research roundtable: improving the care of moms and babies through evidence-based practice...

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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 P roviding 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 Keywords emergency Cesarean standardization Professional Issues Deborah J. Schafer, MSN, RNC-OB, Women and Chil- dren Services, PinnacleHealth System, Harrisburg, PA Keywords evidence-based practice knowledge translation quality outcomes Professional Issues S36 JOGNN, 40, S2-S84; 2011. DOI: 10.1111/j.1552-6909.2011.01242.x http://jognn.awhonn.org I NNOVATIVE P ROGRAMS Proceedings of the 2011 AWHONN Convention

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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