Bringing Evidence Based Change to Hospital Policy and Procedure

Pretend you are a floor nurse on a busy surgical floor.  Where would you turn for advice for carrying out an unfamiliar procedure on your patient safely and correctly?  The Policy and Procedure Manual, of course!  If you follow that manual to the letter, can you be sure that you have performed the procedure using best practice criteria?  The answer to that question is “No”.

Policy and Procedure instructions are often based on the best knowledge and practice available at the time of their writing and many may never have been based on scientific evidence at all. These policies and procedures can merely reflect “the way we’ve always done it”.  Until recently, nursing research was not emphasized in the profession.  Now that it is, the research data is flowing, but not necessarily to the Policy and Procedure Manual.  A report from the Committee on Quality of Health Care in America published in 2001 observed that “scientific knowledge about best care is not applied systematically or expeditiously to clinical practice.  An average of about 17 years is required for new knowledge generated by randomized controlled trials to be incorporated into practice”(Danforth & Perrin, 2001, p. 13).   I am optimistic that the process has improved some since 2001 however, I was on a Policy and Procedure Committee just three years ago and there was rarely a mention of current research findings during any of our Policy and Procedure review sessions.  As an Operating Room Nurse and a Graduate student, I have often wondered how the game changing research I am reading about in my classes filters into the hospital and to the patient’s bedside.  Improving this process represents one of the key challenges for health care in the 21^st century.  We have the data and the technology.  Now we need a better system to connect the research with nurses and their patients. 

I work in a University Hospital.  Our bright red Policy and Procedure Manual was long ago replaced with an online version that is accessible to nurses from any computer terminal.  Our University Medical Library is also accessible to our nurses with a wealth of information regarding evidence based best practice.  Access to one’s own medical library is not even necessary.  Internet access and Google will provide a similar bounty of data upon which to make an informed choice for evidence based nursing care.  Google Scholar is an excellent source of research and scholarly papers that can be searched on your computer or smart phone by topic or title (Google Scholar website, n.d.).   It is even possible to utilize Google Scholar to have an email alert sent whenever a new study pertaining to your specified area of interest becomes available.  So, with this technology at their fingertips, it would be possible for the average nurse to go to their computer and look up data to determine how best to perform nursing functions in an evidenced based way.  Unfortunately, most nurses will not have the time to do that and may also not have the proper training to search efficiently.

We need to ensure that hospitals make updating their Nursing policies and procedures, using evidence for best practice, a top priority.  With all the effort hospitals currently make towards the goal of Continuous Quality Improvement, how can they not focus on this important aspect of quality care?   And with all the concern lately about rising health care costs in America, how can our Country not?

This could be accomplished utilizing existing personnel in Nursing and/or the Medical Library or by applying for a grant to help pay for additional personnel as needed.  Grant money is available to help bring hospitals forward into the Information Age.  A check of the site Grants.gov yields hundreds of opportunities dealing with Information Technology and the Internet in health service (Grants.Gov, n.d.).  Admittedly, this would be a big, time consuming job initially but the benefits of using best practice could result in big cost savings for the hospital by improving efficiency, reducing complications and saving human lives.  An article in the online journal of Miller-McCune states that  “Providing appropriate, effective and safe care where we know how to do it-no “medical mysteries” included-could annually prevent the deaths of hundreds of thousands of Americans” (Millenson, 2008, para. 8). 

The old Policy and Procedure Manual can be transformed utilizing the speed and access of the Internet.  Conducting the number of literature searches that would be required to update Nursing Policy and Procedure to reflect best practice based upon research evidence would be prohibitive if not for the Internet. As Dr. Peter Yellowlees, Professor of Psychiatry and Director of the Health Informatics Program at the UC Davis describes it, “The Web offers an amazing combination of immediacy, global reach, personalization and specialization” (Yellowlees, 2008, p. 8).  Because of this ability to personalize and specify, once the policies have been updated, the process for ongoing updates can be started using a notification service like the one provided by Google Scholar.  Specific Nursing policy and procedure topics could be entered into the site resulting in an email alert of new research available on each of the specified topics of nursing care.  When it comes time to convene a Policy and Procedure Committee meeting to examine the procedures that are up for review, there would be a body of evidence to consider and inform changes.  If the evidence was not compelling or if more data was needed before making a change, that policy or procedure could be flagged for review the next meeting.  This way, meaningful changes could be made to the policy to keep it up to date with best practice.  When committee members are asked to review a policy before a scheduled meeting, they would have substantive information to digest before making recommendations to the Committee.  Because the Policy and Procedure Manual is on-line, making changes would be relatively easy.  Getting the word out to staff would prove to be an education challenge for the various hospital units, but each of them could decide the best way to accomplish this.  Continuing Education Units, CEU’s, could be given to provide extra incentive to periodically learn the updated procedures.  Nurses would likely be very receptive to this ongoing education as it would be providing valuable information for patient care.  A hospital nurse’s day is filled with procedures to accomplish.  It would be reassuring for them to know that the way these procedures are being performed is based upon “best practice” information.

The Internet can and will affect our lives in the most amazing ways imaginable, and some that are still unimaginable.  Arguably, this idea is lack luster and some may argue, rather boring faced with the exciting promise of the Information Technology Age.  As an Operating Room Nurse who is being exposed to the exciting promise of research more regularly than some of my peers, I feel frustrated thinking about the information that is sitting out there that could help my practice and my patient’s outcome if only I knew about it.  I would be pleased to know that a mechanism was in place in my hospital to bring the appropriate changes to my practice, change that is based upon current research findings.  If you are thinking that this idea needs more bells and whistles to make it sexier, how about giving all the nurses a handheld computer to access and consult this valuable information more swiftly.   After all, speed of access is what the Information Age is all about. 

I believe that this idea could be a game changer for the hospital system.  The importance of the Policy and Procedure Committee and/or the Continuous Quality Improvement Committee would be elevated.  Scholarly health care providers would be anxious to serve on these committees.  Nurses would become more aware of the importance of Nursing Research.   Some may be inspired to conduct research of their own and to pursue higher education to become more effective as nurses and nurse researchers.  By taking this important action to update Nursing Policy and Procedure everyone wins; the patient, the nurse, the hospital, the research community and our Country.  

References

Danforth, W. H., & Perrin, E. B. (2001). Crossing the quality chasm:  A new health system for the 21st century: executive summary. Retrieved from The National Academies Press: http://books.nap.edu/catalog.php?record_id=10027

Google Scholar website. (n.d.). http://scholar.google.com/scholar/about.html

Grants.Gov. (n.d.). http://www.grants.gov/

Millenson, M. L. (2008, September 19). Evidence of a need for change. Miller-McCune . Retrieved from http://www.miller-mccune.com/health/evidence-of-a-need-for-change-4241/

Yellowlees, P. M. (2008). Your health in the information age- How you and your doctor can use the internet to work together. Bloomington, IN: iUniverse.

                                            

CNN Heroes

I just finished watching the latest edition of CNN heroes on TV.  As with previous years, it proved to be an inspiring and emotional experience.  If you have not ever watched this, CNN profiles people from around the world who are passionately pursuing various causes.  These people have been nominated by others because of the contribution they are making to the world.  Viewers vote on the nominees and a certain number are chosen to be CNN heroes.  Each is given money to furthur their work, this year $25,000.  At the end of the show, one of the heroes is chosen as CNN hero of the year.  Again, viewers vote to decide the ultimate winner.  This person is then given an additional $100,000.  These people are so remarkable and yet all are so humble.  They enbody the very best of what it means to be human.  So often, watching the news on CNN fills me with despair and sometimes anger.  Watching this special on CNN each year fills me with hope and determination to make the world a better place.  There is a CNN heroes site on Facebook where you can go and view the winners and donate, if you like, to their causes.  They also list the times that the show will replay.  If you are caught up with homework, maybe you could watch it.  I guarantee that you will find it worthwhile!

Physician-Patient Education in a Virtual World

In considering potential doctor-patient applications in virtual world environments like Second Life, I must admit to having some mixed feelings.  I have been exploring Second Life over the past few days and find the experience interesting but frustrating as well.  I see health education opportunities in this technology, but I also see some pitfalls.

I have a wireless connection with my computer, which I believe is common for many people.  Apparently, this can cause some glitches compared with performance when your computer is hard wired to the network.  I have had some glitches with the performance of my avatar which I will ascribe to my wireless connection.  These glitches make the experience a bit cumbersome and would affect the experience that many would have in these types of virtual worlds due to the prevalence of wireless use of the internet.  I wonder if these challenges would put a damper on the positives of using this kind of environment. 

If these limitations could be overcome, and I am confident that they will be, I can see many opportunities for education of patients by their doctors using this kind of technology, especially when dealing with the younger generations.  Young people seem to believe that everything is better when done using a computer.  Their preference for using computer technology could be capitalized upon when providing educational opportunities for this group.  Any type of education, be it learning about healthy choices, learning about a newly diagnosed disease state or preparing for a procedure, operation or hospitalization, could be presented in an appealing way by using this technology.  While reading a brochure or watching a video might be perceived as “boring” and therefore avoided, providing education in a virtual world environment could peak the curiosity and interest of someone who holds a fascination for computer technology, thereby making it much more likely that they would engage and participate in the learning.  Also, when your imagination is engaged, as I find it is when I am in Second Life, I think your concentration is also improved and you would be more likely to remember the information you are receiving. 

Another benefit of this format for learning is, depending on how well you set up your site, the participant could seek out the information and experiences they want and need without the doctor having to always anticipate what their questions and/or needs might be.  Of course, it would be important to try to cover all your bases initially, when developing and constructing your program but, after that, participants would be free to explore and seek out the answers to the questions they feel are important to them and not waste time or risk losing their attention by providing information they already have or have no use for.  Many educators see the benefit of self directed learning.  It is the foundation of the Montessori philosophy, which has proved to be a popular and successful way to educate children.  Learning in a virtual world would utilize this same concept and would hopefully yield a similar success.  We just need to work out a few bugs!

Election Day

Tomorrow is Election Day.  We are living through very challenging times right now.  We have learned that the Leaders we choose can have a profound impact on the course of our lives.  I believe we have taken some important steps forward, especially when it comes to Health Care.  I would like to see that progress continue.  Whether you agree or disagree with my position remember that it does matter who we elect. Voting is the responsibility of those who are priviledged to live in a Democracy.  Get yourself to your polling place tomorrow and VOTE  VOTE  VOTE!!! 

Challenging the Future of Nursing

Two years ago, the Institute of Medicine began a study of the nursing profession aimed at constructing a “blueprint” for the profession’s future development.  This was meant to help the profession to better meet the developing needs of the nation’s health care workforce and the needs of health care delivery in this country.  It is easy to see the role that Health Informatics could play in pursuing the Institute’s recommendations.  The report, “The Future of Nursing: Leading Change, Advancing Health,” which was released earlier this month had these four key recommendations:

          “1. Nurses should practice to the full extent of their education and training.

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

3. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United State.

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.”

In regards to their first point, the Institute identified several issues that they felt needed to be addressed.   The first issue dealt with the variability in state laws pertaining to advanced practice nurses that they felt interfered with the ability of these nurses to contribute to the health care system to the full extent of their ability.  They recommended that the government get involved in establishing a national standardized “scope of practice” for these nurses.  Another issue they identified was the high turnover rate of new nurses and they emphasized the need for transitional residency programs.  These programs smooth the transition from nursing student to professional nurse and have been shown to be quite effective in reducing staff turnover amongst new graduates. 

To their second point, a recommendation was made for improvement in the quality and scope of nursing education to better prepare nurses to meet the increasing demands on their profession that the future holds.  The report stated that nurses must receive more training in “leadership, health policy, system improvement, research and evidence based practice, and teamwork and collaboration, as well as competency in specific content areas including community and public health and geriatrics.”  They also felt that nurses would need higher levels of education to meet the increased expectations that will be placed on them.  They made a call for more opportunities and assistance for nurses to obtain higher education as well as for increased diversity within the ranks of the profession.

Their third point was a call to nurses to accept their rightful place alongside other health care professionals in being part of the solution to the challenges the future holds for our country in delivering safe and equal care for all.  Nurses must accept this responsibility, but they must also be accepted by the other health care professions as peers in this important endeavor.  Efforts must be made to cultivate the relationships needed for successful collaboration, innovation and reform.

The fourth point acknowledged the limitations of our current data systems and infrastructure in helping to predict work force requirements.  Improvements in this area would help provide timely data to inform decision making in regards to the needs of the health care workforce and the delivery of care to the population.

I am currently enrolled in a Master’s Program in Nursing and Healthcare Leadership.  In reading the recent recommendations of the Institute of Health on the future of Nursing, I can’t help but wonder if the findings were “leaked” at an earlier time as I see the fundamentals of these recommendations permeating the curriculum of my newly formed School of Nursing already.  They seem to be following the Institute’s key points exactly.  I can also understand now why they were strongly encouraging all the students to take a Health Informatics course in our first quarter.  They, like me, must have seen that the Internet and associated technologies would play an important role in education, communication, data collection, innovations in health care delivery and health care reform.  Though aspects of this Informatics class have challenged me, I hope I am able to ultimately meet those challenges and learn my lessons well so I may be as effective as possible in meeting my responsibilities as a nurse leader.

Introduction

My name is Suzanne and I am a nurse at UCD.  I am currently enrolled in a Master's program for Nursing and Health Care Leadership.  We were instructed to enroll in an Informatics course as part of our training. I will use this site to complete my course work for my Informatics class and to catalog my growth in the field of Informatic.  I have a lot to learn!