Evidence in Hand: Optimizing the Unique Skill Set of a Hospital-Based Center for Nursing Research and Evidence-Based Practice.

This paper describes how, as the COVID-19 pandemic emerged, one hospital-based center for nursing research and evidence-based practice capitalized on its unique skill mix to quickly pivot to provide hospital administrators and staff with timely, relevant evidence regarding the care of patients and families, as well as the protection of direct care providers and all support staff. The products produced by this center, both proactive and in direct response, contributed to clinical operations decision-making and thus, tangibly impacted practice. The positive outcomes described speak not only to the clinical environment, but also to the presence and specialized contributions of a multiprofessional center for nursing research and evidence-based practice in such a way that was not possible prior to COVID-19.

Impact of a Hospital Evidence-Based Practice Center (EPC) on Nursing Policy and Practice.

BACKGROUND: In 2006, our healthcare system created a hospital Evidence-based Practice Center (EPC) to support the local delivery of high-quality, safe and high value patient care. Since then, the importance of healthcare staff work life has also been highlighted, and together these four elements form the Quadruple Aim framework. Synergistic to this Aim, the Magnet® program promotes and recognizes organizational nursing excellence. OBJECTIVE: To examine the EPC's work to inform nursing policy and practice in support of the goals of the Quadruple Aim framework and Magnet® designation. METHODS: Methods used included the following: (1) descriptive analysis of the hospital EPC's database of rapid reviews; and (2) administration of a 40-item electronic questionnaire to nurses who requested an EPC review during fiscal years (FY) 2015 and 2016. RESULTS: Of 308 rapid reviews completed in the EPC's first 10 years, 59 (19%) addressed nursing topics. The proportion of reviews relevant to nursing increased from 5% (2/39) in the center's first 2 years to 44% (25/60) in FY 2015-2016. The majority of nursing reviews (39/59) examined processes of care. Of 23 nurses eligible to participate in the survey, 21 responded (91%). Nurses with administrative or managerial responsibilities requested 70% of reviews; clinical nurse specialists and bedside nurses requested 17% and 9%, respectively. Reviews were used to support clinical program development (48%), provide clinical guidance (33%), update nursing policies or procedures (24%) and develop training and curricula (24%). Nurses were satisfied with the hospital EPC reviews (mean; 4.7/5), and 95% indicated they were likely to request a future review. LINKING EVIDENCE TO ACTION: A dedicated hospital EPC in partnership with nursing offers a unique mechanism for promoting a culture of evidence-based practice. Nurses at all organizational levels use the services of a hospital EPC to inform nursing policy and practice and are highly satisfied with the process, supporting the Quadruple Aim and Magnet® designation.

Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme.

BACKGROUND: Integration of evidence into practice is suboptimal. Clinical pathways, defined as multidisciplinary care plans, are a method for translating evidence into local settings and have been shown to improve the value of patient care. OBJECTIVE: To describe the development of a clinical pathways programme across a large academic healthcare system. METHODS: We use a 10-step framework (grounded in the Knowledge-to-Action framework and ADAPTE Collaboration methodology for guideline adaptation) to support pathway development and dissemination, including facilitating clinical owner and stakeholder engagement, developing pathway prototypes based on rapid reviews of the existing literature, developing tools for dissemination and impact assessment. We use a cloud-based technology platform (Dorsata, Washington, DC) to assist with development and dissemination across our geographically distributed care settings and providers. Content is viewable through desktop and mobile applications. We measured programme adoption and penetration by examining number of pathways developed as well as mobile application use and pathway views. RESULTS: From 1 February 2016 to 30 April 2018, a total of 202 pathways were disseminated. The three most common clinical domains represented were oncology (46.5%, n=94), pulmonary/critical care (8.9%, n=18) and cardiovascular medicine (7.4%, n=15). Users opting to register for a personal account totalled 1279; the three largest groups were physicians (45.1%, n=504), advanced practice providers (19.5%, n=245) and nurses (19.1%, n=240). Pathway views reached an average of 2150 monthly views during the last 3 months of the period. The majority of pathways reference at least one evidence-based source (93.6%, n=180). CONCLUSIONS: A healthcare system can successfully use a framework and technology platform to support the development and dissemination of pathways across a multisite institution.

Hourly rounding to improve nursing responsiveness: a systematic review.

UNLABELLED: The aims of this study were to synthesize the evidence concerning the effect of hourly rounding programs on patient satisfaction with nursing care and discuss implications for nurse administrators. BACKGROUND: Patient satisfaction is a key metric that influences both hospital ratings and reimbursement. Studies have suggested that purposeful nursing rounds can improve patient satisfaction, but the evidence to date has not been systematically examined. METHODS: A systematic review of published literature and GRADE analysis of evidence regarding nursing rounds were conducted. RESULTS: There is little consistency in how results of hourly rounds were measured, precluding quantitative analysis. There is moderate-strength evidence that hourly rounding programs improve patients' perception of nursing responsiveness. There is also moderate-strength evidence that these programs reduce patient falls and call light use. CONCLUSIONS: Nurse administrators should consider implementing an hourly rounding program while controlled trials discern the most cost-effective approach.

Assessing preventability in the quest to reduce hospital readmissions.

Hospitals devote significant human and capital resources to eliminate hospital readmissions, prompted most recently by the Centers for Medicare and Medicaid Services (CMS) financial penalties for higher-than-expected readmission rates. Implicit in these efforts are assumptions that a significant proportion of readmissions are preventable, and preventable readmissions can be identified. Yet, no consensus exists in the literature regarding methods to determine which readmissions are reasonably preventable. In this article, we examine strengths and limitations of the CMS readmission metric, explore how preventable readmissions have been defined and measured, and discuss implications for readmission reduction efforts. Drawing on our clinical, research and operational experiences, we offer suggestions to address the key challenges in moving forward to measure and reduce preventable readmissions.

'Scared Straight' and other juvenile awareness programs for preventing juvenile delinquency.

BACKGROUND: 'Scared Straight' and other similar programs involve organized visits to prison by juvenile delinquents or children at risk for criminal behavior. Programs are designed to deter participants from future offending through first hand observation of prison life and interaction with adult inmates. These programs remain in use despite research questioning their effectiveness. This is an update of a 2002 review. OBJECTIVES: To assess the effects of programs comprising organized visits to prisons by juvenile delinquents (officially adjudicated, that is, convicted by a juvenile court) or pre-delinquents (children in trouble but not officially adjudicated as delinquents), aimed at deterring them from delinquency. SEARCH METHODS: To update this review, we searched 22 electronic databases, including CENTRAL, MEDLINE, PsycINFO, and Criminal Justice Abstracts, in December 2011. In addition, we searched clinical trials registries, consulted experts, conducted Google Scholar searches,and followed up on all relevant citations. SELECTION CRITERIA: We included studies that tested programs involving the organized visits of delinquents or children at risk for delinquency to penal institutions such as prisons or re formatives. Studies that had overlapping samples of juvenile and young adults (for example, ages 14 to 20 years) were included. We only considered studies that assigned participants to conditions randomly or quasi-randomly (that is,by odd/even assignment to conditions). Each study had to have a no-treatment control condition and at least one outcome measure of 'post-visit' criminal behavior. DATA COLLECTION AND ANALYSIS: The search methods for the original review generated 487 citations, most of which had abstracts. The lead review author screened these citations, determining that 30 were evaluation reports. Two review authors independently examined these citations and agreed that 11 were potential randomized trials. All reports were obtained. Upon inspection of the full-text reports, two review authors independently agreed to exclude two studies, resulting in nine randomized trials. The lead review author extracted data from each of the nine study reports using a specially designed instrument. In cases in which outcome information was missing from the original reports, we made attempts via correspondence to retrieve the data for the analysis from the original investigators. Outcome data were independently checked by a second review author (CTP).In this review, we report the results of each of the nine trials narratively.We conducted two meta-analyses of seven studies that provided post intervention offending rates using official data. Information from other sources (for example, self-report) was either missing from some studies or critical information was omitted (for example, standard deviations).We examined the immediate post-treatment effects(that is, 'first-effects') by computing odds ratios (OR) for data on proportions of each group re offending, and assumed both fixed-effect and random-effects models in our analyses. MAIN RESULTS: We have included nine studies in this review. All were part of the original systematic review; no new trials meeting eligibility criteria were identified through our updated searches. The studies were conducted in eight different states of the USA, during the years 1967 to 1992. Nearly 1000 (946) juveniles or young adults of different races participated, almost all males. The average age of the participants in each study ranged from 15 to 17 years.Meta-analyses of seven studies show the intervention to be more harmful than doing nothing. The OR (fixed-effect) for effects on first post-treatment effect on officially measured criminal behavior indicated a negative program effect (OR 1.68, 95% confidence interval (CI) 1.20 to 2.36) and nearly identical regardless of the meta-analytic strategy (random-effectsOR 1.72, 95%CI 1.13 to 2.62).Sensitivity analyses (random-effects) showed the findings were robust even when removing one study with an inadequate randomization strategy (OR 1.47, 95% CI 1.03 to 2.11), or when removing one study with high attrition (OR 1.96, 95% CI 1.25 to 3.08), or both(OR 1.68, 95% CI 1.10 to 2.58). AUTHORS' CONCLUSIONS: We conclude that programs such as 'cared Straight' increase delinquency relative to doing nothing at all to similar youths. Given these results, we cannot recommend this program as a crime prevention strategy. Agencies that permit such programs, therefore, must rigorously evaluate them, to ensure that they do not cause more harm than good to the very citizens they pledge to protect.