Presentation on theme: "Changing Practice the Easy Way"— Presentation transcript:
1 Changing Practice the Easy Way Integrating quality & translational research modelsPeggy Brown DNP, RN, APRN-CNS-BC, NE-BCClinical Quality CoordinatorThe Nebraska Medical Center
2 Objectives Identify gaps between evidence and practice Recognize the role of Translational Science in improving quality of careDescribe one strategy/technique that you could use to facilitate a practice change
17 Compilation of Implementation Strategies 6 process68 implementation strategies and definitionsPowell BJ, McMillen JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review: MCRR, 69(2),
18 Examples of Strategies PlanningEducation StrategiesFinanceRestructure StrategiesQuality Management StrategiesConduct needs assessmentTrain-the-trainerAlter incentivesRevise rolesSmall tests of changeInvolve executive boardLearning collaborativeAccess new fundingChange physical structureAudit-feedbackVisit other sitesLocal opinion leadersCreate new service teamsImprovement advisorPowell et al. (2012)
20 Translational Research Model Titler & Everett (2001)
21 Characteristics of the Evidence-based practice/Innovation AdvantagesCompatibility with values and needsComplexityFeasibleCostTitler (2008)
22 Communication Mass media Opinion leaders –local, respected, influential, competent, trusted to evaluate knowledgeChange champions- local, expert clinicians, passionate, committed to improve quality, positive working relationshipsConsultation by expertsHallway chats, one-to-oneCommunication
28 Problem StatementIn January of 2014, The Joint Commission began mandating that hospitals with > 1,100 births per year, report the percent of newborns that were fed breast milk only from the time of birth to the time of discharge. From July 2012 to December 2012, 53% of eligible newborns at TNMC were fed breast milk exclusively.
29 DefineData recorded manually by Lactation Consultants for every newborn until automated in August 2013 with OneChart report Goal: top 10th percentile of UHC Top 10th percentile value unknown as new core measure and comparison data not yet available
30 Measures Exclusive breastfeeding Skin-to-skin contact at birth # Newborns fed breast milk only since birth# Single, term newborns discharged aliveSkin-to-skin contact at birth# Newborns with immediate, uninterrupted SSC until after 1st feed# Term, singleton, healthy newborns
31 Analyze Supplementation 50% of breastfed newborns were supplemented with non- breastmilk (Jan’13)Skin-to-skin contact (SSC) at birthLiterature review for evidence-based best practices revealed SSC to be the hospital practice most highly correlated with exclusive breastfeeding during hospitalization20% of healthy term newborns received skin-to-skin contact at birth (mother interviews, Jan’13)
32 Analyze Benefits of skin-to-skin contact at birth Physiologic stabilityRespirations, temperature, glucose levels, decreased crying & stressPromotes attachment behaviorsShort-term and long-termIncreased exclusive breastfeeding in hospitalLonger duration of breastfeeding
33 Critical X’s Solution Supplementation with non-human milk Follow provider orders not to supplement breastfed newborns without first notifying provider. Documentation of informed decision or medical indication for supplementation with non-human milk. Education to providers, nurses and parents on indications for supplementation.Limited skin-to-skin contact at birthImplement evidence-based practice of Skin-to-skin contact at birth
34 Improve – Characteristics of Innovation Skin-to-skin contact at birth has been recommended by leading health organizations since 1998 (WHO, AAP, ABM, NRP) Relatively simple Requires change in work flow Numerous benefits
35 Improve - Communication Increase understanding of advantages of innovationYou-tube videos of SSCsLinks to websitesResearch abstractsUnit meetingsClass for professionalsOne-to-one discussions with change champions/opinion leadersBulletin boards
36 Improve - UsersNurses & Providers Opinion leaders Change champions
42 Control – January 2014Monthly/Quarterly skin-to-skin percentages Feedback for individual trends 10th percentile – Are we there?
43 Share with your Neighbor Strategy you may use to enhance implementation of the next evidence-based practice3 minutes
44 Objectives Identify gaps between evidence and practice Recognize the role of Translational Science in improving quality of careDescribe one strategy/technique that you could use to facilitate a practice change
45 Powell BJ, McMillen, JC, Proctor EK, Carpenter CR, Griffey RT, Bunger AC, York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical Care Research and Review: MCRR, 69(2), Rogers, E.M. (2003). Diffusion of Innovations. New York : Free Press. Titler MG, & Everett, L. Q. (2001). Translating research into practice. considerations for critical care investigators. Critical Care Nursing Clinics of North America, 13(4), Titler, M. G. (2010). Translation science and context. Research & Theory for Nursing Practice, 24(1), doi: / Titler, M. (2008). Evidence for EBP implementation. AHRQ nursing handbook (1st ed., pp. Ch 7) Titler, M. G. (2011). Nursing science and evidence-based practice. Western Journal of Nursing Research, 33(3), doi: /
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