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Lesson 8
Determining Outcomes for Evaluating EBP©
Barbara Bonificio, MS, RN
LEARNING OBJECTIVE
The learner will be able to identify the key indicators for evaluation of evidence based change in practice. The learner will be able to describe aspects of the evaluation plan to implement the evidence-based practice change.
OVERVIEW
In order for you to identify the outcome in any evidence based change in practice, ask “If we are successful in what we are doing, what change in patients or populations can we expect to achieve?” and “In what ways will they be different, as compared to before?”
To begin, look at the national benchmarks that are reflective of the evidence-based practice you are investigating. Next look at your internal data. This data can assist you in determining if a problem exists on your clinical unit or within your institution and if the problem is worthwhile to pursue. This internal data can also be used to track progress toward an identified outcome after you implement a change in practice.
The National Quality Forum (NQF) is an organization leading an effort to understand the extent to which nurses contribute to healthcare outcomes and improved patient safety. You will find some of the nurse sensitive indicators listed below and how they are measured. For example, nursing sensitive indicator data tell us that falls is an area for improvement and that certain benchmarks are used to measure improvement. Maybe your clinical unit has targeted a 50% reduction in fall rate on your clinical unit at the end of the next 6 months. Reduction in fall rate can become the outcome as a result of implementing an EBP practice change.
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Patient-centered Outcome Measures
Death among surgical inpatients with treatable serious complications (failure to rescue): The percentage of major surgical inpatients who experience a hospital-acquired complications and die.
Pressure ulcer prevalence: Percentage of inpatients who have a hospital acquired pressure ulcer.
Falls prevalence: Number of inpatient falls per inpatient days.
Falls with injury: Number of inpatient falls with injuries per inpatient days.
Restraint prevalence: Percentage of inpatients who have a vest or limb restraint.
Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients: Rate of urinary track infections associated with use of urinary catheters for ICU.
Central line catheter-associated blood stream infection rate for ICU and high-risk nursery patients: Rate of blood stream infections associated with use of central line catheters for ICU and high-risk nursery patients.
Ventilator-associated pneumonia for ICU and high risk nursery patients: Rate of pneumonia associated with use of ventilators for ICU and high-risk nursery patients.
Nurse-centered Intervention Measures:
Smoking cessation counseling for acute myocardial infarction.
Each measures the percentage of patients with a history of smoking within the past year who received smoking cessation advice or counseling during hospitalization.
System-centered Measures
Skill mix: Percentage of registered nurse, licensed practical nurse, unlicensed assistive personnel care hours to total nursing care hours.
Nursing care hours per patient day: Number of registered nurses per patient day and number of nursing staff hours per patient day.
Voluntary turnover: Number of voluntary separations during the month.
There are other ways to measure improvements. The Institute for Healthcare Improvement (IHI) developed the concept of “bundles”. A bundle resembles a list-generally three to five interventions-that, when performed collectively and reliably, have been proven to improve patient outcomes. Successfully implementing a bundle is clear-cut: “yes, I completed the entire bundle or no, I did not complete the entire bundle.” There is no partial credit for doing some of the steps some of the time.
For example, the Ventilator bundle has four care steps: raising the head of the bed 30 to 40 degrees; giving the patient medication to prevent stomach ulcers; preventing blood clots when patients are inactive; and seeing if patients can breathe on their own without a ventilator. If all these steps are carried out for every patient every time, the outcome will be a decrease in ventilator-associated pneumonia (VAP).
These are some ideas about what to measure and how to measure the evidence-based practice change. Your evaluation plan needs to be determined before you initiate the change in practice.
In order to evaluate the effectiveness of the EBP:
▪ know the current status of the indicator
▪ know the benchmark
▪ what goal you’d like to achieve
▪ consider frequency of data collection
▪ what data will be collected
▪ by whom
▪ how it will be displayed to the audience
▪ how will the data be used to impact change
Partner with your mentor or Quality Improvement specialist to now how to interpret the data; is the change significant, is it a blip or is there a trend over time.
Recognize success!
When you conducted a data base search in Lesson 5, what benchmarks were available? Using this kind of comparison helps a clinician look at practice with a different set of eyes.
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