research roundtable: improving the care of moms and babies through evidence-based practice...
TRANSCRIPT
noti¢cation tree, and assigning roles when the Ce-
sarean was called by the physician.
Implementation, Outcomes, and Evaluation
Following three events focused on process im-
provements, we identi¢ed and de¢ned three cate-
gories for Cesarean birth. We then de¢ned the role
of each sta¡ member when a decision was made to
proceed with an emergency Cesarean. We im-
proved the physical environment of our unit by
standardizing the set up of our Cesarean suite to
that of the main surgical suites in our surgery de-
partment. We also improved on the set up of our
birthing rooms to reduce the number of steps sta¡
needed to take in preparation for an emergency
case.We developed checklists and a call tree to fur-
ther standardize our work. Before implementation
we held a skills lab to educate sta¡ on the improved
process and provided an opportunity for role play.
We determined quality matrix indicators that have
been measured over a period of 3 years. Over this
time we continued to ¢ne tune our process and
identi¢ed areas for further improvement. We have
improved the time for decision to operating room
(OR) from a mean of 12 minutes to a mean of 2 min-
utes. We have also signi¢cantly reduced the
variability of nursing response time once a Cesar-
ean is called. We have been successful in
sustaining the improved response time by continu-
ing to monitor and track our emergency cases and
sharing our results with sta¡.
Implications for Nursing Practice
Emergency Cesarean is a high-risk procedure that
is commonly performed on many hospital-based
birthing units. Analyzing and standardizing pro-
cesses can save precious time in expediting a safe
delivery in an emergency situation. Continually
monitoring, evaluating, and updating improve-
ments results in sustained outcomes. We believe
our process and results could be replicated and
would like the opportunity to share our success
with others.
Research Roundtable: Improving the Care of
Moms and Babies Through Evidence-Based
Practice Initiatives
Paper Presentation
Purpose for the Program
Providing patient care based on evidence is a
priority for health care organizations. One of
the most challenging aspects of creating and sustain-
ing a culture of excellence is reducing the barriers of
evidence-based practice (EBP) for nurses at the bed
side. Research Roundtable, an innovative strategy
between an urban health care system and a bacca-
laureate nursing program to promote research and
EBP, is one successful initiative. The purpose of the
program is to identify clinical problems that can be in-
vestigated through the EBP process. The program
format includes workgroups comprised of sta¡
nurses, nursing students, advanced practice nurse
facilitators, and nurse faculty consultants.
Proposed Change
Three projects that have resulted in practice
change (analgesia for intravenous [IV] insertion
for laboring women, neonatal intensive care light-
ing and body positioning for gavage feeding for
neonates) will be outlined. Practice changes in-
clude o¡ering analgesia before all IV insertions,
cycled lighting to induce distinct patterns of rest-
activity in preterm infants and left side-lying to pre-
vent gastroesophageal re£ux.
Implementation, Outcomes, and Evaluation
Projects: EBP fact sheets were developed to assist
in sta¡ education and practice change implemen-
tation. Analgesia protocol was approved through
interdisciplinary committees and functions as a
nursing order for all patients requesting medication
before IV insertion. Outcomes: 95% of patient sur-
veys demonstrate e¡ective pain control with
analgesia use; decreased need for anti-re£ux med-
ication despite an increase in preterm infants;
decreased crying/longer sleep cycles.
Program: Pre- and posttest data demonstrate
improved skills in the EBP process and overall
program evaluations are consistently positive.
Nurses demonstrate an increased understanding
of the research process, the ability to ask appropri-
ate questions and the ability to critically appraise
Linda Torres, MPA, Birth-
place, Mercy Medical Center,
Cedar Rapids, IA
Keywordsemergency Cesareanstandardization
Professional
Issues
Deborah J. Schafer, MSN,
RNC-OB, Women and Chil-
dren Services, PinnacleHealth
System, Harrisburg, PA
Keywordsevidence-based practiceknowledge translationquality outcomes
Professional
Issues
S36 JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x http://jognn.awhonn.org
I N N O V A T I V E P R O G R A M S
Proceedings of the 2011 AWHONN Convention
literature in an e¡ort to improve patient care
and provide best practice. Participants function
as resources and drivers of examination of prac-
tice and change at the unit level. Many have
participated in interdisciplinary health teams to
further projects into implementation and evaluation
phases.
Implications for Nursing Practice
The impact of Research Roundtable is evident at
the individual, unit, and organizational levels. The
program has positively a¡ected patient outcomes,
nursing practice, and professional development
and has provided opportunities to collaborate and
network with other health care institutions. It has
played an integral role in promoting a shift in orga-
nizational culture to embrace clinical inquiry and to
recognize EBP as an expectation rather than the
exception for practice change.
Obstetrical Nurses and Matters of the Heart: A
Successful Collaboration In the Development of
a Basic ECG Recognition Course for OB
Nursing Practice
Paper Presentation
Purpose for the Program
In this program we share a powerful collaboration
between perinatal and critical care educators
in designing and implementing an obstetric (OB)-
speci¢c, electrocardiography (ECG) recognition
course. While The Joint Commission (TJC) requires
that Cesarean patients be provided, ‘‘a comparable
level of care to what they would receive in the main
hospital PACU,’’ neither advanced cardiac life sup-
port nor ECG certi¢cation for OB nurses is an
Association of Women’s Health, Obstetric and Neo-
natal Nurses (AWHONN) standard when personnel
with those skills are readily available. Some litera-
ture questions the value of routine ECG monitoring
in the OB postanesthesia care unit (PACU). Conse-
quently, application of national credentialing and
professional organizations’ guidelines is not
uniform, and the postanesthesia expertise of OB
nursing sta¡ varies widely.
Our level II and tertiary care facilities routinely pro-
vide three-lead monitoring during and following
Cesarean birth. As the acuity and complexity of
patients increase, cardiac comorbidities and dys-
rhythmia-inducing conditions, while infrequent,
necessitate management in high-risk labor and de-
livery. This generates a compelling argument for
broadening the OB nurse’s knowledge of cardiac
complications.
Proposed Change
A 2 day standardized ECG class with a posttest pass-
ing score is a requirement across our system;
however, OB nursing sta¡ found the application of
the content in clinical practice and the postcourse
test very challenging and expressed concerns about
the existing format meeting their learning needs. Dis-
cussions with OB nursing sta¡ andamultidisciplinary
team of educators and physicians resulted in a com-
mitment to develop an OB-speci¢c ECG course.
Implementation, Outcomes, and Evaluation
Assessment of the sta¡’s learning needs was the
¢rst step in this process. Sta¡ members were polled
on perception and attitude toward the current
standardized course and the ‘‘ideal’’ learning expe-
rience. Responses revealed the course content was
‘‘confusing,’’ ‘‘di⁄cult to relate to clinical practice,’’
‘‘too speci¢c to the medical-surgical population,’’
and the emphasis on analysis and treatment of un-
common dysrhythmias was ‘‘information overload.’’
As dysrhythmia is of low incidence in OB pop-
ulations, there was concern that the depth
and breadth of instruction diluted the issues of
greatest importance in recognizing abnormal car-
diac events. Based on this feedback, OB and
critical care educators utilized their expertise in
curriculum revision.
Implications for Nursing Practice
Program modi¢cation focused on recognition and
immediate response to critical rhythms, employing
Susan Schory, MA, RNC-OB,
Department of Nursing Edu-
cation and Professional
Development, NorthShore
University HealthSystem,
Evanston, IL
Heather J. Roppel, RN, BSN,
CCRN, Department of Nursing
Education and Professional
Development, NorthShore
University HealthSystem,
Evanston, IL
KeywordscollaborationECGmulti-disciplinarylearning needs
Professional
Issues
JOGNN 2011; Vol. 40, Supplement 1 S37
Schory, S. and Roppel, H. J. I N N O V A T I V E P R O G R A M S
Proceedings of the 2011 AWHONN Convention