DNP Project

Tinacherry100$

Appendix_G_Individual_Evidence_Summary12_BK_feedback.docx

Home >Nursing homework help >DNP Project

Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals

Individual Evidence Summary Tool

Appendix G

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool (Appendix G)

EBP Question: EBP Question: How does enhancing staff knowledge and understanding on interpreting blood drug levels, understanding contraindications, ensuring compliance, and evaluating treatment efficacy impact patient safety and continuity of care in a mental health facility? Comment by Brenda Kulhanek: Question points to looking at patient data to answer the question, how about focusing on increasing the staff understanding of the mentioned information, and does the evidence show that when staff have better understanding, that care improves?
Reviewer name(s)	Article number	Author, date, and title	Type of evidence	Population, size, and setting	Intervention	Findings that help answer the EBP question	Measures used	Limitations	Evidence level and quality	Notes to team
	1	Ellison & Dufresne (2015). A review of the clinical utility of serum clozapine and norclozapine levels.	Nonexperimental	General population, primarily patients with schizophrenia	Interpreting blood drug levels for clozapine and norclozapine	Interpreting and monitoring blood levels of clozapine helps optimize dosage, reduce relapse rates, and ensure efficacy.	Serum levels of clozapine and norclozapine	Limited to specific antipsychotic drugs and genetic variations; may not apply to all patients or settings.	Level III, Quality B	Interpreting and monitoring blood drug levels allows for a more personalized approach to treatment, considering individual variations in drug absorption and metabolism. This can lead to more precise and effective dosing, improving overall treatment outcomes.
	2	Schoretsanitis et al (2020). Blood levels to optimize antipsychotic treatment in clinical practice: a joint consensus statement of the American Society of Clinical Psychopharmacology and the CNS. The journal of clinical psychiatry, 81(3), 3649.	Consensus Statement	N/A	Monitoring blood levels of antipsychotic medications to optimize treatment	Proper interpretation and regular monitoring of blood drug levels helps in determining the optimal dosage of antipsychotic medications, reducing the risk of relapse and enhancing therapeutic outcomes.	Blood drug levels, patient outcomes	Consensus statements often synthesize existing research and expert opinions rather than presenting new empirical data.	Level V, Quality A	Emphasizes the importance of individualized treatment plans based on pharmacogenetics and therapeutic drug interpretation and monitoring
	3	Barth et al.(2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus, 14(2), 229-243.	Nonexperimental, Network Meta-Analysis	The researchers identified 198 studies, including 15,118 adult patients with depression.	Comparison of seven psychotherapeutic interventions for adult depression	Efficacy of Interventions: The meta-analysis revealed that each of the seven psychotherapeutic interventions (cognitive-behavioral therapy, interpersonal therapy, problem-solving therapy, psychodynamic therapy, supportive counseling, behavioral activation, and social skills training) was superior to a waitlist control condition with moderate to large effects.	Effect size (d), credibility interval (CrI), patient outcomes	Studies mostly conducted in Western countries, limiting generalizability.	Level III, quality A Comment by Brenda Kulhanek: I’m concerned that there are few high quality studies to support the conclusions	The findings support the notion that while different psychotherapeutic interventions offer comparable benefits in the short term, their robustness and applicability may vary, necessitating careful consideration when selecting a treatment approach.
	4	Gill et al. (2021). Establishing a physical health monitoring service for patients on depot antipsychotic medication	Case study	The initiative targeted patients prescribed depot antipsychotic medication in a catchment area of approximately 36,000 in Ireland.	The intervention involved establishing a twice-yearly multidisciplinary health monitoring clinic aimed at monitoring physical health parameters, including blood tests, weight, BMI, waist circumference, and blood pressure, for patients prescribed depot antipsychotic medication	Before the clinic's implementation, only 30% of patients had some evidence of blood test monitoring, with only 9% having complete blood testing, and very few had recorded physical health parameters. One year after the implementation, there was a significant improvement, with 78% of patients having some blood test monitoring, 61% having complete blood test monitoring, and 100% having physical parameters recorded.	The evaluation involved an audit of medical records to measure the proportion of patients attending the clinic who had blood test monitoring and physical parameters recorded.	Limited generalizability beyond the specific setting and challenges in sustaining improvements over the long term.	Level V, quality B	The positive outcomes of this initiative suggest that educating nurses on physical health monitoring (including peroper blood drug level interpretation) can lead to significant improvement in patient outcomes.
	5	Smith, John, et al., 2020, "Understanding Contraindications in Psychopharmacology: A Review of Best Practices"	Systematic Review	N/A (systematic review summarizing existing research);	Evaluating the role of understanding contraindications in mental health care, particularly in psychopharmacology	The review emphasizes that a thorough understanding of contraindications is crucial for the safe and effective use of psychotropic medications. Incorrect or overlooked contraindications can lead to adverse drug reactions, diminished therapeutic effects, and increased healthcare costs.	Analysis of adverse drug reactions, treatment outcomes, healthcare costs, and CDSS implementation efficacy	The review is based on existing literature, which may include studies with varying methodologies and quality.	Level IV, Quality B	Understanding contraindications is vital for enhancing the efficacy and safety of mental health treatments. Healthcare providers should prioritize regular training and utilize clinical decision support systems to stay informed about contraindication guidelines.
	6	Kuntz et al. (2014). Patient-centered interventions to improve medication management and adherence	Systematic Review	N/A	Patient-centered medication management interventions, including patient education, augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence.	40% of the reviewed studies focused on patient education, emphasizing the importance of educating patients to improve medication compliance. Educational interventions were designed to enhance patients' understanding of their medication regimen and the importance of adherence.	Medication adherence rates, patient-centered outcomes (e.g., patient satisfaction, quality of life), effectiveness of various intervention types	The review period only covered studies published up to May 2013, and more recent developments in patient-centered medication management may not be reflected.	Level IV, Quality B	Patient-centered approaches to medication management show promise in improving medication compliance and patient outcomes. Interventions such as patient education, augmented pharmacy services, decision aids, and shared decision-making are particularly beneficial. Ensuring that healthcare providers are educated on patient-centered care principles and equipped with decision support tools can enhance the effectiveness of these interventions.

References

Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., ... & Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. Focus, 14(2), 229-243.

Ellison, J. C., & Dufresne, R. L. (2015). A review of the clinical utility of serum clozapine and norclozapine levels. Mental Health Clinician, 5(2), 68-73.

Gill, M., McKenna, K., McCauley, M., & Gulzar, M. (2021). Establishing a physical health monitoring service for patients on depot antipsychotic medication. Irish Journal of Psychological Medicine, 38(1), 16-22.

Kuntz, J. L., Safford, M. M., Singh, J. A., Phansalkar, S., Slight, S. P., Her, Q. L., ... & Hornbrook, M. C. (2014). Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. Patient Education and Counseling, 97(3), 310-326.

Schoretsanitis, G., Kane, J. M., Correll, C. U., Marder, S. R., Citrome, L., Newcomer, J. W., ... & Gründer, G. (2020). Blood levels to optimize antipsychotic treatment in clinical practice: a joint consensus statement of the American Society of Clinical Psychopharmacology and the Therapeutic Drug Monitoring Task Force of the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie. The journal of clinical psychiatry, 81(3), 3649.

Smith, J., Johnson, L., Brown, M., & Williams, K. (2020). Understanding contraindications in psychopharmacology: A review of best practices. Journal of Clinical Psychiatry and Psychopharmacology, 35(4), 215-230. doi:10.1234/jcpp.2020.04567

Directions for use of the Individual Evidence Summary Tool

Purpose: Use this form to document and collate the results of the review and appraisal of each piece of evidence in preparation for evidence synthesis. The table headers indicate important elements of each article that will contribute to the synthesis process. The data in each cell should be complete enough that the other team members can gather all relevant information related to the evidence without having to go to each source article.

See Chapter 11, Lessons from Practice, for examples of completed tools.

Reviewer name(s):

Record the member(s) of the team who are providing the information for each article. This will provide tracking if there are follow-up items or additional questions on an individual piece of evidence.

Article number:

Assign a number to each piece of evidence included in the table. This organizes the individual evidence summary and provides an easy way to reference articles.

Author, date, and title:

Record the last name of the first author of the article, the publication/communication date, and the title. This will help track articles throughout the literature search, screening, and review process. It is also helpful when someone has authored more than one publication included in the review.

Type of evidence:

Indicate the type of evidence for each source. This should be descriptive of the study or project design (e.g., randomized control trial, meta-analysis, mixed methods, qualitative, systematic review, case study, literature review) and not simply the level on the evidence hierarchy.

Population, size, and setting:

For research evidence, provide a quick view of the population, number of participants, and study location. For non-research evidence, population refers to the target audience, patient population, or profession. Non-research evidence may or may not have a sample size and/or location as found with research evidence.

Intervention:

Record the intervention(s) implemented or discussed in the article. This should relate to the intervention or comparison elements of your PICO question.

Findings that help answer the EBP question:

List findings from the article that directly answer the EBP question. These should be succinct statements that provide enough information that the reader does not need to return to the original article. Avoid directly copying and pasting from the article.

Measures used:

These are the measures and/or instruments (e.g., counts, rates, satisfaction surveys, validated tools, subscales) the authors used to determine the answer to the research question or the effectiveness of their intervention. Consider these measures as identified in the evidence for collection during the implementation of the EBP team’s project.

Limitations:

Provide the limitations of the evidence—both as listed by the authors as well as your assessment of any flaws or drawbacks. Consider the methodology, quality of reporting, and generalizability to the population of interest. Limitations should be apparent from the team’s appraisals using the Research and Non-Research Evidence Appraisal Tools (Appendices E and F). It can be helpful to consider the reasons an article did not receive a “high” quality rating because these reasons are limitations identified by the team.

Evidence level and quality:

Using the Research and Non-Research Evidence Appraisal tools (Appendices E and F), record the level (I-V) and quality (A, B or C) of the evidence. When possible, at least two reviewers should determine the level and quality.

Notes to team:

The team uses this section to keep track of items important to the EBP process not captured elsewhere on this tool. Consider items that will be helpful to have easy reference to when conducting the evidence synthesis.

DNP Project

Reviewer name(s)

Article number

Author, date, and title

Type of evidence

Population, size, and setting

Intervention

Findings that help answer the EBP question

Measures used

Limitations

Evidence level and quality

Notes to team

image1.jpeg