The evidence-based nursing practice program at CVMC seeks to advance clinical decision-making for improved patient outcomes and to transform the nursing practice environment through EBP. Towards these goals, a number of EBP initiatives and research projects were completed or begun in 2008.
A multidisciplinary team in the Critical Care Center implemented an EBP initiative that addressed glycemic control in critically ill patients. Though early work began in 2007, the EndoTool™ computer algorithm program (CAP) became operational January 01, 2008. Three CCU nurses designed and conducted a research study to evaluate morbidity and mortality in patients treated with and without CAP for blood glucose management. The research was accepted for presentation at the 9th Annual EBP Conference sponsored by Arizona State University in Phoenix where it received the award for best poster.
Treye Kennedy, BSN, RN, CCRN, provided this critical care nurse perspective – “In patient care, EBP initiatives may increase or decrease nursing work load. EBP can eliminate unnecessary tasks. It can also mean doing more.” Treye’s emphasized “it is about better patient outcomes. Take the EndoTool™ for example. It requires more patient blood sugar measurements, but less time on insulin titration.” This research, demonstrated a reduction in ventilator-associated pneumonia, bloodstream infections and mortality in the patients treated with the EndoTool™ CAP compared to patients treated with physician-written glycemic control orders.
Research into the role fatigue plays in documentation errors made by operating room nurses was completed in the final months of 2007. The research was presented at the 55th AORN Congress in Anaheim in April of this year where it received one of two national merit awards for poster presentations. The research manuscript was accepted for publication in the July Issue of AORN Journal1. Warren A, Tart R. Fatigue and charting errors: the benefit of a reduced call schedule. AORN. 2008;88(1):88-95.
In April, Kimberly Yates, MSN/MHA, RN-BC and Kensley Brumely, MSN, RN gave oral presentations at the regional Sigma Theta Tau conference. Yates’ post-implementation research followed a previous study in which psychiatric and medical patients patient falls were analyzed. Brumely compared the occurrence of rapid response team (RRT) and code blue calls during the establishment and following full establishment of CVMC’s RRT in nonintensive hospital areas.
A group of three psychiatric nurses developed and received approval for a research project to evaluate the effect of the physical environment on mood and anxiety levels of hospitalized psychiatric patients. Monique Robinson, BSN, RN, Veronica McCray, BSN, RN and Beth Rudisill, MSN, RN-BC began the research project mid-year.
CVMC’s Kenny Whiteside, BSN, RN, Patient Care Information Services, presented a talk entitled The “Magic” of Attributes to a standing room only crowd at the 2008 International MUSE (Medical Users Software Exchange) Conference in Dallas, Texas. In the Magic programming language, Kenny has used his knowledge of attributes to make screens user-friendly for Medical Center nurses. Attributes allow for setting defaults and skipping in screens among other things … simple sounding, but the macro coding required is quite complex. Kenny’s abstract was selected as one of six finalists for the International Education Exchange competition. This attests to the quality and practicality of the topic for medical software users abroad as well as here in the United States.
Other presenters at national meetings in 2008 included Beth Rudisill, MSN. RN-BC, Psychiatry at the National Nursing Staff Development Organization (NNSDO) Convention in Minneapolis, and Rebecca Tart, PhD at the 108th General Meeting of the American Society for Microbiology in Boston. Rudisill’s poster discussed suicide prevention outside the psychiatry department, while Tart presented research on healthcare-associated MRSA infections.
A poster, by Tart, Yates and Ann Moore, MSN, RN-BC, CEN, detailing CVMC’s research and EBP program education initiatives, was presented at the 5th Annual FL Magnet Research Symposium in Florida. This regional meeting drew attendees from the West coast and abroad.
We hosted a Dinner Theater in the Fall as a novel way of exposing our nurses to research being conducted at the Medical Center. Eighty-three patient care providers attended the 4-course dinner, which progressed through 3 venues, where they heard 5 different talks.
The Department for Research and EBP encourages Chulay’s model1 of unit-based nursing research where nurses lead research teams in their units. An accomplished researcher or an advanced practice nurse with research experience directs the team. This approach allows nurses to learn the research process by doing.
CVMC’s first unit-based research team is comprised of PACU nurses. These nurses decided to investigate the effect of music on discomfort experienced by their post-operative patients. Though the team began its study in 2007, data collection for the randomized study of experimental and control subjects was completed this year. An abstract of the research was submitted for review and acceptance to the 28th Annual American Society of PeriAnesthesia Nurses (ASPAN) Conference slated for April 2009. The PACU research team is anxiously awaiting news from ASPAN.
Emergency Department (ED) nurses formed CVMC’s second unit-based research team. This team began their study design in June of this year and received approval from the Clinical Research Review Board in November to commence with their research. The team is conducting a comparison study of temporal artery and rectal thermometry measurements in pediatric ED patients.
The Research & Evidence-Based Practice Council sponsored basic EBP education for nurses at the Medical Center throughout 2008. This education is designed to promote clinical inquiry into current practice, encourage willingness to search for evidence, and use the evidence-based approach to clinical issues/problems resolution. During the year, 159 CVMC nurses participated in the educational sessions. In addition, as an outreach endeavor, the Council provided the EBP education to nursing students in local nursing programs.
Seventeen Lenoir-Rhyne College senior nursing students, 7 CVMC Master Degree candidates and 3 employees presented projects at the 2nd Annual CVMC Research & EBP Day in April. Staff and visitors totaling 120 persons attended this event.
Our educational efforts are designed to build the EBP and research knowledge skills of nurses. To further hardwire research and evidence-based nursing practice throughout the organization, the nurse job description was revised in 2008 to include a competency for research and/or EBP.
Many activities and events where held in 2008, the most successful year to date for research and evidence-based practice at the Medical Center. We have a solid foundation for expanding research & EBP initiatives in the years to come.
1. Warren A, Tart R. Fatigue and charting errors: the benefits of a reduced call schedule. AORN. 2008;88(1):88-95
2. Chulay M, White T. Nursing research: instituting changes in clinical practice. Critical Care Nurse. 1989;9(5):106-113.