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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