Evidence to Practice: Blended Methods for Bedside Evidence Integration

Purpose:
Improvement efforts aimed at clinical nursing processes such as assessment and intervention can redesign care delivery and decrease incidence of hospital acquired device related pressure injury for children receiving Non Invasive Positive Pressure Ventilation (NIPPV).

Significance:
NIPPV has gained prevalence as an effective way to manage respiratory compromise in infants and children, however device related pressure injury is an adverse effect of NIPPV. Nursing specific processes directly impact patient outcomes related to hospital acquired device related pressure injury.

Strategy and Implementation:
The strategic approach for improvement focused efforts on process improvement related to nursing assessment and interventions. The process began with a literature review, evaluation of internal (audits) and external evidence (benchmarking), development of a unique audit tool to obtain pre intervention data, educational intervention and implementation, and collection and analysis of post data. A blended educational methodology was adopted to facilitate the translation of evidence into practice. Over 800 front line clinicians, Registered Nurses (RNs) and Respiratory Therapists(RTs), were educated through computer assisted learning, simulation, and just-in-time-education. These multidisciplinary hospital wide educational interventions were designed to define performance expectations, role model behavior, and highlight the collaborative role front line clinicians have in positively impacting patient outcomes.

Evaluation:
Following implementation of this quality improvement initiative, the current NIPPV care standard was revised and the number of hospital acquired device related pressure injuries associated with NIPPV interface use decreased from 15% to 6%.

Implications for Practice:
Implementing programs that support practice review, collaborative discussion and engage front line clinicians in evidence implementation strengthen structure, and improve both process and outcomes.