Construct a PICO(T) question (step 1 in the EBP process).
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VilaHealthTheBestEvidenceforaHealthcareChallenge.docxVila Health: The Best Evidence for a Healthcare Challenge
· Jackie
· Jackie
Introduction
Leading the Change with the First Steps in EBP.
You are a senior staff member at St. Anthony Medical Center, and also a graduate student who has been focusing on Evidence-Based Practice (EBP). Because of your expertise in this area, you have been asked to serve on the hospital’s new EBP Intervention Team. The hospital needs your help in using EBP to address the issue of substandard patient safety scores. In order to complete this task, you will be following the six-part Evidence-Based Practice model, which appears in this activity.
St. Anthony Medical Center
Evidence-Based Practice Model
Here is the six-part Evidence-Based Practice model, which you will use to address the issue of substandard patient safety scores. For this activity, you will be focusing on the first four steps.
· Step 1: Compose a suitable PICOT question.
· Step 2: Search for the best evidence to answer the PICOT question.
· Step 3: Conduct a rapid appraisal of the studies found in the search.
· Step 4: Integrate research evidence with internal evidence, clinical expertise, patient preferences/values.
· Step 5: Evaluate the outcomes of the practice change.
· Step 6: Disseminate the outcome of the EBP practice change.
Jackie
St. Anthony Medical Center
The Chief Nursing Officer, Jackie Sandoval, stops you in the hallway to chat.
Check in with Jackie Sandoval, the Chief Nursing Officer to continue.
Jackie Sandoval
Chief Nursing Officer
Hi there! I’m going to be forwarding to you an email from Marcus Hartley about a new project. Marcus is our Chief Quality Officer. I feel that you’d be the perfect person for this project because you’ve been focusing your graduate studies on Evidence-Based Practice. We’re so lucky to have a nurse on staff like you who has expertise in EBP!
When you get back to your station, please take a look at this forwarded email. There are two documents attached to this email that you should review as well.
Using the information in this email and the documents, you will be able to construct a PICOT question. You will use this PICOT question as a foundation for your search for additional research evidence for an appropriate intervention. Then we can meet again to start on the next step.
Thank you so much! I’m confident that your expertise in Evidence-Based Practice will better enable the hospital to provide quality care for patients.
Your Office
You arrive back at your station. You should read that email that the CNO forward to you from the CQO and look over the documents.
From: Jackie Sandoval, CNO, St. Anthony Medical Center
FW: EBD and Patient Safety Scores
Hi,
Here’s that email I mentioned that I’m forwarding to you from Marcus Hartley. Thanks so much!
--Jackie
From: Marcus Hartley, CQO, St. Anthony Medical Center
To: Jackie Sandoval, CNO, St. Anthony Medical Center
Subject: EBD and Patient Safety Scores
Hello Jackie
As you know, one of our most pressing initiatives right now is patient safety. We are very concerned with our Patient Safety Scores and the incidences related to staff and patient safety over the last two years, many of which could have been prevented. The aggregate scores for the system fell into the Worse than Expected category, which means that the hospital had a higher rate of incidences than what was projected when providing high quality care.
The hospital needs to develop an intervention to address these Patient Safety Scores, and it is important to us that this intervention is evidence-based and that we are using Evidence-Based Practice to improve. We need to see improvement in these safety scores within the next three months, and we need your help.
I’ve attached two documents to this email. The first document is a report that summarizes patient safety incidents at St. Anthony Medical center over the past two years. The second document is a report from Anne Marie McConnell, the Director of Risk Management, which summarizes the results of a focus group that we conducted in regards to patient safety issues.
Is there someone on our staff with expertise in Evidence-Based Practice who could help us with this? I’ve heard that there might be a nurse on staff who’s been studying EBP in graduate school. If so, that would be a good person to get on board.
Thank you.
Sincerely,
Marcus
Patient Safety Data
2018
Aggregate Scores: Worse than Expected
1. Patient Falls - Expected: 0 Observed: 3
2. Medical Errors causing patient allergic reaction - Expected: 0 Observed: 2
3. Staff member in Emergency Department (ED) needed urgent treatment for concussion = 1
2019
Aggregate Scores: Worse than Expected
1. Medical Errors causing patient allergic reaction - Expected: 0 Observed: 4
2. Staff member in Emergency Department needed urgent treatment for lacerations = 1
3. Nurse on critical care unit slipped and broke her arm = 1
Focus Group Results
Between March 13 and March 20, 2020, the Executive Team at St. Anthony Medical Center held four focus groups with staff members from the hospital. The purpose of these focus groups was to acquire their perspectives on safety at the hospital. A total of 31 staff members participated in these focus groups.
Here is a summary of common themes that emerged from the focus groups.
· Staff members are concerned that the EHR needs to be updated to better alert staff about red flags and other information that pertains to patient safety. One concern is that the EHR does not automatically flag patients with allergies to medications. Staff members are especially concerned that the EHR does not flag patients who are allergic to antibiotics.
· In addition to concerns that the EHR may need to be updated, staff members are concerned that the forms are not being filled out correctly, which may lead to patient safety issues. Staff members report that training on the EHR is insufficient; the system was updated three years ago, and while new staff members are trained on how to use the EHR, older staff members received only minimal training when the system was updated. Also, staff members report that EHRs are not always filled out in as much detail as they should be, in part because of time constraints, and also because management does not consistently emphasize the importance of filling out the EHRs in detail.
· Staff members are concerned that patient files are not routinely marked when a patient is at risk of falling.
· Staff members recall seeing incidents of patient violence against staff members that were not reported, especially in the ER. These incidents include violent outbursts from patients and from patients’ families, and well as incidents of physical violence. Staff members said that while the hospital has an official policy about reporting these kinds of incidents, staff members may feel pressured to handle these incidents themselves, and to treat these incidents as “just part of the job.” Staff members report that there is a culture of acceptance at the hospital when it comes to violent incidents and a “code of silence,” even though that is almost never stated explicitly. Several staff members said that they wished the hospital would increase the number of police officers or security guards on the premise, and also that the hospital would install more panic buttons.
· Several staff members discussed an instance in 2017 when a nurse slipped and broke her arm. Two staff members reported seeing spilled saline solution on the floor when this occurred.
Jackie
St. Anthony Medical Center
Jackie Sandoval, the CNO, stops by your station.
Check in with Jackie Sandoval, the Chief Nursing Officer to continue.
Jackie Sandoval
Chief Nursing Officer
Hi again! I see you’ve read the email I forwarded to you from Marcus Hartley about your assignment. I hope that this information and data will help you develop an appropriate PICOT question. I’d like to emphasize how important it is for the hospital see improvement in patient safety scores in the next three months.
I trust that you know how to identify appropriate research evidence to support your proposed evidence-based intervention, but I have found an article to get you started. It’s a study on incident reporting. Please use this article as a start to your search for the best evidence.
It’s a good idea to create a search strategy based on your PICOT question to find additional research evidence to support an intervention to improve our safety scores.
Once you have found relevant and timely evidence, it’s standard practice to critically appraise the studies. After that, I will look forward to seeing a good synthesis of the research evidence you found combined with all of the quantitative and qualitative organizational evidence provided by Marcus and Melissa.
Oh, and here’s the citation.
Carlfjord et al. (2018). Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators. BMC Health Services Research (2018) 18:113. DOI 10.1186/s12913-018-2876-5
Your Office
You get to work on your PICOT question. Later, Jackie Sandoval forwards to you another email.
From: Jackie Sandoval, CNO, St. Anthony Medical Center
FW: Committee response to EBP presentation
Hi,
I’m forwarding another email to you that I think you’ll find useful. This email is a summary is from Melissa Cohen, our COO, who conducted an EBP presentation to our medical staff last night. You should be able to use this as additional data to integrate into an implementation strategy for the evidence-based intervention to improve safety scores.
I am giving you this because it represents the kind of qualitative evidence and clinical expertise that must be integrated into recommendations on strategies to implement an evidence-based intervention.
Best, Jackie
From: Melissa Cohen, COO, St. Anthony Medical Center
To: Jackie Sandoval, CNO, St. Anthony Medical Center
FW: EBP and Patient Safety Scores
Hi Jackie
I just wanted to let you know about the presentation I made last night at the Medical Committee’s quarterly meeting about EBP. As an example in my presentation, I discussed the research evidence article you found by Carlfjord et al. To my surprise, this sparked some heated debate!
· Some of the committee members were excited about EBP, but others were very skeptical – and to paraphrase Dr. Booker, the Chief Medical Officer, there isn’t consensus among the Medical Committee on the effectiveness and value of evidence-based interventions.
· Most of the committee members want to see more information and data about how EBP is going to be used in order to support improvements in safety and other areas. Several doctors stated explicitly that they were not on board with using EBP to make such big changes, and that they were not going to change their own practices unless they saw solid research evidence to support the need for those changes. In addition, some of the committee members also wanted to see evidence that substantiates our poor safety scores and the intervention.
· Dr. Booker argued that we need to see what other physicians have to say about EBP, and he suggested that a focus group might be helpful.
· Some committee members were enthusiastic about evidence-based interventions, and several said that they think we should be working towards a culture of evidence across the organization. They expressed the opinion that EBP is the new trend in improving quality of care.
Anyway, I thought you should be aware of this debate as you work on your intervention.
Best, Melissa
