Taylor, ch 5. A step-by-step dynamic process used to solve clinical problems EBP solves problems by applying best research data, best clinical judgment.

Evidence-Based Practice and Quality

ImprovementTaylor, ch 5

A step-by-step dynamic process used to solve clinical problems

EBP solves problems by applying best research data, best clinical judgment and expertise, and objective and subjective information from pts

Finding this research involves looking at previous research studies to see what the best practice is for a particular condition or procedure

What is Evidence-Based Practice?

The client is the focus of EBP It is our duty as nurses to make sure the

patient is receiving the best care possible Nurses need to contribute to the body of

knowledge that makes up best practices by conducting research of their own

Why Do We Care About EBP?

Directs nurses toward a common goal Leads to improved patient care Provides rational and knowledgeable

reasons for nursing actions Gives nurses knowledge base necessary for

appropriate actions Helps resolve current nursing issues Prepares nurses to question assumptions

and values Serves research, education, and practice

Benefits of Nursing Theory and Research

Traditionally by:◦ Tradition◦ Authority◦ Borrowing◦ Trial and error◦ Personal experience◦ Intuition◦ Reasoning

How is Knowledge Acquired in Nursing?

Nursing research which is:◦ “A diligent and systematic inquiry to validate and

refine existing knowledge, and generate new knowledge that influences nursing practice.” (Burns & Grove, 2007)

New Methods of Acquiring Knowledge

Improve care of people in clinical settings Study people and the nursing process Develop greater autonomy and strength as

a profession Provide evidence-based nursing practice

Goals of Nursing Research

Quantitative—involves concepts of basic and applied research

Qualitative—gain insight by discovering meanings. Based on belief that reality is based on perceptions that differ for each person and change over time

Research Methods

State the problem Define the purpose of the study Review related literature Formulate hypothesis and variables Select research design Select population and sample Collect data Analyze data Communicate findings and conclusions

Quantitative Research

Steps are same until the data collection process

Data collection involves gathering information from the same population sample over a specific time period

It analyzes the effects of a variable on that group at different phases of the members’ lives

Qualitative Research

Must know and accept responsibility for:Asking questionsReading literatureUnderstanding Critical thinkingSynthesizing infoApplying science

Role of the Nurse in Evidence-Based Research and Practice

An orderly series of steps that allows a researcher to find the answer to a question◦ Identify the problem◦ Gather data◦ Analyze data◦ Use the findings◦ Evaluate outcomes

Steps to Evidence Based Practice

What do you want to do?◦ Improve practice?◦ Update knowledge?◦ Validate a policy or procedure?◦ Plan a new program or intervention?

1. Identifying the Problem

P = Patient, population, or problem I = Intervention being considered C = Comparison of interest (old or new) O = Outcome wanted

PICO: The Anatomy of the Clinical Question

“In a 55-year-old man with a 35-year-old history of chronic smoking, would the administration of bupropion as compared to a nicotine replacement therapy (NRT) be a better therapy in causing long-term abstinence from smoking?”

Can you identify each PICO component?

Example of a Question

Run a subject search thru Medline or CINAHL

Consider hospital policies and procedures Clinical expertise Cost Chart reviews Patient preference

2. Gather Evidence

Which research applies best? How strong or weak is the research? Is this research relevant to the clinical

situation?

3. Analyze the Data

Apply what you learned from the evidence Include clinical experience Include patient preferences

4. Use the Findings

Did the application of your evidence improve the patient outcomes?

If not, go back to one of the earlier parts of the process and start over, if necessary

6. Evaluate Patient Outcomes

Data: 9 randomized controlled clinical trial study used to address the problem of surgical site infections, CAUTIs

PARTICIPANTS: Adults receiving topical antisepsis prior to surgery, blood cultures, and vascular catheter insertion

INTERVENTIONS: Chlorhexidine gluconate COMPARISONS: Povidone-iodine OUTCOMEzation, catheter-related sepsis RESULT: The use of chlorhexidine for skin antisepsis,

instead of povidone-iodine, would result in significant reductions in hospital-acquired infections

Review with Example

The positive outcomes from EBR can improve the overall performance of an institution

The Quality Improvement department of the institution focuses on the continuing process of creating positive patient outcomes

Part of the department includes Risk Management whose efforts are directed toward preventing errors in patient care

Improving Performance

These reports contain information about circumstances involving errors in patient care that either led to or could lead to injury

The report is not to be placed in the patient’s chart, but does become part of Risk Management and is used to track and prevent errors

Incident Reports

Complete name of person and names of witnesses

Factual account of incident Date, time, and place of incident Pertinent characteristics of person involved Any equipment or resources being used Any other important variables Documentation by physician of medical

examination of person involved

Information Contained in Incident Reports

This accrediting agency promotes quality in institutions by requiring them to meet Accountability Measures or standards of care for various patient conditions

Meeting these measures and standards helps maintain quality of patient care

These measures are based on evidence that the interventions are effective

Joint Commission Insures Quality

Unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof

Serious injury specifically includes loss of limb or function

The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

JCAHO tracks these events in an effort to maintain quality patient care

Sentinel Event

Types of Sentinel Events

NPSGs have come about based on the types of sentinel events that have occurred.

The NPSGs are also part of Risk Management and Quality Improvement

National Patient Safety Goals

A process that looks at the reasons that any error or “near miss” situation occurred

There is usually more than one reason thus avoiding the “blame game”

Root cause analysis transforms an old culture that reacts to problems to a new culture that solves problems before they escalate; thereby improving institutional and personal performances.

Root Cause Analysis