1-There are many areas in nursing where evidence-based practice has improved care processes and patient outcomes including the bundles of checklist to prevent pneumonia related to mechanical ventilation and central line-associated blood stream infection or CLABSI.
To prevent healthcare-associated infection such as the ventilator-associated pneumonia (VAP) for patient who had been intubated for more than 48 hours, the VAP bundles of care are often used. Recommended bundle of interventions for the prevention of VAP includes elevation of the head of the bed at a 30° to 45° angle to prevent aspiration of gastric content, reducing the duration of mechanical ventilation by daily sedation interruption (DSI) and daily spontaneous breathing trials (SBT), peptic ulcer disease (PUD) prophylaxis, and deep-vein thrombosis (DVT) prophylaxis. Moreover, performing oral care every two hours and as needed, maintaining ET tube cuff pressure above 20 cm H20, and managing ventilator circuits and changing only when visibly soiled showed improvements in VAP in critically ill patients.
Another area where evidence-based practice has improved patient outcome is through the use of bundles or interventions to prevent or decreased central line-associated blood stream infections. Those recommended bundle of interventions for the prevention of CLABSI includes proper hand hygiene, skin preparation using chlorhexidine solution greater than 0.5%, adhering to aseptic technique and use of sterile gloves, regular assessment and inspection of site, and daily evaluation whether the use of central line is still necessary.
According to the ANA (2018), when patient received the optimal intervention bundle, the expected time for any ventilator-associated pneumonia to occur takes almost 3.5 times longer that those who did not. At the hospital I work for, when we chart our lines/drains/airways one of the question we are asked is if the patient still meets the criteria for continuing the line. When no longer necessary, it prompts immediate consideration for removal. The bundles/checklist does not only act as a learning tool but also serves as a guideline. By knowing the bundles of interventions we can better care for our patients and avoid unnecessary and preventable infections.
References:
Stevens, K. (2013, May 31). “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
American Nurse Today. (2018). Preventing ventilator-associated pneumonia: A nursing-intervention bundle. Retrieved from https://www.americannursetoday.com/preventing-ventilator-associated-pneumonia-a-nursing-intervention-bundle/
Perin, D. C., Erdmann, A. L., Higashi, G. D., & Sasso, G. T. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Revista latino-americana de enfermagem, 24, e2787. doi:10.1590/1518-8345.1233.2787
2-In wound care it seems like new products are becoming available everyday and current products are continually evolving to improve patient outcomes. Thankfully, the clinic that I work in is smaller and there are only three nurses on staff, so our continuous education is typically done as a group. We usually meet with the product representative face to face and receive instant feedback regarding any questions and concerns we may have about the product. When information needs to be disseminated throughout the facility and to all nursing staff, the education happens is various forms. Least common is face to face in servicing as it is often difficult to get multiple staff members in the same location at the same time (due to staffing shortages). The most utilized form of education is online via an electronic learning forum (E-Learning) staff members can access the “assignments” 24 hours a day 7 days a week from most computers within the facility. Assignments are assigned with a due date and typically have a test following the educational portion in which the staff members must pass to receive credit and meet the educational requirement.
3-The implementation phase of any change can be difficult. In the nursing profession, evidence-based practices have been observed as the best and safest practices as there is proof in the research. However, there will always be those who question, or doubt said proof because some people are afraid of change, even if the change benefits them or others. To implement change, I would begin by addressing the following key factors: why, what, and how. First, the why- what is the issue that lead to the change. Next, the what- the research, the facts, the failures and successes that became the change. Lastly, the how- the demonstration or explanation of the change. Depending on the change and the aspects of our practice that would be affected determines the length of time the implementation phase would take. In my experience (when allowable) taking time to incorporate change over a period has proven least likely to create resistance from others.
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