Pediatric hematology/oncology nurse navigator. She has her bachelor's degree in nursing and certifications in pediatric nursing and pediatric hematology and oncology nursing.
Providing the latest and best care for our patients is of utmost importance for any healthcare facility. Providing this care can be achieved through the use of evidence-based practice. Evidence-based practice is the use of the latest scientific research to guide clinical practice. The use of evidence-based practice takes the guesswork out of whether a new process will work within a healthcare institution. When implementing this type of practice, the scientific research has already been completed to show that the process is effective.
However, it is important to consider the environment that the research was conducted in, and how that compares with the unit that you wish to implement it in. These do not always match. What may work wonderfully for one department may not work in another department. Before instituting any protocol change, even if it is based on evidence-based practice, gather a team made up of those that will be involved in the change to discuss the appropriateness of the protocol for that unit. In this lesson, we will focus on how to develop evidence-based practice.
Let's start with the following scenario and follow it through the evidence-based practice process. You work on a pediatric unit that has a lot of infants admitted for respiratory syncytial virus. Each physician has a specific way to care for these children, but the outcomes vary. Your team decides to create a project to determine the best practice in caring for these children.
Develop a Question
The first step in the creation of evidence-based practice is the development of a question. What are we looking to discover? Use the acronym PICO to assist in question development:
- C-Comparison or intervention
The use of a PICO question will help us to fully understand the problem at hand and what we wish to achieve. For the example that we will follow in this lesson, an appropriate PICO question might be:
In infants admitted with respiratory syncytial virus, does providing high flow oxygen rather than providing low flow oxygen and frequent suctioning decrease the patient's length of hospitalization?
The point of research is that we do not reinvent the wheel. If there are studies that have already been done on a topic there may be no need for further investigation. In addition, researching what has already been studied can save valuable time and resources. A thorough review of the literature is imperative for any research team.
In our example, your team performs a literature review of the currently available studies. You discover that little research has been done specifically related to the type of flow of oxygen that is administered, but significant research has been performed related to providing continuous albuterol. The research concludes that continuous albuterol is not beneficial to this population. But within this article there is a discussion of high-flow oxygen. The article reports that patients that were put on this type of oxygen had a reduction in hospital stay by an average of two days.
Applying the Evidence
Based on your discoveries, you must now apply the information to the patient population that you are serving. If the evidence that you discover cannot be applied to the population that you are working with, then it is not helpful in the creation of the evidence-based practice project. When applying the evidence, ensure that the outcomes of the research study you are using are similar to those that you wish to achieve. It is also imperative that the results of the study are statistically significant. Otherwise, the information is not helpful for your project.
Continuing with our example, the study that you discovered with information on high-flow oxygen will be used to assist your project. This study has statistically significant results related to the use of this type of oxygen. Even though the research project was focused mainly on the use of continuous albuterol, the information that indicates that high-flow oxygen reduced hospital stays by two days is beneficial to your current PICO question. Your team decides to implement a protocol that states that if an infant desaturates below 85% oxygen and fails to increase following deep suctioning, they will be placed on high-flow oxygen. This protocol will be re-evaluated in four weeks.
After instituting a practice change, re-evaluation is imperative. Always set up a re-evaluation time frame. When completing an evaluation, examine what is working well and what is not. For parts of the process that are not functioning effectively, gather your team and decide how to proceed. If a change can be made, make the change, and re-evaluate in an appropriate time frame. Lastly, focus on your outcome. Did you achieve what you were working for? If not, is this a protocol change that should remain in place? Not all practice changes will be effective and so it may not be appropriate to continue them.
After re-evaluation of the protocol changes made for infants with respiratory syncytial virus, you learn that on average, infants given the high flow oxygen are remaining inpatient three days less than the typical admission for the same condition. You deem this project to be a success and decide to leave the changes in place.
Remember, evidence-based practice is the use of the latest scientific research to guide clinical practice. This type of practice ensures that we, as healthcare providers, are providing the highest level of care possible. Let's review the steps for developing an evidence-based practice project:
- Develop a question: create a question that allows the purpose of the project to be clearly understood. Follow the PICO guideline.
- C-Comparison or intervention
- Research: Examine the research that has already been completed on the subject by doing a literature review.
- Applying the evidence: Is the research that you found applicable to your patient population, was it statistically significant, and does it hold the same outcome that you wish to achieve?
- Re-evaluation: Following the implementation of the project, re-evaluate the progress that is being made and what changes are needed.
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