Slide 1 How to Use Research to Change
Practice?
We Will Show You How We Did It !!
Janet King RN BSN CGRN
June Guarente MS RN CGRN
Carol Shea RN BSN CGRN
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Slide 2
Objectives
Participants will :
Describe related research terms.
List steps using research to change practice.
Discuss possible projects that use research to change
practice.
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Slide 3
Research Terms
• Nursing Research
o A systematic inquiry designed to develop trustworthy
evidence about issues of importance to the nursing
profession, including nursing practice, education,
administration and informatics.(Essentials of Nursing Research 2010)
• Evidence Based Practice
o Nursing practice that uses research findings to guide
decisions, actions, interventions and policies.
(Nursing Administration 2005, Vol 20, No 3 pp)
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Slide 4
Research Terms
Research Utilization
o Nurses use evidence from research to guide their practice
Attend a research presentation
Journal clubs
Attend a research poster presentations at National SGNA
Conference
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Slide 5
Sources of Current Research
• Journals
o Peer Reviewed
Professional Organizations
o SGNA
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Slide 6
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Slide 7
Steps to Help Guide
Changing Practice with Research
Define the problem
List supports for the project
Lists obstacles to implementation
List resources
Set a timeline
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Slide 8
Defining the Problem
Our problem
Changing the practice of using Demerol (Meperidine) for
procedural sedation to using Fentanyl
A problem in your setting
A practice in your unit that does not follow current research
or standard of practice
Please write down a problem that you have encountered
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Slide 9
Supports for the ProjectPhysicians and nurses
We identified a core group to work with us
Administration Project time
We set aside time to complete each phase of the project
Money
We did not require any direct funds
Approval
We received approval from our multidisciplinary Endoscopy Committee
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Slide 10
Hospital wide support at MGH
Jeanette Ives Erickson MS RN FAANSenior Vice President
for Patient Care and Chief Nurse MGH
Encourages the development of evidence based practice at the bedside
Supports Collaborative Governance
“Nursing Research Committee”
Promotes Nurse Researchers who provide mentoring and guidance to those developing research projects
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Slide 11
Your Project
Please list supportive individuals in your unit
Will you need project time?
Will you need any financial support?
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Slide 12
Obstacles
Physician preferences
Nurse preferences
Time to work on project
Physical constraints
Access to resources
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Slide 13
Obstacles We Encountered
Opposition to the project
MD’s
RN’s
Time to work on the project
Planning
Gathering data
Analyzing results
Working on presentation for staff
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Slide 14 What Obstacles Might
You Encounter?
Please list obstacles to your own project
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Slide 15
Resources Researchers in your
institution MD’s
RN’s
Research assistants
Other disciplines Pharmacists
Social Workers
Respiratory Therapists
Child Life Specialists
Library Librarian
Internet Journal searches
On-line professional discussion
forums
Survey Monkey
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Slide 16
Resources
Resources we used
Librarian
MD helped with analysis
of data
Nurse Researcher
Survey Monkey
Pharmacist
What resources are
available to help
you?
Please list
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Slide 17
Timeline for Project
Start date of the project
End date of the project
Determine what else needs to happen and when
Keeps you focused
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Slide 18
Time Line
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Slide 19
Developing a Timeline
Please start a timeline for your project
Start date
End date
What needs to happen and when
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Slide 20
Summary of Our Project
It began with an article ……..
“Why are We Still Using
Meperidine (Demerol) for
Conscious Sedation?” (Daniel, et al 2009 SGNA Journal)
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Slide 21
Summary of Our Project
• This led to literature search for additional information
• The literature revealed: Fentanyl more appropriate for certain populations
Renal Failure Elderly Taking MAOI’s
Fentanyl has shorter ½ life Fentanyl acts faster & is cleared more rapidly
½ life of Normeperidine (Demerol’s metabolite) is 14-21 hrs
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Slide 22
Project Outline
Goal = 30 patients
Pre procedure CAS review
Patient survey post procedure
Chart review post procedure
Staff survey Prior to start of project
October 2012
After project was completed
April 2013
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Slide 23
Data CollectionChart review
Pre & post BP
Length of Stay (LOS) in Recovery Room
Patient survey To determine patient comfort during procedure
To screen for nausea & vomiting post procedure
2 Questions Asked to Patient:
1.“Do you feel you received adequate pain relief during your colonoscopy?”
2.“Did you experience any nausea or vomiting today?”
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Slide 24
Project Results
30 patients
Staff survey pre and post
Chart review
Patient survey
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Slide 25
Staff Survey Results
First survey
October 2012
Effectiveness of
Demerol & Fentanyl
for PS
60 responses0
10
20
30
40
50
60
70
Demerol Fentanyl
Somewhat effective
Effective
Very Effective
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Slide 26
Staff Survey Results Second survey
April 2013
Effectiveness of Demerol & Fentanyl for PS
49 responses
Fentanyl demonstrated increase in Effective & Very Effective categories
0
10
20
30
40
50
60
70
Demerol Fentanyl
Somewhat effective
Effective
Very Effective
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Slide 27 Staff Survey Comparison
October 2012 vs April 2013
0
10
20
30
40
50
60
70
Demerol Fentanyl
Somewhat effective
Effective
Very Effective
0
10
20
30
40
50
60
70
Demerol Fentanyl
Somewhat effective
Effective
Very Effective
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Slide 28 Staff Survey Results:
Level of Comfort Using Fentanyl
0
10
20
30
40
50
60
70
October April
Not comfortable
Somewhatcomfortable
Comfortable
Very comfortable
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Slide 29
Chart Review Results
Fentanyl
3/30 low BP
Measured as 20% from baseline
Demerol for previous case
13/30 had low BP
2 patients had low BP both cases
2/13
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Slide 30
% Low BP: Demerol vs Fentanyl
0
5
10
15
20
25
30
35
40
45
%Low BP
Demerol
Fentanyl
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Slide 31
LOS in RR
Fentanyl
59 min
Prior Demerol
69 min
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Slide 32
Fentanyl vs Prior Use of Demerol
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Slide 33
Additional Data
30 patients who
received Demerol
during a 1 week
period at CRP
72 min average
LOS in RR
0
10
20
30
40
50
60
70
80Demerol in thepast
Fentanyl now
Demerolrandomlypicked
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Slide 34
Patient Survey Results
Do you feel you received adequate pain relief
during your colonoscopy today?
1/30 c/o some discomfort
Did you experience any nausea or vomiting
today?
0/30 had n/v
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Slide 35
Our Project Summary
Fentanyl demonstrated to be effective for pain
control with less side effects and decreased
LOS in RR
Staff felt fentanyl just as effective & had
increased comfort using Fentanyl as a result of
project
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Slide 36
SummaryAs nurses we need to stay current
Journals
SGNA website
Educational conferences
Annual meeting
Local chapter meetings
Using evidence based practice to change practice in our own units can sometimes be a challenge
Utilizing a step by step approach and developing a timeline can assist you to implement a process improvement project of your own
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Slide 37
Questions?
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Slide 38
What about you?
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Slide 39
References Daniel, K. & Schmelzer, M. (2009). Why are we still using
Meperidine (Demerol) for conscious sedation? Gastroenterology Nursing , 32(4):298-301.
Dzeletovic, I., et al (2013). Impact of fentanyl in lieu of meperidine on endoscopy unit efficiency: a prospective comparative study in patients undergoing EGD. Clinical Endoscopy, 77 (6) 883-887.
P. Polit, D., Beck, C. (2010). Essentials of Nursing Research-Appraising Evidence for Nursing Practice. Philadelphia:Walters Kluwer/Lippincott.
Turkel, M., Reidinger, G. Ferket, K., Reno, K.(2005). An Essential Component of the Magnet Journey. Nursing Administration, 29 (3) 254-262
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