Performance Improvement

Evidence Based Practice

Nursing Research

Definition

• Process by which individuals work together to improve systems and processes with the intention to improve outcomes (Newhouse, 2007).

• A data-driven systematic approach to improve care locally (Newhouse, 2007).

• It is a cyclic process designed to evaluate work flow and work processes (Hedges, 2006). 

• Best available evidence to guide decision-making in clinical practice.  The use of knowledge gained from rigorous, systematic randomized clinical trials (RCTs), so that study results can be translated into practice (Krugman, 2008).

• Generate new knowledge or test an intervention or concern based on theory and uses rigorous methods (Hedges, 2006).

Purpose

• Improve internal processes and practices within a specific patient group or organization (Hedges, 2006). 

• To compare the organization to standards or benchmarks.

• To increase cost-effectiveness.

• Evaluate the evidence along a continuum to identify the strongest or best evidence to guide nursing practice within an organizational setting and with a specific patient population (Hedges, 2006.)

• To generate new knowledge within the broader scientific community to produce knowledge that is generalizable beyond the study sample (Hedges, 2006). 

• Answer a research question.

Problem-Solving System

• Plan-Do-Study-Act (PDSA)

• Plan-Do-Check-Act (PDCA)

• PICO or PICOTT

• Scientific method

• Research question/hypothesis methods

• Interpretation of data

• Dissemination of findings

• Qualitative and Quantitative Research

IRB

• No

• No/Yes

• Yes

Data Sources

• Local practice assessment

• Critical appraisal of  internal and external sources of data

• Primary/secondary data

Resources/ 

Support

• Clinician (local), performance improvement, department (health system), Nursing Quality Outcomes Council (nursing level)

• EBP mentors and EBP Translation Committee

• Clinician (local), nursing research facilitator, Nursing Research Advisory Council, SON

Impact on

Practice

• Improve patient care processes

• Improve processes in unit and organization

• Incorporates the new knowledge

• Change practice

• Impact practice

• Translates the knowledge

• Generate new knowledge for practice

• Add to professional literature/ knowledge base

Translation of Findings

• Standardization of practices, products, and treatment

• Publications, poster, and podium presentations

• Recommendations disseminated at the nursing unit level, throughout VCUHS, and at local and national professional meetings.

• Professional publications

• May be applied locally at the nursing unit level, throughout VCUHS, and at local and national professional meetings.

• Professional publications

Resources for Presentation/ Dissemination of Findings

• Performance Improvement Poster Template

• EBP Poster Template

• Magnet Empirical Outcomes template

• Research Poster Template

• VCUHS Abstract Template

Examples

• Improvement of the discharge times of patients.

• Decreasing infections associated with central venous catheters.

• Improving patient satisfaction.

• Decreasing pressure sores with the use of pressure dressings.

• Best practice for tracheostomy dressing.

• Positioning in the OR to prevent pressure ulcers.

• Early mobilization to prevent pneumonia.

• Do women delay reporting symptoms of heart attack more than men?

• Does location from the hospital impact follow up treatment for breast cancer patients?

• Does quality of life outcomes in heart transplant patients from pre-transplant to 5 years post-transplant differ?