NURS-8114C

Evidence-Based Practice Healthcare Organization

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PEER #1

Chikita Domonique Smith

1:12pmSep 18 at 1:12pm

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Advocating for Evidence-Based Practice in Healthcare

An illustration of evidence-based practice:

At our institution, the prognosis for patients with central line-associated bloodstream infections (CLABSIs) has greatly improved. Strict hand hygiene, chlorhexidine skin preparation, sterile draping, and daily review of the requirement for the central line were just a few of the evidence-based treatments implemented by our nursing staff. CLABSIs have fallen drastically in the last year, with astounding outcomes.

This illustration shows how the application of evidence-based recommendations can have a direct impact on patient safety and well-being. Additionally, this shows how adopting evidence-based practice (EBP) affects patient outcomes.

Application of EBP:

While there have been examples of effective adoption, it is critical to evaluate the wider use of evidence-based practice (EBP) inside our healthcare organization. In general, I believe that tremendous progress has been made in integrating evidence-based practice (EBP) into our professional pursuits. Other factors also contribute to this phenomenon.

· We provide access to the most up-to-date research by making databases and academic journals available to the public. This facilitates the discovery of relevant evidence for making clinical judgments (Helou et al., 2020).

· Evidence-based practice (EBP) workshops and training seminars are offered on a regular basis to the nursing staff. By doing so, we can learn about the current standards and improve our methods.

· Our nursing administration fully backs EBP efforts, helping to foster an environment where the best available scientific information is given due consideration.

But there are still challenges to be met:

· Some doctors and nurses may be resistant to change if they are accustomed to doing things in a certain way.

· In today’s healthcare system, it can be challenging to commit enough time to do in-depth study and implement EBP (Khoddam et al., 2023).

Advocating for EBP:

Long-term support for evidence-based practice (EBP) across our healthcare system is required to improve patient care. I suggest using the following strategy:

· Workshops and seminars can be organized to inform people about the significance of evidence-based practice (EBP). By highlighting successes like the decline in CLABSIs, we might persuade individuals to utilize evidence-based techniques.

· Peer support groups can help to build a feeling of community and get past hesitation by allowing nurses to talk about and share their experiences with EBP-related issues (Chen-Lim, 2019).

· Building interdisciplinary teams with our healthcare providers is necessary to carry out EBP projects. As a result, everyone involved is expected to act more responsibly and with greater accountability.

· We shall collect data on a continuous basis to track the success of EBP activities (Contreras, Hoffmann, & Slocum, 2021) and submit the results to our superiors.

Finally, as nurses and other healthcare professionals, it is our responsibility to advocate the use of evidence-based methods. This will allow us to better assist patients, make our workplaces safer, and advance our field. Let us continue to advocate for EBP and incorporate it into our routines so that our patients always receive the best care possible.

Reference:

Contreras, B. P., Hoffmann, A. N., & Slocum, T. A. (2021). Ethical behavior analysis: Evidence-based practice as a framework for ethical decision making. 
Behavior analysis in practice, 1-16.

Chen-Lim, M. L. (2019). 
The Practice of Scholarly Inquiry in Post Licensure Nurses. Widener University.

Helou, M. A., DiazGranados, D., Ryan, M. S., & Cyrus, J. W. (2020). Uncertainty in decision-making in medicine: a scoping review and thematic analysis of conceptual models. 
Academic medicine: journal of the Association of American Medical Colleges, 95(1), 157.

Khoddam, H., Modanloo, M., Mehrdad, N., Heydari, F., & Talebi, R. (2023). Nurses’ experience of integrating evidence‐based changes into their practice: A qualitative study. 
Nursing Open.

PEER #2

6:40amSep 18 at 6:40am

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Decreasing Midline Catheter Dislodgment

     One of our evidenced based practice projects within my facility consisted of identifying inadvertent midline catheter removals.  My co-worker and I work in Interventional Radiology and insert all the PICC (peripherally inserted central catheters) and the midline catheters.  

Background

     In 2020, we were able to introduce a midline catheter to the institution.   A midline catheter, defined by Infusion Nurses Society, is a vascular access device intended for placement into a peripheral vein in the upper arm; basilic, cephalic, or one of the two brachial veins, with the internal tip located level at or near the level of the axilla and distal to the shoulder (What is a Midline Catheter? 2021). They are characteristically used for infusion and short-term IV antibiotics (less than 30 days).  Nurses and physicians also like them for patients with difficult veins and for someone needing antibiotics for 2 weeks.  We inserted about five per day.  In the second half of 2020, we noticed a flux of patients needing to come to us to have it reinserted.  My co-worker and I used this for our clinical ladder.  We began to keep a log of anyone that needed a midline after re-insertion.  We also asked the nurses to document this in verge.  Verge is the industry’s leading risk management software company for hospitals and health systems (Verge Health Boosts RWJBarnabas Health’s Approach to Patient Safety, 2020).  This can be tracked by administration as well as quality.  

OBJECTIVE:

     We wanted to stop this from occurring.  The patients are sometimes kept in the hospital longer because if a midline falls out on a Friday night, we cannot put it back until Monday.  Recurrent insertions cost the facility money; we don’t get reimbursed.  The Interventional Radiology team must reinsert these lines when they can be doing other necessary procedures.  Infection risk is also higher because you are now sticking them twice instead of once.

Design

     After proof that midlines were inadvertently being removed, we set up a plan.  We researched using journal articles.  This research study was conducted utilizing the Kean University library database CINAHL and PubMed, and MEDLINE using the keywords, midline catheter, infection, and inadvertent removal.  The journal articles that we found were all related to inadvertent midline removals.  There were four in total.  

Interventions

     We provided in-services on midlines to every nursing unit all the shift’s “huddles”.  We found a device that was in stock at our facility and that we use for the dressing called a STAT lock.  This prevents accidental removal.  We educate staff on STAT lock adhesive, and the use of a tegaderm.  We encouraged the use of kling, kerlex, or a sleeve to those patients at risk of pulling them out.  We provided the staff education about if they push a partially removed midline back that the risk of infection is higher.  We also recommended having a sitter with patients that were identified as a risk for pulling out their lines.  

Result

Because of this Evidenced Based Practice study at my facility, there were zero inadvertent removals six months after this study.    Unfortunately, a year later there were two inadvertent removals.  One was due to an alert patient that thought it was the string on her gown, so she pulled it out by accident.  Another was pulled out within ten minutes of returning to the floor.  This was coincidentally shift change.  If anything will go wrong, chances are it is a change of shift.  

Conclusion

     We were able to generate a problem in the system and with support, we were able to step up and speak up for patient safety. Because of this study, patients were safer, the facility saved money, and the workload on the Interventional Radiology team was spared so they focus on new procedures.  We can and sis advocate for safety based on Evidenced Based Practice.  

References

Swaminathan, L. (2021). Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients with Short-term Indications. Jama Internal Medicine, 50-58.

Verge Health Boosts RWJBarnabas Health’s Approach To Patient Safety. (2020). Retrieved from Verge Health: 
https://www.vergehealth.com/news/press-releases/verge-health-boosts-rwjbarnabas-health-approach-to-patient-safety
Links to an external site.