It is an important responsibility of nurses to deliver exceptional patient care while enhancing the quality of care and patient outcomes. Evidence-based practice (EBP) is critical in healthcare as it combines the most reliable evidence from research and clinical expertise to aid decision-making and enhance patient care. This paper seeks to explore healthcare sites for evidence-based practice (EBP) quality improvement (QI) projects and three practice problems by focusing on why each problem is a potential focus for an EBP QI project, key stakeholders that approve the project’s initiation, comparison of stakeholder requirements across the sites and identifies one proposed healthcare setting for implementing an EBP QI project.
Healthcare Settings for EBP QI Project
Ridgecrest Regional Hospital
Evaluating the evidence-based practice quality improvement (EBP QI) project relies heavily on healthcare sites playing their essential role effectively. Ridgecrest Regional Hospital in Ridgecrest, California, deserves recognition as it stands committed to delivering patient-centered care that exceeds expectations. Thanks to its diverse array of departments catering to a wide range of patients, it is an outstanding setting for confronting prevailing practice problems while embracing evidence-based interventions. Through its diversity, the hospital can champion customized strategies to provide patient outcomes and enhance the overall quality of care bestowed upon individuals. Core stakeholders in an EBP QI project at Ridgecrest Regional Hospital encompass the education department, ICU manager, and ICU director, whose involvement and cooperation remain imperative in securing approval from the Chief Nursing Officer.
Palmdale Regional Medical Center
Palmdale Regional Medical Center is situated in Palmdale. California is a comprehensive medical facility offering specialized services encompassing emergency care, cardiology, and orthopedics. As part of its fundamental principle of providing outstanding patient-oriented care, the medical center stands out as an appropriate institution for undertaking an Evidence-Based Practice Quality Improvement (EBP QI) project. Due to the availability of its specialized services, Palmdale Regional Medical Center serves as an avenue to address distinct practice problems within these domains and bring forth evidence-based interventions that can meaningfully improve patient outcomes while optimizing healthcare delivery. The engagement of primary stakeholders at Palmdale Regional Medical Center, namely the education department, the ICU director, and the ICU manager, highlights their eager participation and support for the EBP QI project. Requesting permission for project approval from these key stakeholders emerges as a necessity to proceed effectively with the desired endeavors.
Antelope Valley Medical Center
Situated within Lancaster, California, stands Antelope Valley Medical Center – an eminent public hospital that deems it vital to cater to a diverse population. Being a major player in healthcare provision throughout this area. It ensures extensive services encompassing emergency care, critical care, and surgical interventions. This versatility in healthcare facilities paves the way for implementing evidence-based interventions ubiquitously across varied specialties while intently evaluating their influence on patient outcomes. Consequently, Antelope Valley Medical Center thrives as an exceptional environment suited for piloting and scrutinizing the efficaciousness of evidence-based interventions, contributing significantly towards elevating patient care standards and improving overall delivery within any context. Notably, esteemed stakeholders embodying positions such as Chief Nursing Officer (CNO) and Chief Medical Officer (CMO) members belonging to Quality Improvement Committee alongside distinguished heads from Surgical Department exert remarkable influences along with invaluable contributions offered by the prestigious Board of Directors in approving proposed EBP QI project at Antelope Valley Medical Center.
Strengths and Weaknesses Comparison of the Sites
The three practice sites each possess their unique strengths and weaknesses. One such site, Ridgecrest Regional Hospital (RRH), stands out for the numerous strengths that render it an ideal location for an evidence-based practice quality improvement (EBP QI) project. Firstly. RRH boasts a diverse patient population, allowing for a comprehensive and representative sample. This diversity permits the assessment of evidence-based interventions across a wide range of patients with varying conditions and backgrounds and enables a more inclusive evaluation. Moreover, RRH cultivates a collaborative environment wherein healthcare providers from different disciplines work together harmoniously. This teamwork greatly facilitates the implementation and evaluation of EBP projects as multiple perspectives and skill sets are brought to the table. Furthermore, the hospital benefits significantly from advanced technology and resources, including electronic health records and specialized diagnostic equipment. These assets prove invaluable in supporting the implementation of EBP projects effectively.
Nonetheless, there are challenges that RDH must confront as well. The nature of a busy and dynamic environment brings time constraints that can hamper the successful implementation and evaluation phases of EBP projects. Similarly notable is RDH’s limited authority over variables relating to patients’ specific health conditions or individual characteristics, which presents an added challenge. However daunting these difficulties may seem, they can still be tackled through diligent planning and meticulous consideration, ultimately leading to improved healthcare quality at RDH.
Palmdale Regional Medical Center (PRMC) holds distinct strengths that deserve recognition. A key strength lies in its proficiency in multiple medical fields, which grants access to specialized knowledge and resources. The emphasis placed by PRMC on delivering exceptional healthcare and promoting community growth creates a favorable setting for implementing Evidence-Based Practice Quality Improvement (EBP QI) projects. Nevertheless, it is imperative to acknowledge the potential ethical dilemmas that may arise due to the necessity of safeguarding patient privacy and guaranteeing informed consent when conducting research at PRMC. Careful consideration and skillful management are vital in navigating these ethical considerations.
The Antelope Valley Medical Center (AVMC) possesses various strong qualities that make it an appealing setting for conducting an evidence-based practice quality improvement project. As a regional referral center, AVMC attends to many patients and manages many intricate health conditions. The healthcare professionals at AVMC possess exceptional expertise that can provide valuable perspectives to inform evidence-based practice initiatives. However, like other healthcare establishments, AVMC must conform to stringent ethical principles that may impact the planning and execution of an evidence-based practice project.
Proposed Practice Problems
Problem 1: Remote Glucose Monitoring System in Hospitalized Patients with Diabetic Ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a grave complication of diabetes that, if left unaddressed in a timely and efficient manner, can give rise to life-threatening conditions. By introducing a remote glucose monitoring system for patients admitted with DKA, healthcare professionals can effectively keep track of blood glucose levels and promptly address any fluctuations or irregularities (Davis et al., 2021). The utilization of this technology has the potential to enhance patient safety, enable timely interventions, and enhance glycemic control. Consequently, patients with DKA may experience improved outcomes as a result.
A remote glucose monitoring system can empower healthcare professionals to track blood glucose levels in real time. It eliminates the requirement for repeated blood draws and ensures more precise and timely information for treatment decisions (Galindo et al., 2020). By incorporating this evidence-based intervention at Ridgecrest Regional Hospital, Palmdale Regional Medical Center, or Antelope Valley Medical Center, nurses, and other healthcare providers can improve patient care and enhance treatment approaches for individuals with DKA.
Problem 2: Problems of Older Adults Living Alone After ICU Hospitalization
The recovery process for older adults who live alone and have experienced ICU hospitalization is accompanied by various difficulties. These challenges include social isolation, limited access to support systems, struggles managing medication regimens, and compromised functional abilities (Provencher et al., 2020). However, implementing interventions that cater to the specific needs of this population can substantially enhance their outcomes and overall well-being.
Ridgecrest Regional Hospital, Palmdale Regional Medical Center, and Antelope Valley Medical Center present viable options for conducting an evidence-based practice project centered around understanding and alleviating difficulties encountered by older adults who reside alone after ICU hospitalization episodes. Central to this endeavor would be creating and implementing comprehensive discharge plans that are acutely sensitive toward restraining variables characteristically associated with older adult demographics (Provencher et al., 2020). Integrating pertinent elements such as arranging auxiliary home healthcare delivery systems alongside efficacious medication management guidance and skillfully fostering connections between patients and community resources to acquaint them with suitable social bolstering apparatuses effectively represents the key focal points for this project (Plotnikoff et al., 2021). Directly addressing these aspects offers healthcare providers the potential to significantly influence the recovery process while minimizing readmission rates within this susceptible population.
Practice Problem #3: Communication with Nurses – An Important Part of Patient Safety
A fundamental requirement is fortifying the pillars underlying optimal healthcare provision: engaging in effective communication between healthcare providers and their valued patients. Such concerted efforts aim to nurture enhanced trust and emphasize crucial elements like maintaining patient safety and yielding favorable healthcare outcomes (Kwame & Petrucka, 2021). Regrettably, instances characterized by miscommunication or an absence may be catalysts for potential drawbacks such as severe errors or inadvertent misunderstandings, inevitably impeding the overall quality of care patients receive. From this perspective, thus emerges the all-important duty to encourage growth in communication practices while simultaneously addressing prevalent barriers that hinder this process—an unwavering commitment to safeguarding patient safety.
An evidence-based practice project to enhance communication with nurses could be initiated at Ridgecrest Regional Hospital, Palmdale Regional Medical Center, or Antelope Valley Medical Center. The project may incorporate standardized communication tools and protocols such as structured handoff processes, bedside shift reporting, and the teach-back method for patient education (Noviyanti et al., 2021). Furthermore, healthcare providers can receive education and training programs to amplify their communication skills and foster a patient-centered approach. By prioritizing effective communication, healthcare providers can ensure patients receive accurate information, understand their treatment plans, and actively participate in their care. By doing so, they can witness improved patient outcomes, increased patient satisfaction, and contribute to a safer healthcare environment.
Stakeholders
The backing of key stakeholders is necessary for the adoption of evidence-based practices. The main parties in implementing the EBP project are patients, their families, and healthcare personnel, including nurses, doctors, managers, and administrators. It is critical to include all relevant parties in the approval process for an EBP project to provide it with the backing and resources it needs to succeed. It can entail getting input and suggestions from each stakeholder group and getting the go-ahead from pertinent decision-making authorities like the board of directors or financing organizations.
Stakeholder Comparison
The approval of the stakeholders is required for each of the three EBP QI project sites. Stakeholder approval is a crucial step in the implementation of an EBP project since it maximizes resource mobilization and allocation, boosts the likelihood of success, and guarantees that the project is well-versed and effective through expertise in the Ridgecrest Regional Hospital. On the other hand, the medical staff and organizational leaders, the nursing staff lead, and senior management should all be consulted before beginning the EBP project at Palmdale Regional Medical Center and Antelope Valley Medical Center. These stakeholders are well aware of how the action would affect the healthcare system.
Proposed Health Care Practice Site and Proposed Practice Problem
The best healthcare site to carry out the EBP QI project is Ridgecrest Regional Hospital (RRH). This choice is based on several factors that align with the identified practice problems. One of these problems involves implementing a remote glucose monitoring system for patients with diabetic ketoacidosis (DKA) who are hospitalized. RRHs’ diverse patient population and various departments make it an ideal setting to address this issue. By implementing a remote glucose monitoring system at RRH, healthcare providers can closely monitor blood glucose levels and respond promptly to any changes or abnormalities in DKA patients (Tan & Majumdar, 2022). The collaborative environment at RRH, where healthcare professionals from different disciplines work together, will greatly assist in successfully implementing and evaluating the remote glucose monitoring system.
Moreover, RRH’s advanced technology and ample resources, including electronic health records and specialized diagnostic equipment, will aid in successfully deploying the remote glucose monitoring system (Davis et al., 2020). These invaluable resources will yield accurate and timely data to facilitate informed treatment decisions, bolster glycemic control, and enhance patient outcomes.
Conclusion
Implementing evidence-based practice quality improvement projects in healthcare settings is imperative to ensure optimal patient care and enhance patient outcomes. Given their diverse patient populations and extensive range of healthcare services, the three hospitals are appropriate healthcare sites for conducting EBP QI projects. By focusing on key practice problems, such as remote glucose monitoring for patients with diabetic ketoacidosis (DKA), the challenges faced by older adults who live alone after being discharged from the intensive care unit (ICU), and improving communication with nurses, healthcare providers have the opportunity to make substantial improvements in patient care and outcomes. RRH is the proposed healthcare site since it uses an advanced patient monitoring system and has diverse healthcare staff for the remote monitoring of glucose for patients with DKA. By incorporating evidence-based interventions into their practices and regularly assessing their effectiveness, healthcare providers can promote patient safety, optimize treatment approaches and establish a healthcare setting that prioritizes the patient’s needs.
References
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Davis, G. M., Galindo, R. J., Migdal, A. L., & Umpierrez, G. E. (2020). Diabetes technology in the inpatient setting for management of hyperglycemia. Endocrinology and Metabolism Clinics, 49(1), 79-93. doi: 10.1016/j.ecl.2019.11.002
Galindo, R. J., Aleppo, G., Klonoff, D. C., Spanakis, E. K., Agarwal, S., Vellanki, P., … & Pasquel, F. J. (2020). Implementation of continuous glucose monitoring in the hospital: emergent considerations for remote glucose monitoring during the COVID-19 pandemic. Journal of Diabetes Science and Technology, 14(4), 822–832.
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Plotnikoff, K. M., Krewulak, K. D., Hernández, L., Spence, K., Foster, N., Longmore, S., … & Fiest, K. M. (2021). Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care. Critical Care, 25, 1-13. https://doi.org/10.1186/s13054-021-03857-2
Provencher, V., Clemson, L., Wales, K., Cameron, I. D., Gitlin, L. N., Grenier, A., & Lannin, N. A. (2020). Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatrics, 20(1), 1–10. https://doi.org/10.1186/s12877-020-1494-3
Tan, W. J., & Majumdar, K. S. (2022). Accuracy of Flash Glucose Monitoring in Critically Ill Patients Receiving Intravenous Insulin. Endocrinology Clinical Research. DOI: 10.23937/2572-407X.1510032
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