CHAPTER 28 Translation of Evidence into Nursing Practice: Evidence, Clinical practice guidelines and Automated Implementation Tools

Fundamentals of clinical practice The current pace of changes with healthcare knowledge and technology continues to accelerate. Computers and decision support systems provide tools for healthcare providers to manage this exponential increase of information so that the most effective treatment decisions can be made that will result in the optimal outcomes for patient

Evidence based practice Is a systematic approach to clinical decision-making that uses the best evidence in making decisions about patient care Provides an approach to coping with the constantly changing knowledge base about the works best in healthcare EBP has three components: A critical appraisal of the relevant research evidence The healthcare practitioner clinical expertise The patient’s values and preferences

Clinical practice guidelines are defined by the Institute of Medicine as systematically developed statements to assist practitioner and patient decisions about appropriate healthcare or specific clinical circumstances. Evidence-based clinical practice guidelines are gaining favor as instruments for promoting quality care Guidelines are defined as quality tools because when implemented effectively, they promote patient outcomes and reduce to outcome variations.

In summary, guidelines are only as good as the evidence on which they are based. Providers need to assess the quality of a guideline and evaluate whether or not it will contribute to improve patient outcomes. Key questions to are here: Who developed this guidelines? Is the guideline developed using an evidence-based approach? Is the guidelines updated? Is it presented in presentable format? Are the benefits and harms presented to support sound decision-making? Are costs considered?

Implementation What is implementation? Effects of guidelines Is defined as applying textual information to real situations. Successful implementation implies compliance and the ability to manage change. Implementation is the active employment of a guideline to promote effective and efficient care in order to improve patient outcomes. Effects of guidelines They have the potential to improve quality of care delivered and the outcomes of that care. The ability of a guidelines to improve the quality care depends on what evidence is incorporated with the guidance and the implementation of that guidelines into practice Evaluation of guidelines Evaluation of the effects of clinical practice guideline use by practitioner focuses now on the computerization of the guidelines.

Putting Nursing Guidelines into Practice: Finding WHAT works The lessons learned from nursing care plans are applicable: guidelines that sit on a shelf will collect dust and not contribute to improved outcomes. Quality improvement using guidelines and other quality tools is most likely achieved and sustained over a long period when there is ongoing commitment from leaders to manage change proactively.

Computers and Guidelines at their best, automated tools are the most powerful resource available to facilitate guidelines implementation. For many reasons, computers are potentially an ideal match for guidelines: Computer permit centralized storage and retrieval of guidelines Computer facilitate communication between different providers or between providers and patients Computer enhance the speed, timeliness, and presentation of feedback reports Computer expand the accessibility of guidelines and related decision analysis tools

Computers make decision analysis infinitely easier and more powerful Computers provide a means for integrating guidelines with clinical information about effectiveness and outcomes In short, computers make it easier for providers and patients to access, use, and communicate guideline-related information. This promotes sound decision-making and facilitates changes

Decision Support Systems Decision analysis offers a way to link the probability of a clinical course to the likelihood of specific outcomes. The results of clinical decisions can be predicted and the probability of alternative strategies can be quantified.

Computerized Reminder Systems Automated reminder are infinitely more powerful, especially when they cannot be ignored or turned off easily. Whatever their form, reminders are most useful when used in real time. Both automated and paper reminders are ideal for health promotion and preventive care. Online access to guidelines Online communication provides a convenient, cost effective vehicle for information dissemination and exchange. Online tools are more powerful when integrated within an overall communication strategy and targeted to the specific information needs of each stake holder

Automated Flow Sheets as Part of an Electronic Patient Record As EHR evolves, mechanisms for recording data will improve so that the frequency of events within specified time periods can be more easily analyzed. These data can then be linked to a variety of computerized tools relevant to guidelines. Computer Used to Facilitate Academic Detailing AD is an acronym used to describe customized educational outreach. Individual providers are targeted for education. Computer can supplement AD in variety of ways.

Choosing Computerized Tools Although a theory based, active, multi prolonged approach aids in the initial consideration of appropriate tools, the unique needs of each healthcare settings also guide in implementing decisions about tools. Nursing Role in Using Automated Tools Nurses must have the proper knowledge on using this automated tools such as the use of specific guidelines in order to improve the outcomes of quality nursing care to the patients