Stakeholder Presentation Notes: Funding an Admission Medication Reconciliation Pilot on a Medical-Surgical Unit
Student Name
School of Nursing and Health Sciences, Capella University
NURS-FPX4005: Nursing Leadership: People, Processes and Organizations
Instructor Name
Month Day, Year
Slides 1 to 3: Opening, the Problem, and Why It Belongs to This Room
Slide 1, title slide. Good morning, and thank you for the fifteen minutes. I am the staff nurse champion on the medical-surgical unit, and I am asking for one half-time pharmacy technician, thirty analyst hours, and one paid hour of education for our nurses, for 26 weeks. That is the entire ask, and I am putting it first so you can spend the rest of this time deciding rather than waiting to find out what I want. There are three slides of problem, four of plan, one of cost, and one decision I would like to leave with today. Please stop me with questions as we go rather than saving them.
Slide 2, the problem in our own numbers. We pulled 120 randomly sampled admissions from an eight-week window on the unit. Forty-six of them, or 38 percent, carried at least one unintended discrepancy between the medication list in the chart and what the patient was actually taking at home. Fourteen involved a high-alert drug: an anticoagulant, insulin, or a long-acting opioid. A best possible medication history was finished within 24 hours in 61 percent of admissions. For scale, the World Health Organization put the global cost of medication errors near $42 billion a year when it opened its patient safety challenge (World Health Organization, 2017). Our own number is the one I want us to act on.
Slide 3, why this belongs to this room and not only to nursing. Three of you already own a piece of it. The national medication information goal requires this organization to maintain and communicate an accurate medication list, so we are not choosing whether to do this work, only how well we do it (The Joint Commission, 2023). Pharmacy absorbs the callbacks when a list is wrong at discharge. The hospitalists rewrite orders they already wrote once. Nursing takes the history at 2 a.m. between two admissions, which is where most of those 46 discrepancies were born. No single department can fix a process that four departments touch, and that is the argument for doing this together.
Slides 4 to 6: The Plan, the Evidence, and the People
Slide 4, what we are proposing. One certified pharmacy technician, trained to obtain a best possible medication history, takes that history within 24 hours of admission using at least two sources: the patient or family, and the community pharmacy or the prior discharge record. The admitting nurse verifies it against what the patient says at the bedside and flags anything that does not match. The pharmacist resolves what the nurse flags. Nothing here adds a new system, and nothing asks a prescriber to do more than they already do. We are moving a task to the discipline that is fastest at it and keeping verification with the person standing at the bedside.
Slide 5, why we think it will work, and how you will know if it does not. A systematic review and meta-analysis of pharmacist-led reconciliation at hospital transitions found consistent reductions in medication discrepancies, which is precisely the outcome we are targeting (Mekonnen et al., 2016). So the prediction is specific: discrepancies below 15 percent by week 20, and a technician-obtained history within 24 hours for 90 percent of admissions. If we are sitting at 30 percent in week 20, the pilot did not work, and I will say so at this table. I would rather bring you a failed pilot with a clean number than a successful one with an anecdote.
Slide 6, who does what. Seven roles, each written down, each with a named alternate: project lead, sponsor, pharmacist, technician, medical director, admissions lead, informatics analyst. We run this on a TeamSTEPPS structure rather than on whoever happens to be free, which means a two-minute brief at the start of the technician's shift, a fifteen-minute huddle once a week with a fixed agenda, and a debrief at the close of every test cycle (Agency for Healthcare Research and Quality, 2023). I am being this specific because pilots on this unit have ended before when one person changed assignments and nobody had an alternate.
Slides 7 to 9: How the Change Is Run, What It Costs, and What Comes Back
Slide 7, how the change is actually run. Kotter's model gives us the sequence: urgency from our own audit, a guiding coalition that is the seven people on the last slide, a one-sentence vision, and short-term wins reported as numbers (Kotter, 2012). Inside that sequence we test in Plan-Do-Study-Act cycles instead of launching everything at once. Cycle one is one technician, one hospitalist team, five admissions a day, two weeks. Every cycle ends with a decision on the record: adopt, adapt, or abandon. That is deliberate. A rollout you cannot adjust is a rollout you can only defend, and defending a pilot is how pilots die.
Slide 8, the ask. It is $20,979 across 26 weeks. The technician is $16,307 of that: 20 hours a week at $24.50 an hour, plus benefits at 28 percent. Nursing education is $1,722, one paid hour for each of our 42 nurses. The informatics build is 30 analyst hours at $85, or $2,550. Job aids and audit tools are $400. There is no software line, no vendor, and no capital request, and I want to be plain about why: everything on this slide is labor. If you approve nothing else today, approve the technician hours, because that is the line that buys the change.
Slide 9, what comes back. Two returns, one clinical and one operational. Clinically, the classic costing study put a single preventable adverse drug event at $4,685 in 1997 dollars, which understates what one costs us now, and preventing five across 26 weeks repays the entire pilot on that old figure alone (Bates et al., 1997). Operationally, the technician takes roughly ten minutes of history-taking off each admission. At about 50 admissions a week, that is 217 nursing hours over the pilot, close to $8,900 of time at our average rate, returned to the bedside. Neither figure is a promise. Both are things we have agreed to measure.
Slides 10 to 12: Risks, the Ask by Role, and the Decision
Slide 10, what could go wrong. Three risks, and what we do about each. The technician is absent or gets pulled: the pharmacist covers high-alert admissions only, and we log the gap rather than hide it. Prescribers read this as one more step: the medical director opens the kickoff, and we bring the first cycle's data to the hospitalist meeting in week four. Weekends have no technician coverage: cycle one runs weekdays only, and weekend coverage becomes a week 12 decision rather than a promise I cannot keep today. The risk I cannot control is attention, which is why I am asking for an owner and not only for money.
Slide 11, what I am asking from each of you. From the chief nursing officer, approval of the 0.5 FTE technician hours and the education time. From the pharmacy director, the technician assignment and a named alternate. From the hospitalist medical director, five minutes at the start of the kickoff and a standing agenda slot at week four and week 12. From informatics, 30 hours for the status report. From the unit council, ownership of the weekly audit from day one, because the group that will own this measure after the pilot should be holding it during the pilot.
Slide 12, the decision. I am not asking for a permanent program today. I am asking for 26 weeks, a named owner in each discipline, and a checkpoint at week 12 where this group sees both measures and decides to continue, adapt, or stop. If the numbers do not move, we stop, and I will bring you the reason rather than a request for more time. If they do move, the week 26 conversation is about making the technician role permanent, and that is a budget conversation I would like us to earn rather than assume. Thank you. What would you need to see at week 12 to say yes to that?
References
Agency for Healthcare Research and Quality. (2023). TeamSTEPPS 3.0 pocket guide. Agency for Healthcare Research and Quality.
Bates, D. W., Spell, N., Cullen, D. J., Burdick, E., Laird, N., Petersen, L. A., Small, S. D., Sweitzer, B. J., & Leape, L. L. (1997). The costs of adverse drug events in hospitalized patients. JAMA, 277(4), 307-311.
The Joint Commission. (2023). National patient safety goals: Hospital accreditation program. The Joint Commission.
Kotter, J. P. (2012). Leading change. Harvard Business Review Press.
Mekonnen, A. B., McLachlan, A. J., & Brien, J. E. (2016). Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: A systematic review and meta-analysis. BMJ Open, 6(2), e010003. https://doi.org/10.1136/bmjopen-2015-010003
World Health Organization. (2017). Medication without harm: WHO global patient safety challenge. World Health Organization.
How this NURS FPX 4005 Assessment 4 example is structured
These are presenter notes, not an essay, and they run in the order the deck runs: an opening that states the ask, a problem slide built from the unit's own audit, then the plan, the evidence, the team, the change method, the cost, and the return. The risk slide sits before the ask on purpose, because a room that has heard its own objections said back to it listens differently to the request that follows. The last slide leaves a decision on the table instead of a summary. This NURS FPX 4005 Assessment 4 example continues the Assessment 3 proposal for the RN-to-BSN Nursing Leadership: People, Processes and Organizations course at Capella University, so the two read as one body of work.
NURS-FPX4005 Assessment 4 questions, answered
How long should the speaker notes be for each slide?
Roughly what you can say in sixty to ninety seconds, which lands near 100 to 150 words. Write them as speech rather than as a paragraph you would read aloud. If the notes repeat the words already on the slide, cut one of the two, because a scorer notices that duplication as fast as your audience does.
Who is the audience for a stakeholder presentation?
The people who control what your plan needs: the nurse executive, the service line or department director, the discipline leaders whose staff you are asking for, and the unit council that will own the work afterward. Name them on the ask slide and say what each one has to approve, because a request addressed to everyone is addressed to no one.
Do I still need citations in a presentation?
Yes. Citations appear in brief form on the slides and in full on a references slide, and the notes should name the source aloud wherever a claim is doing real work. A number with no source behind it is the fastest way to lose the evidence criterion, even in a spoken deliverable graded from a recording.
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