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Two areas where evidence-based practice has been effective is hand hygiene and central venous assess device. Using evidence based practice in these areas has greatly improved patient’s outcomes. The knowledge of evidence-based practice will empower and enrich nurses to practice more safely.
According to research conducted by Mathers, D (2011), adequate flushing od central venous assess devices improve catheter potency and prevent the use of heparin in the flushing solution. Flushing the device with heparin has been associated with increased risk for HIT and hemorrhage in patient and also erroneous lab results has been associated with heparin use. According to the study, there will be reduction in healthcare costs due to the cost difference in saline and heparin. Also, preventing possible adverse effect associated with heparin use in CVAD’s by using saline will help save financially. To repent line occlusion while also preventing potential complications associated with heparin, non-heparin saline flush has been shown to effective.
Hand hygiene has also been shown to greatly improve patient’s outcome both in home and community settings. Proper hand hygiene helps breaks the chain of infection thereby improving patient’s outcome. Huge patient’s outcome has been recorded in facilities where proper hand hygiene with the use of water and soap and alcohol-based hand sanitizer. Its effect can be seen in wound healing, reduction in cross-infection, respiratory tract infection and GI infection.
Mathers, D (2011) The Journal of the Association for Vascular Access. Evidence-based Practice: Improving outcomes for Patients with a Central Venous Access Device retrieved from http://www.avajournal.com/article/S1552-8855(11)70…
Sally F. Bloomfield, BPharm, PhD, Allison E. Aiello, PhD, MS, Barry Cookson, FRCP, FRCPath, Carol O’Boyle, PhD, RN, Elaine L. Larson, RN, PhD American Journal of Injection Control. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including hand washing and alcohol-based hand sanitizers. Retrieved from http://www.ajicjournal.org/article/S0196-6553%2807…
Two noticeable areas of evidence based practice that have benefited greatly to improve patient outcome are that of preventing central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonia (VAP). The complex pathophysiological conditions of the ICU patients sometimes demands use of central venous lines. “Despite the potential benefits central venous lines can have for patients, there is a high risk of bloodstream infection associated with these catheters” (Reyes, Morphet, & Bloomer, n.d). After conducting studies with use of antimicrobial catheter and interventions such as dressing changes every 7 day and PRN, closed infusion systems, aseptic skin preparation, central venous line bundle checking, education, an extra staff in the Intensive Care Unit for auditing and follow up, it was evidenced that such measures have positive outcomes in reducing central venous line associated bloodstream infections rates.
VAPs prevention strategies is another evidenced based practice that has shown drastic positive outcome related to nursing care. There was a research conducted on a sample of 86 mechanically ventilated patients with 43 patients each in the control group and the intervention group. Subglottic secretion suctioning, intake of single-dose antibiotics within 4 hours after intubation, chlorhexidine mouthwash on oral hygiene, elevation of the head of the bed 30 to 45 degrees and monitoring the bed position twice a day, Proper daily examination of the patient for early extubation, check for correct positioning of nasogastric tube before each feeding, closed-circular ventilator etc. were the strategies considered. Although there was no changes observed for the first 4 days of study, signs of early pneumonia were evident in the control group from day 5. This has revolutionized the VAPs prevention techniques. Most hospitals including the place where I work follow these guidelines strictly to improve patient outcomes.
Nasiriani, K., Jarahzadeh, M. H., & Souroush, M. (2017). EFFECT OF COMPREHENSIVE STRATEGIES FOR PREVENTION OF VENTILATOR-ASSOCIATED PNEUMONIA ON INCIDENCE OF THE DISEASE IN HOSPITALIZED PATIENTS IN INTENSIVE CARE UNITS. Journal Of University Medical & Dental College, 8(4), 20.
Reyes, D. V., Morphet, J., & Bloomer, M. (n.d). Prevention of central venous line associated bloodstream infections in adult intensive care units: A systematic review. Intensive And Critical Care Nursing, 4312-22.
Evidence-based nursing practice (EBP) is crucial to the delivery of high-quality care that optimizes and improves patients’ outcomes. Studies continue to show improved outcomes when best evidence is used in the delivery of patient care. To achieve excellence in practice, critical care nurses must apply EBP as the norm. We cannot knowingly continue clinical practice interventions that are not supported by current best evidence, particularly if those actions are known to be unhelpful and possibly injurious. Therefore, EBP should be integrated all the time in nursing daily activities.
Two areas where evidence-based practice has been effective in nursing practice are the followings:
1- The use of oxygen in patients with COPD; it is shown and proved that for patient health and safety, it is essential that nurses follow evidence-based practice in nursing when it comes to giving oxygen to patients with COPD. Despite the belief of some people that providing oxygen to these patients can cause severe problems such as hypercarbia, acidosis or even death, the evidence-based protocol is to provide oxygen to COPD patients. This practice can help prevent hypoxia and organ failure; and the carbon dioxide level is not elevated because of hypoxic drive. Therefore, giving oxygen, which is the correct treatment based on the evidence, can improve COPD patients’ quality of life and help them live longer.
Scott O, Tidy C. Use of oxygen therapy in COPD.http://www.patient.co.uk/doctor/Use-of-Oxygen-Therapy-in-COPD.htm. Revised January 21, 2011. Accessed March,28 , 2018. Google Scholar
2- The last thing a patient wants when going to a hospital for treatment is a hospital-acquired infection. To protect the patients against hospital -acquired infection, nurses play a significant role in helping to prevent illness before it happens by following the evidence-based infection-control policies. It has been proved that by keeping the healthcare environment clean, wearing personal protective clothing, using barrier precautions and practicing correct handwashing the chain of transmission of infectious diseases diminishes/reduces significantly. Although nurses are busy with many responsibilities, the time it takes to control infection is well worth the effort.
References: Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention; May 2009. http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Google Scholar
Nursing informatics is one in are in which evidence-based practice has had an impact on patient outcomes. The other area is in the nursing of chronic diseases and management. Informatics is becoming increasingly present in our profession due to rapidly changing technologic advances. Healthcare systems are assimilating technology into daily practice at a quick pace. Security and patient privacy must be upheld while achieving the goal of transforming data into useful knowledge.
On the other hand, the use of evidence-based practice in the research of chronic disease management has led to discovery of new ways of dealing with chronic infections. There is a large gap between evidence and practice within health care, particularly within the field of chronic disease. This thus led to devising effective ways of dealing with chronic diseases such as asthma, diabetes and obesity, which have been discovered thus providing better patient outcomes. There is hence the development of a collaborative partnership and its evolution into producing a valuable resource for the translation of evidence into practice in the areas of chronic disease management.
The effective of the two on my practice is evident. First, the use of information technology devices is mandatory and effective in simplifying my daily work. At the same time, there is now a proper coordination and management of patient information as informatics allow easy communication. Management of chronic diseases has also seen a decrease in the number of new infections significantly.
Lee, A. (2014). The role of informatics in nursing. Nursing Made Incredibly Easy!, 12(4), 55. doi:10.1097/01.nme.0000450294.60987.00
Khalil, H., Chambers, H., Munn, Z., & Porritt, K. (2015). Improving Chronic Diseases Management Through the Development of an Evidence-Based Resource. Worldviews on Evidence-Based Nursing, 12(3), 139-144. doi:10.1111/wvn.12087
Evidence-based practice is essential as it helps improve patient outcomes as well as promotes patient safety. Two areas of nursing practice in which evidence-based practice has improved patient outcomes include double-checking medications before administering them as well as the EBP of alcohol-impregnated caps to reduce Central-Line Associated Bloodstream Infections (CLABSI).
There have been deaths associated with not double-checking information, before administering the medication. When medications are not double checked before administering, the patient’s life could be at risk. There was a case in which the physician’s hand wrote an order, and the pharmacy mistakenly wrote the orders for a sound-alike medication. The medication was supposed to be given to the patient to lower their blood pressure. Because the wrong medication had been administered, the patient suffered the consequences of a heart attack. Medication errors are one of the leading causes of death, resulting in seven thousand deaths, a year (McInyre & Courey, 2007). In fact, there was evidence that double checking leads to discovering medication errors or near misses (Athanasakis, 2015). The studies consisted of examining medication errors as well as double checking the medications before administration (Athanasakis, 2015). It was found that many of the medication errors included patient-identification errors (Athanasaki’s, 2015). These findings have impacted my nursing practice because ever since nursing school; I have always made sure to check medications by using the seven rights. Before administering medications, I make sure it is the right dose, as well as for the right reason. Because of this EBP, I can deliver safe quality care.
Another evidence-based practice that has improved the lives of patients includes alcohol-impregnated caps. There have been reports of decreased Central Line Associated Blood Stream Infections (CLABSI’s). The decrease in numbers was associated with the use of alcohol-impregnated caps of intravenous access (Sams, Martin, Carraway, Ruge, & Stettler, 2015). The study consisted of pre and post analysis of blood cultures. The study found that there were decreased contamination rates by thirty-two percent, after the implementation of alcohol-impregnated caps (Sams et al., 2015). Those that have cancer are more at risk to develop infections; therefore, they have benefitted from this EBP as it helps reduce bloodstream infections. This study has impacted my nursing practice I always make sure to place those impregnated alcohol caps at the ends of my lines and connections. If I see that the caps are running out in the patient’s room, I make sure to restore them with new ones so that the next nurse can continue this practice. This practice has shown the importance of these caps in patients. Because of the CLABSI intervention, it has been one year since my hospital has had a CLABSI. After seeing the results in my workplace as well as in EBP, I will continue to implement this practice with my patients.
Athanasakis, E. (2015). The Method of Checking Medications Prior to Administration: An Evidence Review. International Journal of Caring Sciences, 8(3). Retrieved from CINAHL Complete database. (Accession No. 110579158)
McIntyre, L. J., & Courey, T. J. (2007). Safe Medication Administration. Journal of Nursing Care Quality, 22(1). Retrieved from SocialSciences Citation Index database. (Accession No. 000243033700008)
Sams, K., Martin, S., Carraway, S., Ruge, D., & Stettler, J. (2015). Alcohol Impregnated Cap Implementation Significantly Reduces Blood Culture Contamination Rates in an Oncology Population. American Journal of Infection Control, 43 (6). Retrieved from CINAHL Complete database. (Accession No. 102785958)
First, we need to understand what is evidence-based practice? Evidence refers to research, known as research-based practice. “Knowledge derived from a variety of sources that has been subjected to testing and has found to be credible” Higgs and Jones (2000). Research is only one of many forms of evidence. One of the concepts is to understand to improve health outcomes, reduce costs, and improve health care quality. Many nurses connect with this concept from on the job experience. Nursing uses evidence-based practice on a daily bases as we learn what works and what doesn’t in certain situations.
The first area of “evidence-based practice that has improved patient outcomes is the use of non-heparinized saline flush with positive -pressure value caps, and proper flushing technique to maintain CVAD patency”. Bowers, Speroni, Jones, and Atherton,( 2008); Hadaway, (2006), & Jasinsky & Wurster, (2009). “Reinforcement of proper flushing techniques has demonstrated improved patency rates of CVADs “. Feehery, Allen, & Bey, (2003).
Outcomes were measured by comparing baseline data with data collected in the same manner post education. This data was obtained by collection a means of questionnaire and bedside observation of the nurse’s flushing technique. There was a significant improvement with both nurse’s knowledge and flushing skill with CVAD’s. With continuing education with non-heparinized flushes has not only increase patient outcomes and has also reduced health care costs across the board. There are less risk factors as noted in another evidence-based study using randomized controlled trials evaluating the use of Normal Saline vs. Heparinized Saline.
Let’s understand that all participates were included in the meta-analysis which systematically combining pertinent qualitative and quantitative study data from several data groups to develop a single conclusion, thus has the greatest statistical power.
These results concluded that Normal Saline can be equally, of not more effective, in keeping the CVC lines patent. The secondary outcomes showed heparinized saline was not superior to normal saline and did not reduce CVC occlusions. Heparinized flushes are associated with potential risk factors such as “coagulation disorders, hypersensitivity reactions and heparin-induced thrombocytopenia”. Goode CJ. (1991), & Goh LJ. (2011). Here are a few advantages of flushing with normal saline vs. heparinized saline. NS is isotonic, has much less side effects from heparin-related complications. Drug itself is less expensive which is economical from both patient and hospital.
Reducing Emergency Room visits and In-Hospitalization by implementing evidence-based practice across the healthcare continuum and community by enhancing the lines of communication. The goal was to” improve post-discharge utilization value using technology to identify high-risk individuals who might benefit from rapid nurse outreach to assess social and behavioral determinants of health with the goal of reducing inpatient and emergency department visits” Hewner, S., Sullivan S.S., and Yu G. (2018).
The project explored a before and after comparison of the interventional sites with similar primary care practices accepting Medicaid. This intervention targeted discharged patients with preexisting chronic problems, thus providing this knowledge to an outreach nurse who telephonically reached out immediately.
Outcomes were as follows; Decrease readmissions and emergency room visits, thus increasing a more expedient outpatient visits resulting in a happier healthier relationship between healthcare providers and their patients while reducing per capita costs. The estimated avoided value over the secular Medicaid trend was $664 per adult with chronic diseases, resulting in $71,289 in revenue from additional outpatient visits.
Bowers, L., Speroni, K.G., Jones, L., Atherton, M. (2008). Comparison of occlusion rates by flushing solutions for peripherally inserted central catheters with positive pressure luer-activated devices. Journal of Infusion Nursing. 31:22–27
*Goode, C L, Titler M, Rakel B, Ones D S,Kleiber C, Small S, Trilo P K.(1991) A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Normal saline verses heparin for patency of central venous catheters in adult patients – a systematic review and meta-analysis. Doi: 10.1097/00006199-199111000-00002, [ PubMed] [Cross Ref].
*Goh L J, Teo HS, Masagoes M. (2011). Heparinized saline verses normal saline in maintaining patency of arterial and central venous catheters. In: Proceedings of Singapore Healthcare .vol 20.p190-196.
Feehery, P.A., Allen, S., Bey, J. Flushing 101: Using a FOCUS-PDCA quality improvement model to reduce catheter occlusions with standardized protocols. Journal of Vascular Access Devices. 2003;8:38–45.
Hewner S., Sullivan S.S., and Yu G. (2018). Reducing Emergency Room Visits and In-Hospitalizations by Implementing Best Practice for Transitional Care Using Innovative Technology and Big Data. Worldviews Evid Based Nurs. Doi: 10.1111/wvn, 12268.
Koufogiannakis, D. (06/01/2011). “What is Evidence? (editorial)”. Evidence based library and information practice (1715-720X), 6 (2), 1
Mathers, Dorothy. Evidence-based Practice: Improving Outcomes for Patients with a Central Venous Access Device. The Journal of the Association Access, Volume 16, issue 2, 64-67.