Transcript Integration of Evidence-Based Practice, Quality

Kathleen M Buckley, PhD, RN, IBCLC
Associate Professor
University of Maryland School of Nursing
1. Compare and contrast the major tenets of
Evidence-Based Practice (EBP), Quality
Improvement (QI), and research
2. Review examples of EBP, QI and research
3. Describe a model for the integration of EBP
 Low
quality healthcare cost the United
States about $720 billion
 Wasteful healthcare spending costs the
healthcare system $1.2 trillion annually
Midwest Business Group on Health,
Juran Institute & The Severyn Group, 2003.
A high reliability healthcare organization
provides care that is safe and one that
minimizes errors while achieving exceptional
performance in quality and safety.
Pronovost, P.J., 2006, HSR: Health Services Research
What are some of the key
strategies that can be used by
a hospital to create
a high reliability organization?
Research
EBP can reduce healthcare costs by as much as 30%!
Soil
Water
Sunlight
problem solving systematic approach to clinical
decision making
 integrates

 best
available scientific research
 experiential evidence, and
 patient’s preferences and values

contributes to improved outcomes
Newhouse et al, 2005.
Melnyk, B.M., 2012
systematic activity
 guided by data
 to study clinical processes and outcomes
 designed to bring about immediate
improvement in care in local setting

Baily et al, 2006.
systematic investigation
 including research development, testing and
evaluation
 designed to develop or contribute to
generalizable knowledge

Dept of HHS, 2005
intent of both – to improve process of care or
practice outcomes or health & well-being of
populations
 both have a clear responsibility to act in an
ethical and moral manner
 both must protect patient rights at all times
& act in a professionally accountable manner





purpose: to improve
current practice in a
particular setting
data is confidential
action is within
existing standards of
care
IRB approval is not
usually necessary
Quality Improvement




purpose: create
generalized
knowledge
desire to
publish/present
action involves
testing new methods
needs IRB approval
Research
Testing use of a well-known IV catheter to
see if it decreases the risk of infiltration.
 Testing use of innovative double-lumen
catheter to see it decreases the risk of
infiltration.
 Presenting at an academic meeting about the
impact of QI efforts on average Hemoglobin
A1c levels.
 Tracking average Hemoglobin A1c levels to
assess a hospital's performance on diabetes
care.

Credibility of findings would be questioned
 Patients’ rights are not protected
 Sanctions are imposed by IRB for
noncompliance

 Nurses
working in Army Military medical
centers
 Problem: lack of clear policy for
decontamination of noncritical equipment
Freeman et al., 2009, AORN Journal







Defined terms clearly
Developed search algorithms
Reviewed literature with structured templates
Wrote annotated bibliographies
Created a table evaluating the evidence
Identified common themes
Formulated a policy based on synthesis of
literature
 Purpose:
to reduce incorrect counts and
prevent retained surgical items
E.K. NORTON, BSN, RN, CNOR;
C. MARTIN, RN, CNOR;
A.J. MICHELI, MS, RN, NEA-BC;
2012, AORN Journal
 reviewed
reported incorrect counts and
count discrepancies
 collaborated with the radiology department
 reviewed and revised the existing count
policy
 root cause analysis
 surgical
procedures that lasted longer than 8
hours
 multiple staff turnovers during a procedure
 documentation discrepancies or omissions of
items added to the surgical field
 communication breakdown
 a lack of standardized practice due to
variability
 interpretation of count policy
 used





a team approach
Invested in radio frequency technology for
sponge count
Revised requisition form for radiology to clarify
item deemed missing
Revised the count policy to standardize practice
Embedded the wound closure time out in the
Pediatric Surgical Safety checklist
conducted observational audits
 Purpose:
Improve management of post-op
gynecological surgical pain
 Sample/Setting: 20 patients from 30-82 years
in a New England medical center
 Design: experimental comparison group
 Method:



Randomly assigned subjects to 2 groups:
Acupuncture with or without PENS
Measured pain within 24-48 hours after surgery
Used Visual Analogue Pain scale
Gavronsky et al., 2012, Pain Management Nursing
Step 3
Creating
Internal
Expertise
Step 4
Implementing
EBP
Step 2
Identifying
Areas of
Concern
Step 5
Contributing
to a Research
Study
Step 1
Establishing a
Foundation
for EBP
Turkel, M.C. et al, 2005, Nurse Admin Q
 Leadership
commitment
 Involvement of APNs
 EBP as part of
Annual Performance
Review
 EBP as part of
Clinical Ladder
Placement
 Securing resources
 Forming a Nursing
Research committee
 Nursing
Staff
meetings
 Research
committee
 Navigating
internal
resources
 Educational
sessions
 Journal clubs
 Critiquing
the
literature
 Validate or change
in practice
 Scholar or
fellowship
 Review
of the
literature
 Proposal to Nursing
Research
Committee and IRB
 Collecting data
 Article publication

Nurses support that engaging in EBP renews
the professional spirit of the nurse, a key
variable in professional satisfaction.”
Maljanian, R. et al, 2002, JONA
 Nurses
comment that ‘‘EBP gives us a voice
and allows us to reclaim our authentic self as
a ‘real nurse’ as well as supports us to
become strong patient advocates, focused on
improving the quality of the care given to
patients.”
Strout, T.D., 2005, Sigma Theta Tau
1.
2.
3.
4.
Grow something that likes you
Learn something
Experiment
Make a long-range plan
Think about how the
landscape you govern
represents the footprint
that you leave behind you
on this earth.
Tom Clothier

Baily, M.A., Bottrell, M., Lynn, J. & Jennings, B. (2006). The ethics of using QI methods to improve health
care quality and safety. Hastings, 36(4). S1-S40.

Department of Health and Human Services. (2005). Code of federal regulations.

Freeman, S.S., Lara, G.L., Courts, M.R., Wanzer, L.J., & Garmon, S.C. (2009). An evidence-based process for
evaluating infection control policies. AORN Journal, 89(3), 489- 507.

Gavronsky, S., Koeniger-Donohue, R., & Hawkins, J.W. (2012). Postoperative pain: Acupuncture versus
percutaneous electrical nerve stimulation. Pain Management Nursing, 13(3), 150-156.

Maljanian, R. et al. (2002).Evidence-based nursing practice, Part 2: building skills through research
roundtables. Journal of Nursing Administration 32(2), 85-90

Melnyk, B.M & Fineout-Overholt. (2012). The State of Evidence-Based Practice in US Nurses. JONA, 42(9), 410417.

Midwest Business Group on Health in collaboration with Juran Institute & The Severyn Group. (2003).
Reducing the Costs of Poor-Quality Health Care through Responsible Purchasing Leadership.

Newhouse, R.P., Dearholt, S. Pugh, L.C., & White, K. (2005) Evidence-based practice: A practical approach to
implementation. Journal of Nursing Administration, 35(1), 35-40.

Norton, E.K., Martin, C., Micheli, A.J. (2012). Patients count on it: An initiative to reduce incorrect counts
and prevent retained surgical items, AORN Journal, 95 (1), 109-121.

Provonost, P.J. (2006). Creating High Reliability in Health Care Organizations HSR: Health Services Research,
41(4), 1599-1617.

Strout ,T.D. C(2005). Curiosity and Reflective Thinking: Renewal of the Spirit. Indianapolis, IN: Sigma Theta
Tau International.

Turkel , M.C., Reidinger, G., Ferket, K., & Reno, K. (2005). An essential component of the magnet journey:
fostering an environment for evidence-based practice and nursing research Nurse Administration Quarterly,
29(3), 254-262.