Comparison Of Quality Improvement Evidence-based
Comparison of Quality Improvement Evidence-based Practice and Nursing ResearchApril, 2014Quality Improvement-Evaluate effectiveness of nursinginterventions and to provide direction forfurther improvement in the achievementof quality clinical outcomes and costeffectiveness.-Not designed to develop nursing practicestandards or nursing science (UAB Centerfor Nursing Excellence, 2010).Evidence-Based Practice-Integration of best clinical research evidence,clinical expertise and patient values.-Is the conscious and judicious use of currentbest evidence in conjunction with clinicalexpertise and patient values to guide healthcare decisions (LoBiondo-Wood & Haber,2010)-A scholarly and systematic problem-solvingparadigm that results in the delivery of highquality health care. (ANA, 2010).Purposes(Dimitroff,2011)-Bring about immediate improvement ofcare in a specific setting-To compare organization to standards orbenchmarks.-Increase cost effectiveness-Make processes more efficient/better-Translate research into practice-Increase the effectiveness of treatment-Encourage some consistency in practice-Utilize interdisciplinary approach in practice-Encourage practice not based on tradition(because that is how we have always done it)Impact onPractice-To improve patient care processes-Seeks to improve processes in unit andorganization-Incorporates the knowledge.-To improve practice.-Seeks to positively impact practice.-Translates the knowledge.DefinitionNursing Research-Formal, systematic and rigorous process ofinquiry used to generate and test theoriesabout the health-related experiences ofhuman beings within their environmentsand about the actions and processes thatnurses use in practice. (Fawcett& Garity,2009)-Systematic investigation designed togenerate or contribute to new knowledgethat can be generalized for broaderapplication (DHS, 2002).-Answer the research question-Test the er-To generate new knowledge for practice.-Seeks to add to professional literature.
HistoryBusiness/auto industryMedicineFlorence NightingaleNursingStandards ofPractice(ANA, 2010)The registered nurse participates inquality improvement. Activities mayinclude (p. 52):-Identifying aspects of practice importantfor quality monitoring.-Using indicators to monitor quality,safety and effectiveness of nursingpractice.-Collecting data to monitor quality andeffectiveness of nursing practice.-Analyzing quality data to identifyopportunities for improving nursingpractice.-Formulating recommendations toimprove nursing practice or outcomes.-Implementing activities to enhance thequality of nursing practice.-Participating on and/or leadinginterprofessional teams to evaluateclinical care or health services.-Participating in and/or leading efforts tominimize costs and unnecessaryduplication.-Identifying problems that occur in dayto-day work routines in order to correctprocess inefficiencies.-Analyzing factors related to quality,safety and effectiveness.-Analyzing organizational systems forbarriers to quality healthcare consumeroutcomes.-Implementing processes to remove orweaken barriers within organizationalsystems.The registered nurse integrates evidence andresearch findings into practice (p. 51):-Utilizes current evidence-based nursingknowledge, including research findings toguide practice.-Incorporates evidence when initiatingchanges in nursing practice.-Participates, as appropriate to educationlevel and position, in the formulation ofevidence-based practice through research.-Shares personal or third-party researchfindings with colleagues and peers.The registered nurse integrates evidenceand research findings into practice (p. 51):-Participates, as appropriate to educationlevel and position, in the formulation ofevidence-based practice through research.-Shares personal or third-party researchfindings with colleagues and peers.The graduate-level prepared specialty nurseor the advanced practice registered nurse:-Contributed to nursing knowledge byconducting or synthesizing research andother evidence that discovers, examines,and evaluates current practice, knowledge,theories, criteria and creative approaches toimprove healthcare outcomes.-Promotes a climate of research and clinicalinquiry.-Disseminates research findings throughactivities such as presentations,publications, consultation and journal clubs.
Nursing’sRole(Sackett etal., 2000)The graduate-level prepared specialtynurse or the advanced practice registerednurse:-Provide leadership in the design andimplementation of quality improvements.-Designs innovations to effect change inpractice and improve health.-Evaluates the practice environment andquality of nursing care rendered inrelation to existing evidence.-Identifies opportunities for thegeneration and use of research andevidence.-Obtains and maintains professionalcertification, if it is available in the area ofexpertise.-Uses the results of quality improvementto initiate changes in nursing practice andthe healthcare delivery system.-Identify practice that requiresimprovement-Collect data-Analyze data-Generate recommendationsImplement processes for change-Analyze organizational barriers-Analyze cost effectiveness of changes-Implement processes to decreasebarriers and cost-Identify the clinical problem-Search for the best evidence-Critically appraise the evidence-Synthesize the evidence-Apply the evidence-Evaluate outcomesAD Graduate-Understand and have an awareness of thevalue and relevance of research in nursing-Help identify problems in nursing practice-Use research findings in practice-Develop and revise or implement clinicalstandards, protocols and critical pathsBS Graduate-Be intelligent consumers of research-Understand every step in research process-Understand how each step relates to theothers-Critically read and understand researchreports, studies-Determine strength of evidence of studies-Generate clinical questions to identifynursing research projects
InstitutionalReviewBoardNo IRBMethods-Plan-Do-Check-Act (PDCA)-Plan-Do-Study-Act (PDSA)-Six Sigma, Lean Six SigmaAssess IRB process related to intendedproject and the level of risk, benefits,confidentiality, generalizability, andpublishing plans.-PICO or PICOT-Iowa Model of Evidence-based Practice-ACE Star Model of KnowledgeTransformation (2004)-Ask a focused clinical questionFind the best clinical evidenceCritically appraise the evidenceApply evidence to practiceEvaluate outcomes-Participate in the implementation ofnursing research-Disseminate findings of nursing researchstudies-Participate on nursing research-relatedcommittees (NR, QI, EBP).Masters Graduate-Be active research team member-Assume the role of clinical expert-Collaborate with an experienced researcherin proposal development, data collection,data analysis and interpretation-Take active role in quality improvementprojects to improve nursing practice in theclinical situationDoctorate Prepared Graduate-Appraise, design and conduct research-Serve as role model, mentor, guide andencourage nurses to engage in the nursingprocess-Collaborate and consult with social,educational, government and health careinstitutions in research-Disseminate research findings to scientificcommunityIRB required.-Scientific MethodResearch Question/HypothesisMethodsInterpretation of DataImplications for practiceDissemination of findings-Qualitative Research-Quantitative Research
Examples ofProjects-Reduce wait time for OR patients-Decrease boarding time for PACUpatients-Evaluate how nursing measures bloodpressure and the accuracy of data entry-Improving documentation of critical labvalues.-Best practices for tracheotomy dressing-For adult acute care medical surgical patientsreceiving blood transfusions, what are thebest monitoring practice to assess for theincidence of adverse transfusion reactions?-Does the evidence say that manual vs.automatic blood pressures as most accurate?-3 year study examining symptoms clustersof patients with congestive heart failure-Does a review of the literature indicate aneed for new knowledge regarding bloodpressure management?ResourcesAmerican Nurses Association (ANA) (2010). Nursing Scope and Standards of Practice. Washington DC: ANA.Balas, E. & Boren, S. (2000). Managing clinical knowledge for healthcare improvements. In V. Schattauer (Ed.). Yearbook of Medical Informatics (p. 6570). Stuttgart, Germany. Schattauer.Dimitroff, L. (2011). Comparing and contrasting nursing research, evidence-based practice and quality improvement: A differential diagnosis. CapitalDistrict Nursing Research Alliance, 7th Annual Conference Presentation.Department of Health and Human Services, 2002.Fawcett, J. & Garity (2009). Evaluating research for evidence-based nursing practice. Philadelphia: F.A. Davis.Hedges, C. (2006). Research, evidence-based practice and quality improvement: The 3-legged stool. AACN Advanced Critical Care, 17(4) 457-459.Melnyk, B. & Fineout-Overholt, E. (2011). The current state of evidence-based practice in nurses across the US. Slide presentation.McLaughlin, M. (2012). Show me the difference! Articulating the differences between QI, EBP and Research. MedStar HealthSackett, D., Straus, S., Richardson, W., Rosenberg, W. & Haynes, R. (2000). Evidence-based medicine. How to practice and teach EBM (2nd ed) Edinburgh:Churchill Livingstone.Sanford Health 2012: Evidence Based Practice, Research, Quality Improvement, Performance Improvement: Articulating Differences and SimilaritiesShirley, M., Hauck, S., Embree, J., Kinner, T., Schaar, G., Phillips, L.,Ashby, S., Swenty, C. & McCool, I. (2011). Showcasing differences between qualityimprovement, evidence-based practice and research. The Journal of Continuing Education in Nursing 42(2). 57-68.University of Alabama at Birmingham Center for Nursing Excellence (2010). Evidence based Practice, Quality Improvement and Nursing Research FactSheet.
-Search for the best evidence -Critically appraise the evidence -Synthesize the evidence -Apply the evidence -Evaluate outcomes AD Graduate -Understand and have an awareness of the value and relevance of research in nursing -Help identify problems in nursing practice -Use research findi
quality improvement essentials—critical elements successful quality improvement programs have in common. This executive report defines quality improvement in healthcare, describes critical quality improvement considerations, components, and tools, and identifies the top five quality improvement essentials: 1.
Types of Evidence 3 Classification of Evidence *Evidence is something that tends to establish or disprove a fact* Two types: Testimonial evidence is a statement made under oath; also known as direct evidence or prima facie evidence. Physical evidence is any object or material that is relevant in a crime; also known as indirect evidence.
Quality improvement in mental health is broadly similar to quality improvement in other health care settings 43 Appendix 1: Quality improvement methods 44 . organisations have embraced quality improvement strategies and what has enabled them to do so. In parti
evidence-based improvement and the levels of evidence that are specified in the law. This guide builds on that ED guidance and provides an initial set of tools to help states and districts understand and plan for implementing evidence-based improvement strategies. This guide recognizes school and district improvement as a continuous, systemic, and
Quality Assurance and Improvement Framework Guidance 2 Contents Section 1: Quality Assurance and Improvement Framework 1.1 Overview 1.1.1 Quality Assurance (QA) 1.1.2 Quality Improvement (QI) 1.1.3 Access 1.2 Funding Section 2: Quality Assurance 2.1 General information on indicators 2.1.1 Disease registers 2.1.2 Verification
about evidence-based practice [2] Doing evidence-based practice means doing what the research evidence tells you works. No. Research evidence is just one of four sources of evidence. Evidence-based practice is about practice not research. Evidence doesn't speak for itself or do anything. New exciting single 'breakthrough' studies
Quality Assurance and Quality Improvement Plan I. Purpose The Quality Assurance and Improvement Plan (QA/QI Plan) is a guide designed to assess, enhance, . The steps include: F ind a process to improve O rganize an effort to work on improvement C l
Reading Practice Test, a practice opportunity for the Nebraska State Accountability (NeSA). Each question will ask you to select an answer from among four choices. For all questions: † Read each passage. Then answer each question carefully by choosing the best answer. † Mark your answers for ALL of the questions. Remember only one of the choices provided is the correct answer. SP10R08XP01 .
