Part 3: Informatics Application Flashcards
“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”
Evidenced Base Practice
“Involves the synthesis of knowledge from research,
retrospective or concurrent chart review, quality
improvement and risk data, international, national, and
local standards, infection control data, pathophysiology, cost effectiveness analysis, benchmarking data, patient preferences, and clinical expertise”
Evidenced Base Practice
published research studies are used in healthcare
quality initiatives as the evidence behind the
development of practice algorithms designed to
decrease practice variability, increase patient safety,
improve patient outcomes, and eliminate unnecessary
costs
Evidenced Base Practice
Use of___promotes the use of _____ and
_____in relation to the patient’s contextual
situation and preferences, with procedures and protocols being linked to ______ rather than based on what is customary practice or opinion
EBP
clinical judgment
knowledge
scientific evidence
Research results are crucial to furthering ____The
concept of using randomized controlled trials and
systematic reviews as the gold standard against which
one should evaluate the validity and effectiveness of a
clinical intervention was introduced in 1972 by Archie
Cochrane, a scientist and a physician
EBP
___ viewed the randomized clinical trial as means
of validating clinical interventions and limiting the
interventions to those that were scientifically based,
effective, and necessary
Cochrane
standards of practice, codes of ethics, philosophies of
nursing, autobiographic stories, esthetic criticism, works of art, qualitative studies, and patient and clinical
knowledge
Evidence
The context change from medicine to nursing requires
nurses to apply other knowledge and nursing theory The
use of research results as the sole basis for clinical
decision making ignores other types of evidence inherent
in nursing practice
Evidence
To use evidence in practice, the weight of the research, also called______ must be determined Evidence hierarchies have been defined to grade and
assign value to the information source For example, an evidential hierarchy developed by Stetler et al 1998
prioritized evidence into six categories
research validity
Evidential hierarchy (6)
Meta analysis Individual experimental studies Quasi experimental studies Nonexperimental studies Program evaluations, such as quality improvement projects Opinions of experts
The
time between research dissemination and clinical
translation may be significant, and this delay may
adversely affect patient outcomes __________
between research and practice requires an understanding
of the key concepts and barriers, access to research
findings, access to clinical mentors for research
understanding, a reinforcing culture, and a desire on the
part of the clinician to implement best practices
Bridging the gap
Lack of EBP knowledge and skills is a barrier to
EBP
Organizational cultures that do not support EBP is a barrier to
EBP
Lack of resources, including clinical decision support tools is a barrier to
EBP
Executive leaders and managers who do not model and/or
support EBP is a barrier to
EBP
Inadequate access to databases by clinicians in order to track
patient and system outcomes is a barrier to
EBP
Negative attitudes toward research is a barrier to
EBP
Strong beliefs about the value of EBP and the ability to implement it facilitates
EBP
EBP knowledge and skills facilitates
EBP
Organizational cultures that support it facilitates
EBP
EBP mentors who have in depth knowledge and skills in
evidence based care as well as individual and organizational
change facilitates
EBP
Administrative support facilitates
EBP
Clinical promotion systems that incorporate EBP competencies facilitates
EBP
EBP tools at the point of care, such as clinical decision support
systems facilitates
EBP
1st Step of EBP
Cultivate a spirit of inquiry
2nd Step of EBP
Ask the burning clinical question in PICOT format
What Step in EBP?
a spirit of inquiry in clinicians and a
culture of EBP must be cultivated in order to stimulate the asking of burning clinical questions to improve patient care
Step 1
What Step in EBP?
process involves formatting clinical questions into PICOT format
Step 2
P I C O T
patient population intervention or interest area comparison intervention or group outcome time
What Step in EBP?
Search
for the evidence is conducted by entering each
key word from the PICOT question into the database that is being searched (e g Medline, CINHAL) and then combining the search words together to reveal the studies that may answer the question
Step 3
Step 3 in EBP?
Search for and collect the most relevant best evidence.
Step 4 in EBP?
Critically appraise the evidence.
What Step in EBP?
Rapid
critical appraisal of the studies from the search is
conducted, followed by an evaluation and synthesis of the
research evidence
Step 4
Step 5 in EBP?
Integrate the best evidence …with one’s clinical
expertise and patient preferences and values in making a practice decision or change.
What Step in EBP?
Evidence
is integrated with the clinician’s expertise and
patient preferences and values to make a decision
regarding whether a practice change should be made
Step 5
Step 6 of EBP
Evaluate outcomes of the practice decision or change
based on evidence.
What step of EPB? Once a practice change is made based on the best evidence, outcomes should be measured to determine positive outcomes of the change
Step 6
Step 7 of EBP?
Disseminate the outcomes of the EBP decision or
change
What Step of EBP? Disseminating the outcome of the practice change through presentation or publication so that others can benefit from the process
Step 7
Computers are used in all areas of research (1)literature search databases, such as CINAHL (2)online literature reference lists, such as RefWorks (3)data capture, collection, and coding (4)data analysis (5)data modeling (6)meta analysis (7)Qualitative analysis and (8)dissemination of results
The role of _____
Informatics
__ has brought to healthcare
a compendium of new tools which support EBP
Information technology
Nursing professionals range in age from their early
20 s to their 60 s with the average age of a registered
nurse today in their early_____
50 s
Nurses use experientially acquired information from
interactions with peers, patients, colleagues, and
physicians ___than scientific evidence from medical and research journals
greater
3 Decision Support Systems
Model Management System
User Interface
Knowledge Base
are automated tools designed to support decision
making activities and improve the decision making
process and decision outcomes
Decision support systems
such systems are intended to use the enormous amounts
of data that exist in information systems to facilitate
decision processes
Decision support systems
are systems designed to support healthcare providers in making decisions about the delivery and management of patient care
Clinical decision support systems
has the potential to improve the patient safety and
outcomes for specific patient populations, as well as
compliance with clinical guidelines and standards of
practice and regulatory requirements
Clinical decision support systems
are systems designed with multiple rules and access to multiple databases for information
Evidenced-based Adaptive Clinical Decision Support Systems
complex systems and contain mechanisms to incorporate
new findings and evidence
Evidenced-based Adaptive Clinical Decision Support Systems
Within the complexity of today’s healthcare
environment, there is an increasing need for accessible
information that supports and improves the effectiveness
of decision making and promotes clinical accountability
and the use of best practices
Clinical Decision Support Systems
Clinical tasks to which ___may be applied include
alerts and reminders, diagnostic assistance, therapy
critiques and plans, medication orders, image
recognition and interpretation, trend analysis, and
information retrieval
Clinical Decision Support Systems
The primary goal of ____ is to optimize the efficiency
and effectiveness with which clinical decisions are made
in order to improve the manner in which care is
delivered
Clinical Decision Support Systems
Without the ability to recall and process all available
complex information, decisions in healthcare often
cannot be justified on the basis of available knowledge,
costs, benefits, possible risks, and patient preferences
Clinical Decision Support Systems
tools that aid nurses in improving their
effectiveness in care delivery, identifying appropriate
interventions, determining areas in need of policy or
protocol development, and supporting patient safety
initiatives and quality improvement activities are
increasingly needed
Clinical Decision Support Systems
It is important to remember that the clinical user’s
experience, knowledge base, and understanding of the current context of care are ____ by, but, rather,
supported in the decision making process.
not replaced
Final decisions should always be made by clinicians who can accept or reject the ____information within the context of the existing healthcare situation.
Clinical Decision Support Systems
CDSS is a ____system, not a _____ system
Tool
Rule
Implementation of ___requires the development of a strategy built on an understanding of available ___
tools, clinician readiness to adopt and use ___, and
areas within the organization that carry significant risks
to patient safety
Clinical Decision Support Systems
Implementation of ___requires the development of a strategy built on an understanding of available ___
tools, clinician readiness to adopt and use ___, and
areas within the organization that carry significant risks
to patient safety
Clinical Decision Support Systems
A CDSS is only as effective and accurate as its
underlying _____
knowledge base
3 Pillars supporting the full benefits of CDS
Best knowledge available when needed
High adoption and effective use
Continuous improvement of knowledge and CDS
methods
Five rights in CDS:
“right ___to the right ___in the right
_____ through the right ____
at the right ____in workflow”
information people intervention formats channels point
1.Assist in problem solving with semi structured
problems
2.Support but not replace, the judgment of a manager
or clinician
3.Improve the effectiveness of the decision making
process
are the purposes of
Decision Support System
There is growing pressure for clinicians including nurses to use_____ that is based on
researched evidence
knowledge at the point of care
Use of CDSS to find and _____related to gaps between optimal and actual practice can result in improved quality of care
prevent errors