Evidence Implementation in Clinical Settings

Introduction

While conducting research and developing strategies for improving clinical practices is essential, one must understand the challenges that arise when implementing the findings. A clinical environment that operates following evidence-based practices promotes continuous improvements in patient outcomes. However, this result can only be achieved by establishing a proper culture and having persistence when developing, implementing, and evaluating an intervention. This paper aims to describe the eight steps for implementing evidence-based practice and six sources of internal information that can be used to evaluate the outcomes.

Integrating Evidence into Practice

Similar to any organizational change, within a healthcare environment, it is necessary to develop a shared vision for the proposed changes that will serve as a guide to all team members. Additionally, having specific goals and presenting evidence supported by expert opinions can help overcome some of the barriers (Mazurek Melnyk, 2016). The eight steps that aid in integrating evidence-based solutions into practice are establishing a team, creating engagement or excitement, disseminating evidence, developing clinical tools, pilot testing, presenting energy sources, creating a timeline, and celebrating success (Hockenberry, Brown, & Rodgers, 2015). It is necessary to have a formal implementation team comprised of staff members and nurses who have a Masters’s or Doctorate who have the expertise and skills necessary to design the changes.

Creating engagement and excitement aligns with the need to create a vision for changing the clinical practice. Since a critical element of implementing a new practice is ensuring that the person follows the new guidelines, one should ensure that they are aware of the changes, why those are necessary, and the potential benefits that this will have on the staff. Disseminating evidence involves presenting the actual data that suggests the need for changes. This element is also a part of the staff engagement process, although it focuses more on the facts underlying the practice change.

Developing clinical tools involves creating a guideline or an algorithm that the person can use to take advantage of the new practice. Also, Hockenberry, Brown, and Rodgers (2015) recommend developing reminders or alert systems that will help the staff to adhere to the practice. Pilot testing is an important aspect that incorporates a test using a small sample. In the context of the clinical practice change, this means that the concept will be proven in a setting where it will be implemented before widespread adoption (Hockenberry, Brown, & Rodgers, 2015). This is also helpful for addressing concerns and answering staff questions that can clarify some of the aspects of evidence-based practice. Preserving energy sources is a part of the planning process, which suggests a need to eliminate fatigue from the changes by dividing a large project into smaller parts. By having phases of implementation, one can share the success of previous stages and encouraged staff for further changes.

Creating a timeline for success involves planning each aspect and time for implementation. In general, having a clear plan that will address different phases and expected outcomes should serve as a roadmap for the personnel. Hockenberry, Brown, and Rodgers (2015) also recommend considering priorities when creating a timeframe for the project. Celebrating success is an unobvious component of the implementation process that can often be overlooked. However, Hockenberry, Brown, and Rodgers (2015) suggest that it is crucial to be able to praise the team members who helped adapt the changes and present the positive outcomes to present the results of the project.

The barrier that can arise when integrating the practice connected to the high staff turnover and patient satisfaction is the lack of support from the organization. Gallagher-Ford, Buck, and Mazurek Melnyk (2015) state that resistance to the evidence-based practice is a common barrier identified by nurses in a 2001 survey and can be seen in not only the personnel but also the leaders and managers of a healthcare establishment. Hence, obtaining organizational support and developing a culture that helps implement new practices is necessary to overcome the barrier and achieve success. This can be done by explaining the connection between high turnover and patient dissatisfaction, which affects the bottom line of a hospital.

Sources of Internal Evidence

Evaluation of outcomes serves as an important element of evidence-based practice adoption since, through this process, one can determine the impact of changes on a health care establishment. Brewer and Wojner Alexandrov (2015) argue that “health status, death, disability, iatrogenic (undesirable or unwanted) effects of treatment, health behaviors, and the economic impact of therapy and illness management” are among the common information that can be collected from internal sources (p. 224). There are a variety of sources within a hospital that one can use, and it is necessary to understand what type of information can be collected through a specific channel.

The six sources of internal evidence that can be used to assess data supporting the improvement of outcomes are – “include quality management, finance, and human resource departments; clinical systems; administration; and electronic health records (EHRs)” (Brewer & Wojner Alexandrov, 2015, p. 227). Quality management reports are usually a part of the hospitals’ assessment of adverse events, such as falls, medical errors, near misses, or others. Additionally, these departments are usually responsible for assessing patient satisfaction rates. This information can be used to discover trends of hospital-specific elements that affect patient health, or it can be compared to other information, for example, nurse-patient ratios.

The data from the finance department can help in examining the cost reduction element of intervention since this is an important aspect of healthcare management. Additionally, the billing registers contain data about the diagnosis and volumes of patients (Brewer & Wojner Alexandrov, 2015). Human resource (HR) departments can provide data regarding employment rates and compensations. This is especially useful for my clinical question since HR records can be used to assess turnover rates in ED and compared to evidence from other internal sources, a trend in improving or decreasing patient satisfaction can be examined.

Clinical systems contain large volumes of data that vary from test results, pharmacy data to dashboards for reporting outcomes. Administration departments are usually responsible for complaints from patients, which can also help examine patient satisfaction ratios. This is usually executed as either a call log or a table (Brewer & Wojner Alexandrov, 2015). Finally, an information source that contains large volumes and a variety of patient-related data is Electronic health records (EHR). This is a suitable source for collecting patient-specific information such as vital sins, diagnosis, and other clinical documentation.

Conclusion

Overall, this paper explained the steps that one has to take when implementing a change in a healthcare setting. Additionally, it provided an assessment of the six main information sources that can help examine the outcomes. Executing change in a healthcare setting is a challenging task that requires one to have not only concrete evidence supporting new development but also persistence in engaging other staff members in the implementation process.

References

Brewer, B. B., & Wojner Alexandrov, A. (2015). The role of outcomes and quality improvement in enhancing and evaluating practice change. In B. Mazurek Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare (3rd ed.) (pp. 224-234). New York, NY: Wolters Kluwer Health.

Gallagher-Ford, L., Buck, J., & Mazurek Melnyk, B. (2015). Leadership strategies and evidence-based practice competencies to sustain a culture and environment that supports best practice. In B. Mazurek Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare (3rd ed.) (pp. 235-251). New York, NY: Wolters Kluwer Health.

Hockenberry, M. J., Brown, T. L., & Rodgers, C. C. (2015). Implementing evidence in clinical settings. In B. Mazurek Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare (3rd ed.) (pp. 202-223). New York, NY: Wolters Kluwer Health.

Mazurek Melnyk, B. (2016). Improving healthcare quality, patient outcomes, and costs with evidence-based practice. Web.