FA 24 Building a Evidence-based practice PDF

Building an Evidence-based practice NURS 526 – Fall 24 Today we will… Define and discuss the role of evidence in improving patient care and health outcomes. Compare and contrast the research process with evidence-based practice. Define the term clinical/health outcome Understand how to...

Building an Evidence-based practice NURS 526 – Fall 24 Today we will… Define and discuss the role of evidence in improving patient care and health outcomes. Compare and contrast the research process with evidence-based practice. Define the term clinical/health outcome Understand how to search literature and use library resources for best practice evidence. Identify key components of the Teach- back method of patient education with evidence supporting best practice.  How do nurses know what is the best or right way to do something? TRADITION - NURSING SCHOOL EVIDENCE-BASED “RECEIVED AND CONTINUING PRACTICE WISDOM” EDUCATION Research Researchers – generate new knowledge and research findings by identifying gaps in knowledge and designs experiments to fill knowledge gaps Quantitative approaches- scientific method of hypothesis testing, rigor in design and measures, reproducible, and generalizable Qualitative approaches- focus on human phenomenon- quality of the human experience are described and interpreted- narrative interviews and participant observations- same rigor in design, interpretation, conclusions Mixed-methods approaches- both quantitative and qualitative methods Translational approaches-”bench to bedside” Evidence-based practice Evidence-based practice (EBP) –makes use of research findings Integrates best evidence from research with clinician expertise and patient lens-perspective EBP requires you know what the research shows in support of interventions Element of developing a critical eye answering the “why..” and “wonder if..” Strengthens development of problem solving and judgement Part of the “life-long learner” obligation of being a nurse EBP requires you mesh research with clinical judgement and patient perspective to determine best practice Understand research design, statistics, dissemination platforms Clinical Practice Guidelines Evidence-based recommendations to be used as guidelines in the medical management of disease processes and in preventive care o based on systematic reviews of evidence and the evaluation of potential benefits and harms of other modes of treatment o developed by health care providers who have clinical expertise in the specialty area o intended to provide objective information and guide health care professionals, care delivery systems, and health plans in decision making  Critical Pathways Treatment routines Have been shown to based on a specific enhance Clinical tools that disorder or collaboration, utilize evidence- circumstance are reduce the cost of based guidelines implemented for a care, and improve specific client client outcomes They typically take Are usually specific the form of to a health care algorithms, possibly organization, with designated reflecting their time frames, to standards of care assist in planning and practice care Standards of Care Reflect the interventions These standards should be that are typically based on high levels of implemented when caring evidence and must be for a client with a specific reviewed regularly to disorder. ensure their currency. Professional specialty Acute care facilities may organizations often develop then develop their own standards of care to assist nursing policies and nurses in planning care and protocols based on these interventions for clients published standards of with specific disorders. care. Organizing your search for literature PICOT Example You’re the nurse manager of a NICU unit. One concern of parents of infants receiving tube feedings is being able to successfully breastfeed their child upon discharge. One of your staff nurses asks if it would be helpful to give the infants cup feedings instead of tube feedings during their NICU stay. PICOT Formation P: Infants in the NICU I: cup feeding throughout the hospital stay C: tube feedings throughout the hospital stay O: greater reported success with breastfeeding post- discharge In infants in the NICU, will cup feeding throughout the hospital stay lead to greater success with breastfeeding post-discharge when compared to tube feedings? Evaluating the Evidence Validity o Did the researchers do a good job conducting the study?  What was the purpose of the study?  What was the sample size?  What were the characteristics of the participants in the study?  How was the study conducted?  How were the results analyzed? Evaluating the Evidence Reliability o Have other researchers been able to produce similar outcomes using the same interventions and research techniques? Evaluating the Evidence Applicability o Was the research performed on a group that is similar to the defined population in your PICOT question? Levels of Evidence Level of Strength of Description Evidence Evidence Level I Strongest A summary and conclusion based on the results of all the randomized controlled trials available on a topic. Termed a systematic review or a meta-analysis. Level II Evidence from at least one large, well-designed randomized controlled trial in which the participants were randomly assigned to either a group that received an intervention or a group that did not receive the intervention (known as the control group). Level III Conclusions based on a well-designed controlled study in which the grouped participants were not randomly assigned. Level IV Moderate Conclusions based on a well-designed study of a group or cohort of clients. Level V Evidence based on a systematic review of qualitative studies. Level VI Conclusions drawn from a single qualitative study. How do we evaluate our interventions? What is an outcome? World Health Organization: “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” International Consortium for Health Outcomes Measure ment : “the results that matter most to patients” rather than those that matter most to physicians and healthcare organizations. The Centers for Disease Control and Prevention says that “an ideal population health outcome metric should reflect a population’s dynamic state of physical, mental, and social well-being. Outcome Examples Infections Diagnosed disease related Post op or post procedure Asthma attack Site specific (urine, blood, Hypertension wound) Hypoglycemia Organism (c. diff, VRE, MRSA) Stroke Symptom related Myocardial infarction Pain Functional status related Nausea Bathing Hypotension (low BP) Dressing Event or complication related Executive cognitive function Fall Toileting Pressure ulcer  Mortality rate Measuri Morbidity rate ng Fall or medication error rates outcom Readmission within 30 days of discharge es Specific Complication rate (VAP, CLABSI, CAUTI) Hemoglobin A1c level to monitor glucose levels over time Process Measurement A health care-related activity performed for, on behalf of, or by a patient. Process measures are supported by evidence that the clinical process has led to improved outcomes. Example: The percentage of patients with chronic stable coronary artery disease (CAD) who were prescribed lipid- lowering therapy. Access Measurement Access to care is the attainment of timely and appropriate health care by patients Access measures shows that there is an association between the measure and the outcomes of or satisfaction with care. Example: The percentage of patients 12 months to 19 years of age who had a visit with a primary care provider in the past year. Outcome Measurement An outcome of care is a health state of a patient resulting from health care. Example: The rate of in-hospital hip fracture among acute care inpatients aged 65 years and over. Structure Measurement Structure of care is a feature of a health care organization or clinician related to the capacity to provide high quality health care. These measures can focus on either health care organizations or individual clinicians. Example: Does the health care organization use Computerized Physician Order Entry (CPOE)? Patient Experience Measurement Experience of care is a patient's report of observations of and participation in health care, or assessment of any resulting change in their health. These measures may consist of rates or mean scores from patient surveys. Example: The percentage of adult inpatients that reported how often their doctors communicated well. Some outcome Some outcome measures are more difficult to track than others Time from triage to being seen by provider in ED challenges Quality of life in older person Outcome measures may serve dual domains measure Infection after hip surgery- clinical or cost Outcome measures can create cause and effect Shorten length of stay after heart surgery can increase readmission rates Looking for balanced measures  Healthcare is a business and has to look to manage costs to stay The fiscally viable Financial Reducing costs does not have to Relevanc be at odds with patient outcomes e of Outcome Focus on best practices Measures Outcome Across disciplines – across service lines- improvement across the teams continuum of care How will you utilize evidence to change how you care or interact with your patients?