Diploma in Healthcare - Unit 4 Protocol Based System PDF

Diploma in Healthcare Unit 4: Protocol Based System Please do not reproduce, redistribute or share without the prior express permission of the author.  Learning Objectives At the end of the lesson, students will be able to: Use protocols, and perhaps be involved in their...

Diploma in Healthcare Unit 4: Protocol Based System Please do not reproduce, redistribute or share without the prior express permission of the author.  Learning Objectives At the end of the lesson, students will be able to: Use protocols, and perhaps be involved in their design and maintenance to assist in the delivery of care Please do not reproduce, redistribute or share without the prior express permission of the author.  4.1 What is evidence-based practice? Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. (Fineout-Overholt E, 2010) Integrating the best scientific research with clinical expertise. Considering patient needs and values. Using the best available evidence together with a clinician's expertise and a patient's preferences in making healthcare decisions. Please do not reproduce, redistribute or share without the prior express permission of the author.  4.2 What is evidence-based practice in nursing? Evidence Based Nursing: “An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. Please do not reproduce, redistribute or share without the prior express permission of the author.  4.3 Key component of EBP Individual clinical expertise Best research evidence Physical Therapy Please do not reproduce, redistribute or share without the prior express permission of the author.  4.4 The important of EBP in healthcare setting To provide the high quality and most cost-efficient nursing care possible To increase satisfaction among patients. It results in better patient outcomes. It increases confidence in decision-making. To advance quality of care provided by nurses. Please do not reproduce, redistribute or share without the prior express permission of the author.  4.5 The 5A’s steps in EBP Ask – formulate clinical question Acquire – Search the best resource for the evidence of your clinical question answer (article or journal) Appraise – evaluate the relevance and validity of your article or journal Apply – apply the evidence to the PT and if needed discuss the evidence with peers Assessing – monitor the outcomes / effect of the evidence to the pt. Please do not reproduce, redistribute or share without the prior express permission of the author.  Example of EBP in healthcare Practice Scenario Please read through the each of the steps below and make note of your answers to the practice questions. The answer key will be at the bottom of the page. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… 1. Assess the Patient A clinical scenario presents itself during your work: Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… 2. Asking a Clinical Question Which of the following clinical questions is the most appropriate? a. What is the best treatment for diarrhea? b. In patients taking antibiotics, are probiotics helpful in preventing diarrhea? c. Do probiotics prevent diarrhea in the elderly hospitalized patient? Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… 3. Acquiring the Evidence Which of the following PubMed search strategies best addresses the clinical question? a. diarrhea AND best treatment; Limited to Free Full Text b. diarrhea AND probiotics AND elderly AND female AND adult; Limited to English c. antibiotics AND diarrhea AND probiotics; Limited to randomized control trial Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… 4. Appraising the Evidence Your search results included the following article. Please read the following article, particularly the methodology section: Effect of a Fermented Milk Combining Lactobacillus Acidophilus Cl1285 and Lact obacillus Casei in the Prevention of Antibiotic-Associated Diarrhea: A Randomized, Double-Blind , Placebo-Controlled Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658588/ You are likely to find that the answers to the below validity questions may not always be clearly stated in the article and that you may have to use your own Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… a. Randomization: Were the patients randomized? b. Concealed Allocation: Was group allocation concealed? c. Baseline Characteristics: Were the patient in the study groups similar with respect to known prognostic variables? d. Blinding: To what extent was the study blinded? e. Follow-Up: Was follow-up complete? f. Intention to Treat: Were patients analyzed in the groups to which they were first allocated? g. Equal Treatment: Aside from the experimental intervention, were the groups treated equally? Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… 5. Applying the Results Think about your patient, her goals, your treatment recommendation for her, the cost and adverse effects of probiotics, and help her decide whether to start taking probiotics. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… 6. Assessing the Outcome Monitor your patient's progress to see if the intervention is successful. Share your results, positive or negative, with fellow physicians and other interested parties to reduce duplication of efforts and promote information sharing. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… Answers to Practice Scenario 1. Ask the Question a. This is a background question about treatments for diarrhea. It does not address the specific treatment being considered or the specific cause of the diarrhea. b. Correct. This question is well focused - we know the patient problem (antibiotics and diarrhea), the specific intervention (probiotics) and the desired outcome (prevention/treatment) for this patient. c. This is a vague question - elderly and hospitalized may not be as important as the specific cause of the problem. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… Answers to Practice Scenario 2. Acquire the Evidence a. This search is too general and does not include the specific treatment or type of study. By limiting to Free Full Text, you may miss important articles that are available from your Medical Library. b. This search may be too limiting. While it has the right problem and intervention, it limits the search by criteria that are not essential to the questions and does not limit to a study design. c. Correct. This search strategy includes the specific patient problem (antibiotics AND diarrhea), the intervention (probiotics), and the right type of study (RCT) to provide good Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… Answers to Practice Scenario 3. Appraise the Evidence a. Yes. It is reported that patients were randomized, but they do not give any details as to how randomization was carried out. b. It is not clear. They do not report enough information to determine if the allocation was concealed. c. Yes. Table 1 displays the characteristics at baseline. It should be noted that more patients in the placebo group were taking laxatives and more patients in the placebo group took beta-lactams during the study. You need to think about how this might affect the outcomes. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… d. Patients were blinded. Both preparations were provided in identically labelled containers; their taste and texture were similar. While this is labelled as a double blind study, it is not clearly states as to who else was blinded. e. Follow-up was complete. They had data for all patients in the study which lasted up to 21 days after the last administered does of antibiotics. f. Yes. The study reported that the analyses of the primary and secondary outcomes were based on the intention-to-treat principle. g. Yes. It appears the both groups were treated the same except for the intervention. All patients were followed in the same way and both groups allowed additional medications as required. Please do not reproduce, redistribute or share without the prior express permission of the author.  4.6 What is a computer-based protocol system in HC? A computer-based protocol system is a paradigm providing a set of tools which allow health care providers access to current guidelines which they can apply in practice. Studies have shown that protocols can aid in optimizing patient care. Please do not reproduce, redistribute or share without the prior express permission of the author.  Cont… In a healthcare setting, a protocol, also called a medical guideline, is a set of instructions which describe a process to be followed to investigate a particular set of findings in a patient, or the method which should be followed to control a certain disease. There are two types of protocol systems: passive and active. Please do not reproduce, redistribute or share without the prior express permission of the author.  4.7 Passive protocol systems Passive protocol systems are a source of information which health care providers have the freedom to choose to consult or not; they are not intrinsically incorporated into the healthcare process. The purpose of a passive protocol system is to give healthcare providers access to information which may remind healthcare providers of steps during patient care which may otherwise be forgotten or changed. Please do not reproduce, redistribute or share without the prior express permission of the author.  4.8 Active protocol systems Active protocol systems are specific guidelines for healthcare providers to follow. They are a central way which healthcare is delivered. Examples of active protocol systems include trigger-automated order entry systems and appointment scheduling. Active protocol systems may provide an explanation function which offers background information, definitions, risks, and the rationale that supports specific recommendations. Please do not reproduce, redistribute or share without the prior express permission of the author.  Thank you Address Telephone Website Lot 33-40, Blok C, Plaza Juta, +6088 431 025/35 kk.cyberjaya.edu.my KM 7.2 Off Jalan Tuaran, 88400 Likas, Kota Kinabalu, Email Sabah, Malaysia [email protected] Please do not reproduce, redistribute or share without the prior express permission of the author.