Implementation Into Practice In Nursing

Evidence based practice is an integral part of nursing care. According to the Academy of Medical-Surgical Nurses, evidence based practice is defined as, “the conscientious use of current best evidence in making decisions about patient care.” (AMSN) The use of evidence based practice has drastically improved patient outcomes, increased quality and safety of healthcare, and reduced costs for facilities. (Melnyk, 2016) In this paper I will provide the history of evidence based practice, how it has already been incorporated and impacted healthcare, and why it is important to nursing and healthcare as a whole.

Evidence-based practice improves patient outcomes. There are apparent gaps between understanding and applying evidence-based practice, but that does not mean that we shouldn’t take the time to try and eliminate those gaps and do what’s best for our patients.

In December 2015, The Joint Commission launched a campaign seeking to reduce readmissions by providing resources for both health care providers and patients to engage patients in the discharge planning process.1,2 According to voluntarily reported data collected by The Joint Commission between January 2014 and October 2015, the major contributors to 197 sentinel events were failures in patient communication, patient education, and patient rights.2 A review of communication during the hospital discharge process found that discharge summaries often lacked information on counseling, treatments, discharge medications, test results, and follow-up plans.3

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

According to Stevens (2013), the call to develop and implement evidence-based practice (EBP) within all healthcare disciplines is fueled by legislative demands for improvement in standard medical metrics such as mortality and morbidity. However, increasing demands by the public for evidence related to the metrics and outcomes of such concepts as quality of life illustrate what may be more important to the client (Stevens, 2013). This client-directed focus has resulted in patient-centered outcomes research (PCOR) (Stevens, 2013). "The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information

Hospital discharge has been defined as “a systemic problem that can be characterized as a dangerous situation in which latent conditions exist such that sharp end individuals are set up to fail” (Anthony et al., 2005). Understanding this process is flawed warrants an investigation for a change in practice. Research has explored a variety of interventions that address reducing 30-day readmissions such as post-discharge phone calls, RED toolkit, BOOST toolkit, transition coaches, and home visits after discharge. Despite these tools, 30-day readmission rates among the older adult population continue to be a challenging issue.

Implementation of a practice change requires the innovator to be able to describe the process of implementation, specifically addressing the methods utilized, with an assessment of the key components of the implementation plan. The Daily Safety Briefing (DSB) initiative does not gather new information, but it does present information in a new way. There is no requirement for subject consent, as safety reporting is already covered under the umbrella of a consent to treatment, which patients sign at the time of admission (Hughes, 2008). Existing safety reports will be summarized into a one page document that will be presented at the DSB.

Hospitals started to be penalized by CMS in 2012 for high readmission rates that could add up to one percent of what Medicare paid the hospital. This affected two thirds of all hospitals in the United States. Now, the penalty has gone from one percent to three percent. The purpose was to increase the focus on the discharge process that will lead to better outcomes with a decrease in readmissions (Polster, 2015). The purpose of this post is to discuss two learning objectives that Tina would be able to meet at the end of receiving discharge instruction. With each objective, this post will discuss the content of instruction, method of instruction, rationale for the chosen method, the time allotted for the task, resources needed, evaluation method, evaluation criteria, what specific criteria needs to be achieved for the objective to be met, potential barriers and a plan to deal with these barriers.

The evidence based interventions we learn can improve patient’s outcomes, help provide quality care, reduce cost and eliminate practices that have become obsolete.

Evidenced-based practice (EBP) originated in Canada from a new form of medical school which was launched during the 1970s at an institution called McMaster University (Hoffmann, Bennett, & Del Mar, 2010). This new medical program was uncommon in a variety of its methods. The primary variation was the abbreviated three year medical program which is very brief in comparison to other medical school framework (Hoffmann, Bennett, & Del Mar, 2010). Instructors conceded that the ideal concept of teaching medical students everything they would possibly need to know in regards to practicing medicine with in this program was an unattainable undertaking (Hoffmann, Bennett, & Del Mar, 2010). In response to this epiphany, instructors at this institution transformed their educational approach and focused on instruction that would provide students with the skills and tools they would need to effectively locate health information while practicing as healthcare professionals (Hoffmann, Bennett, & Del Mar, 2010). This scientific approach to healthcare is now known as evidence-based practice (Hoffmann, Bennett, & Del Mar, 2010). In the past, healthcare practitioners made decisions for patients based on personal and professional experience, hearsay, and lack of scientific evidence (White, 2004). An evidence-based practice links the

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

Evidence based practices are important to explore for various diseases so that their efficacy level can be determined and medical staff can be trained accordingly. Particularly speaking in the context of chronic diseases, evidence based practices are to be evaluated with the joint efforts of multiple healthcare institutions so that it can bring benefits to the overall healthcare industry.

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

Evidence based practice is the basis for needed change in practice and function. It is a sound method for scientific, fact-based change. Changes which have no evidence to support them are fragile, unscientific, and subjective. These changes don’t effect real change over time, as they aren’t able to be proven to a more general population.

Itroduction: Evidence-based practice is an approach to medicine that uses scientific evidence to determine the best practice (Beyea & Slattery, 2006). As nurses perform their daily tasks they must continually ask themselves, “What is the evidence for this intervention?”. Nurses are well positioned to question current nursing practices and use evidence to make care more effective. In order to improve patients’ outcomes it is the responsibility of the nurse to transition evidence-based practice into the norm, through application of daily practice (Flynn Makic, Rauen, Watson & Will Poteet, 2014). Continual evaluation of current practice must be performed to ensure the use of evidence-based practice opposed to practice based upon tradition. The implementation of evidence-based practice standardizes healthcare practices and diminishes groundless variations within care. These variations lead to the production of uncertain health outcomes (Stevens, 2013).