1. QuERY Qu ality Improvement, E vidence Based Practice, R esearch & Y ou Presented by: Karen Gabel Speroni, BSN, MHSA, PhD, RN -Director, Nursing Research & Chair, Research Council Inova Loudoun Hospital & Inova Fair Oaks Hospital: Virginia -Co-Chair, Inova Health System Nursing Research Council: Virginia -Chair, Shore Health System Nursing Research Council: Maryland 11 November 2011 Part 1: QuERY Process Overview

2. OBJECTIVES Review the QuERY concepts and processes Understand the difference between quality improvement (QI), evidence based practice (EBP) and research Karen Gabel Speroni, 11/11

3. CULTURE OF INQUIRY –Standard operating procedure –Why do we do what we do –Is there evidence behind it –Patient outcomes –Care delivery Karen Gabel Speroni, 11/11

4. QUALITY IMPROVEMENT QI: “Systematic, data-guided activities designed to bring about immediate improvement in healthcare delivery in particular settings” (Lynn et al, 2007) –QI / PI: Joint Commission refers to this as PI, or performance improvement Karen Gabel Speroni, 11/11

5. 5 EVIDENCE-BASED PRACTICE EBP: The conscientious use/integration of the best research evidence with clinical expertise and patient preferences in nursing practice (adapted from Sackett et al., 2000) –EBP is a science-to-service model of engagement of critical thinking to apply research-based evidence (scientific knowledge) and practice-based evidence (art of nursing) within the context of patient values to deliver quality, cost-sensitive care –It is distinguished from practice-based evidence (PBE), a practice-to-science model in which data are derived from interventions thought to be effective but for which empirical evidence is lacking –Providers are engaged in data collection, analysis, and synthesis to inform practice Karen Gabel Speroni, 11/11

6. 6 RESEARCH RESEARCH: A systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge (U.S. Department of Health and Human Services, n.d., [45 CFR §46.102(d)] [21 CFR§50.3(k)] [21CFR§312.3]) –Research is distinguished from research utilization, the process of synthesizing, disseminating, and using research-generated knowledge to make an impact on, or a change in, the existing practices in society (Burns and Grove, 2005) NURSING RESEARCH: A systematic search for knowledge about issues of importance to the nursing profession (Polit and Hungler, 1995) Karen Gabel Speroni, 11/11

7. INNOVATION “Innovation” in service delivery and organization [is] a novel set of behaviors, routines, and ways of working that are directed at improving health outcomes, administrative efficiency, cost effectiveness, or users’ experience and that are implemented by planned and coordinated actions” (Greenhalgh, 2004) Karen Gabel Speroni, 11/11

8. So those were the definitions Karen Gabel Speroni, 11/11

9. …and these are the interpretations!! Karen Gabel Speroni, 11/11

10. QI, EBP AND RESEARCH How do you integrate the 3 How do we better understand the differences between the 3 Thru the QuERY process: Qu ality Improvement, E vidence Based Practice, R esearch & Y ou Karen Gabel Speroni, 11/11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

11. QuERY CONCEPT Developed to help hospital nurses become knowledgeable about each unit’s best –QI activity –EBP project –Research study Provides opportunity for nurses from each hospital unit to showcase their best QI, EBP and research work during the last year –OR, to identify strategic planning needs Through the QUERY work and seminar presentations, hospital nurses are exposed to QI, EBP and research concepts, unit best examples, and unit needs to improve patient outcomes Karen Gabel Speroni, 11/11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

12. QuERY MECHANICS Units rotate presentation over a one year period Unit directors collaborate with their nurses to determine best QI, EBP and research work done in last year –If not done, then present ideas Unit directors identify nurse champion responsible for leading the work and presenting the work at the QuERY seminar –QI champion –EBP champion –Research champion Templates for presentation provided Speaking classes offered Karen Gabel Speroni, 11/11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

13. QuERY SEMINAR FORMAT One hour in length –5 min introduction with definitions of QI / PI, EBP, research, innovation –8 minutes QI Unit 1 –8 minutes EBP Unit 1 –8 minutes Research Unit 1 –8 minutes QI Unit 2 –8 minutes EBP Unit 2 –8 minutes Research Unit 2 –7 minutes Closing and questions Invite all hospital nurses Offer at standard time / day of month Offer continuing education unit credits Karen Gabel Speroni, 11/11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

14. QuERY SEMINAR FORMAT At QuERY session offer –Literature on QI, EBP and research –Contest card –Other Post QuERY powerpoint on your hospital nursing research shared drive Karen Gabel Speroni, 11/11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

15. QuERY CONTEST Annually contest judged by nurses selecting the best QI, EBP and research work that improves –Standard operating procedure –Patient outcomes –Care delivery Electronic contest –List definitions –List each units QI, EBP and research work Award prizes Karen Gabel Speroni, 11/11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

16. Winner Prizes Karen Gabel Speroni, 11/11

17. QUALITY IMPROVEMENT ACTIVITIES Circle the quality improvement (QI) activity you think has the most potential to improve standard of care, patient outcomes, and care delivery: 1.List unit and title of activity 2.Unit, title 3.Unit, title 4.Unit, title 5.etc QI Definition: Systematic, data-guided activities designed to bring about immediate improvement in healthcare delivery in particular settings” (Lynn et al, 2007)

18. EVIDENCE BASED PRACTICE PROJECTS Circle the evidence based practice (EPB) project you think has the most potential to improve standard of care, patient outcomes, and care delivery: 1.List unit and title of project 2.Unit, title 3.Unit, title 4.Unit, title 5.etc EBP Definition: The conscientious use/integration of the best research evidence with clinical expertise and patient preferences in nursing practice (adapted from Sackett et al., 2000)

19. NURSING RESEARCH STUDIES Circle the nursing research study you think has the most potential to improve standard of care, patient outcomes, and care delivery: 1.Birthing Inn: Randomized Study Evaluating the Effect of Music on Cesarean-Section Patients’ Pain and Related Outcomes 2.Post-Surgical Unit: Effect of the Workforce Initiatives Safe Handling Minimal Lift Program on Patient Care Provider Injuries, Attributable Costs and Satisfaction 3.Surgical Services: Evaluation of the Prevalence of Methicillin Resistant Staphylococcus Aureus Colonization in Pre-Surgical Patients and Post-operative Infection 4.Employee Health: Effect of Nurses Living Fit™ Exercise and Nutrition Intervention on Body Mass Index in Nurses 5.Intensive Care Unit: Comparative Effectiveness of Standard Endotracheal Tubes versus Endotracheal Tubes with Subglottic Suctioning on Ventilator Associated Pneumonia Rates Nursing Research Definition: A systematic search for knowledge about issues of importance to the nursing profession (Polit and Hungler, 1995)

20. YOUR IDEAS QI activity idea: ________________________________________________________ EBP project idea: ______________________________________________________ Research idea: ________________________________________________________ BEST CONTEST IDEA FORM

21. QUERY Seminars: Quality, Evidence Based Practice, Research & You Date Unit Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

22. 22 Presenters Quality Improvement (QI) Activity –xxx Evidence Based Practice (EBP) Project –xxx Research Study –xxx Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

23. 23 Definitions: Quality Improvement “Systematic, data guided activities designed to bring about immediate improvement in health care delivery in particular settings” (ANCC, 2008. Magnet Recognition Program® Application Manual) Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

24. 24 Definitions: Evidence Based Practice “The conscientious use/integration of the best research evidence with clinical expertise and patient preferences in nursing practice.” (ANCC, 2008. Magnet Recognition Program® Application Manual) Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

25. 25 Definitions: Research RESEARCH: A systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge. (U.S. Department of Health and Human Services, n.d., [45 CFR §46.102(d)] [21 CFR§50.3(k)] [21CFR§312.3]). Research is distinguished from research utilization, the process of synthesizing, disseminating, and using research-generated knowledge to make an impact on, or a change in, the existing practices in society (Burns and Grove, 2005). NURSING RESEARCH: A systematic search for knowledge about issues of importance to the nursing profession (Polit and Hungler, 1995). Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

26. 26 Definitions: Innovation “Innovation” in service delivery and organization [is] a novel set of behaviors, routines, and ways of working that are directed at improving health outcomes, administrative efficiency, cost effectiveness, or users’ experience and that are implemented by planned and coordinated actions” (Greenhalgh, 2004). Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

27. 27 Quality Improvement Activities UNIT: xx Title of activity Purpose Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

28. 28 Quality Improvement Activities UNIT: xx Methods Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

29. 29 Quality Improvement Activities UNIT: xx Outcomes: How did QI activity –Improve standard operating procedure –Care Delivery –Patient Outcomes Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

30. 30 Quality Improvement Activities UNIT: xx Recommendations Next steps Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

31. 31 Evidence Based Practice Project Unit: Title of project Purpose Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

32. Evidence Based Practice Project Unit: 11 Literature review Methods Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

33. Evidence Based Practice Project Unit: Outcomes: How did EBP project –Improve standard operating procedure –Care Delivery –Patient Outcomes Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

34. Evidence Based Practice Project Unit: Recommendations Next steps Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

35. Research Study UNIT: Title of research study Purpose / Objectives Hypothesis Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

36. Research Study UNIT: Methods Results Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

37. Research Study UNIT: Conclusions Implications for practice: How did research results –Improve standard operating procedure –Care Delivery –Patient Outcomes Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

38. QuERY Presentation QI Activity, EBP Project, Research Study Questions? 11 Karen Gabel Speroni, 2011 Contact Kgabelsperoni@smartneighborhood.net to request permission for useKgabelsperoni@smartneighborhood.net

39. QuERY CONTEST 2011 WINNERS QI Activity: Telemetry unit –Educating the Patient about Stroke, thus Educating the Community EBP Project: Intensive Care Unit –Inducing Therapeutic Hypothermia Status Post- Cardiac Arrest Research Study: Surgical Services –Evaluation of the Prevalence of Methicillin Resistant Staphylococcus Aureus in Pre-surgical patients and Post-Operative Infection Karen Gabel Speroni, 11/11

40. Acknowledgements The QuERY concept was innovated via the Inova Fair Oaks Hospital Research Council, Fairfax, Virginia –Hospitals adopting concept Inova Loudoun Hospital, Leesburg, Virginia Shore Health System, Easton and Cambridge, Maryland Karen Gabel Speroni, 11/11

41. Speroni, 201141 Speaker Contact Information Karen Gabel Speroni, PhD, RN Director, Nursing Research & Chair, Research Council –Inova Loudoun Hospital –Inova Fair Oaks Hospital Chair, Nursing Research Council, Shore Health System Clinical Scientist, Institutional Review Board –Inova Research Center –George Mason University –Chesapeake Research Review E-mail: kgabelsperoni@ smartneighborhood.ne t kgabelsperoni@ smartneighborhood.ne t

42. Speroni, 2011 Questions & Answers