7/21/2017 Rebecca Culver Clark, PhD, RN & Deborah Hodges, BSN, - - PDF document

7/21/2017 1

Rebecca Culver Clark, PhD, RN & Deborah Hodges, BSN, RN Carilion Clinic, Roanoke, Virginia

 The presenters for this presentation have disclosed no conflict

• f interest related to this topic
• 1. Discuss strategies to secure grants to fund research and

evidence-based practice endeavors

• 2. Discuss an exemplar for writing and implementing a

successful grant application

7/21/2017 2

 Who has written a grant application?  Who has been successful?  Biggest fears?

Identify your general goals or those of grantor

 You might just want to get funded

• Professional development, post-doc work
• Bucket list item

 Your professional organization has call to action  You are working with a clinical area of interest (sepsis,

immunizations, etc)

 You receive an RFP from an organization asking for

submissions on a topic

 Circular process  Write often  Be comfortable with feedback  Work with someone who has experience  Consider being a reviewer for grant applications

You can’t get funded if you don’t write/submit the application

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Research or not-research Academic or clinical Consider your education, expertise, and resources

Educational criteria (MSN, PhD, RN) Previous funding success Facility infrastructure to manage grant funds

Decide why you need the money

Hardware/software? Postage? Etc Salary (PI, data collection, data analysis) Travel

 Meets criteria (for PI, organization, type of work)  Submitted on time, page/word limit, key components included  Generally graded on rubric by busy people!  Looking for:

• New and different
• Significant and applicable to broad population
• Realistic
• Well written

 Aims match grant expectations  Strategies consistent with aims  Budget realistic and justified

 Addresses implementation and dissemination  Start early  Highlight/bullet important areas  Charts to detail complex components  Outline/matrix your application

• Aims match the goals
• Strategies are consistent with aims
• Budget is realistic and justified

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Goal Goal Aims Aims Strategies Strategies Budget Budget Timeline

 Coincidence

• Approached by employee of company (investigator-initiated funding)
• Priority funding area: pneumococcal immunizations

 Analysis of web site and criteria

• Much of focus on biological/bench science related to drugs,
• Window that looked at increasing immunization rate
• Did not specify “research”
• Asked for concept paper first

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 Ensured that goal (increasing pneumococcal immunization

rates) supported by organization

 Met with team of nursing leaders

• Was there interest in topic, clinical need?
• Were there areas that could serve as sites for study?
• Could we implement a study, track data?
• Did we have resources for managing/distribution of funds?
• PI with expertise and experience?

 What did we need money for? Primarily salary support

• 1. Type of work—Quality improvement study
• 2. Significance– Improve immunization rates
• 3. New and different—Ambulatory setting

(Health education not so new!)

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 Literature review:

• Gaps in knowledge: Affecting adult immunizations in ambulatory

settings

 Project goal: Develop interventions to improve

immunizations that can be implemented and sustained in ambulatory settings

• Aims: measurable
• Focus on patients and provider behaviors
• Educational flyer/health literacy considerations
• Scripting for providers

 Need for theory-based interventions, not one-off

• Planned change (Ajzen)
• Gained framed messages (Bartels, Kelly, Rotherman)
• Feedback and audit for providers

 Sample and setting

• Adult immunization levels for pneumococcal in VA 68%;

Recommended – 90%

• Approximately 30,000 patients seen annually in pre-surgical

testing site

• Screened 90%, immunized only 20% of at-risk patients

 Use of quality improvement data analysis

• Two years of data—baseline and intervention
• Controlled for seasonal variation
• Track impact of additive interventions (staff education and

patient education)

 Project aims realistic and specific

• From 24% to 50%
• Sample size consistent with volume in PST

 Electronic medical record for data collection and reports  Strong data analysis team & department for managing funding  Budget

• Careful consideration of salary and time
• Did not request vaccines
• Money for participants in focus groups
• F & A

 Consultant (in-house) with expertise, reader, advice, great resume

with lots of funding

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 Read by many people  Flow chart for writers/readers to understand relationships  Use of charts to clarify complex flow of patients  Cover letter that summarizes key points

Goal

• Increase

immunization rates Aim

• Integrated

education

• Pt ed flyer,

3rd grade literacy

• Gain-framed

messages Strategies

• Focus group

feedback

• Role-playing

education; scripting for messaging 1.Budget

• Incentives for

participants

• Staff

education time; snacks

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 Implementation

• Fidelity to grant components
• Meet timelines for implementation, volume of participants
• Meet expectations for reports, both internal and external

 Dissemination

• Poster presentations
• Publications

 The next steps

• This grant was for $130,000
• Based on this work, we wrote another grant application

and received $170,000

 Federal resources

• Health Resources and Services Administration (bhpr.hrsa.gov/nursing/
• National Institute of Nursing Research

(www.ninr.nih.gov/researchandfunding/dea/desp/oep/fundingopportunities#.V3VUD7g rLIU)

 Professional organizations (not inclusive)

• AONE
• Oncology
• AACN
• AORN

 Lists of/links to grant sources

• American Association of Colleges of Nursing (www.aacn.nche.edu/faculty/funding-
• pportunities)
• Sigma Theta Tau (www.nursingsociety.org/advance-elevate/research/research-grants)

 Foundations

• Robert Wood Johnson (www.rwjf.org/en/how-we-work/grants/funding-
• pportunities.html)
• American Nursing Foundation (ANF)

 Investigator-initiated grants, Drug and product evaluations  Organizational supports (internal grants)

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Deborah Hodges BSN, RN, CAPA Rebecca Clark, PhD, RN

• Dr. Rebecca Clark, PhD, RN, Principal Investigator
• Julie Jackson, RN IV Project Leader
• Deborah Hodges BSN, RN CAPA – Project Leader
• Brenda Gilliam MSN, RN MS HCA, CAPA, Unit

Director ORS

A Me Merck P Pharm armaceu ceuticals icals g grant s ant supported

• rted t

this is IRB-determ termined ined quality i ality improv

• vemen

ement p t projec ect. t.  Discuss key components of a grant funded project

implemented in a Pre-surgical Testing setting.

 Discuss strategies to aid in staff motivation and

participation in the project.

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• CDC R

Recommendatio mmendations: ns:

Adults 65 years of age and older, adults age 19-64 with chronic diseases and/or smokers should receive a pneumococcal vaccination.

• Pre-surgic

e-surgical V al Volume: me:

Approximately 2500 patients per month seen prior to surgical procedure.

• Vacci

Vaccination R Rate: te:

In 2012, our pneumococcal vaccination rate was 24%, with a significant number of eligible patients not successfully immunized (76%).

Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Accessed November 20, 2015

• Departmental and Individual Goal: Increase immunizations

to 50% of eligible patients

• Develop evidence-based tools and processes for improving

immunization rates

• Share effective strategies with other ambulatory settings

Educa Educatio ion n for Pre- for Pre-surgic ical al St Staff aff

• CDC guidelines for pneumococcal vaccination
• Common misconceptions regarding the vaccine
• Role playing with scripted answers

Use of gain-framed messages emphasizing health promotion

• Review of proper completion of pneumococcal screening

tool in EMR.

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Reinforcement an forcement and Fe Feedback back

• Leadership established departmental and individual

goal of immunizing 50% of eligible patients

• Immunization rates tracked monthly, reported to staff

highlighting individual and group achievements

• Gift cards awarded to nurses with highest vaccination

rates Targeted e eted education f ation for p patient ents

• Created informative flyer developed from focus

group feedback

• Placed pneumococcal vaccine promotion posters

in PST visit rooms and check-in area

• Engaged clerical staff to provide flyer and

encourage patients to read information while waiting for visit with nurse

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An Annual pneumococca eumococcal immuniza l immunization rat tion rates 2012-2 2012-2015

2012 = 2012 = 24% 24% 2013 = 2013 = 43% 43% 2014 = 2014 = 42% 42% 2015 = 2015 = 53% 53%

2015 focus: Re-engag 2015 focus: Re-engage e staff staff in in initia initiative

• Merck Pharmaceuticals provided updates on current

CDC recommendations for pneumococcal vaccination.

• Interactive staff conference to solicit staff input for

declining rates

• Monthly individual vaccination rates were emailed to

staff by leadership

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Educ Educat ation

• Staff
• Knowledge of current literature supporting project
• Guidelines for practice
• Scripted answers-consistent message delivery
• Proper documentation
• Reinforcement and Feedback-data speak volumes
• Patients
• Health promoting benefits of vaccination
• Education to allow patient to make informed decision

Leader Leadersh ship s suppo pport of rt of the the pr project

• ject
• Departmental and individual accountability for immunizing

50% of eligible population

• Support of project leaders and coordinated project work time
• Department success celebrations
• Individual rewards and recognitions
• Long term process – 1 year
• Difficult to stay focused with many other priorities
• Finding time to work together,
• Lapses in-between, challenging to restart
• Staff resistance
• Not all on board with something even so positive as

immunization

• Preparing abstracts, posters and presentations
• New skill set
• Personal and professional growth

7/21/2017 14

Finding the money

• Scan professional literature, web-sites for RFPS
• Brainstorm ideas that might fit with criteria

Writing the grant application

• Write often, integrate feedback
• Be sure you meet criteria
• Start early, be sure aims, strategies and budget are coordinated

Using grant funds

• Be faithful to grant application
• Submit reports on-time
• Write some more!

 Rebecca Culver Clark, PhD, RN

• rebeccaclark04@gmail.com

 Deborah Hodges, BSN, RN

• dlmarshall@carilionclinic.org.