Evidence-Based Practice: From Concept to Implementation through Team Engagement. Linda Miller, BSN, RN Rachel Smigelski-Theiss, MSN, RN, ACCNS-AG

Transcription

1 Evidence-Based Practice: From Concept to Implementation through Team Engagement Linda Miller, BSN, RN Rachel Smigelski-Theiss, MSN, RN, ACCNS-AG

2 Background Unit 28 Twig, Inova Alexandria Hospital 20 Bed Telemetry Unit 25 RNs 7 Clinical Technicians Nurse Manager CNS Patient Profile Congestive Heart Failure Cardiac History/Diagnosis Respiratory Failure, Pneumonia Acute Kidney Injury

3 HCAHP Scores Prior to EBP Implementation Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? Top Box Score 50.0 Rank 1 Before giving you any new medicine, how often did hospital staff describe possible side effects in a way you could understand? Top Box Score 28.6 Rank 1 Composite Score: Medication Communication Top Box Score 39.3 Rank 1

4 Problem Needed to improve patient engagement and knowledge regarding medication side effects Action: Collaborated with Nursing Research & Evidence Based Practice Council EBP team developed Nurse Manager Clinical Nurse Specialist Clinical Practice Council representative

5 Mentorship Application of the Johns Hopkins Nursing Evidence-Based Practice Model PET Model Practice Question Evidence Translation

6 Development of PICO Question Population/Problem-Intervention-Comparison- Outcome Question P: In adult medical/surgical patients in a hospital care setting I: will an interactive patient education strategy related to medications C: (no comparison) O: result in improved patient perceptions/outcomes as measured by HCAHPS medications questions?

7 Review of Evidence Literature obtained by librarian and EBP mentors Subjects: patient education, teaching, medication adherence, implementation Keywords: teach-back, show me, return demonstration, repeat back, tell back, care transitions, treatment adherence, evidence-based practice 8 articles selected for review Reviewed articles discussed in daily huddles and monthly CPC meetings

8 The Literature Ranked Evidence Type: Case Studies Quality Improvement Non Experimental Literature Summary Randomized Control Trial Systematic Review Evidence Level & Quality: One Level I Article (strongest) One IIA Articles Two II B Articles One III A Articles Three VB Articles (weakest)

9 Literature Findings Teach-Back was associated with increased knowledge retention Use of Ask 3/Teach 3 increased HCAHPS Teach-Back helped establish patient understanding Patients with low health literacy are more likely to report poor communication Teach-Back confirms comprehension & reveals misunderstanding Documentation of understanding was correlated with a 30% lower readmission rate

10 Project Implementation Kickoff Standard Workflow Formal Education on Ask 3/Teach 3

11 Project Implementation Focus on the congestive heart failure (CHF) patient population Improve awareness of CHF patients Focus on cardiac medications Ace Inhibitors/ Angiotensin Receptor Antagonists Alpha Adrenergic Agonist Anti-arrhythmic Anti-coagulant Anti-platelets Beta Blockers Calcium Channel Blockers Diuretics Lipid-Lowering Agents Potassium

12 Standard Workflow Operating Unit Process Name Process Location Target Time Created Reviewed/ Revised Author IAH Ask 3 Teach 3 U28 12 minutes 5/22/2014 5/22/2014 U28 EBP Team Step Process Step Responsible Time Goal Critical Notes on Step 1 RN receives order for CHF patient to receive cardiac medication. RN 2 When nurse pulls medication from med room, RN also pulls appropriate Ask 3 Medication card and takes to patient's room. RN <1 minute 3 In patient's room, prior to medication administration, RN completes Ask 3 Card (fills in name of medication). RN <1 minute RN shows patient Ask 3 card and educates patient on medication name, purpose, and side effects. Patient teaches back to the nurse the medication name, purpose, and side effects. If information is not clearly understand, RN should retry education. RN RN RN 5 minutes Use key words, such as "side effects" 5 minutes 5 minutes Ask the patient, "What is the name of your medication? Why do you need to take it? What are common side effects?" 7 The RN clips the medication card to the white board. RN <1 minute 8 Medication name, purpose, and side effects reviewed with each medication administration. RN 2 minutes 9 Education of medication is included in ishaped reporting RN <1 minute 10 Following shift, RN verifies patient can teach back information on medication card. RN <2 minutes

13 Standard Workflow

14 Building Team Engagement Anticipation Selection Excitement Motivation

15 Follow-Through True North Wall Identification of CHF patients Data Collection Coaching

16 HCAHPS Scores Post EBP Implementation: What the medication was used for

17 HCAHPS Scores Post EBP Implementation: Side Effects

18 HCAHPS Scores Post EBP Implementation: Composite Score Medication Communication

19 Barriers to Implementation & Sustainability Language Barriers Cognitive Function Accurate Identification of CHF Patients Relocation

20 Conclusion Formal EBP Education Real Time Implementation Mentorship Staff involvement was instrumental in the successful implementation of an EBP project.

21 Acknowledgements Joni Brady, MSN, RN, CAPA Suzy Fehr, PhD, RN-BC, NE-BC Mary Ann Friesen, PhD, RN, CPHQ Larisa Golding, MSN, RN-BC Inova Alexandria Leadership Team Nursing Research & Evidence-Based Practice Council Unit 28 Twig Staff Members

22 References 1. Ahrens, S. L., & Wirges, A. M. (2013). Using evidence to improve satisfaction with medication side-effects education on a neuro-medical surgical unit. American Association of Neuroscience Nurses, 45(5), Bowskil, D., & Garner, L. (2012). Medicines nonadherence: adult literacy and implications for practice. British Journal of Nursing, 21(19), Cloon, P., Wood, J., & Riley, J.B. (2013). Reducing 30-day readmission. The Journal of Nursing Administration, 43(7/8),

23 References 4. Jager, A. J., & Wynia, M.K. (2012). Who gets a teach-back? Patient reported incidence of experiencing a teach-back. Journal of Health Communication: International Perspectives, 17, Kandula, N.R., Malli, T., Zei, C.P., Larsen, E., & Baker, D.W. (2011). Literacy and retention of information after a multimedia diabetes education program and teach-back. Journal of Health Communication: International Perspectives, 16, Kimbal, S., Buck, G., Goldstein, D., Largaespada, E., Logan, L., Stebbins, D., Kalman-Yearout, K. (2010). Testing a teaching appointment and geragogy-based approach to medication knowledge at discharge. Rehabilitation Nursing, 35(1),

24 References 7. Poe, S. S. & White, K. M. (2010). Johns hopkins nursing evidence-based practice: Implementation and translation. Indianapolis, IN: Sigma Theta Tau International. 8. Van Scoyoc, E.E., & DeWalt, D.A. (2010). Interventions to improve diabetes outcomes for people with low literacy and numeracy: A systematic literature review. Diabetes Sepectrum 23(4), White, M., Garbez, R., Carroll, M., Brinker, E., & Howie-Esquivel J. (2013). Is teach back associated with knowledge retention and hospital readmission in hospitalized heart failure patients? Journal of Cardiovascular Nursing 28(2),