NURS 4100 – Quality and Safety Through Evidence-Based Practice

NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Challenges and opportunities to making EBP a universal reality Not many could argue against the idea that adopting evidence-based practice (EBP) improves quality; however, not everyone knows how to apply it. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper The call for evidence-based quality improvement underscores the need for realigning care to make it more effective, safe and efficient. But, as we think about how to apply EBP at the point-of-care, we must consider how EBP is incorporated into the workflow with different technology tools. Both workflow and technology are critical elements to apply EBP. We must also think about having a culture that invites inquiry and new knowledge. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Permalink: https://nursingpaperessays.com/ 2036-2 / ? Why Adopting EBP is Important Looking back to the mid-1990s, nurses realized that to affect better patient outcomes, new knowledge must be transformed into clinically-useful forms that are effectively implemented across the entire care team and measured in terms of meaningful impact on performance and health outcomes. With that, the goal of EBP was to take current knowledge and connect it to standardize care to improve care processes and, ultimately, patient outcomes. Without EBP, healthcare providers are at risk for significant variances in care. So, not only is it important to adopt EBP, it’s also necessary to have methodologies in place to apply it and make it sustainable. From a holistic perspective, EBP can be defined as looking at the literature of the best, currently available clinical research, as well as the clinical expertise within a specialty area, and connecting it to clinical experience. In addition, EBP considers patient values (or preferences) within a situation. These three components must work together. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Ultimately, for clinicians to apply EBP, they’ll need: The necessary tools The right culture to embrace it The engagement skills to bring patient values into the care process In February 2016, Elsevier conducted a national study in collaboration with the Ohio State University College of Nursing. 1 A total of 256 nurse executives across the country were surveyed about their beliefs and perceptions of EBP, along with some environmental aspects of their organization. The study also included outcomes related to HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores, patient satisfaction information and data from the NDNQI, the National Database of Nursing Quality Indicators. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper One of the study’s cardinal findings was that, even though all the respondents indicated that quality and safety were the highest priority within an organization, focusing on EBP was the lowest. This is an extremely telling finding, considering that in order to achieve quality and safety, EBP must be applied. Why is there such a gap between making quality and safety the highest priority in healthcare, and the actual adoption or application of EBP within an organization? Closing the Gap Patients expect to receive evidence-based care at the point-of-care. The reality though, is that this is not happening. So, we need to ask ourselves why and how we make EBP a reality so that a level of safe, quality care is delivered to patients across the care continuum. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper While numerous perceived barriers to adoption have been identified, the most common are: The enormous amount of healthcare literature available, making it impossible for medical professionals to keep current Inadequate access to information technology The lack of time and autonomy to change practice There are, however, several ways the industry can expand its focus on EBP: Make EBP an inter professional priority and lead with nurses. Nurses are the largest workforce in the U.S. healthcare system. If we start with nurses, we can make a tremendous impact. This means pushing nurses to practice at the top of their license and embrace EBP. Ultimately, this is not just a nursing solution; it is an inter professional team concept. Employ models and frameworks. These are critical to EBP. Having a model and/or framework that organizations can embrace to either implement or align with proprietary professional practice models makes a significant difference. Models and/or frameworks make transparent that this a way to apply EBP. Too often, EBP is thought of as a theoretical concept that is difficult to embrace, and that’s just not the case. Employing models and/or frameworks also engages clinicians and clinical scholars who are experts in their respective fields. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Cultivate the right culture. If organizational culture simply accepts things the way they are and doesn’t question why, practice will never advance. Leaders that truly embrace cultures of EBP encourage their clinicians to ask why something is always done one particular way or another. Also, inquiry can bring about positive change. If a culture of inquiry does not exist in which people who don’t understand ask questions, practice will not change. What if an organization has evidence-based tools but they are not immediately accessible to staff? This is a problem that exists in many organizations. Evidence-based tools are available, but the staff that cares for patients doesn’t always know where to find them. A solution to this problem is to integrate evidence-based decision-making into the Electronic Health Record (EHR) in a way that it is actionable for the clinician. To help bridge the gap between quality, safety and EBP, organizations need return on investment (ROI) tools to help make the case for why they should invest in areas such as care planning, methodologies that ensure nurses have the latest information, and help CFOs make the connection between these types of purchasing decisions and the bottom line. Also, know that these tools aren’t just for patient safety exclusively; they keep the clinicians safe as well. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper EBP Opportunities and Challenges Probably one of the greatest challenges and opportunities is applying EBP across the continuum of care. This is very much aligned with the Affordable Care Act and movement from fee-based to value-based service. Does it make sense for a patient with heart failure to receive care at an inpatient hospital setting that uses evidence-based guidelines and methodologies, to then be sent home and receive care at a heart failure clinic that doesn’t use an evidence-based approach to care? There’s a great opportunity to establish EBP as a standard pillar across all healthcare settings to ensure the patient receives evidence-based, consistent care from all providers while engaging them in their own healthcare as well. The key to advancing quality and safety in healthcare To significantly impact the improvement of quality in healthcare, one needs to apply evidence-based practice (EBP). Without EBP, healthcare providers are at risk for variances in care that could seriously affect patient outcomes. A “no-brainier,” right? Yet, healthcare organizations throughout the U.S. continue to grapple with how to apply EBP. A recently published study conducted in collaboration with Elsevier Clinical Solutions and the Ohio State University College of Nursing surveyed 256 nurse executives about their beliefs and perceptions of EBP, along with some environmental aspects of their organizations. 1 Among the study’s cardinal findings: even though all the respondents indicated that quality and safety were the highest priority within their organizations, focusing on EBP was the lowest. This presents a dilemma of sorts, because In order to achieve quality and safety, EBP must be applied. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Why is there such a contradiction between focusing on quality and safety, and EBP? And what must healthcare organizations do to achieve parity among these three goals? The answer lies in: • Developing the right organizational culture • Education and leading with nurses • Employing models and framework and, • Advancing an inter professional approach. Establishing the right organizational culture Simply disseminating evidence-based resources throughout an organization and expecting clinicians to implement evidence-based guidelines is not enough. In fact, clinicians often admit that they do not know where to find the evidence-based resources within their organization. EBP requires real behavior change, from long-held practices and organizational cultures of “this is the way we’ve always done it here,” to practice supported by science. Leaders who truly embrace a culture of EBP encourage their clinicians to ask questions. If a culture of inquiry does not exist in which people who don’t understand ask questions, practice will not change. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Transformation to an EBP culture requires a dynamic team vision along with clear expectations from leaders that EBP is the foundation of all care delivered within their organization. One way to do this is to embed the organization’s vision, mission and strategic plan with its expectations for EBP, as well as making sure that EBP is incorporated in the on boarding process for all new clinicians. Also, those clinicians who fall short on some EBP competencies when hired should be provided with some form of continuing education, including skill-building activities, until they achieve full competency. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Education and leading with nurses Nurses are the largest workforce in the U.S. healthcare system. If we lead with nurses, we can make a tremendous impact. According to The Future of Nursing Report by the Institute of Medicine, this means pushing nurses to practice at the top of their license and embrace EBP. We must bridge the gap between education and practice. For per-licensure in nursing schools, both faculty and students are hungry for tools that help them apply EBP. Post-censurer, using EBP in the work setting helps nurses apply it and advances their critical thinking. Overall, nurses should be expected to meet new EBP competencies for practicing, which means that baccalaureate and associate degree programs must teach students EBP. Employing Models and Framework Models and frameworks are critical to EBP. Having a model and/or framework can guide the transformational process by applying evidence at the point of care while integrating the commitment of EBP with other organizational goals. 2 Too often, EBP is thought of as a theoretical concept that is difficult to embrace, but that’s just not the case. Employing models and/or frameworks also engages clinicians and scholars who are experts in their respective fields. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Advancing an inter professional approach Nursing and other inter professional healthcare executives must build a culture and environment that supports evidence-based care implementation and sustainability to achieve the best patient outcomes. 3 Evidence-based councils composed of a team of interdisciplinary clinicians can also enhance EBP throughout an organization and lead to a higher quality of care and improved outcomes. Physicians in particular, who have primarily relied on clinical trials in the past are now viewing evidence-based methodologies as additional options to arriving at quality-focused, value-based care. Along with nurses and other allied health professionals, they are beginning to adopt inter professional EBP as a cornerstone to greatly improve the momentum of this movement. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Probably one of the greatest challenges – and opportunities – for EBP is applying it across the care continuum. EBP is very much aligned with the Affordable Care Act and movement from fee-based to value-based service. So, in looking at EBP’s application across the continuum of care, consider this: does it make sense for a patient with heart failure to receive care as an inpatient in a hospital setting that employs evidence-based guidelines and methodologies, to then be sent home and receive care at a heart clinic that doesn’t use an evidence-based approach to care? We now have a great opportunity to establish EBP as a standard pillar across all healthcare settings to ensure that each patient receives evidence-based, consistent care from all providers. In addition, using EBP can enable patients to become more active participants in their healthcare. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper As we look ahead to the future, EBP can be incorporated as a standard component of healthcare in all care settings in several ways: first, we need for the evidence to become more evident in the workflow. This involves transitioning from static documents to information that is actionable and evident to clinicians. Next, it is important that integration of EBP with EHR vendors is facilitated in a way that makes it usable to clinicians in their everyday practice. And let’s not forget to continue to advance an inter professional approach. Evidence-based practice can provide an exceptional opportunity to optimize patient care and outcomes by creating and leveraging the right tools, culture, education and patient engagement skills in the overall care process. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Evidence-based practice is a problem-solving approach in which the best available and useful evidence is used by integrating research evidence, clinical expertise, and patient values and preferences to improve health outcomes, service quality, patient safety and clinical effectiveness, and employee performance. This study aimed to identify the effects of nurses’ patient safety culture perceptions and their evidence-based nursing attitudes on the hospital’s patient safety level and employee performance. A cross-sectional design was employed in this study. Participants included nurses working in a state hospital in Burdur, Turkey, and 218 nurses responded to the research instrument (participation rate: 55.7%). Data were collected through face to face interviews that were conducted from February 20–May 20, 2016. The results of the analyses revealed that evidence-based nursing attitudes and hospital safety culture dimensions explained 29.2% of the total variance in the hospital patient safety level, while evidence-based nursing attitudes and hospital safety culture dimensions explained 15.5% of the total variance in nurse performance. The “evidence-based nursing related beliefs and expectations” aspect of the evidence-based nursing attitude dimension, and the “management support for patient safety” aspect of the patient safety culture dimension were significant predictors of nurses’ performance. The present findings add to the increasing interest in improving evidence-based practice and service quality in order to achieve better patient outcomes. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper What Is Evidence-Based Practice? Evidence-based practice (EBP) is a patient-centered approach founded on independent scientific research, clinical expertise and patient experiences. Nurses and other healthcare providers who utilize this approach must consider the most recent healthcare research when determining the course of care and treatment. The field of nursing earned recognition as an applied science in the 1960s, and research efforts intensified. The accumulation of research may have led to increasing knowledge levels; however, healthcare leaders began to express concern at the widening gap between the ideal healthcare environment and what patients were actually experiencing. Moreover, they were worried that the growing amount of scientific background and research was not being transferred and applied consistently to clinical patient care, thereby failing to meet the goal of improved and consistent outcomes. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper In response, the Institute of Medicine (IOM) — which changed its name to the National Academy of Medicine (NAM) in 2015 — issued Crossing the Quality Chasm: A New Health System for the 21st Century in 2001. This report noted prior research that indicated the current system was causing preventable harm. It also reiterated the need for uniformity across the healthcare system to ensure that all patients were receiving the highest quality of care no matter where they sought treatment. To reach that goal, it was theorized that incremental changes would not be enough — a complete overhaul would be necessary. One of the recommendations was to implement EBP. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper How Is Evidence-Based Practice Used in Nursing? The transition to EBP has impacted nursing in several ways. First, nursing education has changed. Colleges and universities have altered their BSN program curricula to incorporate EBP. Students pursuing the degree, even through accelerated online RN to BSN programs, will find coursework that focuses not only on increasing a nurse’s overall knowledge base, but also on the importance of professional accountability. These programs emphasize critical thinking skills and encourage students to consider the patient’s clinical, cultural, religious and socioeconomic backgrounds, as well as relevant scientific research. The growing use of EBP has also led to a greater interest in and emphasis on nursing research. While bachelor’s programs may contain at least one course related to nursing research, students may find it beneficial to further hone their skills. Although research may not frequently be a task assigned to entry-level nurses, it can be helpful to know about new and emerging scientific data since it can have a more direct influence on current and future professional nursing practices than in the past. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Becoming familiar with various research methodologies may prepare nurses for careers away from the bedside. With the accumulation of clinical experience and the completion of a Master of Science in Nursing (MSN) degree, nurses will find many more opportunities in research. These roles are often more independent and require less patient contact. Nurse researchers may design studies or trials, collect and review data, and write and publish their findings. What Are the Benefits of Evidence-Based Practice? The ultimate goal of the EBP movement is to standardize and improve access and quality of care across the healthcare system. Certain patient and nurse benefits include the following: Improved patient outcomes . The heavy focus on raising the overall quality of care may lead to improved outcomes and health for patients. Using the most current healthcare research can help minimize complications associated with chronic illness and prevent additional illness or disease. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Lower costs of care . Roughly one in four Americans are living with multiple chronic illnesses and the cost of caring for these patients can often be substantial. Using EBP’s patient-centered approach may help eliminate unnecessary costs linked to treating chronically ill patients as well as reduce expenses for healthier patients, too. Superior nursing skills . Incorporating EBP throughout a nurse’s education and clinical experiences develops more advanced critical thinking and decision-making skills. Nurses are better able to adapt to situations, utilize informatics and work in interdisciplinary teams. They also feel a greater sense of confidence and pride in their work. Advancing Patient Care Evidence-based practice has become an integral component of delivering high-quality, patient-centered care. Nursing students in an RN to BSN program will learn EBP theories and apply this knowledge in their careers. Offering benefits to both patients and nurses, evidence-based practice is helping to lead the way in advancing patient care. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper The Benefits of Evidence-Based Practice in Nursing Benefits for Patients Providing the best possible patient care is the hallmark of nursing practice. Evidence-based practice allows nurses to direct patient care according to scientific research, including randomized controlled trials, patient care studies and compiled patient data, relying on nursing interventions that have proven successful in the past with similar patient populations. “Patients and families receive more consistent nursing interventions and achieve better clinical outcomes. Patients fall less often and suffer from fewer pressure ulcers,” writes Debra Wood, RN, for Nurse Zone. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Benefits for Health Care The health care industry’s embrace of evidence-based practice as health care costs continue to rise is not coincidental. Evidence-based practice across the health care spectrum often results in better patient outcomes — meaning fewer demands on health care resources — and lowered health care costs. Wood cites as an example the traditional nursing practice of instilling normal saline before suctioning a mechanically ventilated patient. “Now, nurses know that the saline offers no benefit and just wastes time and supplies,” Wood writes. Benefits for Nurses The benefits of evidence-based practice for patients and healthcare do not, fortunately, come at a cost for nurses. Rather than referring to outdated academic texts or facility traditions to make decisions about patient care, evidence-based practice allows nurses to contribute research to the science of nursing and apply the most recent research and practices while discarding unproven methods. It also provides something just as important — a sense of authority in practice. “Nurses who embrace evidence-based practice feel empowered and enjoy a greater satisfaction with their care giving role,” Wood writes. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Evidence-based healthcare and quality improvement This is the tenth in a series of articles about the science of quality improvement. We explore how evidence-based healthcare relates to quality improvement, implementation science and the translation of evidence to improve healthcare practice and patient outcomes. Evidence-based practice integrates the individual practitioner’s experience, patient preferences and the best available research information. Incorporating the best available research evidence in decision making involves five steps: asking answerable questions, accessing the best information, appraising the information for validity and relevance, applying the information to care of patients and populations, and evaluating the impact for evidence of change and expected outcomes. Major barriers to implementing evidence-based practice include the impression among practitioners that their professional freedom is being constrained, lack of appropriate training and resource constraints. Incentives including financial incentives, guidance and regulation are increasingly being used to encourage evidence-based practice. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Keywords evidence-based medicine, general practice, implementation, primary care, quality improvement Introduction For quality improvement initiatives to be effective, they should be based on sound evidence. However, there are two main considerations relating to this evidence base. First, the intervention or interventions that the quality improvement initiative seeks to implement should have evidence of benefit: they should lead to improvements in patient outcomes that are, ideally, both clinically important and cost-effective. Evidence that translates basic research into its clinical application through new health technologies (either products or approaches) has been termed the ‘first translation al gap’. Second, quality improvement initiatives should be based on sound evidence of what works to implement these products or approaches. This is the ‘second translation al gap’, which forms the basis of quality improvement and implementation science.[1] We now consider evidence-based healthcare in the context of both these translation al gaps. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper What is evidence-based healthcare? How much of what health and other professionals do is based soundly in science? Answers to the question ‘is our practice evidence based?’ depend on what we mean by practice and what we mean by evidence. This varies from discipline to discipline. A study in general practice found that around 31% of therapeutic clinical decisions were based on evidence from randomized controlled trials (RCTs), whereas 51% were based on convincing non-experimental evidence.[2] Sacker et al defined evidence-based medicine (EBM) as ‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients … integrating individual clinical expertise with the best available external clinical evidence from systematic research’.[3] The expansion of EBM has been a major influence on clinical practice over the last 20 years. The demands of purchasers of healthcare keen to optimize value for money have been one driver. A growing awareness among health professionals and their patients of medicine’s potential to cause harm has been another. In this article, we examine the nature of what is nowadays more broadly referred to as evidence-based healthcare (EBHC) in the context of quality improvement and discuss its strengths and limitations. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper The tools necessary for evidence-based healthcare The tools needed to practice in an evidence-based way are common across healthcare disciplines. Doctors, nurses and allied health professionals all need the skills to ensure that the work they do – whether with individual clients or patients, or in the development of policies for quality improvement – is based on sound knowledge of what is likely to work. Of the following five essential steps, the first is probably the most important: • convert information needs into answerable questions, i.e. by asking a focused question • track down the best available evidence • appraise evidence critically • change practice in the light of evidence • evaluate your performance. Step 1. Asking a focused question Before seeking the best evidence, you need to convert your information needs into a tightly focused question. For example, it is not enough to ask ‘Are antibiotics effective for Otis media?’ We need to convert this into an answerable question: ‘Do antibiotics reduce the duration of symptoms when prescribed to children with Otis media?’ NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper The PICOT approach can be used as a framework to focus a question by considering the necessary elements. It contains four components: • Patient or population (children under 5 years) • Intervention (antibiotics) • Comparison intervention (placebo) • Outcome (duration of specific symptoms, e.g. pain, or rate of complications). Question Form a focused clinical question using the PICOT format to find the evidence for the effectiveness of smoking-cessation interventions in adult smokers who have had a heart attack. Answer • P Adult smokers who have had a heart attack. • I Providing smoking cessation intervention. • C Providing usual care. • O Mortality and quit rates. This gives us the question ‘In smokers who have had a heart attack does a smoking-cessation intervention in comparison with usual care reduce mortality and improve quit rate?’.[4] NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Step 2. Tracking down the evidence The second step in the practice of evidence-based healthcare is to track down the best evidence. Doctors and nurses often assess outcomes in terms of surrogate pathological end points rather than commonplace changes in quality of life or the ability to perform routine activities (‘the operation was a success, but the patient died’). Traditionally, doctors making decisions about what works have attached much weight to personal experience or the views of respected colleagues. Over time, knowledge of up-to-date care diminishes so there is a constant need for the latest evidence and simple ways to access and use it.[5,6] A study of North American physicians has shown that up-to-date clinical information is needed twice for every three patients seen, but they only receive 30% of this due to lack of time, dated textbooks and disorganized journals.[7] Quality Care and Patient Safety Evidence-based practice is established as a proven intervention. This has been a growing trend over the past few decades; as more research reveals proven practices, nurses are relying more upon such proven methods. This is driven by the growing demand for the provision of higher quality of care and patent safety, reduced costs, and greater efficiency. Research has revealed that EBP also provides greater consistency in care from institution to institution and provider to provider. According to Majid et al., “Evidence-based practice (EBP) provides nurses with a method to use critically appraised and scientifically proven evidence for delivering quality health care to a specific population.” 1 NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Patient Advocacy The nursing role is one of patient advocate. An advocate is one who defends or promotes the rights of others (in this case, patients). In the process of patient care, nurses learn about their patients and know their needs. Nurses act as advocates and liaisons between the patient and the doctor, the family and doctor, or the patient and family and the health care system. In the state of California, patient advocacy is built into the state’s nurse practice act. 2 Patients often cannot speak for themselves, and nurses must be able to speak on behalf of their patients. Nursing Informatics At many medical facilities, the electronic health record, or EHR, is how patient information is recorded. Departments such as lab, x-ray, and physical therapy can access the EHR to document their care, share information about the patient, and request additional assistance from others – all within the medical record software on computers. Nursing informatics , then, is a partnership between information technology and nursing practice. NURS 4100 – Quality and Safety Through Evidence-Based Practice Case Study Paper Let’s look at how informatics is used in patient safety and evidence-based practice. Patient Safety Patient safety encompasses the entire spectrum of patient contact from the beginning of the visit at registration to the follow-up after discharge. At the registration area, where patient-identifying information is collected, informatics helps design the questions that are asked. Correct identification of the patient and their condition is critical to ensure the correct care is provided. Patient safety events are negative incidents that can, or actually did, cause injury or harm. Many of these events are preventable by using previous data and current information available to staff in the medical record software. Patient safety occurrences can be investigated through the patient’s record and the data collected from behind the front lines of bedside nursing. Usually, events occur due to a system failure, not a person failure. Once the problem is identi

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