Evidence-Based Poste

1. What is the problem?
Many elderly patients often complain of back ache and are put on steroid epidural injections. Clinicians have the number of these epidural injections limited. The main problem that led to this study is the increased immobility among the patients who are put on long term epidural steroids.
2. Why is the problem important and relevant? What would happen if it were not addressed?
It is important to focus on the wholeness of the patient. Considering the possible outcomes of the therapy. If left unaddressed, some patients are left immobile many of which are the bread winners and this leaves the family in great loss and the burden of taking care of their patient.
3. What is the current practice?
Currently, clinicians prescribe limited doses for patients with back pain. This temporarily reduces the pain and inflammation and promotes patient’s comfort. In some instances, patients may be placed on long term use of these steroids.
4. How was the problem identified? (Check all that apply)
(x)Safety and risk-management concerns (x)Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness) (x)Unsatisfactory patient, staff, or organizational outcomes	· Variations in practice within the setting (x)Variations in practice compared to community standard · Current practice that has not been validated · Financial concerns
5. What are the PICO components?
P – (Patient, population, or problem). The problem is common in patients who are elderly and have back pain. These patients have history of manual work during their lifetime that have to led to the chronic back pain. I – (Intervention) administration of alternative drugs for the management of back pain, for instance NSAIDS. C – (Comparison with other interventions, if foreground question). The use of NSAID is far much safer to patient compared to the epidural steroids for back pain since it does not have serious complications like the steroids. O – (Outcomes are qualitative or quantitative measures to determine the success of change). Increasing mobility in patient who have back pain and prevent further damage of the spine bones.
6. Initial EBP question ❑Background ❑Foreground
The continuous use of epidural steroids.

JohnsHopkinsNursingEvidence-BasedPractice

AppendixB:QuestionDevelopmentTool

JohnsHopkinsNursingEvidence-BasedPractice

Appendix B Question Development Tool

© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing

7. List possible search terms, databases to search, and search strategies.
Epidural steroids Steroids for back pain
8. What evidence must be gathered? (Check all that apply)
( x) Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase) (x)Standards (regulatory, professional, community) Guidelines · (x)Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences) · Position statements
9. Revised EBP question (Revisions in the EBP question may not be evident until after the initial evidence review; the revision can be in the background question or a change from the background to a foregroundquestion)
10. Outcome measurement plan
What will we measure? (structure, process, outcome measure)	How will we measure it? (metrics are expressed as rate or percent)	How often will we measure it? (frequency)	Where will we obtain the data?	Who will collect the data?	To whom will we report the data?
The degree of immobility in patients receiving epidural steroid, especially the elderly.	The number of patient s who have become immobile after a long-term administration of epidural steroids, divided by the total number of patients receiving epidural steroids multiplied by one hundred.	Measurement can be taken after every 18 months (1.5 years)	From hospital and rehabilitation centers.	Researchers.	The research leader.

References

Epstein N. E. (2013). The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature. Surgical neurology international, 4(Suppl 2), S74–S93. https://doi.org/10.4103/2152-7806.109446

Mayo Clinic. 2021. Steroid Injections for Back Pain: Why Limited Dosing? [online] Available at: <https://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/epidural-steroid-injections/faq-20058277> [Accessed 8 January 2021].

Directions for Use of the Question Development Tool

Purpose

This for misusedtodevelopananswerableEBPquestionandtoguidetheteam intheevidencesearchprocess.Thequestion,searchterms,searchstrategy,and sourcesofevidencecanberevisedastheEBPteamrefinestheEBPquestion.

What is the problem, and why is it important?

Indicate why the project was undertaken. What led the team to seek evidence? Ensure that the problem statement defines the actual problem and does not includeasolution.Wheneverpossible,quantifytheextentoftheproblem.Validate the final problem description with practicing staff. It is important for the inter-professionalteamtotakethetimetogethertoreflect,gatherinformation,observe currentpractice,listentoclinicians,visualizehowtheprocesscanbedifferentor improved,andprobetheproblemdescriptioninordertodevelopasharedunderstandingoftheproblem.

What is the current practice?

Definethecurrentpracticeasitrelatestotheproblem.Thinkaboutcurrentpoliciesandprocedures.Observepractices.Whatdoyousee?

How was the problem identified?

Check all the statements that apply.

What are the PICO components?

P(patient,population,problem)e.g.,age,sex,setting,ethnicity,condition,disease, typeofpatient,orpopulation

I(intervention)e.g.,treatment,medication,education,diagnostictest,orbest practice(s)

C (comparison with other interventions or current practice for foreground questions; is not applicable for background questions, which identify best practice)

O (outcomes) stated in measurable terms; may be a structure, a process, or an outcome measure based on the desired change (e.g., decrease in falls, decrease in length of stay, increase in patient satisfaction)

Initial EBP question

A starting question (usually a background question) that is often refined and adjusted as the team searches through the literature:

· Background questions are broad and are used when the team has little knowledge, experience, or expertise in the area of interest. Background questions are often used to identify best practices.

· Foreground questions are focused, with specific comparisons of two or more ideas or interventions. Foreground questions provide specific bodies of evidence related to the EBP question. Foreground questions often flow from an initial background question and literature review.

List possible search terms, databases to search, and search strategies.

Using PICO components and the initial EBP question, list search terms. Terms can be added or adjusted throughout the evidence search. Document the search terms, search strategy, and databases queried in sufficient detail forreplication.

What evidence must be gathered?

Check the types of evidence the team will gather based on the PICO and initial EBP question.

Revised EBP question

Often, the question that you start with may not be the final EBP question. Back- ground questions can be refined or changed to a foreground question based on the evidence review. Foreground questions are focused questions that include specific comparisons and produce a narrower range of evidence.

Measurement plan

Measurescanbeaddedorchangedasthereviewoftheliteratureiscompleted andthetranslationplanningbegins:

· A measure is an amount or a degree of something, such as number of falls with injury. Each measure must be converted to a metric, which is calculated before and after implementing the change.

· Metrics let you know whether the change was successful. They have a numerator and a denominator and are typically expressed as rates or percent. For example, a metric for the measure falls-with-injury would be the number of falls with injury (numerator) divided by 1,000 patient days (denominator). Other examples of metrics include the number of direct care RNs (numerator) on a unit divided by the total number of direct care staff (denominator); the number of medication errors divided by 1,000 orders.