Follow the directions on the attached document below.I also attached an example document and it is due tomorrow.
1
eer Review: Draft of Persuasive Memo
11 unread reply.11 reply.
Peer Reviews are a two part assignment. You must post your paper AND go back and provide feedback. Please see the instructions below.
1. Read the Assignment Sheet –
Persuasive Memo: Short Proposal to Solve a Problem
2. Review the
Rubric – Persuasive Memo
3. Review how to
Present Research in a Meaningful Way
· Research must include an attributive tag AND an end citation. For example, an attributive tag should be included when you present research as this gives the research credibility; for example, In the article, “Knowing your Evidence,” John Smith, an expert in forensic analysis, explains that……. (31). This shows the reader where the research came from, and that the person being referenced is credible because we know his credentials. There must also be an end citation in addition to the attributive tag – it’s not enough to just have an attributive tag.
· Having both an attributive tag (name of article, author, and author’s credentials) and end an end citation (“31” in this example), tells the reader when the research starts and when it ends. This is not an option in this course. If you have a direct quote, you must include the page or paragraph number.
4. Draft your memo including design, format, and research.
5. Review a
Sample Persuasive Memo
Actions
6. Read the
Guidelines for Participating in Peer Reviews
and
Rubric – Peer Reviews
7.
Post draft by Wednesday
8.
Respond by Friday to TWO other student. In addition to providing general feedback, use the questions below to conduct your peer reviews. Respond to students that have not received feedback first.
Peer Review Questions:
The memo should be addressed to a specific audience, an audience with the power to make the change. In addition, memo should be divided into a minimum of five (5) paragraphs.
Paragraph one (1) should prepare the audience by providing background information on the topic and or situation and the purpose of the memo.
1. What background information does the writer use to connect with the audience and prepare them to read?
2. Is the purpose statement clear and specific? The audience should know from the start why the memo is being written.
Paragraph two (2) should include the current the situation. Don’t assume the audience knows and or sees what you see as a problem or challenge.
3. How does the memo address the current situation and or problem? What type of evidence does the writer include to show the current situation?
Paragraph three (3) should detail what is being proposed.
4. What is being proposed, and what is the plan to execute it? This section should be specific. Help the audience visualize what you are proposing.
5. Is proposal realistic and supported by evidence?
6. What research is being used to support what is being recommended/proposed?
7. Is the research presented correctly and in a meaningful way, with an attributive tag (lead in) and a parenthetical reference to close the research reference?
Paragraph four (4) should explain the benefits and address any questions the audience may have.
8. What are the benefits of this proposal?
9. As a reader, do you see any counterarguments? If so, are they addressed in the memo?
10. Is it clear that the benefits of this proposal out way the negative aspects if there are any?
11. Are there any limitations (organizational, legal, ethical, financial, etc.) to this proposal? If so, are they included?
Paragraph five (5) should conclude the memo and include a call to action.
12. Is there a conclusion which recaps (briefly summarizes) the memo?
13. Does the conclusion include a call to action and what should happen next? If not, provide suggestions.
Other things to consider.
14. Is the memo formatted correctly?
15. Is the memo divided into a minimum of five (5) paragraph? The memo may have more than five as each section of the memo could potentially have multiple paragraphs is needed.
16. Are there headings/subheadings within the memo to help the reader follow along?
17. Is memo written clearly and easy to follow along. You don’t need to address grammar unless there are sections of the memo that are hard to follow because of sentence structure and grammatical errors.
MEMORANDUM
DATE:
TO: Tundra Medical System Surgeon and Anesthesia Champions
FROM: Name, Director of Strategic Initiatives
SUBJECT: Improving the Surgical Quality Journey with an ERAS Program
Surgeons, anesthesiologists, and health care systems strive for excellence in surgical care. This is
a time when the Surgical Quality Journey needs to collaborate and implement the most current
evidence-based surgical quality initiatives. There is overwhelming literature to support that the
use of an Enhanced Recovery After Surgery (ERAS) program significantly improves outcomes,
reducing morbidity and decreasing costs. This memo requests that Tundra Medical System
Surgeon and Anesthesia Champions support the use of the ERAS program to improve the surgical
care and recovery care of patients.
Current Surgical Care Model
Observation of the process for surgical preparedness in the offices of 15 surgeons of varying
specialties was completed for 6 months. In short, it was observed that patients receive limited
examination and discussion with surgeons preoperatively. There was no program that addressed
patient education, optimization, and assessment for surgical readiness. Patients were not
provided with information of what to expect before, during, and after surgery regarding their
pain management, mobility expectations, nutritional requirements to optimize healing and other
measures they could engage in to prevent complications.
Anesthesia care in the medical center was similarly observed. Like the surgeons, the time spent
preparing a patient for anesthesia and review of what to expect before, during and after
procedure was very limited. Outdated processes such as patient fasting for six to eight hours
prior to procedure and heavy intra-operative use of intravenous fluids to maintain perfusion was
noted. Pain management included early and often use of narcotics and opioids to manage
surgical pain.
Changes in care are driven by objective matrix that are measured over time and represent
quality of care outcomes. In review of these matrix, data such as length of stay, surgical site
infections, length of time for return of bowel function, narcotic and opioid pain medication
usage, and overall patient satisfaction have had little movement in the last 3 years.
Enhanced Recovery After Surgery (ERAS) Model
Enhanced Recovery After Surgery is not a new idea. Melnyk, Megan, et alia found that ERAS has
been around since the 1990s and was developed to change the way patients physiologically
respond to the stressors of surgical procedures (Melnyk, Megan, et al. 343). It has since been
Commented [MP1]: Purpose of memo is clear
Commented [MP2]: While the current situation is
presented here, it must be cited. The student is referencing
data in this whole section and it must be cited.
Commented [MP3]: The research is cited effectively with
an attributive tag to start and closes with a parenthetical
reference, but we, as readers don’t know who the authors
are and why we should trust them.
found to have the added benefits including reduced complications, decrease in hospital stay, and
improvement in cardiovascular and bowel function as well as a quicker return to baseline status
(Melnyk, Megan, et al. 343).
The modern approach to ERAS encompasses many aspects of the three stages of surgical care:
pre, intra, and post procedure. Preoperatively, ideas such as comprehensive education, patient
optimization including evaluation of baseline nutritional status and prior pain management
routines, carbohydrate loading, and bowel preparation are addressed. Intraoperatively, care
that includes restrictive use of intravenous fluids, maintenance of normothermia, and use of
regional anesthesia versus general anesthesia is done. Postoperatively, care including
prophylactic management of nausea and vomiting with early alimentation, early mobility,
restricted use of narcotics in favor of NSAIDS, and early removal of catheters and drains is
employed (Melnyk, Megan, et al., par. 343).
The Impact of the Changes
The ERAS processes are a paradigm shift in the way elective surgical patients are prepared and
cared for. Fitzgerald, in referencing the thoracic surgery program at University of Virginia Health
System (UVA), wrote that the challenge was to get the buy-in of the clinicians (Fitzgerald, par.
10). These professionals were very invested in the care they provided to their patients and truly
believed they were doing very well (Fitzgerald, par. 10). Per Melnyk, Megan, et alia, even minor
changes that are simple to implement, represented what was thought to be fundamental care
and thus was difficult to achieve (Melnyk, Megan, et al. 348). Joliat, Gaetan-Romain et alia, also
noted that to start to change the way care is delivered, there had to be some challenging to the
usual care surgical care trends (Joliat, Gaëtan-Romain, et al., par. 1). They go on the further say
that the success of improving care and embracing new challenges and way of thinking depended
of the leadership of the clinicians and their willingness to apply evidence-based
interventions (Joliat, Gaëtan-Romain, et al., par. 1).
Data Analysis
At Tundra Medical Center, once there is commitment to embrace the literature and embark
upon changes, data collection and assessment will drive sustainability. Fitzgerald noted that at
UVA, ERAS resulted in better educated patients both before and after surgery, which in turn
proved to result in decreased pain and shorter lengths of stay (Fitzgerald, par. 7). The ERAS
program at UVA diminished the use of morphine related medications by 74% in one group and
59% in another, shortened length of stay by two days and saved over $1.3 million for a group of
139 patients (Fitzgerald, par. 22). Joliat, Gaetan-Romain et alia state that ERAS and associated
pathways do two things: improve patient outcomes and decrease costs (Joliat, Gaëtan-Romain,
et al., par. 4). In review of several studies, there was a 40% reduction in morbidity for colorectal
cases and for liver specific procedures, surgery complications were reduced by 30-50% (Joliat,
Gaëtan-Romain, et al., par. 4). In those same studies, there was a cost savings realized of $1
million for 198 cases (Joliat, Gaëtan-Romain, et al., par. 5).
Commented [MP4]: It’s not enough to cite at the end of a
para—the research must be presented in a meaningful way.
Commented [MP5]: We need to know the author’s title
in order to be able to trust what he/she is saying
Commented [MP6]: Excellent job of using support in this
section, but it must be presented in a meaningful way.
Commented [MP7]: What data? Headings should be
specific, they’re like a summary to the text that follows.
The Road to Change and Success
There are many examples of successful programs in the volumes of evidence-based
literature. Available to help Tundra Medical Center is Improving Surgical Care and Recovery
(ISCR). Wick, Elizabeth, et alia reports ISCR is a program partnership of well-respected
organizations including with the American College of Surgeons (ACS), Johns Hopkins Medicine
Armstrong Institute for Patient Safety and Quality as well as the Agency for Healthcare Research
and Quality (AHRQ) Safety Program (Wick, Elizabeth, et al., par. 1). ISCR is an effective program,
offering support of the ERAS process that starts from the initial roll out including coaching calls,
webinars and a nurse consultant with vast experience in establishing ERAS programs (Wick,
Elizabeth, et al., par. 6-7). ISCR program is free, funded by AHRQ and is comprehensive,
providing evidence-based literature with the pathways to model helping organizations
implement their own unique ERAS programs.
Please consider partnering the Executive Team and the Office of Strategic Initiatives to
implement an ERAS program to improve the surgical care and recovery care of patients. Your
support and engagement in this initiative is appreciated. Please let me know if you have any
questions and or if I can help in implementing this change. I look forward to improving the care
we provide to our patients.
Works Cited
Fitzgerald, Andrea. “Enhanced Recovery Program Reduces Opioid Use and Costs, Benefits
Patients at UVA.” A Press Ganey Publication, August 2018. INDUSTRY EDGE,
https://www.pressganey.com/docs/default-source/default-document-library/enhanced-
recovery-program-reduces-opioid-use-and-costs-benefits-patients-at-uva .
Joliat, Gaëtan-Romain, et al. “Beyond surgery: clinical and economic impact of Enhanced
Recovery After Surgery programs.” BMC Health Services Research, vol. 18, no. 1, 29
December 2018, doi:10.1186/s12913-018-3824-0.
Melnyk, Megan, et al. “Enhanced recovery after surgery (ERAS) protocols: Time to change
practice?” Canadian Urological Association Journal, vol. 5, no. 5, October 2011, p. 342-
348, doi:10.5489/cuaj.11002.
Wick, Elizabeth C., et al. “AHRQ Safety Program for ISCR expands scope in 2019.” Bulletin of
American College of Surgeons, vol. 103, no. 12, 4 December 2018, pp. 16-20,
http://bulletin.facs.org/2018/12/ahrq-safety-program-for-iscr-expands-scope-in-2019/#.
https://www.pressganey.com/docs/default-source/default-document-library/enhanced-recovery-program-reduces-opioid-use-and-costs-benefits-patients-at-uva
https://www.pressganey.com/docs/default-source/default-document-library/enhanced-recovery-program-reduces-opioid-use-and-costs-benefits-patients-at-uva
http://bulletin.facs.org/2018/12/ahrq-safety-program-for-iscr-expands-scope-in-2019/
Accessibility Report
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Sample Persuasive Memo_2019-1
Report created by:
Yanira Leon
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