Overview about the project (go to third page for specifications and instructions)
After identifying a topic for your project proposal, this week you will write your question in PICOT format, and identify a process model to guide your project. In upcoming weeks, you will use the PICOT question to find relevant evidence when searching the literature.
As a nurse, you must maintain an inquisitive mind, not taking everything in the clinical environment at face value. While policies and procedures may guide how you practice, asking on what evidence they are based is the first step to improving the quality of health care and patient outcomes. This spirit of inquiry is the basis of evidence-based practice.
Two types of questions can be asked to formulate that burning question that will lead to searching for and identifying the best evidence. Background questions, or those broad questions for which the answers can be found in textbooks, are often the first that come to mind. Determining the background questions can be a good starting place for writing foreground questions. It is the foreground questions that will guide you to the research that, once analyzed, will clarify the best evidence.
Writing foreground questions in the PICOT format will compel you to specify:
1. The patient population (and setting if pertinent) (P)
2. The intervention or issue of interest (I)
3. Comparison intervention or no intervention (C)
4. The outcome (O)
5. The time frame (if pertinent) (T)
This focused framework will drive the literature search to determine what external evidence exists. Writing this question looks easier than it is. You will find your mind wandering to research questions that require random assignment and a control groupa quantitative research study. However, taking the time in this step to clarify the question will pay off in terms of time well spent in searching the literature.
In addition to writing your PICOT question, this week you will determine which model you will use to guide you through the steps of the process. In your text, Evidence-based practice in nursing and healthcare, the authors discuss process models and change models. Process models provide a roadmap of the steps of evidence-based practice change, while change models guide you, as the change agent, in gaining stakeholder support for the project. Some of the models included in your text do both. Below is a list of the models discussed in your text divided into these categories.
1. Models used to guide the EBP process only
a. Clinical scholar model
2. Models used to guide organizational change primarily
c. Ducks change curve model
d. Kotter and Cohens model of change
e. Rogers theory of diffusion of innovation
f. Prochaskas transtheoretical model of behavior change (recent applications)
3. Models used to guide both the process and change
c. Rosswurm and Larrabee
d. Johns Hopkins nursing evidence-based practice model (JHNEBP)
In red color you will find my comments. First page is the work to be performed and second page is the reference of my first discussion assignment for this project. Please follow the guidelines for this assignment. Feel free to ask for any clarifications. You need to incorporate only evidenced based references/sources no older than 5 years. Please complete the PICOT format to add the time frame.
Melynk and Fineout-Overholt (2011) note that there are seven steps to the evidence-based practice (EBP) process. The first step is to cultivate a spirit of inquiry. To encourage this spirit of inquiry, you are asked in this discussion to:
1. Briefly describe the problem or issue that you have decided to be the topic for your project proposal in order to orient your classmates and faculty (My project research will be on adverse drug events)
2. Indicate how it relates to your area of specialization (my area of specialization will be a family practice as an advanced nurse practitioner)
3. State your PICOT question. Indicate in parentheses after each segment, what part of PICOT the preceding words represent. For example: In patients recently discharged from the hospital following care for heart failure (P), do hand-off calls by the nurse to the primary care provider using the SBAR format (situation, background, assessment, recommendation) (I) compared to no calls (C) decrease readmission rates (O) over a one year period (T).
P-Increase in hospital readmissions r/t ADEs
I-Use of teaching methodology during patient encounter opportunities
C-Closed-ended questions vs. teach-back
O-Decreased hospital readmissions, improved patient satisfaction, increased medication compliance
T- (please provide time information)
Discuss which process model resonates with you and will help keep you focused during the project. Process models included in your text (Melnyk & Fineout-Overholt, 2011) are:
o Clinical scholar model
o Stetler model of evidence-based practice
o Iowa model of evidence-based practice to promote quality care
o Model for evidence-based practice change by Rosswurm and Larrabee
o Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model
(please choose from the list one appropriate model for this project)
Below you will find the information about the first part of the project so you can have an idea of what we are discussing. I am developing an evidenced based project on adverse drug events.
What piqued your interest about this issue or problem?
What picked my interest in the subject was to find out statistics that show the increase in adverse drug events; and to notice that they are usually the result of medical interventions. The events include medication errors, adverse drug reactions, allergic reactions, and overdoses. ADEs can happen anywhere: in hospitals, long-term care settings, and outpatient settings. In the clinical setting I was able to notice a deficit in patients knowledge about medication regime, compliance importance and more. I believe it all comes down to a deficit in education provided by the professionals including, doctors, nurses and all staff in general.
How does it relate to your area of specialization?
As a future Nurse Practitioner, I believe I have a great responsibility over my shoulders in regards to making sure my patients are going home with the essential understanding about their disease process, including treatments and other non-pharmacological options. Furthermore, I believe it is my duty as a NP to recognize educational deficits and try to provide the best care possible integrating my knowledge and additionally adapting to the specific situation and provide an individualized care for my patients.
What gave you the idea that evidence exists to support this change?
There are many researches and studies completed on the subject. I found there are even national action plans that were created for adverse drug event prevention. A medication error is defined as inappropriate use of a drug that may or may not result in harm; such errors may occur during prescribing, transcribing, dispensing, administering, adherence, or monitoring of a drug (Koh, 2014)
Provide a rationale as to why this will be an evidence-based project to improve outcomes and not generate new evidence (research).
Estimated cost of ADEs is $200-400 million dollars/year (Agyemang & While, 2010). 20% of harm is r/t medication errors (Health Research and Educational Trust, 2013). 40%-80% of information is forgotten by patients (Teach-back gives direction, 2011). Most common ADEs are linked to Insulins, Anticoagulants, and Opioids.
Agyemang, R., & While, A. (2010). Medication errors: Types, causes and impact on nursing practice. British Journal of Nursing, 19(6), 380-385. Retrieved from: http://www.mendeley.com/research/medication-errors-types-causes-impact-nursing-practice/
Health Research and Educational Trust. (2013). Implementation guide to reducing harm from high-alert medications. Retrieved from: hret-hen.org.
Koh, H. (2014). National Action Plan for Adverse Drug Event Prevention. . Retrieved from U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. : https://health.gov/hcq/pdfs/ade-action-plan-508c.pdf
Teach-back technique improves patient safety. (2001). Patient Education Management, 14(4), 44-45. Retrieved from URL: http://web.ebscohost.com/ehost/detail?vid=4&sid=2
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