Develop a presentation no longer than 10-12 minutes with comprehensive speaker’s notes that covers all of the major areas of your proposal.
You will need to post your Evidence-Based Practice Presentation to the main forum in Topic 8 as directed by the instructor for class discussion and peer feedback.
While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Organizational Culture and Readiness Assessment
The purpose of the assessment is to evaluate the strengths and weakness, in the readiness of evidence-based practice (EBP) innovation, practice change and the capacity to facilitate EBP changes in the Cuyahoga County Correctional Center (CCCC). The Organization Culture and Readiness Assessment (OCRA), will measure questions about EBP focusing on the culture and its readiness for application (Melnyk & Fineout-Overholt, 2015, p. 569). The use of the assessment scale will view what support is needed to assist in the changing attitudes, behaviors, skills and the thought processes of individuals who are responsible for caring for patient/inmates (Helfrich, Li, Sharp, & Sales, 2009).
Based on the OCRA the CCCC is getting ready for EBP organizational change in some areas, but the scores of the assessment questions both can hinder and support efforts for implementation. For example, scores were noted for the nursing administrators, providers and the healthcare staff focus themselves on committing to EBP. However, mentorship from Advanced Practiced Nurses scored lower due to those currently employed and possible time constraints.  However, the security rating was much lower with obligating themselves to EBP in healthcare, they are more focused on the safety of the environment but rank high on the shared responsibility of the outcome of the care, possibly due to the entire system is employed under the sheriff’s department.
Another area that had interesting sores were the overall workshops, technology for implementing communication and collaboration to support EBP. The scores were higher in the EMR for medical staff interoperability for healthcare shared medical records with the county hospital.  However, the ratings were much lower in the internal connection of innovation that promotes EBP between medical providers and security.  Another attractive area was the extent of decision generation in this type of environment suggesting there is a lack of administration healthcare leadership in implementing EBP, which leads to decisions generated from the administration who has little to no knowledge of scientific understanding or skill that encourage EBP. The overall rating for the CCCC is a two, which indicate that the CCCC is getting ready for EBP implementation (Melnyk & Fineout-Overholt, 2015, p. 569).
There are challenges and barriers to implementing EBP in the correctional healthcare setting and can be a slower process due to lack of time in research understanding, insufficient time available, inadequate access to internal interoperability, personal characteristics, lack of medical libraries and organizational and cultural barriers. However, it is imperative that in this different environment that manages the safe care of patient/inmate must understand the initiative to implementing EBP must be a strategic interconnection system that promotes appropriate practices that support common challenges of safety for those in the custody of the CCCC.
Evidence-Based Practice Proposal
In a complex healthcare environment, such as the Cuyahoga County Correctional Center (CCCC) can be difficult to assess the patients’ medical needs and implement treatment timely. The initial time of treatment is critical and can affect healthcare outcomes. The process in which care is delivered can have a trickle-down effect on patient health, their families, medical staff, medical escorts, the institution, and taxpayers.  Chronic issues can become acute concerns, which need to be evaluated urgently, if not, patient health is jeopardized, and the quality of health continues to diminish.
Diminished health leads to medical emergencies and an ambulance trip to the hospital, causing decrease medical security due to the need for a security medical escort detainment to secure the patient at the hospital.  Families are affected by this problem which can cause stress that negatively affects the body which can also cause acute medical concerns.  The medical staff is affected because now they have to respond to a medical emergency that could have been prevented if treatment delivery time was implemented sooner.  The institution is affected by increasing expenses for external hospital travel by ambulance cost, facility operational costs, and possible litigation disputes that are usually settled out of court with monetary from the taxpayers.
The CCCC was built to house 1,749 inmates but often accommodate over 50% over capacity, leaving inmates to be placed on mats on the floors in the pods. The increased population has led to more significant health concerns which include increasing mental health problems. The complexity of healthcare services is expanding in the CCCC, which is the second largest jail in the state of Ohio. The CCCC manage over 26, 000 inmates per year, which house various level of security that includes maximum security to minimum security such as those who are weekenders (Cuyahoga County Sheriff, n.d.).
Security has increased obligations to maintain order and control while the healthcare staff must face frequent medical emergencies due to the delay in care.  Delivering quality healthcare services that include evidence-based practices, in an environment that require continuous security restrictions for safety and correctional action protocols, can be challenging. As the focus of healthcare changes from individual hospitals to healthcare systems, system integration and standardization in practices, it is also essential for the nursing profession to adjust (Warren et al., 2016). Conforming to a standard that promotes EBP is also imperative in this correctional environment, which can consist of innovation. For example, telemedicine, EMR, and security cameras for all medical officers to capture activity and recording of all inmates’ behavior.
In the process of retrieval of the patient/inmate, the pod officer calls the dispensary to report a patient medical concern or condition. After, the medical staff views the inmate’s medical records, and if deemed necessary for further assessment, the health provider writes out a ticket and give the ticket to the medical escort so they can pick up the patient and escort the patient to the dispensary. The card that is placed on the desk has the patient/inmate health concern, which is often evaluated by security staff. The medical security escorts who must retrieve the patient/inmate with deteriorating health often there are delays due to inadequate staffing, communication in the urgency of the patient/inmate, judgments in healthcare status by medical correctional officers and separation of inmates that requires extra security for evaluation. However, time management is vital in retrieving inmate/patients with particular kind of health problems to accomplish the best health results and technology that incorporates coordination of care is paramount to enhance safe practices (Kleib, Simpson, & Rhodes, 2016).
To improve the quality care for all patient medical concerns.  The clinical care barriers to implementing care must be demolished to create a more effective healthcare delivery system.  The actions of a team impact healing of patients and therefore the need for different professions to honor what each profession or service brings to the collective process of healthcare delivery is vital (Treadwell, Binder, & Giardino, 2014). It is important to utilize the development of the PICOT format to produce a question for this vulnerable population to help guide the best evidence in care (Melnyk & Fineout-Overholt, 2015, P. 25). For example, the (P) Cuyahoga County Correctional Center healthcare system, (I) Correctional staff and healthcare through process in safety standards of care, (C) compared to coordination/ collaboration healthcare system timely patent retrieval for health evaluation and stabilization, (O) decrease the risk of medical emergencies, litigation, family stress and death, and (T) while in the custody of CCCC.
Security in this healthcare environment takes precedence over quality care delivery by the healthcare staff in the effort to provide safety.  The different points of view of priorities of safety and bias judgments can contaminate the process of timely exceptional care which can prolong care that exacerbates the health of the patient/inmate. For example, in the CCCC the primary issues that are brought to the dispensary consist of chest pain, difficulty breathing, allergic reactions, decrease blood glucose and mental health issues.  The leading cause of deaths of in the United States is heart disease, chronic respiratory disease, diabetes and suicide listed as the top 10 out of 100,000 per population according to the Health, United States, 2015 report (Center for Disease Control and Prevention, 2016). To meet the healthcare needs of this complex population, how patients are retrieved must be modified to promote collaboration in the way all stakeholders view acute patient healthcare assessments.
Communication and collaboration that promotes professional, secure safe, timely quality care are vital when initiating evidence-based practices.  It fosters workshop that incorporates learning of all disciplinary teams to create a healthy work environment to establish the best practices possible when retrieving patients/inmates for their health concerns.  Communication and collaboration combine a joint safety team of awareness of self-deception, reflection, mindfulness, authenticity, and truthfulness (Kupperschmidt, Klentz, Ward, & Reinholz, 2010) to promote safe environments and safe health stability in patients/inmates.
Literature Support
The retrieval of patient/inmates in the Cuyahoga County Correctional Center (CCCC) must be done through a collaborative effort, which includes the medical staff and the correctional security staff. A concerted and coordinated effort will minimize potential health crisis and lower taxpayer cost.  It is implemented evidence-based practice (EBP) in the CCCC that will link strategies and decrease barriers in the CCCC environment, which is the second largest jail in Ohio and manage a population of over 26,000 inmates and the population continues to increase. The full services provided by the CCCC which includes medical, mental health, social services, and pharmacy must work as one team that support professional quality services that enhance the lives of many while in the custody of CCCC. EBP is about finding evidence and linking it to clinical decisions and practice changes that support timely quality care.
Center for Disease Control and Prevention
            This official database, which is listed under Health and Human Services, serves as a national agency that helps to improve the overall health of the public. Based on the Center for Disease Control and Prevention (CDC) website they focus on identifying health problems, and actively investigate diseases through epidemiologic and laboratory studies and data collection, analysis, and circulation by working with partners at the local, state and national level to improve health policies. The CDC website also noted being responsible for overseeing environmental health concerns, conducting research for disease prevention, conducting research and training programs for occupational safety to ensure safe and healthy working condition in the effort to prevent and control diseases (Center for Disease Control and Prevention, 2017).
The CDC mission will help support the capstone project by bringing awareness to various chronic illness that has led to death in the United States, which are often seen in many patients/inmates at the CCCC.  The information will help with my capstone project.
The terms used to retrieve this information was CDC Mission Statement. The electronic data based used Google
Cuyahoga County Sheriff
            The Cuyahoga County Sheriff Department (CCSD), developed a website, which speak of being able to provide superior care and manage over thousands of inmates annually. Also, the CCSD has two locations available for services that included a Euclid jail site and Cleveland jail site. The CCSD Cleveland location consists of two large jails that are combined which is their largest location; Jail I and Jail II structured area is over one million square feet. The CCSD official site has clearly noted in large letters listed under the Cuyahoga County Sheriff logo. “Together we thrive” (Cuyahoga County Sherriff, n.d.). This newsletter written by the CCSD will support a joint collaborative effort to accommodate the many patients/inmates, who reside at the CCCC, to support health services during their length of stay at the CCCC, which will support the capstone project.
The terms used to retrieve this information was Cuyahoga County Sheriff’s Department corrections (609,000). The electronic data based used Google
Online Journal of Issues in Nursing
Authors, Manal Kleib, the founder of the Nursing Informatics Association of Alberta, Nicole Simpson, holds the background in clinical practice, research and education, and Beverly Rhodes, program director and president of Nursing Informatics Association of Alberta, (2016). These authors wrote the scholarly article, “Information and Communication Technology: Design, Delivery, and Outcomes from a Nursing Informatics Boot Camp,” a level IV peer viewed article. Based on their research they suggest information technology (IT) and educational classes (EC) can improve the outcome of patients and organizations with the use of IT and EC.  The authors   also believe that IT and EC can produce opportunities for improvements in practice and can influence the quality and safety of patient care. While this study only implemented views of the nursing profession, it recognizes the variations of utilizing IT along with EC to the differences in practice.  The authors of this article believe IT and EC will promote the efforts in developing competencies to enable a comprehensive understanding of collaborative preparation with the use of IT to form quality, and safety policies practice in the environmental development in the effectiveness of care (Kleib, Simpson, & Rhodes, 2016). This article will help stimulate collaborative training with the use of IT and EC, which will support change and the capstone project.
In the electronic search for this article the terms used was nursing information and communication information technology excluding jail including or prison and health disparities (242). Database search was CINAHL and GCU Library Resources.
Online Journal of Issue in Nursing  
Betty Kupperschmidt, a nursing Associate Profession teaching at the University of Oklahoma focuses on educating administration and clinical theory. Emma Kientz, a nurse master, and a creator of healthy work environments for student and faculty at the University of Oklahoma. Jackye Ward, Vice-President of Patient Care Services and Chief Nursing Officer at the Valley View Regional Hospital, an acute care hospital that holds 168 beds, located in Oklahoma, and Becky Reinholz, an ICU nurse and the creator of an agency-wide Change Nurse Development Program, (2010). Based on their research, healthy work environments are beneficial for providers, recruitment, retention, and quality and safety of patient care. These authors also noted healthy environments correlated with employee engagement that includes management trust, employees who are respectful and administrative support that encourages communication and collaboration skills to produce a physically safe environment. This peer review article focuses on nursing communication skills that have no bearing on security communication tactics of enforcement to ensure a safe environment. However, the authors use a Parse’s nursing theory to promote their research, which emphasize on positive collaborative interaction to improve the quality of the work environment. The article promotes an individual responsibility as professionals to become skilled communicators to promote relationships of respect with all member of the team (Kupperschmidt, Klentz, Ward, & Reinholz, 2010). This article will help with team building and environmental change, which will be an asset to all employees working at the CCCC and it will help with the capstone project.
In the electronic search for this article, the terms used health work environment, professional communication, and skilled communicator (22). Database search was CINAHL and GCU Library Resources.
American Association of Managed Care Nursing
Janet Treadmill has her doctorate in nursing who is also, a Director of Providers and Care Coordination for Texas Children’s Health Plans and focus on preventive population health management. Brenda Binder who has her doctorate in nursing is the Director of Graduate Nursing, as well as Interim Associate Dean at Texas Woman’s University who is also an Associate Professor. Angelo Giardino, a Professor of Pediatrics and Section Chief of Academic General Pediatrics at Baylor College of Medicine who focuses on enhancing complex care clinic and primary care practices is a board member for various regional and national boards. These three authors wrote an article on “An Integrative Review of Interprofessional Collaboration”. The authors of this article focus on clinical practice sites that are team based. These professional authors believe there can be an interprofessional collaboration that thrives from the professional experience of education to achieve interdependency that promotes the wonders of interprofessional collaboration. The authors used Dr. Jean Watson, a nursing theorist who developed the theory of Human Caring which was noted for promoting caring environments to offer the potential for self and group development that support and cultivate quality health. Although this article focuses on the profession of nursing it incorporates the act of enhancing groups and environments through professional collaboration at all levels, which will help support the capstone project (Treadwell, Binder, & Giardino, 2014).
The electronic search keywords used for this article were interprofessional communication, health care, transform (1,530,000). The Database searches were Google and American Association of Managed Care Nursing.
Worldviews on Evidence-Based Nursing
            Joan Warren, Maureen McLaughlin, Joan Bardsley, Joanne Eich, Carol Ann Esche, Lola Kropkowski and Stephen Risch are all healthcare system nursing leaders who collaborated to implement evidence-based practices (EBP) to support improving system performance. These authors’ goals are to link evidence to practice and find ways to overcome barriers that impede implementation to embrace Magnet principles by creating an online plan for free EBP education competencies to promote best-shared practices.  Also, the authors aim is to encourage Magnet conferences to help lead, mentor and educate nurses for implementing EBP. Although the authors are nursing scholars, they understand the challenges faced in teaching to bring positive practice changes with the use of education, and innovation. This article will help support positive practice change at the CCCC with the use of educational competencies.
In the electronic search for this article, the terms used for this article was evidence-based practice, healthcare system organizational readiness (2,228). The database used was CINAHL and GCU Library Resources.
In conclusion, the right to health is an essential human right with does not depend on the legal status of individuals. The patients/inmates must receive the quality of healthcare at CCCC that support their right to have medical and mental health treatment that support failing health.  It is vital as professional participants in healthcare to have the same concern and render the same care for all life and contribute to serve better the health of those in the custody of CCCC to decrease health disparities.
Solution Description
There can be many challenges and barriers when implementing change. However, building a healthy environment that supports security safety and safe healthcare practice that ensure timely retrieval of acute patient/inmate while in the custody of CCCC must be developed. Standards that require a rethinking of values, processes and a group effort on collective views of experiences within each group must be implemented as a foundation for shared learning and understanding through interprofessional communication and collaboration will support safe, and timely quality care.
Proposed Solution
Interprofessional collaboration occurs when professions work together to achieve common goals and are often used as resources for solving various problems and complex issues. Collaboration promotes relationships and benefits for collective achievements mutually to decrease barriers and advocate for shared goals in safe practices (Fremont, Kranz, Phillips, & Garber, 2017). Collaboration potentially reduces self-sufficiency in environments demanding great flexibility and innovation, leads to improved efficiencies, skill mixtures, increase responsiveness, improve holistic services, promotes innovation and creativity. Also, it stimulates better patient/inmate health outcome, decreases complication and mortality rate, error rates and reduces hospital stays.  Nevertheless, using collaborative intervention efforts to improve the coordination of care are achievable with appropriate, cost-effective training. Leadership knowledge in the variation of services and with the use of IT will improve access to care and coordination of services approaches in the CCCC vulnerable environment to deliver the highest quality of safe practices cross settings (Green & Johnson, 2015).
Organizational Culture
            There are a citizen culture and a culture that exist behind the prison’s walls. In the justice system of American, any individual who breaks the law by committing a crime has the potential of being incarcerated. In the CCCC the levels of security vary ranging from maximum protection for induvial committing heinous crimes to individual committing misdemeanors (Cuyahoga County Sheriff, n.d.). The overcrowded population and lack of staff can produce inequities in safety and care.
In the CCCC prison culture, the security officers consist of individuals who are devoted to the law in which they serve and those who are disloyal. According to Fox 8, Cleveland News, the public record showed some of CCCC officers had been charged with dereliction of duty, excessive force, sexual assault, drug trafficking and bribery (Fox 8 Cleveland, n.d.) Nevertheless, the healthcare providers which consist of physicians, nurse practitioners, registered nurses, licensed practical nurses and nursing assistants can also promote a sense of judgment in criminal history and drug abuse, which can have a trickle-down effect in the medical and mental health care provided. The CCCC constraints, quality inconsistencies and limitation in acute care retrieval can leave health needs unassessed. However, by understanding biases that lead to disconnections between multiple factors related to the CCCC through education and IT the entire staff will be better prepared to serve this vulnerable population.
Expected Outcome
            An implication of the problem is the realization that when patients are in the custody of the CCCC, it is the responsibility of all employees to keep them safe.  Healthcare assessments must be rendered timely during acute situations. An ineffective system for retrieval of patients will produce unhealthy outcomes that lead to deaths and litigations.  In 2014, the CCCC paid $200,000 ‘to a patient/inmate’s family to settle a lawsuit because a patient was found dead in his cell, who was known to be a suicidal risk choked on a deodorant cap (Heisig, 2014).  Another incident of death that led to litigation was in 2015; A patient/inmate died from a heroin overdose, and the family sued because they believe the prompt proper medical treatment was not provided (Heisig, 2016).
The broken, disconnected system of the CCCC must be reconnected through team and collaboration efforts that provide compassionate and coordinated care that is aligned with the secure healthcare practice that promotes timely care that is pertinent to patients/inmates’ medical and mental circumstances. Also, communication efforts create a working environment that supports exceptional care for patients/inmates that consist of a collaborative team effort and promotes self-accountability in individuals who are willing to adjust current practices to ensure safe, secure healthcare practices are implemented.
Method to Achieve Outcomes
Ensuring effort to achieve the expected outcome can be achievable. It is essential to identify the benefits and barrier related to new found practices, identify models of use to promote high quality, cost-effective patient/inmate care that help support the best outcome for all stakeholders. Teamwork intervention in training and development involves classroom-type settings with the use of IT. For example, lectures on the importance of providing social support within teams and promoting ways to manage interpersonal conflict among groups to enhance team effectiveness (McEwan, Ruisse, Eys, Zumbo, & Beauchamp, 2017). Another area in stimulating teaming in collaboration is utilizing interactive workshop-style formats so teams can take part in various mock group activities to discuss team processes and goals. Furthermore, simulation training to enact various teamwork skills to deal with interpersonal communication and coordination to foster taskwork competencies and effectiveness to examine the extent of team achievements (McEwan, Ruisse, Eys, Zumbo, & Beauchamp, 2017).
Outcome Impact
Implementing productive initiatives in team coordination and collaboration among medical and security personnel in this complex, vulnerable organization will improve patient care, and transform the culture into a culture of safety and reliability. Also, it will promote patient-centered care for those who need timely acute medical assessments. A team effort in accomplishing safe practices will foster open communication that enables competence of therapeutic retrieval process that promotes environmental changes and awareness. Understanding the strengths, limitation, and values, self-determination and receptiveness within the CCCC environment will foster quality healthcare and stakeholder satisfaction.
Implementation Plan
Change implementation within the CCCC must include various phases to achieve the goal of timely safe acute patient care retrieval.  Improving the workplace requires staff to be involved and innovations to be maintained (Mitchell, 2013). It consists of both teams the medical providers and the correctional officers and the ethical principles to guide the professional handling of critical medical patients/inmates’ issues using effective communication and collaboration that will be established in phases in an eight-month period. There is no specific timeframe for completion of each phase.  However, phase four must last for four months before re-evaluation to ensure implementation of communication and collaboration to retrieve acute patients/inmates in a safe, timely manner to verify patient safety is being appropriately achieved.
Phase One
Phase one will start with a preparation phase.  In this phase, the project will be introduced to the Director of Nursing, the nursing supervisor, the Director of Corrections and the warden.  In this phase, a 45-minute meeting will be held on the sixth-floor medical unit in Jail One’s conference room. There will be a computer needed to present a power point presentation of the current retrieval process of acute patients/inmates that will be compared to the innovative retrieval process that will include communication and collaboration initiatives used from evidence-based practices; this will allow questions to be answered and a clear understanding of why communication and collaboration need to be established. Written consent will not be required; this phase will need to allow presentation, coordination of scheduling, and the availability of the conference room.
Phase Two
Phase two will consist of validating using a questionnaire for all correctional officer who works in pods with inmates. The survey will list various problems, and the officer would need to mark yes or no if they feel they should make a call to the dispensary for further evaluation or have the inmate write a kite. (A note to request to be placed on the provider list for evaluation). The questionnaire will also have writing space for listing any concerns or questions which will need to be answered by the medical team. In this phase, there will also be a questionnaire for the medical team. The medical team questionnaire will have questions for better ways to deliver care if the patient/inmate are in an acute situation or if the acute inmate has separations from other inmates. Also, if an acute assessment is needed and the dispensary is full of patients/inmates or acute assessment plans to treat the inmate/patient in the case of the breakout of violence.
Phase Three
In this evaluation phase, all questionnaires will be observed, and questions will be answered before the presentation of the project for the entire correctional officers who work in the inmate pods, correction officers who work in the dispensary and the medical staff, this will allow some issues to be addressed and incorporated into the presentation. The presentation will be presented using informational technology and will run one hour before work schedule; this will allow convenience for all involved staff.
Phase Four
In phase four, the translation phase or the pilot of the learned interventions will be applied to all medical pods on the six floors. The time the call was received would be documented by the medical personnel who answered the call, and the pod office must also record the time the request was made. The time the information given to the medical pod officer will be recorded by the medical staff and recorded by the medical officer.  Also, the time the patient/inmate arrival for assessment is documented by the medical provider and the security medical staff on both shifts for four months. Writing down times from both area of service will allow comparison of times and staff awareness of tracking.
Phase Five
In this phase the re-evaluation of the intervention will be assessed, and the revision of plan will be readdressed for questions and concerns for needed adjustments in the project. Questionnaires will go out to all involved staff for a re-evaluation of the project.  Also, a written scale will be given to the patient/inmate that will be numbered from one to ten and an area for writing at the bottom if patient/inmate need to write comments or concern which will be used to improve their healthcare experience.
The implementation of this EBP change plan is achievable. The increased cost of this project will be with the use of a computer to make the questionnaires, Xerox machine to xerox the questionnaires, time spent for employees filling out their surveys and later during presentation review for training. The involved employees will need to arrive at work one hour earlier to watch the presentation. Another cost will be implemented based on change revisions, which will be implanted, and if further training is needed for clarification of communication process.
Practices based on evidence is a critical part of achieving quality healthcare. Understanding the process of developing and implementing evidence into practice offer current research finding to assure operation for improvements and safe quality care is received (Dontje, 2007). It is important to use evidence to create formal change within organizations. It is essential to understand the staff and the inmates feeling about how care is rendered, and multiple factors can influence strategies to achieve quality safe care at the individual level (National Collaborating Centre for Methods and Tools, 2011). Identifying goals, defining necessity, identifying assumptions, identifying interventions, developing indicators to measure and explaining logic will promote healthcare retrieval practice change in the CCCC (Center for Theory of Change, 2017).
Evaluation of Process
An evaluation plan is a fundamental part of the EBP process that provides information that is significant to improve the project. It helps to assess the quality of the project for reaching the EBP goal, it evaluates the data collected from the project activities and outcome, and it requires review by the principal investigator and the project funding committee.  The evaluation plan will also include the participants, the stakeholders, and the relevant items developed in the evaluation process (Brown University, 2018).
Data Collection Methods
The evaluation method can include quantitative data, which provides data that can be counted; it measures the number of individuals who participated in the study and the number of people who completed the study. Qualitative data provides information from participant observation, focus groups, case studies, interviews and from written documents. A mixed method is data collected from quantitative data and qualitative data (Agency for Toxic Substances and Disease Registry, 2015). Using quantitative, qualitative or both can provide considerable information for evaluation, which can improve the process for patient retrieval at the CCCC.
For this project, a mixed method will be used. The collection of data will take a collaborative effort, which will include, the medical staff and the security staff.  The quantitative data will begin with the pod officer recording the time the initial call was placed to the medical office and the name of the individual who received the message.  The medical staff will be marking the time the initial request was received, who placed the call, the time the message for retrieval was given to the dispensary medical officer and the times the patients/inmates arrived for assessment. The dispensary correctional officer will record the time the data was received for patient/inmate retrieval and the time the patient/inmate walked into the dispensary.
The qualitative data will derive from all participant in the EBP project, which will include the pod officers, the medical staff, the dispensary pod officers, the director of corrections, the warden the director of nursing, the nursing supervisor, and the patient/inmate.  This qualitative data will be collected by interviews, focus groups and surveys to evaluate the process of collaboration, effectiveness, safety, and efficiency.
Outcome Measurement
The time in which health care services for patients/inmates are delivered increase the likelihood of desired health outcomes and are consistent with evidence-based practices (EBP). The outcome measures require safety that relates to medical concerns and the environment in which treatment is rendered, and patient-centered care to meet the medical needs of the patient/inmate that includes providing additional education and medical support for continuing wellness. Also, outcome measurements, which include effectiveness in the process that promote EBP, efficiency in maximizing comparable qualities and timeliness by retrieving patients for needed care without undue delay (Agency for Healthcare Research and Quality, 2017). Outcome measure must promote a difference in time in the retrieval of the patient/inmate that encourages quality health outcomes.
Validity, Reliability and Applicability
Critical appraisal of the research literature is vital when it comes to analyzing the quality of the project validity and reliability. It allows the researcher to implement the research finding into practice that supports EBP. Critically appraising quantitative studies assess the accurateness or the validity; asking did the strength of the conclusions drawn are from the results used from scientific methods?  Appraising also, evaluate the reliability; the consistency of the measurements; asking can the methodology used produce the same results using the same conditions every time? The applicability is also appraised evaluating the study coordination and timeliness with the patients to whom the evidence would be applied (The University of Texas MD Anderson Center, n.d.). The validity will be confirmed by the documented data of the times of initiation of acute concern to the time patient was retrieved, and the patient assessment of treatment was rendered, which will be free of bias. The continued quality communicational process of timely retrieval and the applicability will be determined by the quality service that produces safety, wellness and decrease further damage to health that includes addition stakeholder cost in ambulance services, hospital treatments, family stress and new litigation.
Strategies for Successful Implementation
To accomplish implementation the known barriers must be discussed, and each part of the process must be re-assessed including new questions generated from the project progress and verifying manager support. Another strategy for successful implementation would be to use another theory to promote behavior change and re-evaluating the tools selected to encourage behavior change at an individual level to be used as part of the adoption process to modify the intervention specific situation, to the desired change to promote safe, effective practices. For example, if an acute condition happens in a further location such as in Jail II, the time and the communication protocol would be slightly adjusted due to distance.
Implications for Practice and Future Research
As the research project unfold and all the checkpoints have been verified, there could be gaps or barrier, which would deprive the patient/inmate of receiving the best care that is based on evidence. However, understanding a gap in the findings help in creating a change in identifying relevant issues, and demonstrates knowledge in the topic of study that promotes more conclusive research finding to support implementation (Tom, 2012). Effective communication and collaboration to ensure safe, timely practice will be introduced to the other pod officers, medical staff, and new hires.
Effective communication and collaboration that guarantee timely patient/inmate retrieval will be a continual evaluation process and stakeholder feedback will be included. Effective communication and collaboration will help to ensure, while the patients/inmates are in the custody of the CCCC who has an acute medical condition will be assessed timely to allow the safe value of applying facts from many sources. Also, through critical evaluation of the data from those sources will help make knowledgeable decisions on the most effective course of treatment or interventions to be applied (Farley et al., 2009) to support patient/inmate wellness.
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