Evidence-based Practice Change Research Articles

Conversion to Chlorhexidine Gluconate for Perioperative Vaginal Preparation: An Evidence-Based Process Improvement Project.

Surgical site infections (SSIs) occur during the postoperative period and involve the operative site. To lower the occurrence of SSIs in their patient population, the gynecology SSI prevention committee at a large academic medical institution initiated a process improvement project examining vaginal antiseptic skin prep solutions. Some studies indicate that chlorhexidine gluconate (CHG) is superior to povidone-iodine in the reduction of microbial skin counts and SSIs. After reviewing the available literature, the committee members determined there was an opportunity to make an evidence-based practice change and realize significant cost savings by converting povidone-iodine prepping kits to CHG prepping kits for vaginal procedures. The committee members worked with perioperative and facility leaders to revise the vaginal preparation policy, provide staff member education, and convert to CHG prepping kits. Facility leaders supported this cost-saving conversion for all perioperative units, and the project led to a successful, large-scale, evidence-based process improvement.

Clinical Opioid Withdrawal Scale (COWS): Implementation and Outcomes.

The opioid crisis has shown evidence worldwide and locally. There was no protocol to detect opioid withdrawal at this organization. The purpose of this project was to develop a nursing-driven opioid withdrawal management tool using the validated Clinical Opioid Withdrawal Scale (COWS) to address an increase in opioid-addicted patients. Evidence-based practice change was executed using the San Diego 8A's method for adult trauma step-down patients experiencing opioid withdrawal with the COWS tool affecting frequency of nursing attempts at managing opioid withdrawal over an 8-week period. Training was provided to 45 nurses on COWS use in opioid-positive patients exhibiting withdrawal symptoms. Nurses were tested and retested to establish reliability. Nursing management included communication with MDs, safe opioid use education, social work consultation, use of nonopioid pain relief, or other symptomatic medication management. Nursing withdrawal management: pre-COWS = 25%; post-COWS = 96%. There was a statistically significant increase in the percentage of patients evaluated correctly following COWS initiation (n = 28, χ = 29, P < .0001, 95% CI, 47.71-83.74). Data were collected on a matched cohort of symptomatic toxicology-positive patients before and after change (n = 28 pre-COWS and n = 28 post-COWS). Use of the COWS tool with corresponding interventions by trauma nurses is feasible and results in improved withdrawal management.

Reports of three organizations’ members about doctor of nursing practice project experiences and outcomes

BackgroundHolders of the Doctor of Nursing Practice (DNP) degree were envisioned to improve health and health care outcomes by implementing quality improvement initiatives, applying evidence-based practice changes (EBP), and influencing policy. Little is known about the nature of the DNP project experience and its relationship with subsequent experiences of graduates. Filling these knowledge gaps is important because of the investment of time, faculty and student effort, expense, and the projects' potential long-term effects on the organizations in which they were conducted. Purpose(1) Describe the impetus for foci, outcomes and activities of DNP projects and (2) determine the extent to which project foci are a part of post-graduation experiences. MethodsA cross-sectional descriptive survey design was used and a via mailed paper and online version was sent with return options to graduates of Doctor of Nursing Practice program. The sampling technique was designed to maximize the capture of DNP graduates. Three mailings were sent to 5,830 nurse members of three national organizations with memberships that included advanced practice registered nurses, nurse administrators and nurse educators. The 1,308 DNP prepared respondents were demographically and geographically representative of organizational members. FindingsMost (65.2%) reported the topic of the project was their own idea and they sought out an organization in which to conduct it. Twenty-five percent indicated not all aspects of the reorganization/initiative/policy change were completed by graduation. Five project foci emerged with the majority reporting an EBP initiative or an EBP project involving reorganization in the setting (57.7%) There was also a wide variation in the number, types and combinations of activities reported to be a part of the project. There was wide variation in the relationship of project foci and activities with reports of post-graduation experience by position title. Discussion/ConclusionFindings suggest potential avenues for innovations during the DNP project experience innovations. Long term effects of projects on organizations in which they were conducted and the relationship of project activities with post-graduation roles should be considered.

East meets west in psychiatry: Yoga as an adjunct therapy for management of anxiety

PurposeProvide yoga for coping and symptom management in a locked, adult inpatient psychiatric unit. DesignHatha yoga was offered to inpatients with mood disorders and/or psychosis 3 times per week in this evidence-based practice change project. Impact on sleep was examined using recorded sleep hours. Anxiety symptoms were assessed using 6 of the 7 symptoms recorded on the Generalized Anxiety Disorders (GAD) 7. Sustainability of benefits was examined. A self-assessment was conducted at discharge to determine acquisition of new coping skills. ResultsNo difference in sleep hours or interruptions was noted. A statistically significant increase in the total anxiety scores (z = −1.9815, p = 0.02385) and sustainability of benefits (z = −2.0894, p = 0.03662) between the first and second yoga class were observed. A positive change from baseline in sustainability of symptoms for “less anxiety” (k = 0.108) and “more relaxed” (k = 0.083) was found. There was a significant increase in utilization of yoga (p = 0.0015) and meditation (p = 0.013) as coping mechanisms at discharge. ConclusionsAdults in an acute inpatient psychiatric unit who participated in yoga practice identified yoga and meditation as newly-acquired coping mechanisms and reported significant improvement in anxiety symptoms with sustained benefits ranging from half day to full day.

Evidence-Based Practice Competence in Nursing Students: An Exploratory Study With Important Implications for Educators.

Evidence-based practice (EBP) is a core pillar of nursing education and an expectation in clinical practice. Students struggle to conceptualize the use of EBP into actual clinical practice despite the development of EBP competencies. This study explored perceptions of EBP education and competence in baccalaureate students using Melnyk's (Worldviews on Evidence-Based Nursing, 11, 2014 and 5) EBP competencies for practicing registered nurses as a basis for comparison. The researchers used a sequential, mixed-methods design. A survey was developed to assess information sources and patterns of use, and semistructured interviews explored factors affecting students' understanding of EBP and information-seeking behaviors in the clinical setting. There were 118 participants in the survey and 12 in follow-up interviews. A major theme was that participants had difficulties distinguishing between EBP and research. Students were able to identify experiences that fostered attainment of basic EBP competencies, such as searching for evidence, but were less able to describe higher-order activities such as integrating evidence to plan EBP changes or disseminating best practices. Clinical learning environments are an ideal place to apply and see EBP in action, but nurse educators cannot assume students arrive ready to apply EBP knowledge and skills to clinical practice. Nurse educators need evidence-based tools to assess student EBP competence across a variety of settings. Research examining the generalizability of the EBP competencies in varying curricular models as well as didactic and clinical settings is needed.

Patient, Nurse, and Organizational Factors That Influence Evidence-Based Fall Prevention for Hospitalized Oncology Patients: An Exploratory Study.

Hospital falls remain common despite decades of studies and guidelines to reduce their rate. Research evidence alone is insufficient, and integration of patient values and preferences, clinician expertise and experiences, and organizational culture is needed to ensure sustainable practice changes. Little is known about the best strategies for integrating these constructs to sustain effective fall prevention programs. Guided by the Comprehensive Framework for Implementation Research (CFIR), this study aimed to identify patient, nursing staff, and organizational-level factors that influence effective and sustainable fall prevention strategies with the goal of identifying variables amenable to targeted interventions. A descriptive research design engaged four oncology units in a Midwestern academic medical center and included patients (N=39) and nursing staff (N=70). Questionnaire data were collected from patients with interview assistance, and nursing staff completed a demographic form and two standardized instruments adapted for the study. Data were analyzed using descriptive statistics and narrative summaries. Findings indicated two-thirds of patients did not see themselves at risk for falling, despite nearly half having a fall history. Nursing staff indicated knowledge gaps related to specific known risks and interventions, and confidence in fall prevention management was lowest for team communication about patient risks and engaging patients and families in preventing falls. Engagement of patients in fall risk assessment and management, clear and routine communication among team members, and creating a culture of true engagement with appropriate leadership and resources can potentially improve the sustainability of successful fall prevention programs. The CFIR can guide the planning of fall prevention and other evidence-based practice changes to become hardwired and sustainable over time even with the ongoing introduction of new initiatives.

Implementation of Pre-/Post-Weights to Enhance Direct Breastfeeding in the NICU

IntroductionMother's own milk (MOM) is recommended as the optimal nutrition for preterm infants. Direct breastfeeding (DBF) is correlated with a longer duration of receiving MOM during hospitalization. Infants' transition to DBF may be enhanced when accurate pre-/post-weights are incorporated into nursing practice. An evidence-based practice change was introduced to promote use and increase consistency in methodology of pre-/post-weights after DBF in the neonatal intensive care unit (NICU), with the ultimate goal of increasing DBF at hospital discharge.MethodsThe practice change was introduced through an educational program, a video demonstrating pre-/post-DBF weighing techniques, and a return-demonstration. A 10-item pre-/posttest was used to evaluate nurses' knowledge gained by an educational intervention that included seven knowledge questions, three attitude questions, and three demographic descriptors.ResultsNurses' knowledge gained following the educational intervention was statistically significant (p &lt; .001) using a paired t-test.ConclusionsThe use of pre-/post-DBF weights as an accurate assessment of MOM transfer can promote DBF during hospitalization through education of NICU nurses. Understanding nursing characteristics and attitudes can aid in promotion of DBF in the NICU by bedside nurses.

Abstract WP493: Benefit of an Advanced Practice Nurse-Led Stroke Telemonitoring Program

Introduction: Hypertension (HTN) remains the leading modifiable risk factor for stroke. Recently updated guidelines from the American Heart Association support a blood pressure (BP) goal of ≤ 130/80 mmHg and home blood pressure monitoring (Benjamin et al., 2017). The purpose of this evidence-based practice change project was to implement a new home blood pressure telemonitoring (HBPT) program for stroke patients with HTN, promote self-care management and reduce secondary stroke risk. Methods: An advanced practice nurse (APN) led 16-week HBPT pilot project was implemented to monitor blood pressure (hospital admission, discharge, 7-days HBPT and 30-days post discharge) and perception of the HBPT experience. Eligibility for HBPT was determined by the stroke team in collaboration with case management. Home care nurses assured home delivery of the HBPT device and educated the patient/family on device management. Daily readings were transmitted to the home care dashboard and monitored for alerts. Patients returned to the stroke office 30-days post discharge for evaluation of BP and HBPT experience. Results: Sixteen out of 112 patients were eligible for HBPT. The mean age was 71 years-old; 54% males; 55% females. Stroke types included 67% ischemic and 33% hemorrhagic. A significant change (improvement) in BP was noted from: admission to discharge (P = 0.007) and admission to 30-days post-discharge (P &lt; 0.001). All patients achieved target BP at discharge and 30-day post-discharge. All patients reported a positive HBPT experience. Conclusion: An HBPT program can be beneficial in promoting secondary stroke risk reduction and enhancing patient self-care management skills.

Home Care Program Increases the Engagement in Patients With Heart Failure

Heart failure patients seen in the outpatient home care setting and in cardiology clinics have repeated emergency department visits, hospital admissions, and readmissions despite receiving education about their medications diet and self-care interventions such as daily weights. The objective of this evidence-based practice change was to determine, in home care patients, whether the use of standardized teach-back methodology educational materials would improve their knowledge and confidence in the self-care of their chronic disease. Of the 22 patients enrolled, 15 were not readmitted to the hospital within 9 months of home care admission. The Self-Care of Heart Failure Index revealed an improvement in patient and caregiver contributions to heart failure self-care maintenance (daily adherence and symptom monitoring). The findings suggest that engaging patients by increasing their knowledge of their disease and their self-confidence can reduce hospitalizations and subsequent readmissions.

Implementation of an Evidence-Based Practice Change to Offer Nitrous Oxide During Labor

ObjectiveThe aim of this evidence-based practice change was to implement use of nitrous oxide as a pain management option during labor and to examine women’s satisfaction with that option. DesignEvidence-based practice change guided by the model for evidence-based practice change. SettingLabor and delivery unit in a tertiary medical center in the southwestern United States. ParticipantsLaboring women who met eligibility criteria were offered the option of nitrous oxide during a 2-month period. MeasurementsProcess indicators to measure compliance with the practice change among staff, uptake of nitrous oxide among women, and women’s satisfaction with the choice to use nitrous oxide. ResultsNitrous oxide was offered to 26% (n = 55) of eligible women. Most of the 55 women who used nitrous oxide during the implementation period reported satisfaction with it and indicated that they would consider nitrous oxide for a future labor. ConclusionOur experience implementing a practice change to offer nitrous oxide to laboring women indicated that use of nitrous oxide was feasible in this setting and that women were receptive to this option, were satisfied with its use, and would use nitrous oxide for a future labor.

In Reply.

We thank our colleagues for their interest in the published work1 and their thoughtful comments. The study of clinical decision support, process of care measures, and clinical outcomes is a complex area that demands increased attention from the peer-reviewed literature, academic institutions, and industry.We concur with Dr. Freundlich et al. that multicenter studies of clinical decision support are necessary to advance the field. To maximize generalizability and reproducibility, multicenter research is a natural step in the evolution of evidence-based practice change. Donabedian’s classic “ structure-process-outcomes” framework clearly identifies that the context within which care is delivered must be incorporated into clinical and health services research.2 A decision support system that is associated with clinical impact in one health system or structure of care may demonstrate no value in another setting, or vice versa. Multicenter pragmatic clinical trials and Randomized, Embedded, Multifactorial, Adaptive Platform (also known as “REMAP”) trial designs are potential cost-effective avenues to study clinical decision support.3 With support from a multitude of national and international anesthesiology organizations, the Multicenter Perioperative Outcomes Group, on behalf of its more than 40 contributing member organizations, has invested in the Initiative for Multicenter Perioperative Clinical Trials (IMPACT).4 We look forward to working with centers and investigators from around the world that wish to use this infrastructure for pragmatic perioperative trials.We also share Doctoral Candidate Patel’s interest in the complexity of data elements and factors involved in clinical research. We struggle, however, to identify a specific way forward offered by Patel et al., or any recommendation underlying their correspondence. The “curse of dimensionality” is not unique to the study of decision support systems or healthcare research in general. Nor is pharmaceutical research, and the billions of dollars expended each year on unsuccessful drug targets, an appropriate model for future work. In fact, much of current drug development involves the use of hypothesis-generating phenome-wide or genome-wide association studies that provide hundreds of candidate targets for a given disease state; these potential targets are then evaluated at scale using computational, theoretical models. Although increased sample size and data breadth may address some issues with analyses of multifactorial clinical outcomes, data heterogeneity and quality issues often arise in concert. Increased sample size may have allowed adequate power to detect a difference in infrequent outcomes such as stage 2 acute kidney injury.In summary, we concur that new data types and approaches are needed to advance the science of decision support system evaluation. Although our current analysis demonstrated process of care impact, it could not evaluate the impact on many crucial clinical outcomes inconsistently recorded in the electronic health record, such as surgical site infection, pulmonary complications, delirium, or patient satisfaction. Finally, the positive impact upon process of care measures and some resource outcomes should offer encouragement to clinicians and researchers seeking to advance care for their patients. Changing clinician behavior remains a goal almost as elusive as improving clinical outcomes.Support provided by the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.Dr. Tremper is the founder of, and has an equity interest in, AlertWatch (Ann Arbor, Michigan), the company that developed the decision support system being evaluated.

Revisiting the Pain Resource Nurse Role in Sustaining Evidence-Based Practice Changes for Pain Assessment and Management.

Effective pain management is unlikely to occur without consistent and timely assessments. To improve assessment and management of pain, ward-based pain resource nurses were introduced in 2007 to facilitate hospital-wide evidence-based practice changes using three key targets. One-year post implementation of this quality improvement project, promising results were revealed. The purpose of this study, 8years post implementation, was to (a) evaluate sustained practice improvements in pain assessment and management, (b) assess current pain resourcenurse knowledge and attitudes to pain, (c) explore characteristics of the pain resource nurse role, as well as (d) any perceived contextual changes regarding study findings. A mixed-methods approach was used to address study aims. Quantitative data were collected from documentation audits and a "Knowledge and Attitudes Survey Regarding Pain." Qualitative interviews explored the characteristics of the pain resource nurse role, and a focus group discussion explored the context of change. Significant improvements were observed for the documentation of pain scores on admission and for each nursing shift. Survey results highlighted potential knowledge deficits in key practice areas, even though interview findings suggested that pain resource nurses provided a resource for peers, raised awareness of best practice, and imparted knowledge to other ward staff. An important facilitator for the pain resource nurse role was the ongoing collaboration and support from specific pain teams, and barriers to engage in the role were competing workload priorities, and limited awareness among other ward staff. Implementing and sustaining evidence-based practice change in clinical practice is challenging. Ongoing evaluation is necessary for identifying the long-term implications of practice improvement interventions and issues that influence the adoption of evidence-based practice. Strategies to address barriers, and to increase awareness and engagement of the pain resource nurse role with wider collaboration require further investigation.

Falls prevention strategies for patients over 65 years in a neurology ward: a best practice implementation project.

The aim of this project was to promote evidence-based practice with regard to fall prevention and management, by implementing the recommendations from the best available evidence to reduce fall rates. Falls are a main cause of disability in older people and the most common adverse event in all hospital patients. It is essential to implement the recommendations from evidence-based interventions to reduce these events. A pre and post implementation audit method was used in a neurology ward, which employed the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) and Getting Research Into Practice (GRiP) module. The 15-month project evaluated between 20-30 patients from a sample at each audit (baseline in April 2016 and during three follow-up cycles in December 2016, March 2017 and June 2017). The data were inputted into an informatics system from nursing records and audited according to evidence-based processes and outcomes criteria. The baseline outcomes identified five barriers: incomplete fall registration, lack of an established fall prevention protocol for at-risk patients, limited knowledge about the fall prevention protocol, lack of a fall risk assessment scale and lack of multifactorial individual plans for fall prevention. Strategies were carried out and implemented following GRiP and all the criteria improved from baseline. The project successfully increased evidence-based practice on falls and provided mechanisms for sustaining evidence-based practice changes. Further audits are needed to improve some outcomes.

Implementing Enhanced Recovery After Surgery (ERAS) Program on a Specialty Nursing Unit

Implementing Enhanced Recovery After Surgery (ERAS) guidelines is an effective method to standardize patient care, improve patient outcomes, and develop quality improvement projects. Completing the required ERAS Implementation Program provided by the International ERAS Society enabled the hepatopancreaticobiliary surgery team at Carolinas HealthCare System to successfully implement evidence-based practice changes for pancreaticoduodenectomy patients on an acuity-adjustable unit resulting in improved care and cost reduction.

Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care.

Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba, derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. To explore the use of gemba boards and gemba huddles to facilitate practice change. Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted.

Piloting Medication Histories in a Pediatric Postanesthesia Care Unit

Develop a medication history process for pediatric postanesthesia care unit (PACU) patients to identify discrepancies between home and inpatient medications and prevent medication errors. Pilot an evidence-based practice change to perform PACU medication histories. Inpatients or surgical admissions to general care units at a pediatric tertiary care 348-bed hospital ages 2-18 years were included. Parents/guardians were asked about their child's prescription and over-the-counter medications, allergies, and adherence. Data included patient age, surgery, medication categories, and error classifications. Information was compared to the patient's medical record. From June to July 2016, 75 medication histories were performed, covering 44.6% of eligible cases within the period. Seventy-four discrepancies were found, the most frequent being omission. The medication category with the most errors was vitamins/herbals/supplements. The workflow designed assessed discrepancy frequency and type in surgical patients' medication lists when transitioning from the PACU to general care units.

Moving Shift Report to the Bedside: An Evidence-Based Quality Improvement Project

A Midwestern, 532-bed, acute care, tertiary, Magnet® designated teaching hospital identified concerns about fall rates and patient and nurse satisfaction scores. Research has shown that the implementation of bedside report has increased patient safety and patient and nurse satisfaction. An evidence-based practice change incorporating bedside report into standard nursing care was implemented and evaluated over a four-month time period on three nursing units. Fall rates, HCAHPS and Press Ganey® scores, and nurses’ response to a satisfaction survey were measured before and after the project implementation. This article begins with the background of the problem and literature review, and then presents the project methods, measures, and data analysis. Results demonstrated that patient fall rates decreased by 24%, and nurse satisfaction improved with four of six nurse survey questions (67%) having percentage gains in the strongly agree or agree responses following implementation of bedside report. HCAHPS and Press Ganey® results demonstrated improvement in Press Ganey® scores on two of the three nursing units. In this project, implementation of bedside report had a positive impact on patient safety, patient satisfaction, and nurse satisfaction. The authors conclude with discussion of findings and implications for nursing management.

Examining the sustainability potential of a multisite pilot to integrate alcohol screening and brief intervention within three primary care systems.

The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.

Trends in narcotics and sedative use during mechanical ventilation of preterm infants in Canadian neonatal intensive care units

ObjectiveMechanical ventilation (MV) in preterm infants (PTI) causes discomfort. Whether it causes pain is controversial. Meta analysis reviews of published work on PTI during MV have shown no clinically significant impact of opioids on pain scales, and hence not recommended for routine use in neonatal intensive care units (NICUs). Similarly regular use of sedative midazolam is also not recommended. Therefore we hypothesized a downward trend in narcotics and sedatives used in MV of PTI in NICUs. This study aimed to assess trends of sedatives and narcotics use during MV of PTI in Canadian NICUs during 2004-2009. MethodsPTI born at gestational age (GA) of 24 hours were identified retrospectively from the Canadian Neonatal Network database for 2004-2009. PTI were excluded if moribund on admission, had major congenital anomalies, surgery (except laser eye surgery), necrotizing enterocolitis, chest tube or history of maternal narcotic abuse. PTI were classified according to whether they received any narcotics (morphine, fentanyl, methadone, sufentanyl, meperidine, alfentynl and codiene) or sedatives (chloral hydrate, midazolam, lorazepam, phenobarbital, pentobarbital, ketamine and propofol) for > 24 consecutive hours during MV. Trends of narcotics and sedatives were assessed using the Cochrane-Armitage Trend test separately for PTI born at <29 and 29-34 weeks of GA. ResultsAmong 5 638 study subjects, 2 169 (38.5%) received narcotics and 897 (15.9%) received sedatives. The most common narcotics were morphine (62.2%) and fentanyl (63.8%) and sedatives were phenobarbital (44.9%) and chloral hydrate (44.2%). A significant decreasing trend (P <0.01) in the use of any sedatives during MV was observed in PTI <29 and 29-34 weeks of GA. However, the use of any narcotics during MV increased significantly (P=0.03) among PTI <29 weeks of GA, and no change in trend was detected for PTI born at 29-34 weeks of GA. ConclusionsThe use of sedatives during MV in PTI born at <35 weeks of GA was positively affected, however the narcotics use during MV remained constant for PTI born at 29-34 weeks, and increased in extremely low GA group (less than 29 weeks) suggesting evidence based practice change was not observed during the study period.

CE: Oral Care for Head and Neck Cancer Symptom Management.

: An evidence-based practice change at a radiation oncology center in a large academic medical center was designed to reduce the severity of oral mucositis in adults receiving radiation treatment for head and neck cancer. In the intervention described, patients were given newly created oral care kits and educational materials to improve their oral hygiene. Evaluations were conducted at three points during the project (before radiation treatment, during week 4 to 5 of treatment, and one month after treatment). At week 4 to 5-when the severity of oral mucositis is expected to peak-patients reported improved oral hygiene practices and reduced oral mucositis severity. The authors conclude that the use of these oral care kits and educational materials lessened the effects of oral mucositis during and after radiation treatment.