NURS FPX 8035 Evaluating and Sustaining Change from EBP

Paper Details

Evaluating and Sustaining Change from EBP

The Tufts Medical Center Hospital, part of Villa Health, has uncovered a flaw in the hospital’s patient safety rankings. Among the categories with “worse than projected” results in 2018 and 2019 were fall-related injuries, allergic reaction-related medical errors, and injuries to hospital staff (Almquist, 2021). In response to the identification of this issue, an evidence-based incident reporting procedure was established.

Will an evidence-based incident reporting system (I) be implemented for patients and staff at Tufts Medical Center Hospital (P) in comparison to the current (C) reporting structure for incidents, resulting in a reduction in patient and safety events such as falls, medication errors, and staff injuries (O) over the next year (T)?” We have noticed some outcomes after putting the plan into action for twelve weeks.
Outcomes Analysis

Data from the evidence-based event reporting system for the first quarter of 2020 showed a drop in the number of falls, medical errors, and staff injuries compared to the same period in 2019. The process of evaluating the intervention’s impact starts here. More information from the incident reporting system will be necessary, including the location of occurrences, the responsibilities of reporters, reports on exceptional catches, and incident reports that have an influence on the three particular metrics that the team is attempting to improve upon. It is feasible to use these data points to determine the true impact that has been exerted on the outcomes that have been seen.

Another important source of information for the research is feedback from participants about the intervention. More qualitative data, rather than merely the number of patient safety events, may be gathered in order to evaluate the intervention’s efficacy and effectiveness. In order to understand how the intervention influences staff and patient safety behaviors, it is vital to get staff comments on the success of the intervention as well as their ideas for system modification or improvement throughout the intervention (Fineout-Overholt et al., 2011). Two efforts that got positive comments from the ICU team were an informative poster presentation and expanded rounds by environmental services.

Continuing Evaluation Plan

Implementing a continuous assessment plan via the use of a PDSA cycle is a successful strategy.

Continuous Quality Improvement (CQI) is a cornerstone of the health-care industry, and the Plan, Do, Study, Act cycle is one of the most often used procedures in the industry. There are four stages in the PSDA cycle, which are as follows: 1. Develop a change plan based on the facts you have gathered, 2. Carry out (do) the planned change, 3. Monitor qualitative and quantitative measurements at predetermined intervals to determine if the intended impact has occurred, and 4. Act to modify the change or standardize the change (Laverentz & Kumm, 2017).

An adequate time frame for this project’s PDSA cycle would be quarterly. To study the efficacy of the evidence-based intervention, both quantitative and qualitative data are needed. The quantitative data for this project will continue to include patient falls, medical errors, and staff member injuries according to Carlfjord et al. (2019) Gathering qualitative data for the project will require leaders to be very intentional in their approach.

Initially, there were differing opinions among the medical staff about the implementation of an evidence-based intervention, so gathering feedback from the medical providers through a short survey would help the team understand the effect of the intervention from their perspective. Early feedback data from nursing staff in the ICU was very promising. Town halls and staff

meetings are excellent venues to gather staff perspectives about how the intervention is going, what could be improved or eliminated, and to gauge change to the organizational culture.

Strategies to Sustain Change

Sustaining evidence-based practice change is a challenge faced by most health care organizations today. Organizational culture is key, and a structure or framework is needed for leadership and staff to work together in a flattened hierarchy. One important structure that should be implemented is shared governance. Shared governance structures help employees feel valued and invested in the success of the organization. These councils open the door to communication and collaboration with leaders at all levels, and multi-disciplinary groups that have a vested interest in improving patient care (Kroning & Hopkins, 2019).

Organizations with robust shared governance structures in place may choose to also develop higher level interventions such as Research Fellowship programs. These programs recruit staff nurses to learn from experts within the organization and to develop, implement and evaluate a project that is relevant either in their practice area or hospital-wide (Tucker et al., 2020).

Communication with staff at all levels of the organization is critical to sustaining change in any type of organization. It will be important for Tufts Medical Center leadership to support evidence- based practice change by utilizing multi-modal communication channels such as staff meeting discussions, bulletin board flyers, emails, newsletters, and personal conversations to report out the successes of EBP projects and to recognize staff contributions to these successes.

Additionally, providing basic education on EBP to staff and providers on an ongoing basis will help leaders build and sustain a culture of EBP and help pique the interest of those staff that may not yet be involved in shared governance or research activities.

Conclusion

Villa Health’s Tufts Medical Center Hospital has seen some early success with the implementation of an evidence-based intervention to reduce safety events. Early quantitative and qualitative data points to continuing the project, and a continuous improvement plan will be implemented using a PDSA cycle quarterly. Quantitative data will continue to include falls, medication errors, and staff injuries, while qualitative data points will include provider and staff perspectives from surveys and town halls.

Changing organizational culture to one that supports EBP requires intentional activities and support from leadership. Shared governance, research fellowship programs, and multi-modal communication strategies are needed to keep evidence-based practice in front of staff throughout the hospital and to create a culture of inquiry and change. Organizations that implement these strategies will see that empowered staff feel valued and invested in the organization and will reap the rewards of their continued attention to building an evidence-based practice culture.

References

Almquist, S. (2021). Integrating and implementing qualitative evidence ([Unpublished manuscript]). Capella University.
Carlfjord, S., Öhrn, A., & Gunnarsson, A. (2018). Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators. BMC health services research, 18(1), 1-9.
Fineout-Overholt, E., Gallagher-Ford, L., Mazurek Melnyk, B., & Stillwell, S. B. (2011).

Evidence-based practice, step by step: Evaluating and disseminating the impact of an evidence-based intervention: Show and tell. AJN, American Journal of Nursing, 111(7), 56–59. https://doi.org/10.1097/01.naj.0000399317.21279.47
Kroning, M., & Hopkins, K. (2019). Healthcare organizations thrive with shared governance.

Nursing Management, 50(5), 13–15. https://doi.org/10.1097/01.numa.0000557781.40049.2d
Laverentz, D., & Kumm, S. (2017). Concept evaluation using the pdsa cycle for continuous quality improvement. Nursing Education Perspectives, 38(5), 288–290. https://doi.org/10.1097/01.nep.0000000000000161
Paragraphs: Organization (MEAL Plan). (2021). Walden University. https://academicguides.waldenu.edu/
Tucker, S. J., Gallagher-Ford, L., & Jang, E. (2020). Ebp 2.0: Implementing and sustaining change: The evidence-based practice and research fellowship program. AJN, American Journal of Nursing, 120(2), 44–48. https://doi.org/10.1097/01.naj.0000654320.04083.d0

Appendix

One of the feedback items identified from the last assignment was paragraph structure.

Paragraphs were too long and were not always properly structured. To improve paragraph structure, the MEAL plan was used for this paper. Paragraphs are organized according to the MEAL plan as follows:

Main Idea: Topic sentence, claim the paragraph is advancing
Evidence: Quotes or paraphrased source material which supports your topic
Analysis: An explanation of the relevance of the evidence provided, and an evaluation in your own words.
Lead out: A conclusion that leads the reader into the next paragraph.

The MEAL plan can be used to outline each paragraph prior to writing, or during the revision and editing process.
In this paper, the MEAL plan was used during the editing and revision process to ensure that each paragraph is serving a specific purpose, reduce repetition, and advance the paper’s central argument (Paragraphs: Organization (MEAL Plan), 2021).