Marie A. Fioravanti, MSN RN Trish Hanselman, RN Dawn Scrima, RN Jess Graff BSN, RN Ron Mennow, BSN RN Linda Zsolcsak, RN

Transcription

1 Marie A. Fioravanti, MSN RN Trish Hanselman, RN Dawn Scrima, RN Jess Graff BSN, RN Ron Mennow, BSN RN Linda Zsolcsak, RN

2 Background Institute of Medicine Report Evidence-based practice (EBP) has become the gold standard for promoting quality outcomes, best practices, and nursing excellence. American Nurses Credentialing Center s (ANCC) Magnet Model

3 Five basic components Magnet Model transformational leadership structural empowerment exemplary professional practice new knowledge innovation and improvement empirical quality outcomes Organizational Committees EBP not filtering to the bedside.

4 Lack of time Barriers To EBP Inability to access journal articles Inability to conduct an electronic literature search Underdeveloped critical appraisal skills Lack of understanding of research language (Gale, 2009)

5 Goals of the Capstone Project Create a Unit Based Committee(UBC) to implement EBP Decrease the UBC member s barriers to EBP through mentoring and education Evaluate work accomplished by the UBC

6 Project Design Overi Objective Activities 1 Introduction and objectives of project Team Building: Setting ground rules EBP Administer the DEBP survey 2. Overview of EBP principles 3. Brainstorming session for project identification 4. Mentor 2 Didactic Session 1 1. Scheduled meeting with SMH librarian and literature search 2. Finalize PICO question 3. Mentor 3 Didactic Session 2 1. Finalize project with supportive literature 2. Design pre - survey tool of current nursing practice 3. Mentor 4 Didactic Session 3 1. Design educational sessions for professional staff nurses regarding practice change 2. Present plan to UD 3. Administer the pre - survey tool of current nursing practice to staff nurses on 6A 4. Mentor 5 UBC-EBP Administer the DEBP survey post survey to UBC Educational sessions related to practice change Mentor 6 UBC-EBP Roll out of practice change Mentor 7-19 Mentor weekly 20 Data collection evaluation 21 If successful the UBC will go to hospital committee to recommend a practice change. If negative outcome the committee and the Unit Director will implement a corrective plan.

7 Interventional Goals Goal: Increasing the nurses knowledge Developing a researchable question HSLS Appraising the evidence to critique the appropriateness of the findings Developing interventions to change nursing practice. Overall Goal: QA improvement EBP project that changes practice on the unit into a sustainable nursing practice change.

8 A Nurse s Perspective What to expect/wasn't quite sold Time How did they expect me to do all this research when I hadn't really had much experience in doing research? I felt like it was going to be difficult, just a lot of aggravation, and probably wouldn't work out. I turned out to be wrong.

9 Unit Based Committee (UBC) Why are we doing so many post operative vital signs?? Committee looked at Best Practice: Literature review: Evidence-based practice Bariatric Centers of Excellence It is not necessary to do vital signs on post-operative patients as frequently as UPMC SMH standards of care management of a surgical patient describes

10 Post-Operative Patients Traditional Vital Signs Upon admission Then every ½ hour x 3 Then every 1 hour x 2 Then every 4 hours New Unit Standardized Vital Signs Upon admission Then in one hour x 1 Then every four hours

11 UBC Nursing Considerations Nursing Judgment Key Physician orders will be followed regarding vital signs

12 Implementation Plan Committee agreed upon a new standard based on the evidence Developed a plan and proposed to Unit Director Designed a poster Unit based education, , Unit Based Professional Practice Council (all staff educated) Start Date Feb 1, 2011

13 New Resources Positive outcomes Patients Nursing staff

14 Where we are now Positive staff feedback Observations Depending on outcomes, make a recommendation to Standards committee to change the post vital signs standards of care.

15 Evaluation and Outcomes Tool Developing EBP(Gerrish, 2007) Condition A and C Transfer to a unit of higher care Back to the OR Falls Pain and Sedation score Self- reporting Staff Satisfaction Continuation of the committee

16 Future Implications Lessons Learned Magnet Nursing care based on evidence-based practice Improved patient outcomes Perhaps New Model at UPMC Health System

17 Questions

18 References American Nurses Credentialing Center. Magnet Recognition Program, Application Manual Silver Spring, MD: American Nurses Credentialing Center, American Nurses Credentialing Center. Magnet Recognition Program Excellence in Nursing Services, Application Manual Silver Spring, MD: American Nurses Credentialing Center, Fink, R., Thompson, C. J., Bonnes, D. ( 2005). Overcoming Barriers and promoting the use of research in practice. Journal of Nursing Administration. 35(3), Gale, B. V. P., & Schaeffer, M., A. (2009). Organizational readiness for evidencedbased practice. The Journal of Nursing Administration. 39(2), Gerrish, K., Ashworth, P., Lacey, A., Bailey, J., Cooke, J., Kendall, S., & McNeilly, E. (2007) Factors influencing the development of evidenced-based practice: a research tool. Journal of Advanced Nursing. 57(3),

19 References Institute of Medicine Shaping the future for health. To err is human: building a sager health system. November Available at is-human-building-a-safer-health- System.aspx Melnyk, M., Fineout-Overholt, E., Stillwell, S., B, & Williamson, K., M. Improvement in health care. The Seven Steps of Evidence-Based Practice. American Journal of Nursing 110 (1) p

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