Conceptual models related to evidence based practice, techniques for framing clinical questions amenable to search of the literature, and skills in performing a computerized search and analysis of the literature. Standardizing port access and dressing practice by implementing evidencebased policies are associated with measurable improvement in patient outcomes. Smileys clinic is a family medicine clinic that is part of the universitys residency training program. Reducing clabsi in the nicu with iv tubing competency tessa toscano university of san francisco. Ebp strategies allow nps and other health care providers to translate research findings into clinical practice. Central lineassociated bloodstream infections clabsis result in thousands of deaths each year and billions of dollars in added costs to the u. The national institute for health and care excellence nice produces evidencebased medical technologies guidance to evaluate and, where appropriate, encourage adoption of novel and innovative medical devices and diagnostics within the national health service nhs in england. Evidence based nursing ebn is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. Evidencebased practice is a philosophical approach that is in opposition to tradition. Biopatch protective disk with chg the evidencebased. Task force of the american college of critical care medicine of the society of critical care medicine in collaboration with the infectious disease society of america. A response to quality deficits caused by a thats the way its always been done mindset, the call for evidence.
The guidelines for the prevention of intravascular catheterrelated infections have been developed for practitioners who insert catheters and for persons who are responsible for surveillance and control of infections in hospital, outpatient, and home healthcare settings. Evidencebased practice is a conscientious, problemsolving approach to clinical practice that incorporates the best evidence from welldesigned studies, patient values and preferences, and a clinicians expertise in making decisions about a patients care. Peripherally inserted central catheter picc line care purpose. The purpose of this guideline is to provide information on the best practices related to preventing complications with picc lines.
This change can lead to improved outcomes, increased efficiency, and better patient experience. At our institution, we have been using the foam dressing for over a decade and continue to witness wrong placement of the sponge dressing. Evidence based method is the scientific way of proving a natural phenomenon whiles practice based knowledge is gained through practicing in an area or field for a long time to acquire experience. Best available evidence although evidencebased practice encompasses more than just applying the best available evidence, many of the concerns and barriers to using ebp revolve around finding and applying research.
A range of treatment approaches and supports that are derived from, and supportive of, the positive cultural of the local society and traditions. Evidencebased practice academy of medicalsurgical nurses. Profile people school of nursing vanderbilt university. Skip to main content an official website of the department of health and human services. Using the collaborative evidencebased practice model. Implanted ports are an important lifeline for patients receiving antineoplastic treatments. Evidence based practice is a process that brings together the best available research, professional expertise, and input from youth and families to identify and deliver services that have been demonstrated to achieve positive outcomes for youth, families, and communities. Ebn implements the most up to date methods of providing. Using practicebased evidence to complement evidencebased practice in a childrens mental health outcomes roundtable for children and families february 2011 introduction in the last 15 years, there have been increased efforts to improve childrens mental health services by identifying practices shown to be effective. Chlorhexidineimpregnated dressing for prevention of colonization of central venous catheters in infants and children a randomized controlled study.
Mavis schorn is a professor, senior associate dean for academics and a nursemidwife in the faculty practice at vanderbilt university school of nursing. Peripheral ivs are the most frequently used invasive device in hospitals, 6 and standards of care now recommend clinically indicated replacement. More than 1,000 intensive care units across the country reduced clabsi rates by 41 percent when their clinical teams used the tools in this toolkit along with the core cusp toolkit. When you care for a patient who has a peripherally inserted central catheter picc, change the dressing once a week if he currently has a transparent dressing or at least every 48 hours if its a gauze dressing. Evidence based pediatric nursing and evidence based obstetric nursing came from a need to teach basic nursing care while incorporating research from an everchanging health care system.
Evidencebased practice ebp is defined by duke university medical center as the integration of clinical expertise, patient values and the best research evidence into the decisionmaking process for patient care. Listing of content related to the topic evidencebased practice. This report was prepared by a working group composed of professionals. Toolkit for reducing central lineassociated blood stream. The purpose of this quality improvement initiative was to reduce the clabsi rate in the neonatal intensive care unit from 3. Nov 01, 2009 cindy, i am wondering about your tegaderm drsg with blob of chlorhexidene.
Aacn practice alerts are directives to guide evidencebased nursing practice within the context of a healthy work environment. Pdf the art of evidencebased practice researchgate. Experts warn against choosing compounded bioidentical. Skin patch device influencing ambulatory cardiac monitoring. Many of the practices surrounding implanted ports remain controversial. In spring semester of 2015, my 5 colleagues and i proposed chlorhexidine bio patches as our nursing practice improvement topic through an evidence based research study at pace university.
A focus on central lines preventing hospitalacquired infections the centers for disease control estimate that 41,000 bloodstream infections occur in u. Pereiras current practice is located at smileys clinic in minneapolis. This guideline provides recommendations regarding best practice for the use and management of invasive devices based on current. Use biopatch disk as part of a piv bundle to help protect the insertion site. Describe techniques used to prepare chronic wounds. Aegis chlorhexidine gluconate chgimpregnated foam discs help reduce risk factors associated with clabsi. Apta is committed to help physical therapist develop, synthesize and use evidence. Chrystian pereira, pharmd, bcps college of pharmacy. I know many institutions use these products under the manufactures age recommendations. Pita adam, md, msph medical school university of minnesota. Clinical evidence to support the efficacy of biopatch. Central line care must be guided by credible evidencebased standards that focus on central lineassociated bloodstream infection prevention. In the sheaidsa practice recommendations and 2011 cdc guidelines a chlorhexidinecontaining sponge dressing has received a category 1b recommendation and the highest possible rating for the quality of evidence. Feb 10, 2020 this site also serves as support for the book entitled, evidence based medicine.
Written proposal for a research project that was submitted by a nrc member for her masters in nursing preparation. Case report cvc picc dialysis 25 reducing catheterrelated bloodstream infections. Guideline peripherally inserted central venous catheters picc 1. Evidence based practice promotes decisionmaking that reflects bestavailable information, rather than clinical experience and perceptions of therapeutic efficacy, which can be inaccurate.
Evidencebased practice is used to close the gap between the research being conducted and the practicethe researchpractice gap, says marquetta flaugher, arnpbc, dsn, an apn at bay pines fl va hospital. Evidencebased practice definition of evidencebased. Discuss the pros and cons of the adjuncts to wound healing discussed in this article. It provides continual antisepsis over 7 days, thus preventing skin organisms from entering at the insertion site and tracking extraluminally up the catheter and into the bloodstream. The authors show that antimicrobial biopatch disk is an efficacious choice for the prevention of crbsis. Evidence based practice ebp is a process in which the practitioner combines wellresearched interventions with clinical experience and ethics, and client preferences and culture to guide and inform the delivery of treatments and services. The biopatch dressing comes as a round sponge which is placed circumferentially around the insertion site. Home evidencebased practice libguides at duke university.
A systematic search for and critical appraisal of the most relevant. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. You can find many textbooks on the subject, but the most concise information can be found in the chapter on evidencebased practice in the new edition of the ins textbook. Reducing clabsi in the nicu with iv tubing competency. Evidencebased practice is a process that brings together the best available research, professional expertise, and input from youth and families to identify and deliver services that have been demonstrated to achieve positive outcomes for. Biopatch is a chlorhexidine chg impregnated sponge dressing that is placed at the insertion site of central venous catheters. I am tryng to get policy changed at my institution.
Evidencebased standards guide the use and maintenance of. This guide provides an overview of evidencebased practice resources. Oct 19, 2007 i am looking for evidence based practice information and research on using biopatch and chloraprep on infants. It is a problem solving approach to clinical practice and administrative issues that integrates. This technology allows observation and provides antiseptic coverage of the catheter insertion site, reducing catheter related bloodstream infections and local site infections compared with. Central lineassociated bloodstream infection clabsi. While not exactly a new concept in healthcare scottish physician, archibald cochrane, championed researchbased care during the mid20th century, evidencebased practice has transformed healthcare during the last decade and a half. This is the second maintenance of certification article on wound healing. Helping primary care offices keep their resolutions to put evidence into practice. Sep 06, 2019 this guide includes a tutorial about evidence based practice ebp in health, a reference shelf of supporting ebooks, and a toolkit of online sources of evidence. Evidencebased practice ebp is the objective, balanced, and responsible use of current research and the best available data to guide policy and practice decisions, such that outcomes for consumers are improved.
Pdf using the collaborative evidencebased practice. Patricia pita adam, md, msph, is the department of family medicine and community healths vice chair for clinical affairs. At our institution, we have been using the foam dressing for over a decade and continue to witness wrong. Errors in placement and dressing disruption have been well described with a sponge dressing. Chloraprep, alcohol, biopatch disc, an occlusive transparent tegaderm dressing, and an optional statlock connectors should be change with each dressing change and as needed.
Introduction evidencebased practice in health uc library. Practices that integrate the best research evidence with clinical expertise and patient values. The case for adopting the 3m tegaderm chg iv securement dressing for central venous and arterial catheter insertion sites is supported by the evidence. Clinical practice guidelines introduction only personnel trained in the technique of aseptic insertion and maintenance of the catheter should handle catheters. Evidencebased practice challenges nurses to look at the why behind existing methods and processes in the search for improvement. These alerts are based on published evidence and guidelines. The key to advancing quality and safety in healthcare michelle r. Biopatch protective disk with chg the evidencebased choice. He uses the zio patch system in his 10person private group practice at three. Excellence every day portal a focus on central lines.
In the first, buchanan, kung, and cederna dealt with the mechanism and. It is a major paradigm shift in our approach to making patient care decisions. Guidelines for the prevention of intravascular catheter. Tegaderm chg iv securement dressing for central venous and. Several other practice changes were implemented that contributed to the decrease in crbsi rates. Vpn login pulse secure is required for offcampus or. The purpose of this article is to discuss evidence based practice ebp fr om the perspective of a selfidentified. The goals of the tutorial are to clearly outline the theory of ebp and to explain how that theory can be put to practice in the daytoday work of caring for patients. I am looking for evidence based practice information and research on using biopatch and chloraprep on infants. Used originally in the health care and social science fields, evidencebased practice focuses on approaches demonstrated to be.
The oncology nursing society ons is committed to identifying the evidence base for oncology nursing and demonstrating the impact of oncology nursing interventions on patient outcomes. Evidence based recommendations for the prevention of clabsi 20 1. Evidencebased practice agency for health research and. Central lines are common 48% of icu patients clabsis are associated with bad outcomes 5004,000 u. Evidence based practice pace university eportfolio. Reducing clabsi in the nicu with iv tubing competency tessa a. Browse the aana professional practice website for information and resources to assist crnas and others interested in learning more about evidencebased practice. The order for replacement of an existing suprapubic catheter from a licensed medical provider should be verified. Cdc is providing guidelines and tools to the healthcare community to help end clabsis. Experts warn against recommending compounded bioidentical hormones in menopause two internationally recognized womens health experts raise concerns from use of hormone therapy from a compounding pharmacy to manage menopausal symptoms. Reports indicate that up to 45% may become infected. These textbooks attempt to bridge the gap between clinical practice and evidence based bedside nursing interventions for all nursing students and nurses.
The toolkit for reducing central lineassociated blood stream infections clabsi can help your unit implement evidencebased practices to reduce and, in many cases, eliminate clabsi. Practice parameters for evaluating new fever in critically ill adult patients. Cdc, in collaboration with other organizations, has developed guidelines for the prevention of clabsi and other types of healthcareassociated infections. New cdc guidelines for prevention of intravascular.
Purpose this guideline has been developed as part of the icare intervention bundle for the management of intravascular devices ivds. Johnson dressing helps reduce local infections, catheterrelated bloodstream infections crbsi and skin colonization of microorganisms commonly associated with crbsi in patients with central venous and arterial catheters. The second step in the evidencebased practice ebp process is to search for and find external scientific evidence that addresses your clinical question. This policy was communicated throughout the institution in an interdisciplinary clinical practice manual. Discuss the appropriate use of different dressings presented in this article. As evidencebased practice is increasingly adopted, so are the available resources to assist with putting evidence to practice. Establishment of an external ventricular drain evd best practice guideline. This approach is using evidence based practice ebp as a foundation. Some degree of reliance on the way it was always done can be found in almost every profession, even when those practices are contradicted by new and better information.
Integrating positive psychology into a clinical psychological assessment and intervention model and how to measure outcome poul nissen university of aarhus, copenhagen, denmark in this paper, a model for assessment and intervention is presented. Aegis chgimpregnated foam disc medline industries, inc. Aacn practice alerts are directives to guide evidence based nursing practice within the context of a healthy work environment. Troseth, msn, rn, dpnap, faan, chief professional practice officer, elsevier clinical solutions tuesday. Please let me know what your own hospital policy is and how you came to it. Case report cvc picc dialysis 9 techniques to prevent central venous catheter infections. In late 2003, the ons commissioned nursing scientists to develop evidence based summaries for the management of specific cancer symptoms.
Using an evidence based approach allowed for the adoption of the latest standards while taking proactive steps to mitigate risk proved to be a successful strategy. She teaches in the university of minnesota medical center family medicine residency and is also one of the family medicine team members on the minnesota primary care transformation collaborative. Central line associated blood stream infections clabsi. I believe pharmacy practice can serve to improve the health and wellbeing of patients and further improve the health of a community. Heic revised the hospitalwide vad policy, including successful sicu practices for insertion, dressing change, catheter care, and maintenance. Facilities can monitor the rates of clabsi and assess the effectiveness of prevention efforts through cdcs national healthcare safety network nhsn. The dedicated primary care provider must educate his patients and help them to make wise, evidencebased decisions about their hormone replacement. In the current practice climate, an overwhelming amount of misleading information is readily available to our patients. Evidencebased standards guide the use and maintenance of venous implanted ports. Unfortunately, patients with evds are prone to getting infections, and these infections can dramatically impact the patients hospital course, and ultimately the risk of death. Ahrq reports adding to the momentum for evidencebased care.