Paper
Wednesday, July 13, 2005
This presentation is part of : Research to Promote Evidence-Based Nursing
Research Testing Strategies for Implementation of Evidence-Based Practices
Diane M. Doran, RN, PhD1, John Mylopoulos, PhD2, André Kushniruk, PhD3, Lynn Nagle, PhD4, John P. Hirdes, PhD5, Brenda Laurie-Shaw, RN, MN6, Dyanne Affonso, RN, PhD1, Edith M. Hillan, PhD, RN7, and Ann Tourangeau, RN, PhD1. (1) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (2) Dept. of Computer Science, University of Toronto, Toronto, ON, Canada, (3) School of Health Information Science, University of Victoria, Victoria, BC, Canada, (4) Informatics, Mount Sinai Hospital, Toronto, ON, Canada, (5) Dept. of Health Studies & Gerontology, University of Waterloo, Waterloo, ON, Canada, (6) Nursing Informatics, University Health Network, Toronto, ON, Canada, (7) Office of the Vice President & Provost, University of Toronto, Toronto, ON, Canada
Learning Objective #1: Understand how point-of-care (POC) technology enables documentation of nursing-sensitive outcomes and can automatically trigger best-practice guidelines
Learning Objective #2: Understand how outcomes feedback motivates nurses to integrate evidence with practice
Kitson developed a framework to represent the interplay of the many factors that influence the uptake of evidence into practice. Information and feedback were identified as key components of the context for changing practice. Drawing on Kitson's work, this study's goal was to improve the utilization of outcomes information and best practice guidelines at the point of care by providing nurses with real-time feedback about the outcomes of their care and using personal digital assistants (PDAs) to increase nurses' utilization of evidence at the point-of-care (POC).

Methods: A cross-sectional design was used. Data collection included workflow analysis, group interviews, and chart abstraction to identify characteristics of data repositories for linkage between users and health records. The sample included nurses, nurse managers, and patients. A prototype system was designed that enabled nurses to use PDAs to simultaneously document patients' responses to treatment, access electronically accessible resources to support clinical decision-making, and receive feedback to modify care.

Main Findings: In order to inform prototype design, data were collected by documenting nurses' episodes of information transfer. 39.8% of written information was recorded onto “personal paper” at the POC and later transcribed. Nurses often sought information away from the POC; for example, a centrally located health record, or electronically accessible patient information (68%), drug dictionary (5.6%), or policy/procedure (1.0%). A frequent source of information for most staff nurses was “colleagues”, yet not all colleagues are able to offer evidence-based advice.

Conclusions: The prototype system has the potential to improve ease of health information documentation and utilization of best practice guidelines at the point of care.

Implications: A follow-up study will involve usability testing of the Prototype System, and a randomized controlled trial to determine the impact on clinical decision-making and the quality of care.

See more of Research to Promote Evidence-Based Nursing
See more of Third International Evidence-Based Nursing Preconference
Promoting Evidence-Based Nursing: Innovation for Nursing Practice
Sigma Theta Tau International
13 July 2005
Hawaii’s Big Island