Answering your question: EBP, QI, or Research? And where to start? Lynn Gettrust, MSN, RN, ACNS-BC Perioperative CNS Mary Hagle, PhD, RN-BC, FAAN Nurse Scientist Clement J. Zablocki VA Medical Center Milwaukee, WI

Objectives Differentiate aims for EBP, QI, and research. Formulate the approach for an EBP and research project

Integration of QI, EBP, and Nursing Research QI Have evidence or data Need more evidence EBP No Evidence Evidence NURSING RESEARCH Adapted from Julia W. Aucoin, DNS, RN-BC, CNE

BEST AVAILABLE EVIDENCE CLINICAL EXPERTISE PATIENT PREFERENCES EBP

Evidence-Based Practice (EBP) EBP is the use of best evidence to make patient care decisions. EBP integrates three components: 1. The use of current best evidence by the nurse and shared with the patient 2. The professional nurse's knowledge and expertise 3. The patient’s preferences and values in the current context

EBP Process Asking a clinical question Searching for the best evidence Appraising and Synthesizing the evidence Making recommendations Implementing a practice change Evaluating and sustaining the practice change

Constant purpose of improvement through measuring, understanding and revising processes – Using process and outcome measures – Decisions made for individual organization Quality Improvement (QI)

Decisions about practice recommendations Adopt, adapt, no change, research Strength of Evidence Burden of Change

When is it RESEARCH and not QA/QI/PI? It is RESEARCH when there is...a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to " generalizable " knowledge. (45 CFR d) Research

Generate knowledge applicable to patients in many settings May benefit an individual patient, but cannot be guaranteed Provide science for our actions Benefits of research

Finding the Evidence Convert clinical question into a format that aids the literature searching process PICO(T) format – Population – Intervention – Comparison – Outcome – Time

PICO(T) Population: For adults needing urinary catheter insertion, male/female, excluding bladder surgery / long- term indwelling / SCI / GU procedure or with problems, Intervention: Allow free urine drainage during urinary catheter insertion versus Comparison: Current state of clamping & varying practices, Outcome: Safe patient with no adverse events, such as bladder spasm, discomfort, hypotension/ fall, or UTI and – Standardized, evidence-based nursing procedure that is retrievable. Timeframe: During urinary catheter insertion and immediately post-insertion