Improving Registered Nurses' Knowledge of Evidence-Based Practice Guidelines to Decrease the Incidence of Central Line-Associated Bloodstream Infections: An Educational Intervention

Bir yoğun bakım ünitesinde sık görülen enfeksiyonların önlenmesi için bir bakım paketinin etkinlik ve maliyetinin analizi: Yarı deneysel bir öntest-sontest tasarım çalışması

Amaç Sağlık hizmeti ilişkili enfeksiyonlar hasta güvenliğini tehdit etmekte, hastanede yatış süresinin uzamasına, morbidite, mortalite ve maliyetlerin artmasına neden olmaktadır. Bu çalışma, sağlık hizmeti ilişkili enfeksiyonları önlemeye yönelik müdahalelerin etkinliğini ve bu müdahalelerin maliyete etkisini değerlendirmek amacıyla yapılmıştır. Metod Bu araştırma bir yoğun bakım ünitesinde 1 Ocak – 30 Haziran 2018 ile 1 Ekim 2018 – 31 Mart 2019 tarihleri arasında 27 eğitim öncesi ve 27 eğitim sonrası olmak üzere toplam 54 hasta ile yarı deneysel ön test-son test tasarım çalışması olarak yapılmıştır. Bulgular Çalışmada enfeksiyon oranları Ocak-Mart 2018'de 20.34, Nisan-Haziran 2018'de 25.7, Ekim-Aralık 2018'de 20.97 ve Ocak-Mart 2019'da 17.77 olarak bulunmuştur. Dört farklı dönemin enfeksiyon oranları karşılaştırıldığında, eğitim öncesine göre eğitim sonrasında enfeksiyon oranlarında azalma olduğu ancak bu düşüşün istatistiksel olarak anlamlı olmadığı saptanmıştır (p>0.05). Eğitim öncesi ortalama maliyet 11361.35₺, eğitim sonrası ortalama maliyet 9149.87₺ olarak belirlenmiştir. Tüm maliyetlerin en önemlisi olan ortalama yatak maliyeti eğitim öncesine göre %95 güven aralığında %25,7 oranında azalmıştır. (5241.86₺-13251.50₺, sırasıyla 3489.03₺-10257.41₺). Sonuç Sonuç olarak, çalışmada eğitimin yoğun bakım hemşirelerinin sağlık hizmeti ilişkili enfeksiyonlara ilişkin puanlarında anlamlı bir artış sağladığı, sağlık hizmeti ilişkili enfeksiyon oranlarında, hastanede kalış sürelerinde ve eğitim sonrası maliyette istatistiksel olarak anlamlı olmasa da azalma sağladığı belirlenmiştir.

Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy

BACKGROUND

Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking.

OBJECTIVES

The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility.

METHODS

This educational intervention took place at a 286-bed community hospital certified by the Joint Commission as a primary stroke center. Bedside registered nurse (RN) staff from 4 units received a poster presentation linking the American Heart Association's and American Stroke Association's current evidence-based clinical practice guidelines to standardized stroke order sets and bedside nursing care. The 90-second oral poster presentation was delivered by a graduate nursing student during preshift huddle. The poster and supplemental materials remained in the unit break room for 1 week for RN viewing. After the pilot unit, a pdf of the poster was also delivered via an e-mail attachment to all RNs on the participating unit. A preintervention online survey measured nurses' self-perceived likelihood of performing an ordered intervention based on whether they were confident the order was evidence based. The preintervention survey also measured nurses' self-reported confidence in their ability to explain how the standardized order sets are derived from current evidence. The postintervention online survey again measured nurses' self-reported confidence level. However, the postintervention survey was modified midway through data collection, allowing for the final 20 survey respondents to retrospectively rate their confidence before and after the educational intervention. This modification ensured that the responses for each individual participant in this group were matched.

RESULTS

Registered nurses reported a significant increase in perceived confidence in ability to explain how standardized stroke order sets reflect current evidence after the intervention (n = 20, P < .001). This sample was matched for each individual respondent. No significant change was shown in unmatched group mean self-reported confidence ratings overall after the intervention or separately by unit for the progressive care unit, critical care unit, or intensive care unit (n = 89 preintervention, n = 43 postintervention). However, the emergency department demonstrated a significant increase in group mean perceived confidence scores (n = 20 preintervention, n = 11 postintervention, P = .020). Registered nurses reported a significantly higher self-perceived likelihood of performing an ordered nursing intervention when they were confident that the order was evidence based compared with if they were unsure the order was evidence based (n = 88, P < .001).

DISCUSSION

This nurse education strategy increased RNs' confidence in ability to explain the path from evidence to bedside nursing care by demonstrating how evidence-based clinical practice guidelines provide current evidence used to create standardized order sets. Although further evaluation of the intervention's effectiveness is needed, this educational intervention has the potential for generalization to different types of standardized order sets to increase nurse confidence in utilization of evidence-based practice.

Teaming Up to Take Down Community-Acquired Bloodstream Infections: A Program Aimed at Educating and Training Nurses in the Community

Background: Advances in medical technology have allowed pediatric patients to be discharged home with complex devices, including central venous catheters (CVCs). For these patients to be safely discharged, families require training to care for these catheters. At a large children's hospital, extensive family education and training for CVCs was already established. However, community caregivers were not receiving the same training. In an effort to target these caregivers, an education program was designed and implemented in 2011.

Methods: The program was originally designed and implemented by nurses on a gastroenterology unit and has expanded to include instructors from the vascular access team, hematology/oncology department, and pulmonary department. All community nurses providing care for pediatric patients in the region are welcome to attend the free class with education hours offered. The class is structured with lecture time and skills practice through simulation.

Results: Since the program began in 2011, 34 classes have been offered and 305 nurses have attended from multiple home health companies and school districts in the region. Community-acquired central line-associated bloodstream infection (CLABSI) rates for the pediatric gastroenterology and oncology patient populations have decreased significantly since the class began.

Conclusions: An education program targeting nurses in the community who care for complex patients with CVCs can decrease community-acquired infection rates and complications. This program can be designed and tailored for multiple patient populations with varying complexities and medical devices.