RESPONSE DISCUSSION

Respond to your colleagues in one of the following ways:

Provide additional strategies for addressing challenges to obtaining a sample from the identified population

Suggest a different population that may be appropriate for addressing the research problem

Summarize the strengths of the data collection method identified in the post

Share any problems or concerns over the identified data collection method

Suggest an alternative data collection method and provide your rationale

What are the researchable populations in your area of practice? Which would be most appropriate for use in your research study?

DISCUSSION

Johnson et al., (2016) found that an increasing number of providers were unaware of the American Heart Association (AHA) guidelines related to appropriate usage of telemetry monitoring. As a result of the improper utilization, the AHA published the American Heart Association (AHA) Practice Standards for Electrocardiographic (ECG) Monitoring in Hospital Settings to examine “best practices” for in-hospital ECG monitoring, and guide appropriate utilization of cardiac monitoring (Johnson et al., 2016). In my acute care setting, physicians are non-adherent to hospital policy, and consequently, patients are remaining on telemetry longer than required according to the AHA guidelines. Due to overutilization of telemetry monitors, patients who need it do not have access to the resource. The researchable and most appropriate populations in my area of practice for my research study are adults age 19 years and older.

What are the challenges of obtaining a sample from this population? How could you address those challenges?

One of the difficulties of obtaining a sample from this population is that some of the patients in that age group may not have a history of heart disease. However, I believe that a solution to that problem could be to select patients 40 or 50 years old with a telemetry order and a diagnosis of cardiac disease at random.

What approach would you use to collect data from the sample? Provide a rationale for the approach you choose based on this week’s Learning Resources.

To fully implement the evidence-based change, the practitioner must have a spirit of curiosity and inquiry as well as an organizational culture that supports those qualities. The infrastructure for this acute care setting nurtures research, growth, and development. The practitioner will advocate for provider education and exploit SMART goals as monitor posts for implementation of evidence-based change. The goals are specific, measurable, attainable, relevant, and time sensitive.

Prior to implementation of the study, the Primary Investigator (PI) will meet with the unit-based stakeholders to identify and discuss the practice problem. The PI will also discuss interventions simultaneously to improve quality of care on the unit. After approval from stakeholders, the PI will initiate a proposal to the Walden University Institutional Review Board (IRB) for expedited approval for an Electronic Medical Record (EMR) review project.

Setting. Inpatient Cardiac Unit.

Participants. Approximately 100 Electronic Medical Records (EMR) - 50 before intervention and 50 after intervention.

Method. A retrospective EMR review will be conducted on 100 patients; 50 prior to intervention and 50 post intervention.

Inclusion Criteria. Adult patients 19 years and older with a cardiac history and telemetry orders.

Exclusion Criteria. Adult patients 19 years and older without a cardiac history and no telemetry orders.

Study design. The EMR review

Screening Procedure. Following approval from Walden’s IRB, the PI will use the EMR database to collect a list of all unit-based patients with an order for telemetry. Once this list is compiled, the PI will select every other chart until 50 patients have been identified. The PI will then meet with stake holders to discuss the need for education based on the AHA guidelines. Demographic data, telemetry orders, total time on telemetry, and diagnoses will be retrieved from the EMR.

The rationale for this approach is the accessible population is also the representative of the target population which is adults 19 years of age and older and meeting the inclusion criteria (Gray et al., 2017).

References

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing

research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders

Elsevier.

Johnson, A. E., Knight, A. M., Mock, C. K., Maygers, J. M., & Zakaria, S. (January 01, 2016).

Attitudes Surrounding Continuous Telemetry Utilization by Providers at an Academic

Tertiary Medical Center. Journal of Clinical Outcomes Management, 23, 3, 127-134.