Quality_Improvement_and_Evidence_Pased_Practice

QUALITY IMPROVEMENT AND EVIDENCE PASED PRACTICE According to the QSEN competence the definition of Evidence-base practice (EBP) is: “integrate best current evidence with clinical practice and patient/family preferences and values for delivery of optimal health care.” (QSEN). While Quality Improvement (QI) is defined as: “Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.” (QSEN). Both EBP and QI were utilized to optimize healthcare given for an area of clinical concern in the facility described below. 2. Some years ago I was working in a unit where the infection control department found that the central line bloodstream infection rate was an astounding 21%. An infection rate of 21% was completely unacceptable and was deemed an emergent situation that required immediate action. The institution decided to form a special team that was dedicated exclusively to the placement and care of central lines. The team began by doing research to find out what the CDC, IHI and other healthcare facilities around the country were doing to reduce Central Line Associated Bloodstream Infections (CLABSI). In their research they found that facilities were using a Central Line Bundle. “A Central line Bundle is a group of evidence-based interventions for patients with central catheters that, when implemented together, result in better outcomes than when implemented individually. The Bundle consisted of 6 key components: hand hygiene, maximal barrier during insertion, chlorhexidine, optimal site selection, and daily review of line necessity and removal as soon as possible.” ("Prevent central line," 2011). In addition to the bundle a checklist is used for the things that are to be monitored before, during, and after the insertion. The implementation of the insertion checklist, together with the use of the bundle and daily care by this exclusive team resulted in a decrease from 21% to 11% infection rate within six weeks. The team later on went on to change the catheter used to an antibiotic permeated catheter and additionally began to use a chlorohexidine permeated sponge to the insertion site. All of the steps taken successfully decreased the infection rate to less that 2%. 3. According to QSEN and the KSA’s this facility took the appropriate steps to correct an identified area of concern. Firstly, the problem was identified by using continuous surveillance and other QI processes. The infection control team collaborated with the management, doctors, nurses, and other disciples to formulate a plan to solve the problem. The team then moved forward by doing research to see what was being done in the healthcare community to decrease these types of infection. They discovered that current research showed best results were achieved by implementing specific things in as specific way. The team then implemented action based on evidence based practice from what they discover was most instrumental in decreasing infection. As is outlined by the QSEN this facility used the best current evidence along with clinical practice to deliver the best health care to decrease central line associated bloodstream infections. This facility did an excellent job in identifying areas that required improvements and effectively achieving a positive outcome. According to Burke and Motacki this facility utilized evidence based practiced and the Focus method. F-Focus on an opportunity for improvement. O-Organize a team involved with the process. C-Clarify the current Process. U-understand the causes of variation in the process. S-Based on the evidence, Select the improvement (Motacki & Burke, 2011) This facility demonstrated that they understood the value of seeking and using information from outside sources that was based in evidence. Not only did they find evidence of best practice but they educated a special team to carry-out the new practice as is referred to in QSEN “...facilitate integration of new evidence into standards of practice”.(QSEN) They were able to integrate the new information into practice to achieve best outcome for their patients. Motacki, K., & Burke, K. (2011). Improving organizational performance. In Y. Alexopoulos & D. Frazier (Eds.), Nursing Delegation and Management of Patient Care (pp. 123-134). St. Louis, Missouri: Mosby Elsevier. Prevent central line infection. (2011). Retrieved Jan. 12, 2012, from http://www.IHI.org The quality and safety education for nurses (qsen). (n.d.). Retrieved Jan.17, 2012, from http://www.qsen.org/ previous | next Close