All Entries in the "Evidence-based practice" Category
Winner of HCPro’s nurse leader best practices contest
Editor’s note: This best practice was submitted by Anjie Vickers, RN, BSN, NE-BC, Carolinas Medical Center, Charlotte, NC. Anjie won a free book. Congratulations Anjie and thanks to everyone who submitted a best practice!
I am the nurse manager of a 19-bed progressive care unit, which I have managed for almost 11 years. The culture has dramatically changed from that of the one I started with. That was one in which the nurses exhibited horizontal violence, resisted change, and lacked shared ownership. How I changed it to one that is now a healthy work environment that embraces shared decision making, learning, and engagement involved a combination of the following.
I created an expectation of peer accountability. If the employee came to me with a complaint about someone else, I set clear expectations asking if they had spoke to their peer first and foremost. Peer review and accountability has evolved over time and continues to improve even more. We have most recently adopted the practice of bedside report and have expectations that peers will communicate, mentor, and develop each other with peer-to-peer feedback and expectations of each other.
We created our unit-based council (UBC), which has grown over time to now include each of the following:
- Quality unit-based council
- Professional development unit-based council
- Coordinating unit-based council
We have sub-committees off these councils that include our Sunshine Committee, Peer Interviewing team and Self-Scheduling committee. We also empower our staff to be the champions of different goals and areas, such as restraint champion, skin care liaison, and falls champion. This helps to create an engaged workforce where everyone is part of our success.
Our community liaison assists with coordinating and organizing our volunteer events such as volunteering at a men’s homeless shelter.
Areas that we have been successful include:
- Falls champion-Quality UBC: Reduced our falls from a total of 25 in 2010 to eight in first quarter 2011, one in second quarter, and zero in third quarter
- Skin care champion-Quality UBC: Reduced unit-based pressure ulcers from 18 and 20 in last two quarters respectively of 2009 to zero in first half of 2010
- Professional Development Council achieved recognition of Hallmarks of a Healthy Work Environment in 2010
The feedback from patients and families speaks highly of the engagement of this department and includes many compliments.
Should visiting hours be restricted?
At many hospitals around the country, visiting hours are a thing of the past. Patients’ families are free to come and go as they please without restriction.
The issue provokes much debate among nurses, particularly when visiting hours are in place in high-tech, high-acuity areas such as the ICU.
A recent article in the periodical Briefings on The Joint Commission highlighted the issue because The Joint Commission is evaluating its compliance with CMS requirements in the area of visiting rights, specifically in the Patient Rights chapter and other areas of Joint Commission standards.
Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor, discussed research findings about visiting hours.
Di Giacomo-Geffers writes:
“Emotion is certainly a factor in the exploration of visitation hours, but nothing can turn the tide of medicine the way cold hard numbers can.
A physician in Milan whose work I’ve admired, Alberto Giannini, presented a fascinating report in 2008 to the 3rd EfCCNa Congress and 27th Aniarti Congress in Florence entitled “Should we open or close the ICU to family members?” Dr. Giannini used information gathered from a number of polls regarding ICU patients’ perception.
He led off with a discussion about what patients ranked as their most immediate perceptions during treatment in the ICU. Many of the items listed were logical due to their relation to physical comfort-being thirsty, for example, was most highly reported at 63%, and sleep deprivation, temperature issues (feeling too hot or too cold), and even hunger made the list. But an overwhelming 62% reported being afraid or anxious, and 46% felt lonely or isolated during their time in the ICU. [more]
ANA praises Joint Commission standards for nurse-led medical homes
The American Nurses Association (ANA) issued a press release applauding The Joint Commission for implementing standards that allow nurse-led practices to qualify as primary care medical homes.
Beginning July 1, The Joint Commission will use a set of ambulatory care guidelines to accredit primary care medical homes, a decision the ANA says will give advanced practice registered nurses (APRNs) the opportunity to provide services to patients under an innovative care delivery model.
Medical homes have been encouraged by the Affordable Care Act (ACA) as a way to provide more cost-effective, high-quality, patient-centered care, as well as more choice and access to patients seeking care.
According to a statement on the Joint Commission website, the new primary care medical home (PCMH) option will focus mostly on education and self-management of the patient. Care provided by other clinicians and facilities is tracked and coordinated by a primary care clinician and an interdisciplinary team, and evidence-based treatment practices guide their care. The PCMH opportunity is also aimed at improving patient satisfaction and patient outcomes.
Applications are now being accepted from organizations ready for survey.
Click here to read the ANA news release.
Recognizing CAUTIs
Hospitals with a focus on providing safe patient care through evidence-based practices have been working to reduce preventable conditions such as central line-associated bloodstream infections and ventilator-associated pneumonia for the past few years.
A urinary tract infection (UTI) is defined as an inflammatory response of the urinary epithelium to invasion by a pathogen and can be divided into two forms:
Uncomplicated: Occurs in otherwise healthy community-dwelling women and produces characteristic symptoms such as dysuria (burning and pain with urination), suprapubic discomfort, and frequent urination.
Complicated: Occurs in patients with an abnormality of the urinary system or other health problem that compromises host defenses or treatment responses. [more]
Join an online journal club
Starting a journal club is a great way to read articles that will help update practice. Journal clubs consist of groups of nurses who meet regularly to discuss and critique research articles appearing in scientific journals. Creating one is a good way to get started in evidence-based nursing practice.
An alternative to forming a journal club at your facility is to join an online club that is already established. Some nursing associations and nursing journals offer journal clubs in which a journal article—whether published in that journal or not—is critiqued. [more]
Promoting evidence-based nursing practice
by Deanna Miller, RN, MSN/Ed, HCE
Recently I discovered that some of my nursing staff had decided that they would no longer utilize filter tubing with central lines. Because the facility policy did not state “to use” or “not to use,” I could not refer them to policy as a directive or a guideline. There were other staff nurses that were fit to be tied because of the non-use. The debate began. My final words were these: “Bring me the evidence that states “to use” or “not to use” and we will make the determination together.
I am a huge proponent of autonomy but weeks went by without any evidence being provided to me. This had to be settled once and for all. I finally contacted an acquaintance from the Nursing Infusion Society who was able to give me the information and the “Evidence” that I needed. I then provided the information to my staff nurses. They were astonished that this type of information could actually be found so easily and it triggered their curiosity. My plan is to challenge them weekly with a question to be answered with “Evidence.” If you can give me the evidence, we can change the practice …
How do you get your staff involved in EBP? Share your ideas.
