| Learning Objective #1: The learner will be able to describe the process to change the practice enviornment by revising clinical practice guidelines to evidence based. | |||
| Learning Objective #2: The learner will be able to identify the process to monitor and evaluate the implementation of evidence based clinical practice guidelines. |
Evaluation and Monitoring of an Evidence-Based Culture Change
The Nursing Advisory Board (2005) describes Evidence-Based Practice (EBP) as an opportunity to invigorate the practice environment. Implementing an
EBP practice culture in a multi-site tertiary care center required a carefully constructed plan. This culture change was prompted by an initiative to revise
and update hospital procedures and clinical practice guidelines based on current evidence.(Phase 1) The EBP leadership group, consisting of dedicated
administrators, researchers and unit-based educators served as mentors and educators skilled in conducting evidence review and determining the levels
of evidence. The EBP program was evaluated using both quantitative and qualitative analysis.
Phase two of the project addressed the process of developing outcome measures that demonstrated compliance, effectiveness and efficiency.
The National Quality Forum (NQF) research recommendations identified pain assessment and management measures as nursing sensitive performance
indicators. Due to lack of compliance in both the assessment and documentation of patient's pain level, an initiative to improve positive patient outcomes
was initiated.The pain standards of care were revised by EBP experts and benchmarking practices with other Magnet hospitals. Structured education
was implemented through a variety of consistent educational interventions. In addition, nursing quality and informatics incorporated the EBP pain
guidelines into the new electronic documentation system resulting in improved compliance both in practice and documentation. Focused monitoring
including unit and individual feedback was continually provided to leadership and staff. Real time data via web-based data reporting was implemented to
access monitoring activities. Improvements in an understanding of the importance of frequent assessments of pain and documentation of pain scores according to the revised EBP-based standard was demonstrated. Future projects are currently in the process of implementation, including falls, pressure ulcers, restraint usage and smoking cessation. The rapid-cycle improvement process will be used to incorporate EBP into guidelines and bring evidence to the point of care.