brief and will update the RNs on the change that is to be implemented.
The key communication and management issues for the project will be the project manager communicating with team members and RNs being educated on the use of the devices that are purchased for the purpose of quality of care enhancement.
Instruction on how to use the devices will be a main issue that has to be achieved within the project, and measurement of the implementation of the devices will have to be conducted via survey. Throughout the project, interviews with team members on how the milestones are being achieved will have to be conducted.
RNs who stand to benefit from the project will be informed of the device and its usage once it has been selected and ordered. They will schedule their training tutorial times.
Failure to communicate effectively with stakeholders will lead to the project failing to have a meaningful impact, as the main outcome is quality care improvement, and that depends upon RNs learning how to use the device so that they can improve their IVC care.
Stakeholder
Communication Need
Communication Method
What and when
Who is responsible?

RNs
To understand the impact of using Near-Infrared light devices on current IVC work practices
Face to Face, In-service; group meeting
Visit from project manager/sponsor to team to describe their process changes
Nurse Unit Manager


6 Human Resources and Cost Management Requirements
6.1 Budget and Expenditure

The project has a limited Budget of $25000 dollars to cover salaries, device purchasing and other project costs. The near-infrared light device costs $2000 to purchase. Training to the clinical staff on how to use the device will be in-service and online self-learning programs. These will not require any additional cost as the main tutorials will be videos on how to use the devices that are available for free streaming and downloading from the Internet. Material costs used for training purposes (print-outs, videos, and demonstrations) will equal to a projected total cost of $250. No extra cost will be attributed to cover overtime or salaries as the project can be completed while everyone is already on the clock.

There is no IT infrastructure budget needed since the project is not addressing an infrastructural change and the information requirements for the project are available for free download from various sources, including tutorials from the company that manufactures the devices.

The training schedule will be implemented during normal work hours so there is no need for additional costs for overtime pay or for scheduling additional nurses. The scheduled work shifts will be constructed to allow for nurses to spend the thirty minutes it takes to become familiar with the device and to practice with it.

There are no ongoing costs related to the device, and it is not something that requires upgrades or costs for maintenance. The device is simple to use. If the Ward purchases five such devices, the total cost will come to $10,000, leaving an additional $14,750 including material costs for training. So this project will come well under budget.

7 Risk Management Plan

The objective is to purchase and implement usage of near-infrared light devices to assist RNs with IVC work. The risk inherent in this project is that the devices will be inefficiently used and quality care for patients will not be improved.
The risk can be quantified in terms of patient dissatisfaction causing job dissatisfaction for nurses, which can lead to nursing turnover and higher costs for the Ward in terms of training.
The response that should be developed to mitigate this risk is to focus on ensuring that all RNs in the Ward are effectively trained in how to use the device. The risk management plan will consist of every RN establishing a time for the tutorial and signing in for this time. Each RN will be tested on how to use the device so that its proper utilization is understood.
Controlling for risk will be a schedule on which is clearly seen the times in which RNs will be educated on how to use the device. The scope of the risk is that failure to address the issue could lead to patients not coming to the Ward and nurses leaving the Ward because of no satisfaction. The schedule must coincide with RN work .
7.1 Quality Management

7.2 Methodologies and Standards
The project manager is in charge of quality management and will ensure quality on the project through daily interviews with team members. The standard for each team member during the project is to achieve at least one milestone per week.
7.3 Monitoring Procedures
Monitoring will be performed by meeting with team members daily to obtain reports on progress. This will be an observational method of monitoring. The project manager will gather through direct observation of the team members what steps they are taking for that day and where they are in terms of achieving a milestone for the week.
7.4 Review Process
The review process will consist of nurses documenting their use of the near-infrared light device on camera or in front of the project sponsor or unit nurse so as to pass the test for understanding of how to use the device. The unit nurse will determine whether the individual RN requires more training before moving on to implementing the device in practice or whether the RN has demonstrated sufficient understanding of how to use the device. This measure will be achieved by direct observation of the RNs correct use of the device in practice.
7.5 Change Management
The change management process will be based on using the leadership skills of the project manager to inspire the RNs in the Ward with a vision that will enable them to accept the new device implementation and not resist the change to the current IVC practice. This will depend upon the practice manager highlighting the need for the change in the face-to-face meetings with the nurses, which will be conducted during the shift hours so that every RN is afforded time in the face-to-face meeting with the project manager for the explanation of the change practice. Concerns about the change will be heard during this time and the project manager will address any questions or issues that the RNs have regarding the device and its usage. It is not expected that any RNs will resist the device usage as current practice methods for IVC on children call for the device’s implementation and desire for the device has already been raised by many RNs in the Ward.

7.6 Review and Acceptance Procedures

Review and acceptance procedures will include conducting surveys with patients after using the near-infrared light device for IVC work to gauge patient satisfaction levels. These reviews will be informal and the nurse will record the patient’s response on a chart that will be provided to the project manager at the end of the day. The project manager will review these survey responses to determine the effectiveness of the device.

7.7 Documentation and Record Keeping

The records of the informal survey responses will be kept by the project manager on file so that they may be recalled at any time in order to show the outcome of the device implementation.
8 Project Closure & Outcome Realization
Outputs will be handed to the project sponsor in a face-to-face meeting to discuss the project’s effectiveness. Any outputs outstanding, such as surveys of patient satisfaction will be limited to a week extension and then these will be provided to supplement those already obtained. Roles for staff will not change, although new staff training for new hires will be required to include the device tutorial. There will be no ongoing contracts for ongoing management and there will be no ongoing costs, such as software upgrades or infrastructural maintenance. The devices will be kept in the Ward and made available to all RNs so long as they have demonstrated to the unit nurse sufficient understanding of how to use the device.
The project manager is responsible for monitoring progress towards outcomes realizations and will report these findings to the project sponsor for further discussion. No review of lessons learned will be necessary unless nurses are not demonstrating sufficient returns or positive experiences with the device for IVC work in the Ward. If problems occur during device usage, the project manager will discuss with the project sponsor the issues that nurses are bringing forward and decide on a new approach to implementing the device in a more effective manner.
9 Appendices


Refenence Groups



Project Sponsor/ Steering Committee/

Business Owner



Consultants



Working Parties



Project Manager &



Team







KEY:



Direct relationships that may be managerial or contractual



(or both)







Indirect relationships that may exist in some circumstances.



They may also be managerial or contractual (or both).