DevelopmentofanIntegrationModelofEvidenceBasedPractice(EBP...

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Development  of  an  Integration  Model  of  Evidence-­‐‑Based  Practice  (EBP), Process  Improvement  (PI)  and  Patient  Safety.

Michelle  Pendleton,  DNP,  RN,  Bill  Harrington,  MBA,  BS,  Kelly  Johnson,  MSN,  RN,  CPPS,  Kim  Tharp-­‐‑Barrie  DNP,  RN,  SANE,  Jill  Berger,  MSN,  MBA,  RN,  NE-­‐‑BC    

Michelle  Pendleton Michelle.pendleton@nortonhealthcare.org 1951  Bishop  Lane,  Ste  103 Louisville  KY  40218 502-­‐‑272-­‐‑5366

Contact

The  passing  of  the  Affordable  Care  Act  (ACA)  spurred  the  movement  from  “volume-­‐based”  to  “value-­‐based”  healthcare  financing.    In  mid-­‐2011,  the  Centers  for  Medicare  and  Medicaid  Services  (CMS)  released  an  extensive  document  on  Hospital  Value-­‐Based  Purchasing  (HVBP)  Final  Rule,  and  the  InsAtute  of  Medicine  considers  paAent  safety  “indisAnguishable”  from  the  delivery  of  quality  health  care  (Aspen  et  al,  2004;  Commikee  on  the  Quality  of  Health  Care  in  America,  2001).    Buyers  and  consumers  of  healthcare  are  holding  providers  accountable  for  the  quality  and  cost  of  care.  As  care  providers  work  to  improve  the  quality  scores  and  as  the  quality  targets  related  to  reimbursement  get  progressively  harder,  sustaining  the  good  results  of  today  are  not  enough.  Providers  and  organizaAons  must  conAnuously  look  to  the  evidence  for  alternaAve  methods  of  care  delivery,  uAlize  a  consistent  process  improvement  model  for  change,  and  incorporate  conscious  consideraAon  for  paAent  safety.    

Introduction

Through  the  collaboraAon  and  leadership  of  a  DNP  registered  nurse  and  a  PhD  student  in  industrial  engineering,  Norton  Healthcare  (NHC),  in  Louisville  Kentucky  has  embraced  the  journey  to  integrate  the  models  of  evidence  based  pracAce  (EBP)  (Johns  Hopkins),  conAnuous  process  improvement  (DMAIC)  and  paAent  safety.  Combining  DMAIC,  paAent  safety  and  EBP  helps  to  ensure  that  decisions  are  based  on  a  combinaAon  of  best  evidence  and  creaAvity,  potenAally  miAgaAng  false  starts  or  trial  and  error  and  prevenAng  “reinvenAng  the  wheel”.  

Project  Description

Tools  for  use

Acknowledgements Norton  Healthcare  departments  of  Clinical  Effectiveness,  Institute  for  Nursing  and  Risk  Management   With  special  thanks  to: Shirl  Johnson Director,  Clinical  Effectiveness Jodi  Behr   Chair,  Evidence  Based  Practice  Matrix Todd  Lammert System  Director,  Clinical  Effectiveness

ACer  a  literature  search  looking  for  current  models  of  integraAon  yielded  minimal  results,  a  comparison  of  the  purpose,  strength  and  opportunity  of  EBP  and  DMAIC  was  completed.  This  exercise  provided  a  gap  analysis  of  each  methodology  and  idenAfied  where  each  method  could  complement  the  other.  

EBP  and  PI  Comparison  Summary

DMAIC  (NHC  implemented  model)  

EBP  (Johns  Hopkins)   Both  DMAIC  and  EBP  

Purpose   Understanding    our  problem/environment  

Leveraging  the  documented  leanings  of  others  

Robust  way  of  knowing  our  own  problems  

Strength   •Guided  process  •Sustain  improvement  

Framework  to  appraise  fit/appropriateness  of  external  knowledge    

Ensure  that  decisions  are  based  on  a  combina@on  of  best  evidence  and  crea@vity,    mi@ga@ng  false  starts      defensible  scien@fic  evidence  

Opportunity   •  “a  long  @me  to  complete”  •limited  to  internal  knowledge    

•Rigor  rela@ng  to  iden@fying  root  cause  •  “charter”  type  document  to  provide  an  overview  or  guiding  document  to  complete  work  (scope  creep)  

Strengths  of  one  complement  the  opportuni@es  of  another    

A  key  component  of  prac@ce-­‐focused  doctorate  degrees  such  as  the  doctorate  of  nursing  prac@ce  (DNP)  is  to  transform  the  health  care  delivery  system  by  designing,  evalua@ng,  and  con@nuously  improving  the  context  within  which  care  is  delivered.  This  innova@on  has  poten@al  to  shorten  project  cycle  @me  and  ensure  improving  

quality  and  safer  pa@ent  care.      

References                American  Association  of  Colleges  of  Nursing  (AACN),  (2004),  Doctor  of  Nursing  Practice  (DNP)  position  statement.  Retrieved  from  h\p://www.aacn.nche.edu/dnp/dnp-­‐‑position-­‐‑statement              Aspden  P,  Corrigan  J,  Wolco\  J,  et  al.,  eds.  (2004).  Patient  safety:  achieving  a  new  standard  for  care.  Washington,  DC:  National  Academies  Press              Commi\ee  on  the  Quality  of  Health  Care  in  America.  Crossing  the  Quality  Chasm:  A  New  Health  System  for  the  21st  century.  (2001).  Washington,  DC:  National  Academy  Press              Federal  Registrar  (2011),  v76,  no.88  retrieved  from  h\p://www.gpo.gov/fdsys/pkg/FR-­‐‑2011-­‐‑05-­‐‑  06/pdf/2011-­‐‑10568.pdf                Johns  Hopkins  Evidence  Based  Practice  Used  with    Permission  Modelh\p://www.hopkinsmedicine.org/institute_nursing/continuing_education/evidence_based_practice.html  

Integrated  Project  Checklist Johns  Hopkins  Question  Development  

 Easy  to  follow  tools  and  a  checklist  were  developed  and  implemented  to  ensure  that  quality  and  practice  projects  integrate  the  knowledge  and  skills  for  clinical  and  administrative  leadership  across  services  and  sites.  

Summary  of  Evidence  Table

Synthesis  is  KEY

Framework  Components NHC  PaAent  Safety  Campaign

Practice  Question

Evidence Translation

Johns  Hopkins  EBP  Model NHC  PI  Model  DMAIC

Define

Measure

Analyze Improve

Control