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CHANGING PRACTICE THE EASY WAY INTEGRATING QUALITY & TRANSLATIONAL RESEARCH MODELS Peggy Brown DNP, RN, APRN-CNS-BC, NE-BC Clinical Quality Coordinator.

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Presentation on theme: "CHANGING PRACTICE THE EASY WAY INTEGRATING QUALITY & TRANSLATIONAL RESEARCH MODELS Peggy Brown DNP, RN, APRN-CNS-BC, NE-BC Clinical Quality Coordinator."— Presentation transcript:

1 CHANGING PRACTICE THE EASY WAY INTEGRATING QUALITY & TRANSLATIONAL RESEARCH MODELS Peggy Brown DNP, RN, APRN-CNS-BC, NE-BC Clinical Quality Coordinator The Nebraska Medical Center

2 OBJECTIVES 1.Identify gaps between evidence and practice 2.Recognize the role of Translational Science in improving quality of care 3.Describe one strategy/technique that you could use to facilitate a practice change

3 HERE A GAP, THERE A GAP, EVERYWHERE A GAP, GAP

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9 CLOSE THE GAP

10 MEET YOUR NEIGHBOR Share your experience with a GAP 3 minutes

11 FOLLOW A MAP

12 http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx

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14 TRANSLATIONAL SCIENCE “Diffusion & implementation” “Knowledge translation & integration”

15 DISSEMINATION OF EVIDENCE RESEARCHERUSER Practice guidelines Publications Tool kits Presentations

16 IMPLEMENTATION OF EVIDENCE USER PATIENT

17 COMPILATION OF IMPLEMENTATION STRATEGIES 6 process 68 implementation strategies and definitions 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), 123-157.

18 EXAMPLES OF STRATEGIES PlanningEducation Strategies FinanceRestructure Strategies Quality Management Strategies Conduct needs assessment Train-the- trainer Alter incentives Revise rolesSmall tests of change Involve executive board Learning collaborative Access new funding Change physical structure Audit- feedback Visit other sites Local opinion leaders Create new service teams Improvement advisor Powell et al. (2012)

19 FOLLOW A MAP

20 TRANSLATIONAL RESEARCH MODEL TITLER & EVERETT (2001)

21 CHARACTERISTICS OF THE EVIDENCE- BASED PRACTICE/INNOVATION Advantages Compatibility with values and needs Complexity Feasible Cost Titler (2008)

22 COMMUNICATION Mass media Opinion leaders –local, respected, influential, competent, trusted to evaluate knowledge Change champions- local, expert clinicians, passionate, committed to improve quality, positive working relationships Consultation by experts Hallway chats, one-to-one

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24 USERS Stakeholders Adoption of practice varies Audit and feedback changes behavior Opinion leaders Change agents

25 SOCIAL SYSTEM Organizational resources Organizational size Organizational culture Readiness for change Structure supporting EBP Leadership support

26 Map: Integrated quality improvement and translational research model EBP: Uninterrupted skin-to- skin contact at birth IMPLEMENTATION EXAMPLE

27 Define Measure Analyze Improve Innovation Communication Social System Users Control Adoption Feedback

28 PROBLEM STATEMENT In 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 DEFINE Data recorded manually by Lactation Consultants for every newborn until automated in August 2013 with OneChart report Goal: top 10 th percentile of UHC Top 10 th percentile value unknown as new core measure and comparison data not yet available

30 MEASURES Exclusive breastfeeding # Newborns fed breast milk only since birth # Single, term newborns discharged alive Skin-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 birth  Literature review for evidence-based best practices revealed SSC to be the hospital practice most highly correlated with exclusive breastfeeding during hospitalization  20% 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 stability o Respirations, temperature, glucose levels, decreased crying & stress Promotes attachment behaviors o Short-term and long-term Increased exclusive breastfeeding in hospital Longer 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 birth Implement 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 innovation  You-tube videos of SSC  Emails  Links to websites  Research abstracts  Unit meetings  Class for professionals  One-to-one discussions with change champions/opinion leaders  Bulletin boards

36 Nurses & Providers Opinion leaders Change champions IMPROVE - USERS

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39 IMPROVE – SOCIAL SYSTEM Provided structure for innovation:  Shared governance structure  Quality triad  Policy/procedure

40 CONTROL – JULY 2013 Audit-feedback Skin-to-skin contact weekly, individual Monthly exclusive breastfeeding %

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42 CONTROL – JANUARY 2014 Monthly/Quarterly skin-to-skin percentages Feedback for individual trends 10 th percentile – Are we there?

43 SHARE WITH YOUR NEIGHBOR Strategy you may use to enhance implementation of the next evidence-based practice 3 minutes

44 OBJECTIVES 1.Identify gaps between evidence and practice 2.Recognize the role of Translational Science in improving quality of care 3.Describe 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), 123-157. 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), 587-604. Titler, M. G. (2010). Translation science and context. Research & Theory for Nursing Practice, 24(1), 35-55. doi:10.1891/1541-6577.24.1.35 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), 291-295. doi:10.1177/0193945910388984


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