Iowa Model Of Evidence-Based Practice Research Articles

Clinical Service Incorporating Mobile Technology on Weight Loss in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: A Translation From Research Trial.

The prevalence and healthcare cost of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased alongside the epidemic surge in obesity and Type 2 diabetes. Weight loss through lifestyle modification remains the primary effective therapy for MASLD. Incorporation of mobile technology in lifestyle interventions has been previously found to be efficacious and cost-effective in facilitating weight loss. However, there is a paucity of studies that have successfully translated lifestyle research into clinical service for weight loss to alleviate disease burden. Our study aimed to describe the process of translating a mobile technology-enabled trial into a tertiary hospital outpatient dietetics service for patients with MASLD. The Iowa Model of Evidence-Based Practice to Improve Quality Care was used as a framework for this paper to guide implementation at the organizational level. Regular engagement of key operational staff and the hospital management team facilitated open discussions of the challenges faced and enabled rapid implementation of strategies that contributed to the smooth piloting of the service. A service adoption rate of 81% was achieved. Preliminary outcome evaluation found that the percentage of patients achieving ≥ 5% weight loss from baseline at 6 months was comparable at 54% and 52% for the service and trial groups, respectively. Evaluation of the implementation process found that a hybrid model of care (in-person consultation supplemented with app coaching) preserved interpersonal connections while maximizing the convenience and scalability of mobile app-enabled service. Although high digital acceptance and adoption rates propelled by COVID-19-supported telehealth, it is prudent to assess patient's access to technology and digital literacy and offer resources to help them benefit from telehealth services.

133 Research in Action: Engaging Clinicians to Advance the Academic Learning Health System

OBJECTIVES/GOALS: Research in Action is an on-demand, interactive curriculum designed to increase the ability of clinicians to advance the Academic Learning Health System (aLHS). The 7-module course provides clinicians with the knowledge and skills to lead rigorous quality improvement (QI) projects, translating research evidence into practice. METHODS/STUDY POPULATION: We engaged nurses, physicians, and advanced practice providers (APPs) working in the health system to participate in focus group and advise us in the creation of the curriculum. We conducted focus groups with these stakeholders on the proposed learning objectives, course content, and mode of delivery (in person, virtual, hybrid). Informed by the focus groups, the course was designed for hybrid format so participants could either (1) access the modules on-demand, or (2) learners could participate in a facilitator moderated course where the modules served as the curriculum to guide development of a QI project. The Iowa Model of Evidence-Based Practice was the framework for curriculum development. Upon completion of the modules, stakeholders reviewed each module and provided feedback for improvement. RESULTS/ANTICIPATED RESULTS: Research in Action is a 7-module course, with modules addressing the following topics: (1) Introduction to Quality Improvement, (2) Identify the Problem and Write a Purpose Statement, (3) Form a Team, (4) Appraise and Synthesize the Literature, (5) Design and Pilot the Project, (6) Integrate and Sustain Practice Change, (7) Disseminate the Results. The curriculum is being piloted with multiple clinician groups in the health system. In the next phase of development, a facilitator guide will be created to guide a cohort of clinicians to apply knowledge through discussion sessions and completion of a QI project in the healthcare setting. We anticipate scaling the program for spread to diverse clinician groups in the health system. Pre- and post-implementation data are being collected from current pilot sites. DISCUSSION/SIGNIFICANCE: The aLHS is an essential means for improving healthcare delivery. Research in Action, a hybrid training curriculum, engages frontline clinicians in creating and leading QI projects that implement research evidence into practice to solve problems commonly encountered in the healthcare setting; thus, supporting the advancement of the aLHS.

Advancing EBP culture and competencies through an academic-research partnership: Process and outcomes of an EBP scholar program.

Evidence-based practice (EBP) is increasingly being adopted in healthcare organizations to improve patient care and outcomes. Yet, barriers remain that prevent consistent implementation of EBP in clinical settings. To increase EBP competencies and promote practice change, a regional academic-community hospital in Los Angeles, California, jointly with a university school of nursing, developed and implemented an EBP scholar program. A multistep EBP process was delivered during monthly didactic workshops to ensure optimal delivery and acquisition of EBP core competencies. The Iowa Model of Evidence-Based Practice to Promote Quality Care was integrated into the curriculum to assist program scholar's efforts to systematically direct EBP implementation at the organizational level. Additional strategies were incorporated including one-to-one mentoring, institutional recognition, and protected time. The 13-item EBP Competency Scale for practicing registered professional nurses was used to measure EBP competency at baseline and post-program completion. Five recruited scholars completed the baseline survey and three completed the postsurvey. EBP competency increased from 52.9% to 62.75%. Scholars submitted abstracts for conference poster presentation, podium presentations, and conference poster awards. One article was submitted and accepted for journal publication. A multistep EBP process can enhance EBP delivery, improve EBP competency, and facilitate dissemination.

Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches

BackgroundModels, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective.MethodsWe used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights.ResultsWe agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08).ConclusionsOur interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future.Trial registrationOpen Science Framework Registration: osf.io/qgh64.

Improving Developmental Positioning in a Level III NICU Using Evidence-Based Teaching and a Standardized Tool: An Evidence-Based Quality Improvement Project.

Positioning and handling is a core measure of developmental care that has been universally difficult to implement in the technical NICU environment. Appropriate positioning has been shown to not only improve postural and musculoskeletal outcomes, but enhance sensory development, physiologic stability, thermal regulation, behavioral organization, sleep facilitation, and brain development. In order to improve the developmental positioning practices of bedside nurses in a level III neonatal intensive care unit, a quality improvement project was initiated. Guided by the Iowa Model for Evidence-Based Practice, this project included an evidence-based educational intervention and a standardized positioning assessment tool. After the intervention, there was improvement in knowledge scores, and positioning scores increased from an average of 8.81 +/- 0.19 to 10.93 +/- 0.15.

Navigating the Path to a Sustainable “PACU Pause” and Standardized Perioperative Handoff: A Quality Improvement Project

PurposeThe purpose of this project was to develop and implement a pause and standardized perioperative handoff to improve the quality of the handoff and the satisfaction of the perioperative team in the postanesthesia care unit (PACU) setting. DesignThe Iowa Model for Evidence-Based Practice guided this evidence-based practice-quality improvement project. MethodsA team was formed of key nurses and other perioperative members to execute the project. The outcome of the evidence review, appraisal, and synthesis supported the change to a pause and standardized perioperative handoff. The project team educated perioperative staff on the practice change and new process. Baseline, 3-month and 1-year data were collected for adherence to the PACU PAUSE and handoff critical elements, and baseline and 3-months for satisfaction. FindingsPACU PAUSE adherence was 42.30% prepractice change, 92.3% postchange and 96.10% at 1-year. Adherence to the 17 critical elements in the standardized handoff was 40.16% prepractice change, 77.36% postchange and 71.78% at 1-year. Nurse satisfaction with the PACU PAUSE and handoff increased 59% and 50% respectively from pre to postpractice change. Operating room nurse and anesthesia provider satisfaction with PACU PAUSE and handoffs was greater than 85% at baseline and increased 14% and 8% respectively. ConclusionsThe PACU PAUSE allows for increased nurse concentration during the handoff and this can improve patient safety. Using a standardized handoff in situation, background, assessment, response format can decrease information loss and miscommunication, improve the quality of the handoff and the perioperative team members satisfaction with the handoff, and may mitigate patient safety events.

SPN 2021 Poster Abstract Awards

SPN 2021 Poster Abstract Awards

Administration of 3% Sodium Chloride Through Peripheral Intravenous Access: Development and Implementation of a Protocol for Clinical Practice.

Patients with traumatic brain injury, cerebral edema, and severe hyponatremia require rapid augmentation of serum sodium levels. Three percent sodium chloride is commonly used to normalize or augment serum sodium level, yet there are limited data available concerning the most appropriate route of administration. Traditionally, 3% sodium chloride is administered through a central venous catheter (CVC) due to the attributed theoretical risk of phlebitis and extravasation injuries when hyperosmolar solution is administered peripherally. CVCs are associated with numerous complications, including arterial puncture, pneumothorax, infection, thrombosis, and air embolus. Peripherally infused 3% sodium chloride may bypass these concerns. To explore the evidence for peripherally infused 3% sodium chloride and to implement the findings. The Iowa Model of Evidence-Based Practice (EBP) was used to guide the project. A multidisciplinary team was established, and they developed an evidence-based protocol for the administration of 3% sodium chloride using peripheral intravenous catheters (PIVs), identified potential barriers to implementation, and developed targeted education to implement this practice change in a large academic medical center. Of the 103 patients in this project, only three (2.9%) identified adverse events. Two were associated with continuous infusions, and one was associated with a bolus infusion. This is the first study to describe a multidisciplinary protocol development and implementation process for the administration of 3% sodium chloride peripherally. Utilizing a multidisciplinary team is critical to the success of an EBP project. Implementing an evidence-based PIV protocol with stringent monitoring criteria for the administration of 3% sodium chloride has the potential to reduce adverse events related to CVC injury.

Introducing evidence based practice in nursing care delivery, utilizing the Iowa model in intensive care unit at Kamuzu Central Hospital, Malawi

BackgroundNowadays, having knowledge of Evidence Based Practice (EBP) and its implementation strategies are critical skills for nurses to promote delivery of safe, effective and quality care. Nursing care delivery is faced with a challenge of delivering EBP. The purpose of this study was to build the capacity of and support nurses to implement an EBP change using Iowa Model of EBP. MethodsAction research using quantitative approaches was conducted in intensive care unit at Kamuzu Central Hospital (KCH). A descriptive, pretest-posttest design using repeated measures was employed. Iowa model was used to implement change. Convenient sampling of six-co researchers and 26 patients was done, the inclusion criteria was all patients with fever. STATA 12.0 software was used to analyze data and paired t-test was used to determine the mean difference of the paired temperature observations. ResultsIowa model effectively supported and guided nurses to: identify fever as a clinical problem; select fever control interventions; implement and evaluate the evidence-based interventions; refine and integrate the evidence-based interventions in routine practice. After Paired t-tests were run; there was an insignificant mean difference for exposure 0.07 °C, t (85) = 1.4123 and the P = 0.1615. This suggest that exposure has minimal effect on temperature reduction. The mean difference for paired temperature observation for: tepid sponge bath was 0.6 °C/hour, (t (85) = 9.8427, P = <0.001.); Ice packs 0.5 °C/hour, (t (56) = 6.7854, P = <0.001); antipyretics-paracetamol 0.3 °C/hour, t (23) = 3.4371, P = <0.002) and intravascular cooling 2.4 °C/hour (t (21) = 19.8080, P = <0.001). These methods had a significant mean difference of temperature reduction. This shows that the methods are effective in reducing temperature. Then a fever guideline was developed to guide nurses in smooth integration of the evidence-based fever control intervention into routine nursing care delivery to ensure sustainability. ConclusionUsing Iowa model improves nurses' EBP capability and capacity. Increasing knowledge of key staff members, team work, availability of local resources are crucial to increase nurse’s capacity of taking their EBP role. For effective EBP initiative it is recommended to: utilize of EBP models, ensure active participation of all nurses at the unit level, have supportive leadership, communicate available EBP policies, guidelines and job description to providers, and integrate the pilot EBP innovation in routine nursing care operations.

Determinants of an evidence-based practice environment: an interpretive description

BackgroundDespite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment.MethodThe study was conducted in an 800-bed comprehensive academic medical centre in the USA with a 25-year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first half of 2019.ResultsFour determinants of the local EBP environment were identified from the perspectives and experiences of participants: (1) the importance of a shared model to guide staff through the EBP process; (2) support for EBP in the form of education, hands-on training, and knowledge infrastructure; (3) active team facilitation by direct care nurses, nurse managers, nurse specialists, and nurse scientists; and (4) a culture and leadership that encourages EBP.ConclusionIntroducing an EBP model is an essential first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.

The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration.

To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 (P < .05). The incidence of adverse events was unchanged. Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

Early Mobilization in the ICU: A Collaborative, Integrated Approach.

Objectives:To develop and implement a protocol to increase patient mobility in three adult ICUs using an interdisciplinary approach and existing resources.Design:The Iowa Model of Evidence-Based Practice was used for synthesis of literature and intervention planning. A retrospective pre- and post-intervention data collection design was used to compare outcomes of interest.Setting:Three adult ICUs (64 total beds) in an urban, academic hospital. Physician, nursing, respiratory therapy, physical therapy, and occupational therapy representatives participated in planning and development. All adult ICU patients were included.Interventions:Development and implementation of an inclusive early mobility protocol in three adult ICUs. Focus on interdisciplinary collaboration to restructure workflow, focusing on optimization and coordination of standard tasks. Multimodal education occurred in an interdisciplinary setting and on-site champions facilitated implementation.Measurements and Main Results:Time from admission to ambulation, overall frequency of ambulation, and frequency of ambulation by age group were assessed across three time periods: no awareness (Time 1), awareness without protocol (Time 2), and protocolization (Time 3). Decrease in hours from admission to ambulation were seen in the cardiovascular ICU (62.3 vs 56.1; p = 0.10) and surgical ICU (64.9 vs 58.6; p = 0.022). Significant increase demonstrated in the proportion of patients who ambulated while in the ICU (24.6% vs 33.0%; p < 0.001). All age groups had increase in frequency of ambulation. The largest gains in patients over 65 years old (T1 = 19.7%, T2 = 26.6%, T3 = 30.9%; p < 0.001). No change found in ICU length of stay, hospital length of stay, or ventilator days.Conclusions:This single-center evidenced-based practice project demonstrated increased mobility for ICU patients without addition of staff resources following implementation of an early mobility protocol using an interdisciplinary approach. Successful implementation led to creation of mobility protocol toolkit for use across all ICUs in the broader health system.

Use of Evidence-based Practice Models and Research Findings in Magnet-Designated Hospitals Across the United States: National Survey Results.

All nurses have responsibilities to enculturate evidence-based practice (EBP) and translate and implement research findings into nursing care, practices, and procedures. To report EBP-related findings from the national Hospital-Based Nursing Research Characteristics, Care Delivery Outcomes, and Economic Impact Survey questionnaire. In this cross-sectional survey research study of 181 nursing research leaders, 127 responded to these questions: "Has your hospital adopted or does it use a model of evidence-based practice?" "If yes, what is the name of the model and how is it used?" "Does your hospital implement (translate) findings from nursing research into clinical practice?" "Describe how your hospital implements these findings and whose responsibility it is." "What factors do you believe facilitate the implementation of findings from nursing research into clinical practice at your hospital?" Qualitative content analyses were used. Over 90% of nursing research leaders specified that their hospital used an EBP model and implements findings into practice. The most frequently reported models were the Iowa Model of Evidence-Based Practice, Johns Hopkins Nursing Evidence-Based Practice Model, and Advancing Research and Clinical Practice Through Close Collaboration Model. EBP models were used most frequently for education and training, nurse residency programs, and EBP and research fellowships. Findings were implemented through policy and procedure committee processes, shared governance structures, and EBP processes. Those responsible for implementing findings were project leads, nursing professional practice councils, and clinical nurse specialists and advanced practice nurses. Implementation facilitators were nursing leadership, dissemination of findings, and engaged and educated nurses. These new findings report >90% EBP model use and implementation. All nurses, especially our leaders, have responsibilities to evaluate EBP and how nursing research findings are implemented (translated) into practice. Ideally, engaged and educated nurses who enculturate, support, and sustain EBP will facilitate advancing nursing practice to improve patient and work environment-related outcomes.

APPLICATION OF IOWA MODEL EVIDENCE-BASED PRACTICE ON MATERNITY NURSES REGARDING POSTPARTUM HEMORRHAGE

The Iowa Model of Evidence-Based Practice give usguide line for nursing decisions to manage day-to-day practical work which haveeffect on patient healthbased on -solving problems through scientific procedures and recognized for its applicability's and usingthrough multi-disciplinary healthcare teams. Aim of study was to apply Iowa model Evidence-Based practice on maternity Nurses regarding Postpartum Hemorrhage. Quasi study used in Obstetric and Genecology Hospital at Ain Shams Hospital. Seventy nurses were work in labor and delivery units/Ain Shams Hospital. Throughout using2tools for data collection as 1- structured self-administered questionnaire: include two parts; A-Socio demographic characteristics of the study nurses B-:Assessment of nurses’ knowledge regarding EBP &PPH. 2- Observational checklist for evaluating nursing management regarding PPH. 45.7% of nurses have poor knowledge before interventionmodel and 80.0% have good knowledge post intervention . 84.3% have unsatisfactory practices toward PPH management before intervention of the model. Meanwhile, after intervention 87.1% had satisfactory practices respectively. IOWA model EBP has appositive effect on nurse’s knowledge and practices regarding PPH. Highly significantly difference before / after knowledge and practice regarding PPH (P ≤ 0.001). from our data we could concluded that, developing teaching programs and periodical training regarding IOWA Model evidence based practice.Specific procedure booklets should be available to standardize the nursing care provided in obstetrics department.

Mock Nursing Research and Evidence-Based Practice Conference to Support Learning in Pre-Licensure Nursing Students.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning and implementation of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787 Evidence-based practice (EBP) is an essential element of quality nursing care and education programs. However, nursing students do not seem to grasp the importance of learning EBP, as evidenced by a lack of competency in their clinical roles (Melnyk et al., 2018). Within the seven steps in the EBP process (Table 1), it was found that nursing students’ most needed improvement is with the competencies of “critical appraisal of published research” and “evaluation and synthesis of evidence” (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010; Melnyk et al., 2018). One common way to teach critical appraisal skills and evaluation of evidence competencies is through the use of journal clubs (Ahmadi et al., 2012). Journal clubs are educational tools used to foster critical appraisal skills, encourage EBP, and disseminate new findings, typically through discussion of an article (Topf et al., 2017). This teaching strategy has been around since the mid-1800s and has since taken on a number of forms, ranging from face-to-face meetings to interactions via online, social media platforms (Rosenthal & Rosenthal, 2017; Topf et al., 2017). Incorporating the concepts of the journal club, this column will describe an innovating teaching strategy using a live “mock” nursing research and EBP conference in a pre-licensure nursing program. The objectives were to (a) engage students in current nursing research and EBP and (b) develop their critical appraisal and evaluation skills. Whereas traditional journal clubs discuss current, published literature (Topf et al., 2017), the mock conference included presentations on projects currently in process by PhD and DNP students. The mock conference took place during the EBP course in a pre-licensure nursing program halfway through the semester. The beginning of the semester was spent providing an overview of the EBP process using the Iowa Model of EBP as a guide (Buckwalter et al., 2017). As an integral component of EBP, much didactic time was spent reviewing non-research and research methodologies and how to critically appraise articles. Standard critical appraisal tools that also include clear descriptions and directions on how to assess an article’s level and quality were used to further guide students (Dearholt & Dang, 2012). The concepts of validity, reliability, and applicability of evidence were discussed in didactic lectures, and examples were provided by the course faculty. Course faculty served as the moderator for the conference. Each presenter had 15 min to discuss their project, with time allotted for questions. Presenters were at various stages in their projects, ranging from beginning protocol development to finalized results, with a variety of methodologies and topics presented. Brochures with presenters’ biographies and evaluation forms were distributed to students. Within the brochures, students were asked to rate presentations on a 5-point Likert scale of 1 (poor) to 5 (excellent). This provided students with experience in evaluating speakers, a component of real nursing conferences. Evaluations were provided to the presenters for feedback. To improve the students’ critical appraisal and evaluation skills, students were asked to (a) identify the methodology used, (b) describe the overall purpose, (c) describe the population and setting, and (d) describe how outcomes were measured. Lastly, students were asked to rate the overall mock conference on the same 5-point Likert scale. I thought this was super interesting and a great way to solidify some of the research concepts we have been learning! It gave us examples in what we are studying, while giving students a chance to practice presentations on their research. Great collaboration! This was a great experience. As a student interested in research, this mock conference sparked further interest into future work. The presenters’ enthusiasm for their work is contagious! This conference was helpful in demonstrating multiple facets of ‘real-world’ application of research and EBP. PhD and DNP students commented that they appreciated the opportunity to practice presenting their projects and that it gave them confidence and helpful feedback for the future. The mock conference, a new twist on the journal club, was a mutually beneficial activity that improved pre-licensure students’ critical appraisal and evaluation skills and provided a forum for PhD and DNP students to practice presenting their project. Based off of feedback from the first mock conference, a PhD and DNP student panel was added where pre-licensure students could ask questions about the two doctoral programs. Future conferences may expand to add faculty and clinicians from the health system, as well as poster presentations.

Abstract TMP77: Nurse-driven Bedside Swallow Screen Facilitates Identification of Dysphagia in Stroke Patients and Reduces Aspiration Pneumonia

Introduction: Dysphagia occurs in over half of patients who have sustained acute stroke, and can lead to aspiration, subsequent pneumonia, increased length of hospital stay and death. Identification of dysphagia is vital to reduce these risks prior to oral intake or administration of oral medications. Swallow screening is an effective tool to identify at-risk patients. However, the swallow screen is often informal or omitted, resulting in premature oral intake. Nurses are highly skilled healthcare team members that are at the bedside with the patients and can be effectively trained as the first line of defense in identification of dysphagia. Methods: We implemented a nurse-driven swallow screen using the Iowa Model for Evidence-Based Practice. An interprofessional task force consisting of neurologists, nurse practitioners, speech pathologists, bedside nurses, nursing leadership, and nursing education selected a reliable swallow screening tool, which has been validated on the stroke population. Bedside nursing staff was trained and validated on the swallow screening tool. Subjects included all patients with ischemic or hemorrhagic stroke admitted to our institution in 2015 (n=220 spanning 12,607 patient days) pre-intervention, and in 2017 (n=263 spanning 12,691 patient days) post-intervention. We evaluated swallow screen completion rate and pneumonia rates on the neurology units. Results: The nurse-driven swallow screen initiative increased the percentage of patients with stroke screened from 73.3% in 2015 to 93.5% in 2017 (p&lt;.001). Pneumonia rates on the neurology unit also decreased following this initiative, with aspiration pneumonia rates decreasing from 9.5 per 10,000 patient days to 4.7 per 10,000 patient days and all pneumonia rates decreasing from 28.6 per 10,000 patient days to 18.9 per 10,000 patient days. Conclusions: Empowering bedside nurses in the swallow screen process significantly improves dysphagia screening rates and decreases pneumonia rates in patients with stroke. In conclusion, implementation of nurse-driven swallow screen at bedside is an effective way to increase dysphagia identification in stroke patients and thereby improve patient care outcomes.

Impact of a Collaborative Evidence-Based Practice Nursing Education Program on Clinical Operations

ABSTRACTCollaborative efforts of the Hawai’i State Center for Nursing (HSCN) and participating local hospitals, supported by local medical libraries, provide training in evidence-based practice (EBP). A critical part of the program was integrating the concepts of The Iowa Model of EBP developed by Dr. Marita G. Titler. The Iowa Model includes critique and synthesis of the best literature, identifying stakeholders and identifying triggers in the process of moving evidence into practice (1). The resulting training program led to the development and implementation of numerous nurse-driven projects and 14 peer-reviewed publications that have demonstrated a positive impact on clinical operations within Hawai’i state health organizations including Hawai’i Pacific Health (HPH). This article focuses on collaboration between the HPH EBP program, the HPH Library and the practical application and impact of that concept in a clinical setting.

Implementation of a Standardized Preoperative Diabetes Medication Guideline and its Effect on Day of Procedure Blood Glucose Levels

The purpose of this project was to determine the effect of implementation of a preoperative diabetes medication management guideline on day of procedure blood glucose (BG) levels. This project was designed as pre- and postimplementation process improvement project based on the Iowa Model of evidence-based practice. Anesthesia providers were surveyed for knowledge and confidence before and following education. Surgical patients with diabetes were provided instructions for all classes of prescribed diabetes medications. Day of procedure BG levels were compared prior to and following the guideline implementation. Provider knowledge scores increased 4.5 points (95% confidence interval [CI] 3.2, 5.8) and confidence improved 31.3 percentage points (95% CI 20.8, 41.7). Mean BG level was 132.3 (SD 37.5) before implementation and 130.4 (SD 44.7) after implementation. The project resulted in significant gains in provider knowledge and confidence, but no significant difference in preoperative BG levels following implementation of the guideline.

Reducing falls in the inpatient hospital setting.

This quality improvement project's objective was to introduce and assess a process change to potentially reduce fall rates on an inpatient medical-surgical unit. The Iowa Model of Evidence-Based Practice was used to guide the implementation of this project. This project was piloted over a 3-month period from October to December 2016 on a 38-bed medical-surgical unit at a community-based hospital in the southeastern United States. Prior to the implementation of this quality improvement project, staff received falls education using a modified pre-existing falls prevention protocol, with a focus on increasing the consistency of bed/chair alarm use for patients identified as being at risk for falling. Preintervention and postintervention fall rates were statistically compared to assess for change in practice. The average monthly preintervention fall rate was 8.67 falls/1000 patient days, as compared with 5.07 falls postintervention, which resulted in an overall decrease of 44.5% in the average number of falls per month. This project illustrated that education and a consistent risk stratification for bed/chair alarm use may be an important component of an effective evidence-based falls prevention program.

Reducing pediatric psychiatric hospital readmissions and improving quality care through an innovative Readmission Risk Predictor Tool.

Less than 30-day readmission has become a national problem. This pediatric medical center discovered that the primary diagnosis of Mood Disorder, not otherwise specified, was the third most common readmission diagnosis hospital-wide. Administration actively sought a resolution to less-than-30-day readmissions because All-Patient-Refined-Diagnostic-Related Groups would soon include pediatric hospitals with reimbursement impact. The Iowa Model for evidence-based practice framed the work of case management to identify readmission risk, reduce readmissions, and improve patient quality. In July 2014, the Readmit Predictor Tool (RPT) and Protocol were developed from literature review of contributing factors of pediatric psychiatric readmissions and assessed levels of readmission risk. The nurse case manager provided follow-up telephone calls to caregivers with children identified as moderate-to-high risk for readmissions. Effects of RPT use resulted in decreased readmissions by 29.5% in the first year, followed by 7.8% and 5.1% reductions in the second and third years, respectively, despite substantial increases in patient acuity during the period. Using the RPT and initiating the psychiatry nurse case manager position, less-than-30-day readmissions decreased over a 3-year period.