NCMB418 LECTURE: Prelim Week

03
Quality & Safety in Critical Care
Bachelor of Science in Nursing 4Y1
Professor: Michael Joseph Diño, PhD, MAN, RN, LPT
QUALITY & SAFETY IN CRITICAL CARE 5) Time frame
Knowledge Translation - How long will it take to reach the desired outcome?
- Applying research in nursing practice Example 1:
- Effective and timely exchange, synthesis and application of "I work in MICU where ventilator-related infections are a
knowledge among researchers and users to capture the common problem. I've heard that oral care of ventilated
benefits of research patients even with water can help prevent this. I wonder if
there's any evidence for that and whether it might help our
patients?"
P – patients in MICU
I – water
C – oral care with water only
O – Prevention of ventilator-related infections
T - (will depend on the time frame set)

The SPIDER tool – can be used when dealing attitudes and

Evidence-Based Nursing (EBN) experiences rather than scientifically measurable data since it
- Under the umbrella of Evidence Based Practice focuses less on the intervention and more on the design.
- Definitions of evidence-based nursing have varied in Deals with "samples" rather than a "patient" or "populations".
scholarly literature 1) S – ample (group of participants)
- Application of the best available evidence often from 2) PI – phenomenon of interest (how and why of behaviors
research findings into the clinical setting to ensure best and experiences)
practice 3) D – esign (how the study was devised and conducted)
- Scott & McSherry’s extensive literature review looked at 4) E – valuation (measurement of outcome; might be
commonalities between EBN definitions and synthesized subjective and not necessarily empirical)
them to come up with the following definition: “An ongoing 5) R – esearch Type (qualitative, or quantitative, or mixed)
process by which evidence, nursing theory, and the Research questions framed using the SPIDER tool tend to
practitioners’ clinical expertise are critically evaluated and begin with "What are the experiences of ...?"
considered, in conjunction with patient involvement, to Example: "What are the experiences of fourth year university
provide delivery of optimum nursing care for the individual.” students in using their critical care units related learning
(Melnyk, B, Fineout-Overholt, E., Stillwell, S., and experience?"
Williamson, K., 2010). S Fourth year university students
PI CCUs RLE
Steps of Evidence-Based Nursing D Survey
Step 1 – Ask Clinical Questions E Experiences (of having the RLE in CCUs)
PICOT Format – framing a clinical question in EBP R Qualitative
1) Population
- What are the characteristics and/or condition of the Step 2 – Gather Evidence
group? To describe if clinical practice is streamlined when questions
- Patient/ population of interest/ problem (start with the are asked
patient, or group of patients, or problem) 1) Internal Evidence
2) Intervention - Direct from client or institutions
- What is the screening, assessment, treatment, or 2) External Evidence
service delivery model that you are considering. - Scientific literatures; research database
- What is the proposed intervention? - Kapag maghahanap ng research = Meta-analysis papers
3) Comparison 3) Database
- What is the main alternative to the intervention, Step 3 – Assess the Evidence
assessment, or screening approach. - Once articles are selected for review, these must be rapidly
- (What is the main alternative, to compare with the appraised to determine those most relevant, valid, reliable,
intervention? This might be no intervention.) and applicable to the clinical question. (Guide: Are the
4) Outcome results of the study valid? What are the results and are they
- What do you want to accomplish, measure, or improve important? Will the results help me care for my patients?)
- What is the anticipated or hoped-for outcome? - Iassess kung quality sya or hindi, kung applicable ba sya sa
setting mo

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1) Internal Evidence – Does this study investigate a

population similar to my client?
2) External Evidence – Is your client demonstrating a
response to the intervention?
Step 4 – Make your Clinical Decision
- Synthesize the studies to determine if they come to similar
conclusions, thus supporting an EBP decision or change
- Research evidence alone is not sufficient to justify a
change in practice. Clinical expertise, based on patient
assessments, laboratory data, and data from outcomes
management programs, as well as patients' preferences
and values are important components of EBP
1) Define – Your clinical question
2) Extrapolate – Applicable information from external
evidence
3) Consider – Clinical expertise
4) Incorporate – Needs and perspectives of clients
5) Develop – Assessment & treatment plan
6) Evaluate – Your clinical decision

Forest plot
- An essential tool to summarize information on previously
published study findings.
- Research figure
- Invented by Richard Peto (Statistician and Epidemiologist,
Pag nagcross ng line ung diamond = parehas lng, walang
University of Oxford)
difference ang intervention
Pag hindi sya nag cross ng line = meron syang pagkakaiba

Salient Points to consider in the use of EBN Practice:

• Promotes use of EBP among advanced practice nurses and
direct care nurses
• Identifies a network of stakeholders who are supportive of
the EBP project
• Cognitive behavioral theory underpinnings
• Emphasis on healthcare organizational readiness and
identification of facilities and barriers
• Encompasses research, patient values, and clinical
expertise as evidence.

Quality and Safety Monitoring

1) Care bundles
- A group of 3-5 evidence-based interventions, when
performed together, have a better outcome than if
performed individually
- can be used to ensure the delivery of the minimum
standards of care
- can be used as an audit tool to assess the delivery of
interventions
- NOTE: cannot be used to assess how well individual
interventions are performed
- encourage the review of evidence and modification of
clinical care guidelines, engendering staff education in
best practice
- key principle = high level of adherence to all
components
- Example: The sepsis care bundle, part of the
international Surviving Sepsis campaign, is the most
widely utilized bundle.
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2) Checklists Advocacy: Access to social care services

3) Continuous quality improvement • PhilHealth
4) PDCA - Plan-Do-Check-Act (PDCA) cycle (Deming Cycle, • DOH
Shewhart Cycle) • DSWD
- a management tool for continuous improvement of a • PAGCOR
business's products or processes. It can be applied to • PCSO
standardize nursing management and thus improve the
nursing quality and increase the survival rate of patients
- Uses: implementation of change, solve problems, and
continuously improve nursing management processes
- cyclical nature; allows it to be utilized in a continuous
manner for ongoing improvement
P - PLAN the change or improvement
D – DO = conduct a pilot test of the change
C – CHECK = gather data about the pilot change to
ensure the change was successful
A – ACT = implement the change on a broader scale;
continue to monitor the change and repeat as
necessary by repeating the cycle
- Expertise Required: easy to use and requires little or no
training.
- Advantages:
• Makes sure that all appropriate steps are followed.
• Offers a systematic improvement method.
• Is an effective process improvement guide.
• Informs future improvement by providing feedback.
• Maintains order during problem solving.
- Disadvantage: Requires significant commitment over
time.

Multidisciplinary plans of care

- benefits to both patients and the hospital system:
1) Improve patient’s outcome
2) Increased quality and continuity of care
3) Improve communications and collaboration
4) Identification of hospital system problems
5) Coordination of necessary services and reduced
duplication
6) Prioritization of activities
7) Reduce length of stay and health care costs.
Format for the multidisciplinary approach categories:
1) Discharge outcomes
2) Patient goals
3) Assessment and evaluation
4) Consultations
5) Tests
6) Medications
7) Nutrition
8) Activity
9) Education
10) Discharge planning
NOTE: Primary consideration = patient’s safety
Information and communication technologies in CCU
1) Clinical Information System
2) Computerized provider order entry (CPOE)
3) Hand-held Technologies
4) Tele-health Initiatives (Tele-ICU)

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