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Evidence-Based Practice New Grad Cohort Class
Transcript of Evidence-Based Practice New Grad Cohort Class
And one more thing...
Improves care on the unit, department
No intent to publish, present
Not rigorous methods, care as usual
Systematic, Rigorous methods
Develop, Refine knowledge
Plan to share findings
Nursing Best Practice
Nursing Evidence-Based Practice at UMMC
Three ways to answer clinical questions
Prevent future falls by improved communication and awareness of fall rates and contributing factors
Implement the Falls Tracking Board on C5E
Audit fall rates and tracking board compliance
Fall rates decreased on C5E. Falls Tracking Board implemented on every unit
Gum Chewing Study
Use of chewing gum in reducing postop ileus after colorectal resection for traumatic injury.
Gum chewing tid x 15 minutes
Bracelet tid x 15 minutes
Systematic Review of Evidence
Critical Appraisal of Evidence
Best Evidence to Improve Care
Post-op Voiding Protocol
Prewarming prior to Surgery
The EBP Process
UMMC EBP Continuum
Participates in journal clubs.
Participates in appraising evidence.
Uses established EBP guidelines in patient care.
Assumes leadership role of an EBP team.
Responsible for locating, appraising and rating the evidence.
Recommend changes in care based on the strength of the evidence.
UMMC Support for EBP
Nursing Research Council
Nursing Grand Rounds
Clinical Practice Summits
Access to HS/HSL library using hospital ID
Hopkins EBP model to guide actions
PAM novice-to-expert behaviors
Nursing Research Council
Clinical Practice & Professional Development (CPPD)
Division-wide teams (Directors, managers, SCN I’s & SCN II’s)
Advanced Practice Nurses
Director of Nursing Research
Director of Translation to Nursing Practice
Director of Outcomes for Nursing and Patient Care Services
The Practice Question
Safety/risk management concerns
Unsatisfactory patient outcomes
Wide variations in practice
Significant financial or cost concerns
Differences between hospital and community practice
Procedures, processes that waste time
Practices with no scientific basis
APN competency in first year of practice
RN turnover within first year of practice
New evidence, changes to guidelines, new information from professional organizations
Origins of EBP Questions
Hospital Acquired Pressure ulcers
Patient, Population, Problem
Nurse (staff issues)
Specific clinical population
i.e. intraabdominal hypertension
Gold standard (Not always available)
May not always be a comparison
Quality of life
Improved treatment outcome
Decreased rate of adverse events
Improved patient safety
Improved patient satisfaction
Improved nurse satisfaction
Steps for PICO development
The Burning Clinical Question
FDA warning 2006
Heparin induced thrombocytopenia (HIT)
What solution should we use to flush lines? – Use PICO
Developing the PICO Question
Intravenous device/ catheter/ arterial/…
All age groups?
ntervention of interest
Intermittent normal saline flush
omparison of interest
Intermittent heparin flush
utcome of interest
Patency of device/catheter
Decreased incidence of HIT (Secondary benefit)
What's the final question?
In adult patients, do intermittent normal saline flushes as compared to intermittent heparin flushes maintain patency of central intravenous catheters?
"In critically ill patients and their family members, does the use of a communication protocol improve patient/family satisfaction?"
"Does the use of filter needles reduce the risk of blood stream infections compared with regular needles?"
Group Work Time
In the MICU population, what is the best practice to prevent yeast CAUTIs and reduce the overall CAUTI rate?
What are the three ways to answer clinical questions?
Guidelines for New Graduate
Nurse Resident EBP Poster Presentation
No more than 5 people per group
Can work with a different cohort
Try to find 3-5 RCT's and a mix of others
Model or Guideline
See Appendix B: Question Development Tool
Break up into Groups
Discuss problems on your units you would like to fix
using the EBP process
Formulate a PICO question using Appendix B