Learning Evidence-Based Practice and Quality Improvementglaclp.com/.../06/Learning-EBP-and-Quality-Improvement.pdf · 2016-10-14 · Learning Objectives •Learn evidence-based practice

Learning Evidence-Based Practice and Quality Improvement:

Following a Team of Child Life Specialists in their Journey to Create a More Comfortable Injection

Experience

Annette Bonjour, CCLS

Kerri Birkett, CCLS

Learning Objectives

• Learn evidence-based practice (EBP) and quality improvement (QI) techniques which can be implemented by child life specialists.

• Leaners will recognize how recommendations, when implemented systematically, can change hospital practice.

• Learners will feel empowered to begin EBP by developing a clinical question and search terms.

• Learners will develop an enhanced understanding on best practices surrounding injections by following a child life EBP project.

What is Evidence-Based Practice (EBP)?

• Also known as: Evidence-Based Decision Making and Evidence-Based Medicine

• Evaluates and considers gathered empirical evidence

• Incorporates family and patient preferences as well as professional expertise

• Guides clinical decision making and treatment planning

• Interdisciplinary

• Unites the child life profession as a whole

• Provides high quality care

• Validates: Why we do. What we do.

Differences

© CCHMC EBP Mentors, 2013

Resource: Child Life Council

Assess Practice Need

• Identify need for change or clarification of best clinical practice

• Consider the priority level of addressing this need

Resource: Cochrane Handbook Child Life Council

Develop a Clinical Question

• Population of interest

• Intervention or issue of interest

• Comparison intervention or issue of interest

• Outcome of interest

• Time involved to demonstrate outcome

Resource: Evidence‐Based Practice in Nursing and Healthcare: A Guide to Best Practice by Bernadette Mazurek Melnyk and Ellen Fineout‐Oveholt, Chapter 2. Child Life Council

Questions in Practice

What clinical questions are you wondering about? • What is a problem that you consistently encounter?

• What is an area of interest?

• A clinical problem that you encounter in your practice could be related to patients, therapeutic approaches or interventions, personnel, collaboration, technology, physical materials, etc.?

Define a Clinical Question

• What clinical issues are you passionate about?

• What questions do you have?

Search for Evidence

• Use PICO question to determine search criteria or search terms

• Include all appropriate databases • Cochrane Database of Systematic

Reviews, CINAHL, MEDLINE, PsychINFO, National Guideline Clearinghouse, Children’s Hospital Association

• Eliminate articles that do not address the clinical question

• Search Terms:

Resource: Cochrane Handbook Child Life Council

Critically Appraise the Evidence

• Determine whether each study is valid and reliable

• Use the LEGEND (Let Evidence Guide Every New Decision) system to evaluate the quality level for each article

• Valid: Were the results of the study obtained using sound scientific methods? Does the test measure what the test says it is really measuring?

• Reliable: Can you reproduce it? Does the test consistently produce the same results when administered to the same individuals under the same conditions?

Resource: LEGEND: Tools for Evaluating the Evidence, available at: http://www.cincinnatichildrens.org/research/project/cpe‐rebp/resources.htm Child Life Council

Level of Evidence

Incorporate Clinical Expertise and Experience

• Use clinical expertise to make recommendations when evidence is inconclusive

• An interdisciplinary group of experts may be formed to help evaluate and make recommendations

Resource: Child Life Council

Incorporate Patient and Family Values and Preferences • Are my patient’s and family’s values and preferences satisfied by the

treatment and its consequences?

• Is the treatment feasible in my care setting?

• Do the patient outcomes apply to my population or question of interest?

• Are the likely benefits worth the potential harm and costs?

• Were the patients in this study similar to my population of interest?

Develop an EBP Statement

• Summarize the evidence incorporating clinical expertise and patient/family values and preferences

• Include possible implications for practice and future research needs

Implementing EBP into Practice

• When there is little evidence • Research project

• Where there is evidence to make a practice change • Quality Improvement project

• Education plan

Resource: Child Life Council

What is Quality Improvement (QI)?

• After sharing the information QI is a way to measure/show that people are using the information and completing interventions

• Improve what we are already doing by altering how we do it

• Producing measurable outcomes

• Creating positive differences by changing outcomes

• That has a lasting impact

• Why do QI or make changes? • To improve the patient experience.

Develop SMART Aim

• An Aim statement describes what a team’s focus is for their improvement work

• It indicates their goal as well as the baseline to clearly define what the team is trying to achieve

• Lastly, it gives a time frame for the work • S – Specific

• M – Measurable

• A – Actionable

• R – Relevant

• T – Time bound

Key Driver Diagram

• Connects the aim/outcomes, key drivers, and interventions

• Provides a roadmap for project

• Helps to focus the interventions accurately, aligning the interventions to address root causes and failures ultimately helping you to achieve your SMART aim

KEY DRIVER DIAGRAM

SMART AIM

KEY DRIVERS INTERVENTIONS (LOR)

Key

Dotted box = Placeholder for future additions

Green shaded = what we’re working on right now

Revision Date: __-__-__

GLOBAL AIM

2003 - 2009 © Cincinnati Children's Hospital Medical Center. All rights reserved.

Project Name: Project Leader:

Evaluate EBP

• Obtain outcome measures and concurrent feedback on implementation of EBP

• Continually re-evaluate

Evidence-Based Practice

Resource: Child Life Council

Plan for Sustainability and Spread

• Sustain - Make improvements “stick” • Spread - Improvements from one practice team or site are adopted by

another team • Both endeavors require change processes but strategies are fundamentally

different from QI rapid change process

Objective: • To successfully spread the improvement beyond the original target patient

population or department if appropriate.

What Can You Do to Help?

• Follow the BESt guidelines when helping patients receive injections

• Encourage/ refer others to the guidelines and information too

• Pass out educational brochures to families and role model appropriate interventions

• Promote the use of non-pharmacological interventions proven through research

• Help us with creating standard order sets

• Can we show our educational slides in your area?

• Be a part of an EBP project!

EBP Modules:

• http://childlife.org/Resource%20Library/EBPModules.cfm

Evidence-Based Practice

References • Chambers, C. T., Taddio, A., Uman, L. S., McMurtry, C. M., & HELPinKIDS, T. (2009). Psychological interventions for reducing pain and distress during routine

childhood immunizations: A systematic review. Clinical Therapeutics, 31(Suppl 2), S77-S103.

• Cincinnati Children’s Hospital Medical Center (2014). BESt Template. http://centerlink.cchmc.org/content2/67597/

• Cincinnati Children’s Hospital Medical Center (2014). Quality Improvement Education. Retrieved from http://centerlink.cchmc.org/content1/11151/

• Cincinnati Children’s Hospital Medical Center (2014). Strength of Evidence Pyramid. Retrieved from http://centerlink.cchmc.org/content2/67597/

• Higgins, J.P.T., & Green, S. (Eds). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration, 2009. Retrieved from www.cochrane‐handbook.org.

• Kassab, M. I., Roydhouse, J. K., Fowler, C., & Foureur, M. (2012). The effectiveness of glucose in reducing needle-related procedural pain in infants. Journal of Pediatric Nursing, 27(1), 3-17.

• Kennedy, R. M., Luhmann, J., & Zempsky, W. T. (2008, November). Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children. Pediatrics, 122(3), 130-133.

• Langley, G. M. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd ed.). San Francisco: Jossey-Bass.

• Lohr, K.N., Eleazer, K., & Mauskopf, J. (1998). Health policy issues and applications for evidence‐based medicine and clinical practice guidelines. Health Policy, 461‐19.

Evidence-Based Practice

References • McMurtry, C. M., Noel, M., Taddio, A., Antony, M. M., Asmundson, G. J., Pillai, R. R., et al. (2015, October). Interventions for Individuals With High Levels of Needle

Fear: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials. Clinical Journal of Pain, 31(10S), 109-123.

• Melnyk, B. M. and E. Fineout-Overholt (2005). Evidence-based practice in nursing & healthcare : a guide to best practice. Philadelphia, Lippincott Williams & Wilkins.

• Morris, J. (2012). Child Life Council Evidence-Based Practice Position Statement. Retrieved from http://childlife.org/files/CLCPositionStatementEBP.pdf

• Shah, V., Taddio, A., Rieder, M. J., & HELPinKIDS, T. (2009). Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: Systematic review and meta-analyses. Clinical Therapeutics, 31(Suppl 2), S104-51.

• Shamszad, K. (2014). Introduction to Quality Improvement Lecture Series. Personal collection of K. Shamszad, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

• Staab, J. (2012). Unveiling a standard for knowledge translation: an evidence-based practice model for the child life profession. Child Life Focus, 30(1), 1-3.

• Taddio, A., Appleton, M., Bortolussi, R., Chambers, C., Dubey, V., Halperin, S., et al. (2010). Reducing the pain of childhood vaccination: An evidence-based clinical practice guideline (summary). CMAJ Canadian Medical Association Journal, 182(18), 1989-1995.

• Taddio, A., Ilersich, A. L., Ipp, M., Kikuta, A., Shah, V., & HELPinKIDS, T. (2009). Physical interventions and injection techniques for reducing injection pain during routine childhood immunizations: Systematic review of randomized controlled trials and quasi-randomized controlled trials. Clinical Therapeutics, 31(Suppl 2), S48-S78.

• Uman, L. S., Chambers, C. T., McGrath, P. J., & Kisely, S. R. (2010). Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews, 11.

Questions?