Research response

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Please Respond to these discussions APA format with a reference

Discussion 1

Two areas where evidence-based practice has been effective is
hand hygiene and central venous assess device. Using evidence based
practice in these areas has greatly improved patient’s
outcomes. The knowledge of evidence-based practice will empower and
enrich nurses to practice more safely.

According to research conducted by Mathers, D (2011), adequate
flushing od central venous assess devices improve catheter potency
and prevent the use of heparin in the flushing solution. Flushing
the device with heparin has been associated with increased risk for
HIT and hemorrhage in patient and also erroneous lab results has
been associated with heparin use. According to the study, there will
be reduction in healthcare costs due to the cost difference in
saline and heparin. Also, preventing possible adverse effect
associated with heparin use in CVAD’s by using saline will
help save financially. To repent line occlusion while also
preventing potential complications associated with heparin,
non-heparin saline flush has been shown to effective.

Hand hygiene has also been shown to greatly improve
patient’s outcome both in home and community settings. Proper
hand hygiene helps breaks the chain of infection thereby improving
patient’s outcome. Huge patient’s outcome has been
recorded in facilities where proper hand hygiene with the use of
water and soap and alcohol-based hand sanitizer. Its effect can be
seen in wound healing, reduction in cross-infection, respiratory
tract infection and GI infection.

Mathers, D (2011) The Journal of the Association for Vascular
Access. Evidence-based Practice: Improving outcomes for Patients with
a Central Venous Access Device retrieved from http://www.avajournal.com/article/S1552-8855(11)70…

Sally F. Bloomfield, BPharm, PhD, Allison E. Aiello, PhD, MS, Barry
Cookson, FRCP, FRCPath, Carol O’Boyle, PhD, RN, Elaine L. Larson, RN,
PhD American Journal of Injection Control. The effectiveness of hand
hygiene procedures in reducing the risks of infections in home and
community settings including hand washing and alcohol-based hand
sanitizers. Retrieved from http://www.ajicjournal.org/article/S0196-6553%2807…

Discussion 2

Two noticeable areas of evidence based practice that have benefited
greatly to improve patient outcome are that of preventing central
line-associated blood stream infections (CLABSIs) and
ventilator-associated pneumonia (VAP). The complex pathophysiological
conditions of the ICU patients sometimes demands use of central venous
lines. “Despite the potential benefits central venous lines can
have for patients, there is a high risk of bloodstream infection
associated with these catheters” (Reyes, Morphet, & Bloomer,
n.d). After conducting studies with use of antimicrobial catheter and
interventions such as dressing changes every 7 day and PRN, closed
infusion systems, aseptic skin preparation, central venous line bundle
checking, education, an extra staff in the Intensive Care Unit for
auditing and follow up, it was evidenced that such measures have
positive outcomes in reducing central venous line associated
bloodstream infections rates.

VAPs prevention strategies is another evidenced based practice that
has shown drastic positive outcome related to nursing care. There was
a research conducted on a sample of 86 mechanically ventilated
patients with 43 patients each in the control group and the
intervention group. Subglottic secretion suctioning, intake of
single-dose antibiotics within 4 hours after intubation, chlorhexidine
mouthwash on oral hygiene, elevation of the head of the bed 30 to 45
degrees and monitoring the bed position twice a day, Proper daily
examination of the patient for early extubation, check for correct
positioning of nasogastric tube before each feeding, closed-circular
ventilator etc. were the strategies considered. Although there was no
changes observed for the first 4 days of study, signs of early
pneumonia were evident in the control group from day 5. This has
revolutionized the VAPs prevention techniques. Most hospitals
including the place where I work follow these guidelines strictly to
improve patient outcomes.

References:

Nasiriani, K., Jarahzadeh, M. H., & Souroush, M. (2017). EFFECT
OF COMPREHENSIVE STRATEGIES FOR PREVENTION OF VENTILATOR-ASSOCIATED
PNEUMONIA ON INCIDENCE OF THE DISEASE IN HOSPITALIZED PATIENTS IN
INTENSIVE CARE UNITS. Journal Of University Medical &
Dental College
, 8(4), 20.

Reyes, D. V., Morphet, J., & Bloomer, M. (n.d). Prevention of
central venous line associated bloodstream infections in adult
intensive care units: A systematic review. Intensive And Critical Care
Nursing, 4312-22.

Discussion 3

Evidence-based nursing practice (EBP) is crucial to the delivery of
high-quality care that optimizes and improves patients’
outcomes. Studies continue to show improved outcomes when best
evidence is used in the delivery of patient care. To achieve
excellence in practice, critical care nurses must apply EBP as the
norm. We cannot knowingly continue clinical practice interventions
that are not supported by current best evidence, particularly if those
actions are known to be unhelpful and possibly injurious. Therefore,
EBP should be integrated all the time in nursing daily activities.

Two areas where evidence-based practice has been effective in
nursing practice are the followings:

1- The use of oxygen in patients with COPD; it is shown and
proved that for patient health and safety, it is essential that
nurses follow evidence-based practice in nursing when it comes to
giving oxygen to patients with COPD. Despite the belief of some people
that providing oxygen to these patients can cause severe problems such
as hypercarbia, acidosis or even death, the evidence-based protocol is
to provide oxygen to COPD patients. This practice can help prevent
hypoxia and organ failure; and the carbon dioxide level is not
elevated because of hypoxic drive. Therefore, giving oxygen,
which is the correct treatment based on the evidence, can improve COPD
patients’ quality of life and help them live longer.

References:

Scott O, Tidy C. Use of oxygen therapy in
COPD.http://www.patient.co.uk/doctor/Use-of-Oxygen-Therapy-in-COPD.htm.
Revised January 21, 2011. Accessed March,28 , 2018. Google Scholar

2- The last thing a patient wants when going to a hospital for
treatment is a hospital-acquired infection. To protect the patients
against hospital -acquired infection, nurses play a significant role
in helping to prevent illness before it happens by following the
evidence-based infection-control policies. It has been proved
that by keeping the healthcare environment clean, wearing personal
protective clothing, using barrier precautions and practicing correct
handwashing the chain of transmission of infectious diseases
diminishes/reduces significantly. Although nurses are busy with many
responsibilities, the time it takes to control infection is well worth
the effort.

References: Scott RD. The direct medical costs of
healthcare-associated infections in US hospitals and the benefits of
prevention. Division of Healthcare Quality Promotion, Centers for
Disease Control and Prevention; May 2009.
http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Google Scholar

Discussion 4

Nursing informatics is one in are in which evidence-based practice
has had an impact on patient outcomes. The other area is in the
nursing of chronic diseases and management. Informatics is becoming
increasingly present in our profession due to rapidly changing
technologic advances. Healthcare systems are assimilating technology
into daily practice at a quick pace. Security and patient privacy must
be upheld while achieving the goal of transforming data into useful knowledge.

On the other hand, the use of evidence-based practice in the
research of chronic disease management has led to discovery of new
ways of dealing with chronic infections. There is a large gap between
evidence and practice within health care, particularly within the
field of chronic disease. This thus led to devising effective ways of
dealing with chronic diseases such as asthma, diabetes and obesity,
which have been discovered thus providing better patient outcomes.
There is hence the development of a collaborative partnership and its
evolution into producing a valuable resource for the translation of
evidence into practice in the areas of chronic disease management.

The effective of the two on my practice is evident. First, the use
of information technology devices is mandatory and effective in
simplifying my daily work. At the same time, there is now a proper
coordination and management of patient information as informatics
allow easy communication. Management of chronic diseases has also seen
a decrease in the number of new infections significantly.

References

Lee, A. (2014). The role of informatics in nursing. Nursing
Made Incredibly Easy!,
12(4), 55. doi:10.1097/01.nme.0000450294.60987.00

Khalil, H., Chambers, H., Munn, Z., & Porritt, K. (2015).
Improving Chronic Diseases Management Through the Development of an
Evidence-Based Resource. Worldviews on Evidence-Based
Nursing,
12(3), 139-144. doi:10.1111/wvn.12087

Discussion 5

Evidence-based practice is essential as it helps improve patient
outcomes as well as promotes patient safety. Two areas of nursing
practice in which evidence-based practice has improved patient
outcomes include double-checking medications before administering them
as well as the EBP of alcohol-impregnated caps to reduce Central-Line
Associated Bloodstream Infections (CLABSI).

There have been deaths associated with not double-checking
information, before administering the medication. When
medications are not double checked before administering, the
patient’s life could be at risk. There was a case in which the
physician’s hand wrote an order, and the pharmacy mistakenly wrote the
orders for a sound-alike medication. The medication was supposed to be
given to the patient to lower their blood pressure. Because the wrong
medication had been administered, the patient suffered the
consequences of a heart attack. Medication errors are one of the
leading causes of death, resulting in seven thousand deaths, a year
(McInyre & Courey, 2007). In fact, there was evidence that double
checking leads to discovering medication errors or near misses
(Athanasakis, 2015). The studies consisted of examining medication
errors as well as double checking the medications before
administration (Athanasakis, 2015). It was found that many of the
medication errors included patient-identification errors
(Athanasaki’s, 2015). These findings have impacted my nursing
practice because ever since nursing school; I have always made sure to
check medications by using the seven rights. Before administering
medications, I make sure it is the right dose, as well as for the
right reason. Because of this EBP, I can deliver safe quality care.

Another evidence-based practice that has improved the lives of
patients includes alcohol-impregnated caps. There have been reports of
decreased Central Line Associated Blood Stream Infections
(CLABSI’s). The decrease in numbers was associated with the use
of alcohol-impregnated caps of intravenous access (Sams, Martin,
Carraway, Ruge, & Stettler, 2015). The study consisted of pre and
post analysis of blood cultures. The study found that there were
decreased contamination rates by thirty-two percent, after the
implementation of alcohol-impregnated caps (Sams et al., 2015). Those
that have cancer are more at risk to develop infections; therefore,
they have benefitted from this EBP as it helps reduce bloodstream
infections. This study has impacted my nursing practice I always make
sure to place those impregnated alcohol caps at the ends of my lines
and connections. If I see that the caps are running out in the
patient’s room, I make sure to restore them with new ones so
that the next nurse can continue this practice. This practice has
shown the importance of these caps in patients. Because of the CLABSI
intervention, it has been one year since my hospital has had a CLABSI.
After seeing the results in my workplace as well as in EBP, I will
continue to implement this practice with my patients.

References

Athanasakis, E. (2015). The Method of Checking Medications Prior to
Administration: An Evidence Review. International Journal of
Caring Sciences, 8(3).
Retrieved from CINAHL Complete
database. (Accession No. 110579158)

McIntyre, L. J., & Courey, T. J. (2007). Safe Medication
Administration. Journal of Nursing Care Quality,
22(1). Retrieved from SocialSciences Citation Index database.
(Accession No. 000243033700008)

Sams, K., Martin, S., Carraway, S., Ruge, D., & Stettler, J.
(2015). Alcohol Impregnated Cap Implementation Significantly Reduces
Blood Culture Contamination Rates in an Oncology Population.
American Journal of Infection Control, 43 (6). Retrieved
from CINAHL Complete database. (Accession No. 102785958)

Discussion 6

First, we need to understand what is evidence-based practice?
Evidence refers to research, known as research-based practice.
“Knowledge derived from a variety of sources that has been
subjected to testing and has found to be credible” Higgs and
Jones (2000). Research is only one of many forms of evidence. One of
the concepts is to understand to improve health outcomes, reduce
costs, and improve health care quality. Many nurses connect with this
concept from on the job experience. Nursing uses evidence-based
practice on a daily bases as we learn what works and what
doesn’t in certain situations.

The first area of “evidence-based practice that has improved
patient outcomes is the use of non-heparinized saline flush with
positive -pressure value caps, and proper flushing technique to
maintain CVAD patency”. Bowers, Speroni, Jones, and Atherton,(
2008); Hadaway, (2006), & Jasinsky & Wurster, (2009).
“Reinforcement of proper flushing techniques has demonstrated
improved patency rates of CVADs “. Feehery, Allen, & Bey, (2003).

Outcomes were measured by comparing baseline data with data
collected in the same manner post education. This data was obtained by
collection a means of questionnaire and bedside observation of the
nurse’s flushing technique. There was a significant improvement
with both nurse’s knowledge and flushing skill with
CVAD’s. With continuing education with non-heparinized flushes
has not only increase patient outcomes and has also reduced health
care costs across the board. There are less risk factors as noted in
another evidence-based study using randomized controlled trials
evaluating the use of Normal Saline vs. Heparinized Saline.

Let’s understand that all participates were included in the
meta-analysis which systematically combining pertinent qualitative and
quantitative study data from several data groups to develop a single
conclusion, thus has the greatest statistical power.

These results concluded that Normal Saline can be equally, of not
more effective, in keeping the CVC lines patent. The secondary
outcomes showed heparinized saline was not superior to normal saline
and did not reduce CVC occlusions. Heparinized flushes are associated
with potential risk factors such as “coagulation disorders,
hypersensitivity reactions and heparin-induced
thrombocytopenia”. Goode CJ. (1991), & Goh LJ. (2011). Here
are a few advantages of flushing with normal saline vs. heparinized
saline. NS is isotonic, has much less side effects from
heparin-related complications. Drug itself is less expensive which is
economical from both patient and hospital.

Reducing Emergency Room visits and In-Hospitalization by
implementing evidence-based practice across the healthcare continuum
and community by enhancing the lines of communication. The goal was
to” improve post-discharge utilization value using technology to
identify high-risk individuals who might benefit from rapid nurse
outreach to assess social and behavioral determinants of health with
the goal of reducing inpatient and emergency department visits”
Hewner, S., Sullivan S.S., and Yu G. (2018).

The project explored a before and after comparison of the
interventional sites with similar primary care practices accepting
Medicaid. This intervention targeted discharged patients with
preexisting chronic problems, thus providing this knowledge to an
outreach nurse who telephonically reached out immediately.

Outcomes were as follows; Decrease readmissions and emergency room
visits, thus increasing a more expedient outpatient visits resulting
in a happier healthier relationship between healthcare providers and
their patients while reducing per capita costs. The estimated avoided
value over the secular Medicaid trend was $664 per adult with chronic
diseases, resulting in $71,289 in revenue from additional outpatient visits.

References:

Bowers, L., Speroni, K.G., Jones, L., Atherton, M. (2008).
Comparison of occlusion rates by flushing solutions for peripherally
inserted central catheters with positive pressure luer-activated
devices. Journal of Infusion Nursing. 31:22–27

*Goode, C L, Titler M, Rakel B, Ones D S,Kleiber C, Small S, Trilo P
K.(1991) A meta-analysis of effects of heparin flush and saline flush:
quality and cost implications. Normal saline verses heparin for
patency of central venous catheters in adult patients – a
systematic review and meta-analysis.
Doi:
10.1097/00006199-199111000-00002, [ PubMed] [Cross Ref].

*Goh L J, Teo HS, Masagoes M. (2011). Heparinized saline verses
normal saline in maintaining patency of arterial and central venous
catheters. In: Proceedings of Singapore Healthcare .vol 20.p190-196.

Feehery, P.A., Allen, S., Bey, J. Flushing 101: Using a
FOCUS-PDCA quality improvement model to reduce catheter occlusions
with standardized protocols. Journal of Vascular Access Devices. 2003;8:38–45.

Hewner S., Sullivan S.S., and Yu G. (2018). Reducing Emergency Room
Visits and In-Hospitalizations by Implementing Best Practice for
Transitional Care Using Innovative Technology and Big Data.
Worldviews Evid Based Nurs. Doi: 10.1111/wvn, 12268.

Koufogiannakis, D. (06/01/2011). “What is Evidence?
(editorial)”. Evidence based library and information practice (1715-720X), 6 (2), 1

Mathers, Dorothy. Evidence-based Practice: Improving Outcomes
for Patients with a Central Venous Access Device. The Journal of
the Association Access, Volume 16, issue 2, 64-67.

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