The main objectives of this section are to explain the justification for the methods used in collecting outcome data for the EBP implementation, describe how the outcome measures are able to assess the extent to which intervention objectives are realized, and illustrate how project outcomes will be measured and evaluated based on existing evidence. Additionally, this section not only details the strategies that will be used to deal with negative project outcomes but also elucidate implications for nursing practice and future research areas.
Justification for Methods Used
A computerized audit tool (e.g., real-time VAP bundle compliance dashboard or virtue instrumentation) will be used to calculate weekly nursing compliance with VAP bundled practices and its effect on outcome measures, such as hospital costs, length of hospital stay, ventilator days, and VAP rates (Sedwick, Lance-Smith, Reeder, & Nardi, 2012). The justification for using the dashboard is grounded on the fact the tool has the capacity to create user-defined measurement systems and provide healthcare professionals with timely and focused information that can then be summarized and compared using the most important indicators (Aydin, Bolton, Donaldson, Brown, & Murkerji, n.d.; Fine-Overholt & Johnston, 2007).
Since the main objective of the EBP prevention is to reduce the prevalence of ventilator-associated pneumonia (VAP) by implementing bundled practices in intensive care contexts, figures of average hospital costs, length of hospital stay, ventilator days, and VAP rates will be compared pre-test and post-test (before and after the project implementation) to identify any shifts or trends. If post-test scores show a declining trajectory in these outcome measures relative to pre-test scores, it will be possible to assume that the project objectives were achieved.
Evaluating Outcomes Based on Evidence
Important outcome measures will be measured and evaluated against the recent National Healthcare Safety Network (NHSN) VAP risk assessment data and the National Nosocomial Infections Surveillance System (NNISS) to provide “the information needed to identify whether VAP is increasing, decreasing, or remaining the same in the ICU” (Greene & Sposato, 2009, p. 21). These tools provide guidelines and risk scores on VAP rate (not exceeding the 25th percentile), mortality and morbidity attributable to VAP, financial cost considerations, and length-of-stay (LOS) in the ICU (Gallagher, 2012; Greene & Sposato, 2009; Sedwick et al., 2012). Validity and reliability will be guaranteed by utilizing conventional definitions and ensuring that the processes used to collect data are standardized so that statistical evaluation is relevant and comparative over time, while applicability will be addressed by comparing the trends in outcome measures with what is contained in the literature (evidence) to note similarities and/or differences.
Strategies for Addressing Negative Project Outcomes
Close monitoring and evaluation of any changes in outcomes will be undertaken after the EBP intervention is fully implemented with the view to supporting positive outcomes and remedying negative ones to achieve consistency with the initial project objectives (Melnyk, Fine-Overholt, Stillwell, & Williamson, 2010). As demonstrated by these authors, “monitoring the effect of an EBP change on health care quality and outcomes can help clinicians spot flaws in implementation and identify more precisely which patients are most likely to benefit” (p. 53).
Implications for Practice and Future Research Areas
The bundled practices contained in the EBP intervention could be used as a standard for clinical decision-making in intensive care contexts. Additionally, this intervention could be used to not only improve patient care outcomes (reduced LOS, ventilator days, and VAP rates) but also to generate marked cost savings for hospitals, patients, and families. An important area of interest for future research is to evaluate the efficacy of the bundled practices across patient age groups and racial orientation.
This paper has provided the criteria to be used in the evaluation process of the EBP intervention. It is hoped that these standards will be effective in evaluating if the outcome measures are a result of the implemented EBP project.
Aydin, C.E., Bolton, L.B., Donaldson, N., Brown, D.S., & Murkerji, A. (n.d.). Beyond nursing quality measurement: The nation’s first regional nursing virtual dashboards. Web.
Fine-Overholt, E., & Johnston, L. (2007). Evaluation: An essential step to the EBP process. Worldviews on Evidence-Based Nursing, 4(1), 54-59. Web.
Gallagher, J.A. (2012). Implementation of ventilator-associated pneumonia clinical guideline. Journal for Nurse Practitioners, 8, 377-382. Web.
Greene, L.R., & Sposato, K. (2009). Guide to the elimination of ventilator-associated pneumonia. Web.
Melnyk, B.M., Fine-Overholt, E., Stillwell, S.B., & Williamson, K.M. (2010). The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53. Web.
Sedwick, M.B., Lance-Smith, M., Reeder, S.J., & Nardi, J. (2012). Using evidence-based practices to prevent ventilator-associated pneumonia. Critical Care Nurse, 34, 41-50. Web.