One significant change I have noticed is a reduction in past due medication error after implementing the updated bedside shift report (BSR). Staff now open the electronic health records during BSR. According to the Agency for Healthcare Research and Quality (AHRQ), the significant elements of a BSR after introducing the nurses to the patient are open the electronic health record at the bedside.

      A nurse performs electronic health record assessment to review the medication administration record and check all medications that have been supplied and documented correctly, vital signs, intake and outputs, etc. During this time, the patient can clarify questions about the medication, its use, and side effects and set short and long term aims with the nurse. Understanding that the nursing staff is receiving the information required to promote care reduces patient and family anxiety and enhances patient satisfaction. This sort of shift report improves staff interaction while assuring nurse responsibility (Lippincott Solutions, 2017).While bedside shift reports, the nurses have the opportunity to clarify relevant information and watch the patient physically, including drains, tubes, intravenous medications, and wounds, which work as an essential evaluation to enhance patient safety. Better interaction also helps the oncoming nurse prioritize duties according to requirements. Nurses are constantly on the same side during the report because they’re both looking at the same information at the same time (Lippincott Solutions, 2017).

References

Lippincott Solutions (2017). Bedside Shift Reports Can Save Lives. Retrieved from http://lippincottsolutions.lww.com/blog.entry.html/2017/11/17/bedside_shift_report-dMev.html

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    Re: Topic 7 DQ 2
 

The most effective and important piece of change is through the evaluation of the patient. After education of the staff and implementation of the education and procedures that are to begin taking place for the surgical patient, surveys will be conducted. As it currently stands, each and every post-operative patient is contacted the next business day and a brief survey is done verbally, a few weeks later, a written survey is sent out. Patients that undergo procedures with expected pain and post-operative medications, will receive slightly different surveys than those surveys that exist today. New questions for those patients who received pain medication will include their satisfaction level with pain in the Post Anesthesia Care Unit on a scale of one to ten, their current level of pain at home, and their satisfaction with their level of pain at home with their current medication. Additionally, the patients will be asked if they know when they are to take two pills in a prescription that states “one to two pill, every four to six-hour”, as well as what to do with any leftover medications they may have after surgery, the current amount of medications left on hand, and where the patient is currently storing their pain medications in the house. The answer to these questions will be compiled each day to create a record of the patient’s understanding of the teachings they were given, and their satisfaction with their care and level of pain after surgery. These surveys will continue to be complied to create monthly satisfaction surveys.

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Anne Kolsky    7 posts   

Re: Topic 7 DQ 1  Internal Project Team Identified  The internal project team for the change project are identified as the nurse, administration, social workers, teachers, case managers, counselors, and support staff (Spruce, 2015).  External Project Team Identified  The external team includes the parent or guardian, the health care provider, mental health providers, external social workers, school board and community members (Spruce, 2015).  Identification of Scope of Project  The EBP internal and external teams or representatives would ideally meet together, but at the very least will be presented the information needed for collaboration to bring consensus to the methods of monitoring students who have been identified with needs through screenings and have been presented with referrals for services (Spruce, 2015).  Identifying the Evidence  The nurses involved in screening will need to present to both groups evidence for the need to screen, identify, give referrals, and monitor to ensure that needed services are in place and implemented. The nurses will also make practice recommendations to both groups as they are stakeholders in not only making things happen, but funding for screening and monitoring. Health care and mental health care will need to support with identification of funding sources, monitoring and surveillance and services (Spruce, 2015).  Importance of Reporting Results to Both Groups  Providing feedback to team members is extremely important. Everyone wants to know if the time, effort, and funding is making a difference. Feedback is important from the stakeholders to make sure needed changes are working in the most streamlined manner. It is recommended to review the process every two years or as often as needed when evidence changes or practice needs change. Teaching the groups the importance of the long-term benefits of early childhood screenings and the financial incentives to both community and family are a must (Spruce, 2015).  Communication Strategies   Internal communication would include teaching screening methods, referral processes, and monitoring from the school perspective. Technology can most definitely be used to integrate EBP for identification and follow-through (Spruce, 2015).  Spruce, L. (2015). Back to basics: Implementing evidence-based practice. AORN Journal, 101(1), 106–112. Doi:10.1016/j.aorn.2014.08.009

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Carrie Smithson    1 posts   Re: Topic 8 DQ 2            Not all EBP projects result in statistically significant results. In this discussion, I will define clinical significance, and explain the difference between clinical and statistical significance. “Statistical significance measures how likely that any apparent differences in outcome between treatment and control groups are real and not due by chance” (Leung, 2019, para. 2). There are common measures used with statistical significance such as p values and confidence intervals. The p values give the probability that any particular outcome would have arisen by chance with the assumption that the new and the control treatments are equally effective as the null hypothesis. Confidence intervals estimate the range which the real results would fall if the trial is conducted many times. “Clinical significance measures how large the differences in treatment effects are in clinical practice” (Leung, 2019, para. 3). Relative risk is independent of the prevalence of the disease and can be applied to populations with different prevalence of the disease. Relative risk is the ratio of the risks in the treatment group to the event rate in the control group. Statistical significance is all about numbers and data collection whereas clinical significance is how the EBP affects the clinical setting as a whole. I can use clinical significance to support positive outcomes in my project. Once the staff is taught how to teach the patients, and teaching is performed, patient outcomes start to progress. It is important to base education on what is specific to your unit so that the patients will receive the most optimal and pertinent information. When patients are educated more about what caused their diagnosis, such as tobacco use causing a stroke or heart attack, they can then take measures to prevent these diseases from occurring again. Patients use the information provided by the nurse staff to make informed decisions on their health care. When a patient makes a life changing change such as tobacco cessation, patient outcomes are more positive. This is my goal with my EBP project.  Reference  Leung, W.-C. (2019, March 1). Balancing statistical and clinical significance in  evaluating treatment effects. Retrieved from  https://pmj.bmj.com/content/77/905/201

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