Application of Evidence-Based Patient Safety and Quality Practices in Care Delivery

Answer

Application of Evidence-Based Patient Safety and Quality Practices in Care Delivery

1. Application of evidence-based Patient safety and quality practices in care delivery

            Evidence-based health care practices in health settings are available for several conditions such as heart failure and asthma. However, implementation of these practices is not usually available in care delivery with variation in practices across different contexts. Traditionally, research on patient safety has focused on analysis of data to establish patient safety issues and to illustrate that a new practice can result in enhanced quality and patient safety. There have been insufficient research focused on how to implement practices (Low et al., 2015). This is inappropriate because it is only though effective application of what is learnt from research that care can be made safer. By and large, implementing evidence-based can be a difficult experience and requires strategies that adequately addresses the complexity of systems of individual practitioners, care, and leadership. This paper seeks to analyze the nature of evidence-based healthcare and translation science through a reconceptualization that integrates the two ideas in modern service delivery.

2. Description of selected advanced practice translation of evidence topic:
   Models of evidence-based practice

There are a number of evidence-based practices in use in clinical settings. Common elements of these models include selection of a practice topic, critique and synthesis of evidence, application, impact evaluation on provider performance and patient care, and consideration of the context in which it is implemented. Learning that takes place during the translation of research into practice is valuable to capture and offer feedback into the process. The Agency for Healthcare Research and Quality (AHRQ) has developed a model that synthesis concepts from scientific information on social marketing, behavior change, social and organizational innovation, and knowledge transfer (Christie, Hamill, & Power, 2012). AHRQ model steps of knowledge transfer represent three major steps namely knowledge creation, diffusion and dissemination, and organizational adoption and application.

Knowledge creation and distillation involves the act of conducting research and packing relevant findings into products that are applicable in real-life situations. The criterion adopted in knowledge distillation includes perspectives of the end users and the traditional knowledge generation considerations (Parlour & Mccormack, 2012). Diffusion and dissemination entails partnering with healthcare organizations and professional opinion leaders to form basis for action. It links researchers with intermediaries who act as connectors to practitioners and health care delivery settings. Mass communication and targeted dissemination can be sued to reach audiences. Targeted dissemination efforts should use multifaceted dissemination strategies placing much emphasis on media and channels that are most effective for specific user segments. End use adoption, execution, and institutionalization stage focuses on getting individuals, teams, and organizations to adopt and consistently apply evidence-based research outcomes and innovations in their everyday practice. There are a number of strategies that can be used including the use of change champion to address implementation challenges (Paplanus, Bartley-Daniele, & Mitra, 2014).

Translation Science

Translation science entails investigation of methods, variables, and interventions that influence adoption by organizations and individuals of EBPs to enhance operational and clinical decision-making in healthcare. This entails testing of the implications of interventions on promoting and sustaining of the EBPs. Translation science should be guided by a conceptual model that analyzes and organizes the strategies that are being tested to build a scientific knowledge base. Some of the conceptual models in use in translating research into practice in AHRQ include health education, adult learning, marketing, social influence, and organizational and behavior theories.

Knowledge translation can be conceptualized as the process from basic discovery to intervention development (gap 1, translation 1, Ti development) to delivery (gap 2, translation 2, T2 know-to-do gap) (Levac et al., 2015). These are the two key obstacles to knowledge translation.

Gap 1: the first gap has to do with the gap between knowledge needs that are identified by patients, clinicians, governments, organizations, and the community and the work conducted by researchers and scientists during the discovery process (Hudon, Gervais, & Hunt, 2015). The gap is an essential aspect of translational research. An integrated approach to topic selection can be achieved through collaboration between the researchers and the end users in topic selection.

Gap 2: the second gap refers to the gap between the discovery research and the clinical research. It is the most commonly addressed on the international stage with considerable work being conducted by many countries (Kitson, 2009). Transitional research starts and ends at this point.

Gap 3: the third translation gap entails the translating of research into practice. This is a complex undertaking in healthcare that is constantly evolving. While there are several models, there is an absence of a standard approach that is widely accepted. Some health experts have suggested that the two processes; evidence-based healthcare and translation science cycle are complementary to each other (Svavarsdottir et al., 2015).

2. Presentation of selected advanced practice translation of evidence analysis

Multifaceted implementation of strategies is required to promote research evidence within administrative and clinical healthcare decision-making. Strategy implementation must also be accompanied with application of both individual practitioner and organizational perspective. Individual decisions on what evidence to apply in practice are likely to result in considerable variability in practice patterns and this may have adverse outcomes on the patients (Laibhen-Parkes, 2014). For instance, an individual perspective of evidence-based practice is likely to leave the decision concerning what evidence-based techniques on endotracheal suctioning to each nurse and respiratory therapist. While some individual are familiar with the research outcome for each endotracheal suctioning, other are not. This can lead to the use of diverse and conflicting practices as people change shifts (Schoville et al., 2014).

Methods of communication influence among social networks of users, and interpersonal communications channels affect the adoption of evidence-based practice. Some of the tested strategies to promote use of evidence-based practice include the use of opinion leaders, mass media, consultant by experts, and change champions coupled with education.

Adoption of evidence-based practice is also influenced by members of the social system such as physicians, clerical staff, and nurses. Some of the tested strategies include audit and feedback, trying the evidence-based practice, and performance gap assessment (Lorenzo, 2013).

The Donabedian model provides a framework for evaluating quality of health services. This model can be used to evaluate the quality of evidence-based practice. Information concerning quality of care can be drawn from the three categories; structure; process; and outcome. Structure comprises of all the aspects of the evidence-based practice that affect the setting in which it is delivered. These include equipment, facility, and human resources. It also includes other organizational features including staff training and payment methods (Bjørk et al., 2013). These factors control the way patients and providers within healthcare systems act. Process comprises of the sum of all practices that make up the healthcare. These include treatment, diagnosis, patient education, and preventive care. Information concerning process is accessible through medical records, direct observations, and interviews with practitioners and patients. Outcome comprises of the effects of healthcare on populations or patients such as change in behavior, health status, or knowledge as well as patient satisfaction and quality of health-related life (Schaffer, Sandau, & Diedrick, 2013). The model can be used to modify processes and structures within the healthcare delivery unit in order to integrate the evidence-based practice and translation of knowledge.

The model has been applied in large health systems in evaluation of overall quality as well as in alignment of improvement work across hospitals and large integrated health systems to enhance quality of outcome for populations. Another example is that is that of the Department of Veterans Affairs which is using the model to integrate their health system from “ill care” focus to “well care” focus (Bareil et al., 2015). The department has been facing serious challenges in distribution of staff and facilities that does not match with the needs of the demographically changed populations. It has since undergone big changes by reinventing itself to meet and address the changing needs of the population it serves through the adoption of the structure, process, and outcome elements of healthcare delivery.

DNP has an important role in advancing evidence-based practice as well as in evaluation and sustainability. While nurses are frequently engaged in evaluation and translation of evidence-based practice, interpersonal collaboration, mentoring, and information systems, DNP professionals are capable of augmenting these experiences and providing additional expertise that would help further develop skills in these areas (Evans, Harding, & Higginson, 2013). DNPs are best positioned to ask questions from clinical settings directly; which is vital in integration of evidence-based practice. Answers can then be evaluated within the clinical contexts allowing direct implementation and improvement of evidence-based.

4. Conclusion

Evidence based practice is the conscientious use of current best evidence in combination with clinical expertise and patient values and principles to guide health care decisions. This requires translation of the evidence/knowledge into action in ways that are feasible, effective, and meaningful to specific settings, populations, and cultures. The evidence must be appraised, synthesized, and then transferred to service delivery contexts and professionals who utilize it and evaluate its outcome on health, health systems, and professional practice.