Evidence-Based Practice & Quality Improvement Guide PDF

## Power analysis - A statistical method used to determine optimal sample size to answer a research question - Data collection continues until the desired sample size is achieved - Descriptive Statistics: Include measures of central tendency (mean, median, mode) and measures of variability (range...

## Power analysis - A statistical method used to determine optimal sample size to answer a research question - Data collection continues until the desired sample size is achieved - Descriptive Statistics: Include measures of central tendency (mean, median, mode) and measures of variability (range and standard deviation) - Inferential Statistics: Statistical tests that test hypotheses and relate findings to a sample or population #### Study Design & Population - **Example of Quantitative Study:** Comparison of two skin preparation procedures for peripheral venipuncture - **Randomization:** - Randomized Studies: Participants are allocated at random to receive one or more interventions - Randomized Controlled Studies: Participants receive one of several interventions, one of which is the standard of comparison - Non-Randomized Studies: Participants are not assigned at random and may self-select or be assigned by researchers - **Effect size:** The difference between intervention groups, a measure of the strength of the relationship between two variables ### Factors to Consider - One factor used to determine necessary sample size is **large effect size** - Large effect size increases the probability of statistical significance and power - **Meta-Analysis:** A method of summarizing and synthesizing the results of findings from a variety of sources and studies - Combines results of several studies into one larger study - General aim is to estimate the true 'effect size' more powerfully than a smaller 'effect size' derived in a single study - **Cohort studies:** A type of research that compares large groups of individuals to investigate causes or links to diseases or clinical outcomes - Retrospective cohort studies: Look at data already collected and were not collected for the purpose of the study. Researchers are not able to guide the exact information being collected or go back and gather missing data. - Prospective cohort studies: Planned in advance and therefore require collection of new data. ### Evaluating Research Reports - Read and analyze the complete study - Examine the significance of the problem - Evaluate literature review, study design, and study population - Identify strengths and limitations of the study - Assess findings and their interpretation - Determine replicability - Determine if findings are useful in clinical practice - Review references for age, cited works older than 5 years may be considered outdated ## EBP - **Evidence-Based Practice (EBP)** incorporates the best available evidence with the expertise of the clinician and patient preferences in the context of care delivery. - Considered the 'gold standard of care' in medicine, nursing, and other health care disciplines. - Evidence in healthcare can be used as the basis for: - Defining healthcare processes (patient assessment, care planning, care delivery) - Policy and procedure development and revision - Creation of patient care management tools - Care of an individual patient **Barriers to EBP:** - Lack of organizational culture and readiness for EBP - Lack of EBP mentors and champions - Inadequate EBP knowledge and skills - Clinician fails to appreciate the value of EBP - Large amount of available information and literature - Contradictory research findings - Patient expectations and demands - Conflicting priorities (workload may impair time for research) - Ability/lack of clinician's authority to initiate practice changes - Environments supportive of EBP - Training and educational support are provided ## Seven Steps of Evidence-Based Practice 1. Cultivate a spirit of inquiry 2. Ask clinical questions in a specified format (PICOT) 3. Search electronic databases to retrieve relevant articles 4. Critically appraise evidence 5. Integrate evidence with clinical expertise and patient preferences and values 6. Evaluate outcomes of practice decisions or changes based on evidence 7. Disseminate EBP results ## Evidence-Based Practice Resources - **Agency for Healthcare Research and Quality (AHRQ):** Maintains a repository of EBP clinical reports on a wide variety of diseases and disorders - **Cochrane Database of Systematic Reviews:** Full text database of systematic reviews and protocols - **Up-to-Date:** Extensive electronic textbook that is continuously updated - **Clinical Evidence:** Compendium of evidence on the effects of common clinical interventions, categorizes interventions (beneficial, likely beneficial, no known benefit, harmful). ## Continuous Quality Improvement - **Quality Improvement (QI):** Follows quality assessment (data collection and analysis) and involves ongoing monitoring and assessment of performance measures - **Continuous QI:** Broadens the focus from clinical aspects of care to all facets of the organization that affect patient outcomes. - **Scope**: Continuous QI is more extensive than quality assessment and improvement. - **Process**: Continuous QI must be a continuous process. - **Focus**: Emphasizes improvement in interdisciplinary processes involved in patient care delivery, not just individual activities. - **Evaluation**: Considers processes by determining how well they are performed, coordinated, and integrated. - **Input**: Recognizes internal customers (employees) and external customers (patients, third-party payers) and values their input. - **Purpose**: Promotes pursuit of objective data to evaluate and improve patient outcomes. ## Performance Improvement - **Performance Improvement:** A term introduced by The Joint Commission for assessment and improvement of performance. - "Performance" is a discrete term, and can be more clearly defined, described, and measured than can "quality". - A challenge is determining which aspects of performance should be monitored and measured. - **Core Performance Measures:** Identify areas of performance improvement that have the greatest impact on patient care and outcomes. ## Hierarchy of Evidence (Pyramid) - **Bottom:** Case Studies and Case Reports - **Middle:** Case Control Studies - **Top:** Systematic Reviews, Randomized Controlled Trials, Cohort Studies, Meta-analysis - **Meta-analysis of randomized controlled trials is statistically stronger than analysis of any single study.** - **Cohort studies:** A type of research involving large groups of individuals to investigate causes or links to diseases or clinical outcomes.