EBP Team Project Jessica Alred, April Dye, Tiffany Scroggins, Leisa Taylor Auburn Montgomery

What is Evidence-Based Practice? According to Howlett, Rogo, & Shelton (2014), “Evidence based practice is the process of combining the best available research evidence with your knowledge and skill to make collaborative, patient- or population-centered decisions within the context of a given healthcare situation” (p. 9).

Steps of the EBP process: Recognizing a need for information Establishing a purpose for the query Formulating a focused clinical question Identifying target resources to be searched for evidence Performing a search for evidence Organizing evidentiary findings Appraising evidence for trustworthiness Assessing evidence for relevance to the focused question Selecting an appropriate action based on relevant evidence Implementing an appropriate action based on relevant evidence followed by evaluation of the action for effectiveness.

Case Study An EBP team was assembled to further explore the utilization of evidence-based practice for a specific case study. The case study selected involves oncology patients who frequently require peripheral intravenous access to receive chemotherapy, blood products, replacement fluids, as well as multiple other therapies. The case study suggests that intravenous access initiation is frequently a source of anxiety and discomfort for such patients. It discusses the application of heat to improve the success of intravenous access attempts and poses the question of whether the application of moist heat or dry heat is the best method.

Peripheral intravenous catheterization or therapy involves the placement of a short, flexible, plastic catheter into a peripheral vein. The device, which typically involves a cannula-over-needle, is available in several different sizes or gauges. Peripheral vein access is most commonly used in a peripheral extremity, such as arm or hand.

EBP Team—Purpose & Goal For the purpose of this project, the EBP team will compare the use of dry heat versus moist heat in the implementation of peripheral intravenous catheterization. The goal of the query is to determine which application of heat is most effective in reducing the number of insertion attempts, therefore decreasing patient discomfort.

Focused Question What is the highest level of evidence available on the use of moist heat versus dry heat in reducing the number of peripheral intravenous catheterization attempts for patients who require frequent intravenous access?

What information was available? The highest level of evidence found during the search was two quantitative studies relevant to the focused question. The EBP team was unable to locate a qualitative study related to the focused question. The search did not reveal a meta-analysis or systematic review related to the focused question. Overall, the EBP team found limited evidence relevant to the focused question.

References Fink, R., Hjort, E., Wenger, B., Cook, P., Cunningham, M., Orf, A., Pare, W., & Zwink, J. (2009). Impact of dry versus moist heat on peripheral IV catheter insertion in a hematology-oncology outpatient population. Oncology Nursing Forum, 36, 199-204. doi: 10.1188/09.ONF.E198-E204 Kaur, M., Kaur, S., & Patel, F. (2011). Effect of moist heat therapy on the visibility and palpability of peripheral veins before peripheral venous cannulation of patients undergoing chemotherapy. Nursing and Midwifery Research Journal, 7, 99-105. Retrieved from http://medind.nic.in/nad/t11/i3/nadt11i3p99.pdf

Quantitative Studies Study 1 Study 2 Two group, randomized controlled clinical trial To determine whether dry versus moist heat application to the upper extremity improves IV insertion rates 136 hematologic outpatients with cancer or other malignancies requiring frequent intravenous access. Participants were randomly assigned to dry or moist heat. Data was collected by observation. SPSS 16 software was used to analyze data. Dry heat was 2.7 times more likely than moist heat to result in successful IV insertion on the first attempt. Clinical Trial To determine if moist heat therapy improves the visibility and palpability of peripheral veins before venous cannulation. 60 subjects whose veins were not visible or palpable All were scheduled to undergo frequent peripheral venous cannulation for administration of chemotherapy. Data was collected by observation SPSS 16 software was used to analyze data. 40% of subjects had clearly visible and easily palpable peripheral veins. 33.3% had the score visible and palpable veins. In 11.7% subjects the veins were visible but not palpable after the intervention.

Highest level of evidence The best evidence found by the EBP team suggests that the application of dry heat is 2.7 times more likely than the application of moist heat to result in successful IV cannulation on the first attempt. (Fink et al., 2009, p. 198). Increasing the likelihood of successful IV cannulation on the first attempt aids in the prevention of venous depletion in patients who require frequent IV access, such as those identified in the case study.

Course of Action The application of dry heat to a selected peripheral extremity prior to intravenous cannulation for clients who requires frequent IV access. Screening clients who require frequent IV access for a prior history of difficulty with intravenous cannulation to determine the need for dry heat application. Screening process should include a questionnaire regarding the success of a client’s previous intravenous cannulation attempts. The screening process should also include a visual assessment of the client’s upper extremity for suitable IV target vessels. If a client is found to have a history of frequent unsuccessful IV attempts or has poorly visible target vessels, the EBP team recommends implementing the application of dry heat therapy to aid in successful intravenous cannulation. The EBP team recommends that outcomes be measured by the rate of successful IV cannulation on the first attempt in patients who were determined by the questionnaire to be at risk for frequent failed IV cannulation attempts.

Conclusion As a healthcare professional, the vast amount of information available can often be overwhelming and cause difficulty in deciding which information is the most accurate. Compounding the issue is the fact that not all information is based on evidence. Therefore, utilizing an evidence-based practice is the most trustworthy and reliable method to ensure that healthcare professionals are providing safe and effective patient centered care. Every patient who seeks medical care deserves to be provided the best care available. It is imperative that healthcare professionals understand and implement an evidence-based practice to ensure that the best care is provided to every patient.