Please Respond to these discussions APA format with a reference

Discussion 1

Two areas where evidence-based practice has been effective ishand hygiene and central venous assess device. Using evidence basedpractice in these areas has greatly improved patient’soutcomes. The knowledge of evidence-based practice will empower andenrich nurses to practice more safely.

According to research conducted by Mathers, D (2011), adequateflushing od central venous assess devices improve catheter potencyand prevent the use of heparin in the flushing solution. Flushingthe device with heparin has been associated with increased risk forHIT and hemorrhage in patient and also erroneous lab results hasbeen associated with heparin use. According to the study, there willbe reduction in healthcare costs due to the cost difference insaline and heparin. Also, preventing possible adverse effectassociated with heparin use in CVAD’s by using saline willhelp save financially. To repent line occlusion while alsopreventing potential complications associated with heparin,non-heparin saline flush has been shown to effective.

Hand hygiene has also been shown to greatly improvepatient’s outcome both in home and community settings. Properhand hygiene helps breaks the chain of infection thereby improvingpatient’s outcome. Huge patient’s outcome has beenrecorded in facilities where proper hand hygiene with the use ofwater and soap and alcohol-based hand sanitizer. Its effect can beseen in wound healing, reduction in cross-infection, respiratorytract infection and GI infection.

Mathers, D (2011) The Journal of the Association for VascularAccess. Evidence-based Practice: Improving outcomes for Patients witha Central Venous Access Device retrieved from http://www.avajournal.com/article/S1552-8855(11)70…

Sally F. Bloomfield, BPharm, PhD, Allison E. Aiello, PhD, MS, BarryCookson, FRCP, FRCPath, Carol O'Boyle, PhD, RN, Elaine L. Larson, RN,PhD American Journal of Injection Control. The effectiveness of handhygiene procedures in reducing the risks of infections in home andcommunity settings including hand washing and alcohol-based handsanitizers. Retrieved from http://www.ajicjournal.org/article/S0196-6553%2807…

Discussion 2

Two noticeable areas of evidence based practice that have benefitedgreatly to improve patient outcome are that of preventing centralline-associated blood stream infections (CLABSIs) andventilator-associated pneumonia (VAP). The complex pathophysiologicalconditions of the ICU patients sometimes demands use of central venouslines. “Despite the potential benefits central venous lines canhave for patients, there is a high risk of bloodstream infectionassociated with these catheters” (Reyes, Morphet, & Bloomer,n.d). After conducting studies with use of antimicrobial catheter andinterventions such as dressing changes every 7 day and PRN, closedinfusion systems, aseptic skin preparation, central venous line bundlechecking, education, an extra staff in the Intensive Care Unit forauditing and follow up, it was evidenced that such measures havepositive outcomes in reducing central venous line associatedbloodstream infections rates.

VAPs prevention strategies is another evidenced based practice thathas shown drastic positive outcome related to nursing care. There wasa research conducted on a sample of 86 mechanically ventilatedpatients with 43 patients each in the control group and theintervention group. Subglottic secretion suctioning, intake ofsingle-dose antibiotics within 4 hours after intubation, chlorhexidinemouthwash on oral hygiene, elevation of the head of the bed 30 to 45degrees and monitoring the bed position twice a day, Proper dailyexamination of the patient for early extubation, check for correctpositioning of nasogastric tube before each feeding, closed-circularventilator etc. were the strategies considered. Although there was nochanges observed for the first 4 days of study, signs of earlypneumonia were evident in the control group from day 5. This hasrevolutionized the VAPs prevention techniques. Most hospitalsincluding the place where I work follow these guidelines strictly toimprove patient outcomes.

References:

Nasiriani, K., Jarahzadeh, M. H., & Souroush, M. (2017). EFFECTOF COMPREHENSIVE STRATEGIES FOR PREVENTION OF VENTILATOR-ASSOCIATEDPNEUMONIA ON INCIDENCE OF THE DISEASE IN HOSPITALIZED PATIENTS ININTENSIVE CARE UNITS. Journal Of University Medical &Dental College, 8(4), 20.

Reyes, D. V., Morphet, J., & Bloomer, M. (n.d). Prevention ofcentral venous line associated bloodstream infections in adultintensive care units: A systematic review. Intensive And Critical CareNursing, 4312-22.

Discussion 3

Evidence-based nursing practice (EBP) is crucial to the delivery ofhigh-quality care that optimizes and improves patients’outcomes. Studies continue to show improved outcomes when bestevidence is used in the delivery of patient care. To achieveexcellence in practice, critical care nurses must apply EBP as thenorm. We cannot knowingly continue clinical practice interventionsthat are not supported by current best evidence, particularly if thoseactions are known to be unhelpful and possibly injurious. Therefore,EBP should be integrated all the time in nursing daily activities.

Two areas where evidence-based practice has been effective innursing practice are the followings:

1- The use of oxygen in patients with COPD; it is shown andproved that for patient health and safety, it is essential thatnurses follow evidence-based practice in nursing when it comes togiving oxygen to patients with COPD. Despite the belief of some peoplethat providing oxygen to these patients can cause severe problems suchas hypercarbia, acidosis or even death, the evidence-based protocol isto provide oxygen to COPD patients. This practice can help preventhypoxia and organ failure; and the carbon dioxide level is notelevated because of hypoxic drive. Therefore, giving oxygen,which is the correct treatment based on the evidence, can improve COPDpatients’ quality of life and help them live longer.

References:

Scott O, Tidy C. Use of oxygen therapy inCOPD.http://www.patient.co.uk/doctor/Use-of-Oxygen-Therapy-in-COPD.htm.Revised January 21, 2011. Accessed March,28 , 2018. Google Scholar

2- The last thing a patient wants when going to a hospital fortreatment is a hospital-acquired infection. To protect the patientsagainst hospital -acquired infection, nurses play a significant rolein helping to prevent illness before it happens by following theevidence-based infection-control policies. It has been provedthat by keeping the healthcare environment clean, wearing personalprotective clothing, using barrier precautions and practicing correcthandwashing the chain of transmission of infectious diseasesdiminishes/reduces significantly. Although nurses are busy with manyresponsibilities, the time it takes to control infection is well worththe effort.

References: Scott RD. The direct medical costs ofhealthcare-associated infections in US hospitals and the benefits ofprevention. Division of Healthcare Quality Promotion, Centers forDisease Control and Prevention; May 2009.http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Google Scholar

Discussion 4

Nursing informatics is one in are in which evidence-based practicehas had an impact on patient outcomes. The other area is in thenursing of chronic diseases and management. Informatics is becomingincreasingly present in our profession due to rapidly changingtechnologic advances. Healthcare systems are assimilating technologyinto daily practice at a quick pace. Security and patient privacy mustbe upheld while achieving the goal of transforming data into useful knowledge.

On the other hand, the use of evidence-based practice in theresearch of chronic disease management has led to discovery of newways of dealing with chronic infections. There is a large gap betweenevidence and practice within health care, particularly within thefield of chronic disease. This thus led to devising effective ways ofdealing with chronic diseases such as asthma, diabetes and obesity,which have been discovered thus providing better patient outcomes.There is hence the development of a collaborative partnership and itsevolution into producing a valuable resource for the translation ofevidence into practice in the areas of chronic disease management.

The effective of the two on my practice is evident. First, the useof information technology devices is mandatory and effective insimplifying my daily work. At the same time, there is now a propercoordination and management of patient information as informaticsallow easy communication. Management of chronic diseases has also seena decrease in the number of new infections significantly.

References

Lee, A. (2014). The role of informatics in nursing. NursingMade Incredibly Easy!, 12(4), 55. doi:10.1097/01.nme.0000450294.60987.00

Khalil, H., Chambers, H., Munn, Z., & Porritt, K. (2015).Improving Chronic Diseases Management Through the Development of anEvidence-Based Resource. Worldviews on Evidence-BasedNursing, 12(3), 139-144. doi:10.1111/wvn.12087

Discussion 5

Evidence-based practice is essential as it helps improve patientoutcomes as well as promotes patient safety. Two areas of nursingpractice in which evidence-based practice has improved patientoutcomes include double-checking medications before administering themas well as the EBP of alcohol-impregnated caps to reduce Central-LineAssociated Bloodstream Infections (CLABSI).

There have been deaths associated with not double-checkinginformation, before administering the medication. Whenmedications are not double checked before administering, thepatient’s life could be at risk. There was a case in which thephysician's hand wrote an order, and the pharmacy mistakenly wrote theorders for a sound-alike medication. The medication was supposed to begiven to the patient to lower their blood pressure. Because the wrongmedication had been administered, the patient suffered theconsequences of a heart attack. Medication errors are one of theleading causes of death, resulting in seven thousand deaths, a year(McInyre & Courey, 2007). In fact, there was evidence that doublechecking leads to discovering medication errors or near misses(Athanasakis, 2015). The studies consisted of examining medicationerrors as well as double checking the medications beforeadministration (Athanasakis, 2015). It was found that many of themedication errors included patient-identification errors(Athanasaki’s, 2015). These findings have impacted my nursingpractice because ever since nursing school; I have always made sure tocheck medications by using the seven rights. Before administeringmedications, I make sure it is the right dose, as well as for theright reason. Because of this EBP, I can deliver safe quality care.

Another evidence-based practice that has improved the lives ofpatients includes alcohol-impregnated caps. There have been reports ofdecreased Central Line Associated Blood Stream Infections(CLABSI’s). The decrease in numbers was associated with the useof alcohol-impregnated caps of intravenous access (Sams, Martin,Carraway, Ruge, & Stettler, 2015). The study consisted of pre andpost analysis of blood cultures. The study found that there weredecreased contamination rates by thirty-two percent, after theimplementation of alcohol-impregnated caps (Sams et al., 2015). Thosethat have cancer are more at risk to develop infections; therefore,they have benefitted from this EBP as it helps reduce bloodstreaminfections. This study has impacted my nursing practice I always makesure to place those impregnated alcohol caps at the ends of my linesand connections. If I see that the caps are running out in thepatient’s room, I make sure to restore them with new ones sothat the next nurse can continue this practice. This practice hasshown the importance of these caps in patients. Because of the CLABSIintervention, it has been one year since my hospital has had a CLABSI.After seeing the results in my workplace as well as in EBP, I willcontinue to implement this practice with my patients.

References

Athanasakis, E. (2015). The Method of Checking Medications Prior toAdministration: An Evidence Review. International Journal ofCaring Sciences, 8(3). Retrieved from CINAHL Completedatabase. (Accession No. 110579158)

McIntyre, L. J., & Courey, T. J. (2007). Safe MedicationAdministration. Journal of Nursing Care Quality,22(1). Retrieved from SocialSciences Citation Index database.(Accession No. 000243033700008)

Sams, K., Martin, S., Carraway, S., Ruge, D., & Stettler, J.(2015). Alcohol Impregnated Cap Implementation Significantly ReducesBlood Culture Contamination Rates in an Oncology Population.American Journal of Infection Control, 43 (6). Retrievedfrom CINAHL Complete database. (Accession No. 102785958)

Discussion 6

First, we need to understand what is evidence-based practice?Evidence refers to research, known as research-based practice.“Knowledge derived from a variety of sources that has beensubjected to testing and has found to be credible” Higgs andJones (2000). Research is only one of many forms of evidence. One ofthe concepts is to understand to improve health outcomes, reducecosts, and improve health care quality. Many nurses connect with thisconcept from on the job experience. Nursing uses evidence-basedpractice on a daily bases as we learn what works and whatdoesn’t in certain situations.

The first area of “evidence-based practice that has improvedpatient outcomes is the use of non-heparinized saline flush withpositive -pressure value caps, and proper flushing technique tomaintain CVAD patency”. Bowers, Speroni, Jones, and Atherton,(2008); Hadaway, (2006), & Jasinsky & Wurster, (2009).“Reinforcement of proper flushing techniques has demonstratedimproved patency rates of CVADs “. Feehery, Allen, & Bey, (2003).

Outcomes were measured by comparing baseline data with datacollected in the same manner post education. This data was obtained bycollection a means of questionnaire and bedside observation of thenurse’s flushing technique. There was a significant improvementwith both nurse’s knowledge and flushing skill withCVAD’s. With continuing education with non-heparinized flusheshas not only increase patient outcomes and has also reduced healthcare costs across the board. There are less risk factors as noted inanother evidence-based study using randomized controlled trialsevaluating the use of Normal Saline vs. Heparinized Saline.

Let’s understand that all participates were included in themeta-analysis which systematically combining pertinent qualitative andquantitative study data from several data groups to develop a singleconclusion, thus has the greatest statistical power.

These results concluded that Normal Saline can be equally, of notmore effective, in keeping the CVC lines patent. The secondaryoutcomes showed heparinized saline was not superior to normal salineand did not reduce CVC occlusions. Heparinized flushes are associatedwith potential risk factors such as “coagulation disorders,hypersensitivity reactions and heparin-inducedthrombocytopenia”. Goode CJ. (1991), & Goh LJ. (2011). Hereare a few advantages of flushing with normal saline vs. heparinizedsaline. NS is isotonic, has much less side effects fromheparin-related complications. Drug itself is less expensive which iseconomical from both patient and hospital.

Reducing Emergency Room visits and In-Hospitalization byimplementing evidence-based practice across the healthcare continuumand community by enhancing the lines of communication. The goal wasto” improve post-discharge utilization value using technology toidentify high-risk individuals who might benefit from rapid nurseoutreach to assess social and behavioral determinants of health withthe goal of reducing inpatient and emergency department visits”Hewner, S., Sullivan S.S., and Yu G. (2018).

The project explored a before and after comparison of theinterventional sites with similar primary care practices acceptingMedicaid. This intervention targeted discharged patients withpreexisting chronic problems, thus providing this knowledge to anoutreach nurse who telephonically reached out immediately.

Outcomes were as follows; Decrease readmissions and emergency roomvisits, thus increasing a more expedient outpatient visits resultingin a happier healthier relationship between healthcare providers andtheir patients while reducing per capita costs. The estimated avoidedvalue over the secular Medicaid trend was $664 per adult with chronicdiseases, resulting in $71,289 in revenue from additional outpatient visits.

References:

Bowers, L., Speroni, K.G., Jones, L., Atherton, M. (2008).Comparison of occlusion rates by flushing solutions for peripherallyinserted central catheters with positive pressure luer-activateddevices. Journal of Infusion Nursing. 31:22–27

*Goode, C L, Titler M, Rakel B, Ones D S,Kleiber C, Small S, Trilo PK.(1991) A meta-analysis of effects of heparin flush and saline flush:quality and cost implications. Normal saline verses heparin forpatency of central venous catheters in adult patients – asystematic review and meta-analysis. Doi:10.1097/00006199-199111000-00002, [ PubMed] [Cross Ref].

*Goh L J, Teo HS, Masagoes M. (2011). Heparinized saline versesnormal saline in maintaining patency of arterial and central venouscatheters. In: Proceedings of Singapore Healthcare .vol 20.p190-196.

Feehery, P.A., Allen, S., Bey, J. Flushing 101: Using aFOCUS-PDCA quality improvement model to reduce catheter occlusionswith standardized protocols. Journal of Vascular Access Devices. 2003;8:38–45.

Hewner S., Sullivan S.S., and Yu G. (2018). Reducing Emergency RoomVisits and In-Hospitalizations by Implementing Best Practice forTransitional Care Using Innovative Technology and Big Data.Worldviews Evid Based Nurs. Doi: 10.1111/wvn, 12268.

Koufogiannakis, D. (06/01/2011). "What is Evidence?(editorial)". Evidence based library and information practice (1715-720X), 6 (2), 1

Mathers, Dorothy. Evidence-based Practice: Improving Outcomesfor Patients with a Central Venous Access Device. The Journal ofthe Association Access, Volume 16, issue 2, 64-67.