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Transcript of Iowa Model
2. National Agencies or Organizational Standards & Guidelines
3. Philosophies of Care
4. Questions from Institutional Standards Committee Is this
a Priority? Nope! Consider other triggers Yes! Form a team! 1. Risk Management Data
2. Process Improvement Data
3. Internal/External Benchmarking Data
4. Identification of Clinical Problem Problem-Focused Triggers: Assemble the
Existing Research (Important enough to
spend time and money
researching) Is there a sufficient research
base? Pilot the change in practice 1. Select outcomes to be achieved
2. Collect baseline data
3. Design EBP guidelines
4. Implement EBP on pilot units
5. Evaluate process & outcomes
6. Modify the practice guideline Yes! Base practice on
other kinds of evidence Case reports
Research Nope! Is change
practice? Monitor and analyze structure,
process, and outcome data Environment
Patient and Family Institute the change
in practice Disseminate
the results Continue to evaluate
quality of care
and new knowledge Yes! Nope! C. Kleiber
G. Budreau Model first published in December 2001
Citation: History of the Iowa Model C.L.Q. Everett
C.J. Goode Other authors: Developed by Marita Titler, PhD, in Iowa City, Iowa, at the University of Iowa. Iowa Iowa. The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical care nursing clinics of North America. 2001 Dec;13(4):497-509 Anita Lee
Richard Rasmussen Iowa City References Critique and
Problem - there is no tool to accurately assess pain in nonverbal population patient
Intervention - specific patient (unresponsive, sedated, unconscious)
Comparison - PAINAD scale/ The Critical Care Pain Observation tool-pilot program
Outcome - comfort management, improved patient outcomes, ventilator weaning, adopted for use-further advantages being explored Implementing the Critical Care Pain Observation Tool Using the Iowa Model Anita: Cameron: Richard: How has it actually worked? Anita's Article: Danielle's Article: Richard's Article: Alma's Article: Danielle: Alma: Who did we cite? What are the pros and cons? Nasogastric Tube Placement Verification in Pediatric and Neonatal Patients Find a Problem:
Nurses’ shift reports are inconsistent and therefore do not promote patient safety
Form a team:
22 volunteer nurse team at UCLA Medical Center Use of an Evidence-Based Shift Report
Tool to Improve Nurses’ Communication
Accuracy issues (estimations instead of precise)
Compliance issues (documenting)
Piloting the change into practice:
Implementation of protocols
Daily weights performed (per shift) and documented (new computer driven documentation system)
Disseminating Results and Outcomes:
A FBM policy was successfully implemented w/o medical compromise to patient care
Improvement in staff compliance and satisfaction Establishing an Evidence-Based Inpatient Medical Oncology Fluid Balance Measurement Policy Use of an Evidence-Based Shift Report
Tool to Improve Nurses’ Communication Nasogastric Tube Placement Verification in Pediatric and Neonatal Patients Research:
Adequate research available to assemble and critique.
Discover what is “best practice”:
Standardize shift-report tool hospital-wide (handout)
Pilot the change:
The 22 volunteer nurse team lead a pilot study
Study showed that time to locate missed info went from 28 min to 21 minutes
Institute the change:
You will never know how many lives this can save. Problem:
Many NG tubes are misplaced in pediatric and neonatal patients due to the outdated procedure of auscultation for sounds to determine verification of placement. Form a Team: Nurses from the facilities’ Evidence-Based Practice Staff Nurses team conducted extensive research on literature to determine current and best practices for this procedure.
Assemble and Critique Research: Most of the research found was intended to improve practice for adult NG tube patients, however, there was a considerable amount found for pediatric patients to constitute a change. Nasogastric Tube Placement Verification in Pediatric and Neonatal Patients Evaluating the change:
Nurses filled out a post-implementation questionnaire to determine their knowledge of assessing NG tube practices.
After the implementation of practice change their knowledge was higher (87.6% to 94.4%).
Overall, the results indicated improvement in nurses’ utilization of EBP methods and favorable outcomes.
The methods of change will continue to be evaluated every three months. Nasogastric Tube Placement Verification in Pediatric and Neonatal Patients 1. Detailed and systematic - easy for organizations and independent researchers to apply
2. Emphasizes that research is easier than you might think, as most Iowa Model research projects do not actually require researchers to do new studies
3. This model integrates evidence-based healthcare knowledge from multidisciplinary team members with various levels of education, work settings, and specializations to become involved. This encourages a collaborative approach with more favorable outcomes for the patient.
4. This model uses “change champions” which are experts in their scope of practice. This ensures that these individuals are passionate about innovation, are committed to improving quality of care, and have positive working relationships with other healthcare professionals (Hughes, 2008). Hughes RG (ed.). Patient safety and quality: An evidence-based handbook for nurses.
(Prepared with support from the Robert Wood Johnson Foundation). AHRQ Publication No. 08-0043. Rockville, MD: Agency for Healthcare Research and Quality; March 2008. Retrieved from: http://www.ahrq.gov/qual/nurseshdbk/docs/TitlerM_EEBPI.pdf Pros Cons Process takes too long to implement
7 steps and too many places places for delay/error
The team assembled may not be strong and/or committed to the topic
May not be sufficient research to guide practice
If not enough research: recommended to run a study. This will only prolong the process.
Pilot study may have errors
Primarily applicable only to large organizations These guys. Suicide Risk Assessment:
6 Steps to a Better Instrument Problem: Nurses do not know how to reliably assess whether a patient is at risk for suicide.
Form a Team: 12 members
Assemble and Critique Research: Eleven relevant studies found
Sufficient Research Base: Not optimal, but enough to create the evidence-based Hermes-Deakin Suicide Risk Assessment
Pilot study and Implementation: Introduced new tool and then surveyed nurses using it after 6 weeks Cameron's Secret Slide Pilot/Implement Change: EBP team disseminated info to staff nurses using power point presentations and posters displayed throughout the unit.
The unit identified a “change champion” to educate colleagues about the practice changes. Featuring Cameron's article,
Suicide Risk Assessment:
6 Steps to a Better Instrument