| Course | NU 730 Systems-Based Practice |
|---|---|
| Unit | Unit 4 |
| Paper type | Quality improvement proposal |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU 730 Unit 4
Quality Improvement Proposal: Reducing Hypoglycemia on Two Medical Units Through a Nurse-Driven Protocol and Order Set Change
Student Name
Department of Nursing, Herzing University
NU 730: Systems-Based Practice
Instructor Name
February 11, 2026
Quality Improvement Proposal: Reducing Hypoglycemia on Two Medical Units Through a Nurse-Driven Protocol and Order Set Change
The Process and the Baseline
The target process is the management of insulin-treated patients on two adult medical units, 3 North and 3 South, with 60 beds combined, in a composite community hospital. Baseline, drawn from the hospital's glucose meter database for July through December: of 4,812 patient-days on which an insulin-treated patient had at least one point-of-care glucose reading, 312, or 6.5%, had at least one reading below 70 mg/dL, and 41, or 0.9%, had a reading below 54 mg/dL, which is clinically significant hypoglycemia. A review of 40 hypoglycemic events found three common patterns: scheduled mealtime insulin given when the patient ate little or nothing, basal insulin doses continued unchanged after the patient became unable to eat, and sliding-scale insulin used alone for patients with type 2 diabetes. Hospital guidance favors scheduled basal insulin with prandial and correction components over sliding-scale insulin alone, with adjustment for intake (Umpierrez et al., 2012; American Diabetes Association Professional Practice Committee, 2024).
The Change, Described Operationally
Two changes are proposed, starting March 16 on 3 North and May 11 on 3 South. First, the insulin order set is revised so that sliding-scale insulin alone cannot be ordered for patients with a documented A1C above 7.5% without an override reason, and so that every order for mealtime insulin includes an instruction: "Give within 15 minutes after the meal if the patient eats at least half; hold if less than half and notify the prescriber for a reduced dose." Second, a nurse-driven hypoglycemia prevention and treatment protocol allows nurses to hold mealtime insulin by the intake rule above, to treat any glucose below 70 mg/dL with a standard 15-gram carbohydrate protocol and recheck in 15 minutes, and to notify the prescriber for a basal dose review whenever a reading below 70 occurs or the patient becomes unable to eat. The diabetes nurse educator trains all nurses on both units in 20-minute huddle sessions over two weeks before each start date.
Why These Changes and Not Others
Three alternatives were considered. Computerized insulin dosing software, which calculates doses from glucose trends, has a strong evidence base in critical care but would require a purchase, integration, and training well beyond this project's scope. Routine endocrinology consultation for every insulin-treated patient would bring expertise but is not available at this hospital, which has one endocrinologist who does not round on inpatients. Continuous glucose monitoring for inpatients is promising but not yet supported by the hospital's policies or laboratory. The two proposed changes, by contrast, target the three patterns found in the event review directly, use staff and systems already in place, and can be tested on one unit within weeks. If they do not produce the targeted reduction, the event review repeated at six months will show which pattern persists, and that finding will decide whether a larger investment is justified.
Improvement Model and Cycles
The proposal uses the Model for Improvement, which starts from a stated aim, a defined measure of improvement, and a set of candidate changes, and then tests each change in Plan-Do-Study-Act cycles (Langley et al., 2009). Cycle 1: test the post-meal dosing instruction with two nurses on one shift on 3 North for one week, collecting their feedback and every hold decision. Cycle 2: extend it to all day-shift nurses on 3 North for two weeks, with the order set change live. Cycle 3: add the full hypoglycemia protocol on all shifts on 3 North for four weeks. Cycle 4: spread to 3 South after the 3 North results are reviewed. Each cycle is small enough to run within a few weeks, and each has a prediction written in advance, for example that fewer than 10% of mealtime doses will be held, so the study step compares what happened with what was expected.
Measures
Outcome: percentage of insulin-treated patient-days with any glucose below 70 mg/dL; target, a fall from 6.5% to below 4% on each unit within six months of start. Process: percentage of insulin-treated patients with type 2 diabetes and A1C above 7.5% on scheduled basal insulin rather than sliding scale alone; percentage of mealtime doses documented with an intake assessment; percentage of hypoglycemic events treated per protocol with a recheck within 20 minutes. Balancing: percentage of patient-days with glucose above 300 mg/dL, because holding insulin could raise glucose; target, no increase above the baseline of 4.1%. All measures are drawn from the glucose meter database and the medication administration record and plotted weekly on run charts.
Owner, Cost, and Resistance
Owner: the 3 North nurse manager, with the diabetes nurse educator as project lead and a hospitalist champion. Cost: order set revision, 16 hours of analyst time; training, about 90 nurse-hours across two units in 20-minute sessions; data extraction and run charts, 4 hours a week of quality analyst time for six months; printed protocol cards, minimal. Total estimated direct cost is about $14,000, largely staff time. Against this, each episode of severe hypoglycemia can extend a stay or lead to a rapid response call.
Resistance is expected from three directions. Some prescribers are comfortable with sliding-scale insulin and may view the order set change as restrictive; the hospitalist champion will present the baseline data at the medical staff meeting, and the override option preserves prescriber judgment. Some nurses may worry that holding insulin will be criticized; the protocol explicitly authorizes the hold, and the nurse manager will state that support in writing. The dietary department may be concerned about the timing of meal trays; the project lead will meet with dietary before cycle 1 to align tray delivery times with glucose checks.
Decision Requested
The proposal asks the nursing quality council to approve the project, the analyst hours, and the training time, and to receive run chart reports monthly, with a decision at six months to adopt the changes hospital-wide, modify them, or stop, based on the outcome and balancing measures together.
References
American Diabetes Association Professional Practice Committee. (2024). 16. Diabetes care in the hospital: Standards of care in diabetes-2024. Diabetes Care, 47(Suppl. 1), S295-S306. https://doi.org/10.2337/dc24-S016
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., & Van den Berghe, G. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 97(1), 16-38. https://doi.org/10.1210/jc.2011-2098
What the NU 730 Unit 4 instructions ask for
Unit 4 calls for a quality improvement proposal on a local problem. You will describe the process and its baseline performance, state an aim, explain the proposed change and why it was chosen, select an improvement model, define measures and identify resources and barriers. Many versions require outcome, process and balancing measures, and some ask for a run chart plan. Common models include the Model for Improvement with PDSA cycles, Lean and Six Sigma. Check whether your section wants a specific format, such as a project charter. The proposal should be feasible for your setting, though you may propose something that needs funding if you justify it. Use clinical guidelines to support the change and improvement literature to support the method.
Inside the NU 730 Unit 4 example
The sample begins with the target process and baseline drawn from glucose data, giving a precise starting rate. The change section describes exactly what will be different, which units, starting which week, and how the order set and nurse protocol work, so a manager could picture it. Alternatives are considered and rejected with reasons tied to cost and readiness. The improvement model section explains the aim, measures and change ideas, then sketches the first test cycles on one unit before spread. Measures are listed by type with definitions and targets, including a balancing measure for hyperglycemia. The owner and cost section names people by role and estimates hours. The proposal ends with a specific request for approval and a six-month decision point.
Reading the NU 730 Unit 4 rubric
The Herzing rubric for a QI proposal tends to reward problem identification with baseline data, an aim statement, the proposed intervention, the improvement methodology, measures, resources and sustainability, and writing. Baseline points require local data with a clear definition. Aim statements earn full marks when they are specific, measurable and time-bound. The intervention criterion looks for an operational description supported by evidence, such as the inpatient diabetes guidelines cited here. Methodology points go to correct use of a named model, including small tests before spread. Measures are scored on whether outcome, process and balancing measures are defined and appropriate. Resources and barriers should be realistic. APA 7 citations to the improvement guide by Langley and colleagues round out the writing criterion.
Common NU 730 Unit 4 mistakes, and how to avoid them
A Unit 4 proposal most often loses ground on a change described in general terms, such as improve glucose management, without saying what will actually be different. Another weakness is an aim with no number or date. Students also skip balancing measures, which leaves the proposal blind to new harm, here hyperglycemia. Naming PDSA without describing a first cycle is common. Baselines drawn from national statistics instead of local data weaken the case. Alternatives are often ignored, making the choice look arbitrary. Cost and owner sections tend to be missing or vague. Finally, end with a decision for leaders to make, because a proposal that only describes the project leaves the reader unsure what you are asking for.
Get a NU 730 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NU 730 classroom, plus the process you are targeting and any local data you are allowed to share. We write a custom example with an aim statement, three measure types, a costed resource list and the resistance addressed, returned in 24 to 48 hours. The first custom sample is free.
More NU 730 papers and MSN samples
- NU 730 Unit 1: Systems analysis
- NU 730 Unit 2: Care coordination plan
- NU 730 Unit 3: Handoff failure analysis
- NU 730 Unit 5: Discussion post
- NU 730 Unit 6: Budget impact analysis
- NU 730 Unit 7: Policy analysis
- NU 730 Unit 8: Outcome evaluation plan
- NU 651 Unit 4: Negotiation preparation document
- NU 715 Unit 4: State licensure and compact analysis
- NSG 520 Unit 4: Receptor distribution study
- NSG 521 Unit 4: Findings vocabulary conversion
NU 730 Unit 4 questions, answered
Which improvement model should the proposal use?
Whichever your instructions name, and where they leave it open, the one that matches your change. Rapid cycle testing suits a small process change you can adjust quickly, while a more structured model suits a change with training and technology attached. Name the model, cite it, then actually use its stages in the proposal rather than mentioning it once in the background.
What is a balancing measure and do I need one?
It is the measure that watches for harm caused by your improvement, such as time added to another role or a delay pushed downstream. In most sections it is expected, and even where the rubric is silent it strengthens the proposal, because a change that only reports upside signals that nobody looked for the cost.
Can I propose something the organization cannot afford?
You can, if the cost is stated and a smaller first version is offered. What loses credit is an expensive proposal written as though money were not a constraint, since the reader is being asked to fund it. Naming the resource requirement and proposing a limited trial reads as competence rather than as a retreat from ambition.
Where can I find a free NU 730 Unit 4 sample paper?
This page holds the complete NU 730 Unit 4 hypoglycemia proposal for free, from baseline and change to measures and the decision requested. A custom QI proposal can address a different problem on your own unit, with the model your section requires.
What is a balancing measure in a quality improvement project?
A balancing measure watches for harm the change might cause elsewhere. In this hypoglycemia proposal, holding insulin doses could raise glucose too high, so the balancing measure tracks patient-days with glucose above 300 mg/dL.