Compliance with titrating practices for ensuring target dose Data on tritration accuracies provide accurate and informed evidence on the level of compliance. Ensure patients have hydralazine Data collected on compliance with CHF protocols and AHA’s guidelines on ensuring patients access to hydralazine.

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 gets the opportunity to share ideas and experiences on the problem and the relevance of evidence-based palliative-focused CHF protocol on the quality and safety of patient care. The manager will highlight instances of non-compliance with CHF protocols and the specific areas that undermine the care team’s response to patients’ demands. A busy schedule may limit the manager from actively participating from the start to the completion of the project.

A.P Clinical service manager Oversees the functions of advanced practice clinicians in a long-term care setting. Opportunity to work with a compliant workforce that responds to guides and protocols for managing patients with reduced ejection fraction in long-term care. Share experiences about successes and failures associated with handling patients with heart failure and reduced ejection fraction A busy work schedule would limit A.P from being available throughout the project.

V.S Advance practice nurse The nurse is part of the workforce in long-term care settings tasked with the responsibility of handling patients with complex and sensitive health needs. The nurse will acquire the knowledge and skills necessary for enhancing compliance with guidelines and protocols for delivering evidence-based palliative care Share experiences on reasons for non-compliance with guidelines and procedures and the implications of the project on quality and safety of care. The nurse may be reluctant to provide adequate and correct information on events within the long-term care setting that trigger non-compliance with vital policies and procedures.

Team Leader The lead leader is D.A (DNP learner). I will utilize experience working in the unit, engaging patients with complex health needs, and familiarity with aspects such as staff compliance to address the need for renewed efforts to utilize AHA’s guidelines for evidence-based practice. Among the qualities I leverage for success include emotional intelligence, effective communication, and collaboration. I am also an active listener and encourages collaborative and well-collaborated practices to optimize care outcomes. Emotional regulation and intelligence enable leaders to interact with different healthcare professionals and patients. The traits reinforce ability to embraces diversity, equity, and inclusion in leading the workforce and improvement efforts.

One leadership approach utilized to lead the team is the transformational style. The approach allows leaders to inspire a shared vision characterized by effo