Where in the World Is Evidence-Based Practice?
March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.
When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.
In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.
- Review the Resources and reflect on the definition and goal of EBP.
- Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
- Explore the website to determine where and to what extent EBP is evident.
By Day 3 of Week 1
Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts.
Expert Answer and Explanation
My selected website is the Centers for Medicare & Medicaid Services (CMS) website. CMS is a federal agency under the Department of Health and Human Services tasked with administering the Medicare program and also works with the different states to administer Medicaid (CMS, n.d.). The website provides different kinds of helpful information to both enrollees of either program (Medicare and Medicaid) and the public.
According to Melnyk et al. (2010), evidence-based practice is a problem-solving approach that applies the best evidence from valid and verifiable research, patient data, and clinician expertise to inform patient-care delivery. From my analysis of the CMS website, there were various areas where evidence-based practice appeared. For example, the website has detailed information on COVID-19 and the vaccination approved by the FDA supported by evidence-based data, which is made available to the public and the beneficiaries of the Medicare and Medicaid services. The website also provides different forms of assessment information which compiles evidence from patient data on different performance metrics, for example, the Medicaid & CHIP Scorecard. The different packages offered by the organization as described on the website are also backed by evidence.
From the general outlook of the website, the work done by CMS is purely grounded on EBP. The organization caters to different public healthcare needs, which require the backing of proven statistics and evidence on best practices. For example, the Basic Health Program incorporates statistics from different state agencies, including the Census Bureau and the CDC, to advise the program’s implementation, including administration of the COVID-19 vaccine. Without EBP, the CMS would be operating at a loss given that it may not have a proper estimation of where it needs to focus its interventions, the budget estimates for its interventions, and the expected outcomes that also inform its scorecard reports. The application of evidence facilitates continuous improvement efforts in reducing health care costs and improving the quality of care for Medicare and Medicaid beneficiaries which goes a long way in realizing quadruple aims (Sikka et al., 2015).
Based on the information discovered from the CMS website, my perception of the organization has improved. The positive perception is due to the evident inclusion of EBP in the different activities conducted by the organization.
Centers for Medicare & Medicaid Services (CMS) (n.d.). Centers for Medicare & Medicaid Services. https://www.cms.gov/
Melnyk, B.M., Fineout-Overhold, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53.
Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost, and meaning in work. BMJ Quality & Safety, 24, 608–610. doi:10.1136/bmjqs-2015-004160
Second Alternative Answer
The current facility at which I am employed uses Elsevier Nursing Skills as its policy for performing nursing skills to include tracheostomy care. However, the tracheostomy care policy states that the nurse should refer to their facilities policy for the frequency of which to perform the trach care. Therefore, a gap exists in our trach care policy or lack thereof. It created confusion among the nursing staff as to how to care for established versus fresh trach sites. There is also no guidance on how to taper down care as the trach site heals.
Joint Commission offers a function on their website called Tracers. Nurses can use it to make individual tracers that target a specific practice at the point of care (Siewert, 2018). For the nursing leadership to determine current practice, a tracer could be established to evaluate the frequency of trach care provided for new versus established tracheostomies, the occurrence of HAIs in relation to trach care frequency, and respiratory distress/desaturation episodes in relation to the frequency of cleaning or changing out the inner cannula. Data for the tracer can be collected via staff interviews, observation of practice, and chart auditing (Siewert, 2018). From this data, it can be determined if harm is coming to the patient from current trach care practices and what are those practices.
Nursing leaders can use clinical reasoning and judgment based on the data, along with a literature review, to formulate a trach care policy to include time intervals based on the age and condition of the tracheostomy. The new policy can be evaluated by implementing a small test of change and creating a corresponding tracer. The Institute for Healthcare Improvement (n.d.) recommends the use of the Plan-Do-Study-Act cycle to implement these small tests of change. Tracers can provide real-time data for the evaluation of small tests of change during the Do and Study steps. According to Bhattarai and Shah (2018), real-time data analysis prevents delays in updates in care practices by months. Based on the data analysis, nursing leaders can determine if the policy needs to be reevaluated or is effective in preventing patient harm.
Bhattarai, S., & Shah, R. K. (2018). Leveraging real-time data to drive quality improvement in a pediatric health system. Pediatric investigation, 2(3), 184–187. https://doi.org/10.1002/ped4.12060
Institute for Healthcare Improvement. (n.d.). Science of improvement: Testing changes. Institute for Healthcare Improvement. Retrieved November 30, 2021, from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx
Siewert B. (2018). The Joint Commission Ever-Readiness: Understanding Tracer Methodology. Current problems in diagnostic radiology, 47(3), 131–135. https://doi.org/10.1067/j.cpradiol.2017.05.002