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QuERY Quality Improvement, Evidence Based Practice, Research

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QuERY Quality Improvement, Evidence Based Practice, Research & You Part 2: Research Processes Presented by: Karen Gabel Speroni, BSN, MHSA, PhD, RN – PowerPoint PPT presentation

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Title: QuERY Quality Improvement, Evidence Based Practice, Research


1
QuERY Quality Improvement,
Evidence Based Practice, Research You Part 2
Research Processes Presented by Karen Gabel
Speroni, BSN, MHSA, PhD, RN -Director, Nursing
Research Chair, Research Council Inova Loudoun
Hospital Inova Fair Oaks Hospital
Virginia -Co-Chair, Inova Health System Nursing
Research Council Virginia -Chair, Shore Health
System Nursing Research Council Maryland 12
November 2011

2
OBJECTIVES
  • Review of day 1 Provide examples of quality
    improvement (QI) activities, evidence based
    practice (EBP) projects, research studies and
    innovations
  • Day 2 focus
  • Research and innovation examples focus
  • Review of steps from study idea inception to
    dissemination of findings
  • Review definitions of QI, EBP and research

3
QI, EBP Research
  • What is Quality Improvement?
  • Activity
  • What is Evidence Based Practice?
  • Project
  • What is Research?
  • Systematic nursing research

3
4
Quality Improvement
  • Systematic, data guided activities designed to
    bring about immediate improvement in health care
    delivery in particular settings
  • ANCC, 2008. Magnet Recognition Program
    Application Manual

4
5
The QI Report SQUIRE Standards for QUality
Improvement Reporting Excellence
  • Problem or purpose, and aims of the proposed
    change
  • Methods
  • Context of the organization or setting
  • Intervention
  • Process for change
  • Measures
  • Analytic methods
  • Results
  • How the change evolved and adjustments that were
    made
  • Outcomes
  • Impact of the change on the organization
  • Challenges
  • Discussion
  • www.squire-statement.org

6
Evidence Based Practice
  • The conscientious use/integration of the best
    research evidence with clinical expertise and
    patient preferences in nursing practice
  • Adapted from Sackett et al.,2000
  • The utilization of clinical expertise, clinical
    judgment, and best research/practices to improve
    patient outcomes
  • Inova Loudoun Hospital, 2010

6
7
Evidence Based Practice Nursing Models
  • Iowa Model
  • Stetlers Model
  • Rosswurm and Larrabees Model
  • John Hopkins Nursing Model
  • ACE Star Model of Knowledge and Transformation
    (Academic Center for Evidence Based Practice)
  • ARCC Model (Advancing Research Clinical
    Practice through Close Collaboration)
  • PARiHS Framework (Promoting Action on Research
    Implementation in Health Services)

7
8
Research
  • A systematic investigation, including research
    development, testing, and evaluation, designed to
    develop or contribute to generalizable knowledge
  • U.S. Department of Health and Human Services,
    nd., 45 CFR 46,102(d)

8
9
Nursing Research
  • A systematic search for knowledge about issues of
    importance to the nursing profession
  • Polit and Hungler, 1995

9
10
Innovation
  • Innovation in service delivery and organization
    is a novel set of behaviors, routines, and ways
    of working that are directed at improving health
    outcomes, administrative efficiency, cost
    effectiveness, or users experiences and that are
    implemented by planned and coordinated actions
  • Greenhalgh, 2004

10
11
Nurses are Scientists!!
11
12
QI, EBP AND RESEARCH
  • How do you integrate the 3
  • How do we better understand the differences
    between the 3
  • Thru the QuERY process
  • Quality Improvement, Evidence Based Practice,
    Research You

13
QuERY CONCEPT
  • Developed to help hospital nurses become
    knowledgeable about each units best
  • QI activity
  • EBP project
  • Research study
  • Provides opportunity for nurses from each
    hospital unit to showcase their best QI, EBP and
    research work during the last year
  • OR, to identify strategic planning needs
  • Through the QUERY work and seminar presentations,
    hospital nurses are exposed to QI, EBP and
    research concepts, unit best examples, and unit
    needs to improve patient outcomes

14
QuERY CONTEST
  • Annually contest judged by nurses selecting the
    best QI, EBP and research work that improves
  • Standard operating procedure
  • Patient outcomes
  • Care delivery
  • Electronic contest
  • List definitions
  • List each units QI, EBP and research work
  • Award prizes

15
Publications 2011 ILH
  • Speroni, K.G., Lucas, J., Dugan, L.,
    OMeara-Lett, M., Putman, M., Daniel, M.
    Atherton, M. Comparative Effectiveness of
    Standard Endotracheal Tubes versus Endotracheal
    Tubes with Continuous Subglottic Suctioning on
    Ventilator-Associated Pneumonia Rates (2011)
    Journal of Nursing Economic. 29(1) 15-21.
  • Book contribution McLaughlin, M Bulla, S.
    Real Stories of Nursing Research A Quest for
    Magnet. 2009. Jones and Bartlett Publishers,
    Los, Angeles. Chapter 30, OMeara-Lett, M. See
    http//www.jbpub.com/catalog/9780763761660/
  • Improvement Use of the Hi-Lo Evac tube for all
    intubations throughout the hospital except in the
    OR

16
Publications 2011 (continued)
  • AHRQ Health Care Innovations Exchange. Innovation
    Profile/Attempt Nurse-Led Weekly
    Educational Program for Children Focuses on
    Physical Activity and Food Choices, Leading to
    Healthier Behaviors, Lower Body Mass Index
    (Karen Gabel Speroni, Inova Loudoun Hospital).
    In AHRQ Health Care Innovations Exchange Web
    site. Rockville (MD) cited 2009 Apr 13
    updated 2011 July 20. Available
    http//www.innovations.ahrq.gov/content.aspx?id24
    06.
  • Improvement Implementation of hospital-based
    Living Fit program for hospital employees and
    community members
  • Speroni, K.G. (2011) Prospective Evaluation of
    the Effect of the Nurses Living Fit Intervention
    versus No Intervention on Body Mass Index of
    Nurses. JOGNN, 40, S86S87.
  • Speroni, K.G., Earley, C., Seibert, D., Kassem,
    M., Williams, D. (2011). Prospective Evaluation
    of the Effect of the Nurses Living Fit
    Intervention Versus No Intervention on Body Mass
    Index of Nurses. Journal of Womens Health,
    20(3), 480-481.

17
Publications 2010 ILH
  • Dawson, E., Speroni, K.G., Salisbury, M.,
    Atherton, M. (2010). Effect of the Workforce
    Initiatives Safe Handling Minimal Lift Program on
    Patient Care Provider Injuries, Attributable
    Costs, and Satisfaction. Journal of the
    Association of Occupational Health Professionals.
    XXX(3) 22-26.
  • ONeil, S., Speroni, K.G., Dugan, L, Daniel, M.
    (2010). A Two-tier Study of Direct Care
    Providers Assessing the Effectiveness of the Red
    Rule Education Project and Precipitating Factors
    Surrounding Red Rule Violations. Journal of
    Quality Management in Health Care, 193, 1-6.
  • Harrison, G., Speroni, K.G., Dugan, L., Daniel,
    M.G. (2010). A comparison of the quality of blood
    specimens drawn in the field by Emergency Medical
    Services verses specimens obtained in the
    Emergency Department. Journal of Emergency
    Nursing. 36(1) 16-20.
  • Improvement Policy change to allow blood drawn
    by EMS.

18
Publications 2010-2011 IFOH
  • 2011
  • Suchicital, L.G., Gujral, H., Speroni, K.G.,
    Eldridge, D. Atherton, M. (2011). Prospective,
    Randomized, Pilot Study Evaluating the Effect of
    Ice Chip Administration versus None on the
    Bitterness of Crushed Medications in Post
    Operative Bariatric Patients. Journal of
    Bariatric Nursing and Surgical Patient Care.
    6(1) 15-20.
  • Improvement Evaluate procedures for provision of
    ice chips procedure prior to medication
    administration
  • 2010
  • Bergin, C., Kelly, K., Travis, T. Speroni,
    K.G. (2010). Interim Analysis of the
    Pre-Operative Incentive Spirometry Education
    (POISE) Intervention. Journal of Perianesthesia
    Nursing, vol 25, No. 3 (June) pp 196-198.
  • Improvement Documentation in the medical record
    of pre-operative incentive spirometry levels
  • Dunn, K.D., Speroni, K.G., Kassem, M. Stress
    Reduction Through Yoga. Advance for Nurses.
    Posted on January 26, 2010. www.advanceweb.com
    Retrieved from http//nursing.advanceweb.com/Stud
    ent-and-New-Grad-Center/Student-Top-Story/Stress-R
    eduction-Through-Yoga.aspx?rpid14

19
Publications 2011 SHS
  • 2011
  • Hanlon, L., Punzo, A., Jones, R.A., Gabel
    Speroni, K. G. (2011). Cardiopulmonary
    Complication Rates in Patients Undergoing Total
    Knee Arthroplasty and Reinfusion of Shed Blood.
    Journal of Orthopaedic Nursing. 30 (5) 307-311.
  • Improvement Stopped usage of reinfusion device
  • Stagg, S., Sheridan, D., Jones, R. A., Speroni,
    K. G. Evaluation of a Workplace Bullying
    Cognitive Rehearsal Program in a Hospital
    Setting. (2011) The Journal of Continuing
    Education in Nursing, 42(9), 395-403. 
  • In press
  • Trinkley, D., Bryan, S., Speroni, K.G., Jones,
    R.A., Allen, H. Evaluation of Domestic
    Violence Screening and Positive Screen Rates in
    Rural Hospital Emergency Departments. In
    November, 2011, Online Journal of Rural Nursing
    and Health Care.
  • Ganter-Ritz, V., Speroni, K.G, Atherton, M. A
    Randomized Double Blind Study Comparing
    Intradermal Anesthetic Tolerability, Efficacy,
    and Cost-Effectiveness of Lidocaine, Buffered
    Lidocaine and Bacteriostatic Normal Saline for
    Peripheral Intravenous Insertion. In Press,
    March/April 2012, Journal of Infusion Nursing.

20
Selected Publications 2005-2009
  • Speroni, K.G., Tea, C., Earley, C., Niehoff, V.,
    Atherton, M. (2008). Evaluation of a Pilot
    Hospital-Based Community Program Implementing
    Fitness and Nutritional Education for Overweight
    Children. Journal for Specialists in Pediatric
    Nursing, 13(3), 144-153.
  • Improvement Hospital provision of
    exercise/nutrition classes for children at Inova
    Fair Oaks Hospital
  • Bowers L., Speroni K.G., Jones L., Atherton M.
    (2008). Comparison of Occlusion Rates by
    Flushing Solutions for Peripherally Inserted
    Central Catheters with Positive Pressure
    Luer-Activated Devices. Journal of Infusion
    Nursing, 31(1), 22-27.
  • Speroni K.G., Earley, C., Atherton, M. (2007).
    Evaluating the Effectiveness of the Kids Living
    Fit Program A Comparative Study. Journal of
    School Nursing, 23(6), 329-336.
  • Also see http//www.loudountimes.com/news/2007/dec
    /22/Speroni-Inova-obesity-nutrition/ for
    newspaper article covering research Solinger, S.
    Learning to eat Inova researcher says education
    is key to solving childhood obesity.
    Loudoun-Times Mirror. December 22, 2007 updated
    December 28, 2007.
  • Speroni, K.G. (2006). A hospital nursing
    community outreach program on childhood obesity.
    Nursing Spectrum. Retrieved June 19, 2006, from
    http//community.nursingspectrum.com/MagazineArtic
    les/article.cfm?AID22247
  • Companion article to Hawke, M. (2006). Taking
    Research to the Bedside. Nursing Spectrum.
    Retrieved June 19, 2006, from http//community.nur
    singspectrum.com/MagazineArticles/article.cfm?AID
    22054.

21
Selected Publications 2005-2009 (continued)
  • Leonard Y., Speroni K.G, Atherton M. Corriher
    J. (2006) Evaluating use of flash sterilization
    in the OR with regard to postoperative
    infections. Journal of the Association of
    peri-Operating Room Nurses, 83(3), 672-680.
  • Speroni K.G, Dawson E., Atherton, M., Corriher
    J. (2005). Influenza vaccination, incidence of
    symptoms and resulting absenteeism in hospital
    employees. American Association of Occupational
    Health Nurses Journal, 53 (11), 477-483.
  • Speroni K.G, Hannah, J., Corriher, J.,
    Atherton, M. (2005). Evaluation of demographic,
    behavioral, and procedural factors on pain
    perception by patients undergoing colonoscopy and
    moderate sedation. Gastroenterology Nursing
    Journal, 28(6), 502-508. Nominated for Best
    Author award
  • Dugan L., Leech L., Speroni K.G., Corriher J.
    (2005). Factors affecting hemolysis rates in
    blood samples from newly placed IV sites in the
    Emergency Department. Journal of Emergency
    Nursing, 31(4), 338-345.
  • Improvement Eliminated use of 22G or smaller
    catheter when drawing blood

22
  • Speronis Steps
  • From Study Idea Inception
  • to Publishing Research

23
Step 1 Study Idea
  • Discuss your study idea with
  • Nurse peers
  • Nurse manager / unit director
  • Research mentor
  • Present your study idea to Research Council (RC)
  • Follow Standard Operating Procedure (SOP) for
    documenting study idea
  • Complete a contest card

24
Step 2 Literature Review
  • Conduct literature review
  • Email hospital librarian with your study title,
    study purpose/objective, proposed search terms
    and request search over last 10 years
  • Document search terms, databases searched and
    years searched
  • Utilize standardized literature review tool to
    review article
  • Draft a 1-2 page summary for the protocol
    introduction section
  • Specify from an evidence based practice
    perspective how research results could improve
    standard of care, care delivery and patient
    outcomes

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
25
Step 2 (continued)
  • Keep electronic copy of all articles referenced
    in introduction / background section of protocol
  • Determine target journal for dissemination of
    findings to facilitate writing style of
    introduction, search terms, and reference
    formatting in text and the reference listing
  • Present findings to RC to verify if evidence
    sufficient to answer best practice question or if
    research should be conducted

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
26
Step 3 Confirm Study Team
  • Study team member types
  • Principal Investigator
  • Sub-investigators
  • Hospital contact
  • Statisticians
  • Administrative support
  • Other multidisciplinary team members needed to
    complete research
  • Ensure team completes human subjects protection
    coursework
  • Specify requirements for authorship with study
    team following Authorship SOP

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
27
Step 4 Draft Research Protocol
  • Draft the research protocol
  • Follow RC template
  • Append survey instrument(s) subject completes
  • Surveys patients/subjects touch are appended to
    the protocol
  • Pilot electronic surveys before submitting to
    Institutional Review Board (IRB)

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
28
Step 5 Draft Case Report Forms
  • Draft data collection tool
  • Follow RC template
  • Case Report Form (CRFs)
  • Patients / subjects do not touch

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
29
Step 6 Draft Study logs
  • Draft study logs
  • Follow RC template
  • Randomization or observation log
  • Screen Failure Log
  • Protocol Deviation Log
  • Early Termination Log
  • Other logs specific to study

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
30
Step 7 Draft Table Shells
  • Table shells
  • Follow RC template
  • Track to each
  • Protocol data collection point
  • CRF item
  • Survey item

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
31
Step 8 Statistician
  • Identify statistician
  • Work thru RC
  • Provide to statistician draft study documents
  • Protocol / survey instrument
  • CRFs
  • Table shells
  • Ask them to review / write
  • Sample size calculation
  • Data analysis methods
  • Confirm database software statistician will use
    for analysis
  • Design database
  • Receive statistician approval of database

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
32
Step 9 Evaluate Grant Opportunities
  • Review affiliated associations request for
    proposals
  • Work with Grants Management Office

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
33
Step 10 Draft IRB Documents
  • Draft IRB documents
  • IRB application
  • Other required IRB documents
  • Informed Consent Form
  • Investigator information
  • Send to research mentor for review
  • IRB documents
  • Final Study documents
  • Protocol
  • Case Report Forms
  • Study logs
  • Table shells
  • Follow IRB SOPs in preparation for research
  • Obtain required signatures

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
34
Step 11 Plan Study Initiation Meeting
  • During IRB review create Study Initiation Meeting
    (SIM) document
  • Agenda
  • Protocol
  • Study procedures
  • Chart documentation
  • Informed Consent
  • IRB approved Informed Consent Form
  • IRB ICF SOPs
  • Case Report Forms
  • Study Logs
  • Table shells
  • Study requirements
  • RC SOPs
  • Reporting to RC
  • Study files maintenance
  • Database entry
  • Authorship requirements / team assignment
  • Study timeline

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
35
Step 11 Plan Study Initiation Meeting (continued)
  • Finalize SIM document with research mentor
  • Schedule SIM based upon date after expected IRB
    review
  • Include all investigators study team members
    participating in daily research
  • Email invite for SIM meeting

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
36
Step 12 Hold SIM
  • Review content of SIM
  • Discuss authorship, follow authorship SOP and
    targeted journal authorship requirements if
    specified by journal
  • Register with www.clinicaltrials.gov if
    randomized study / journal requires
  • Document attendance
  • Review database entry procedures
  • Document and address all study process issues
    identified during SIM
  • Email team when recruitment / study work will
    begin

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
37
Step 13 Initiate / Conduct Study
  • Submit monthly update to RC Chair
  • Attend each RC meeting
  • Ensure ongoing completion of study documents
  • Track IRB continuing review due dates
  • Ensure research conducted following IRB SOPs
  • Notify IRB of human subjects protection issues,
    serious adverse events and protocol deviations

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
38
Step 14 Database Entry
  • Ensure ongoing data input
  • Once final data obtained, conduct 100 quality
    assurance (QA) review of database
  • Document fixes to database, apply fixes and
    conduct QA of fixes
  • Lock database
  • Provide locked database to research mentor for
    verification prior to sending to statistician

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
39
Step 15 Data Analysis
  • Using locked database, analyze data per protocol
    data analysis methods
  • Populate table shells

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
40
Step 16 Report Writing
  • Review authorship SOP and journal authorship
    requirements if specified
  • Verify target journal
  • Review authorship guidelines
  • Copy FROM PROTOCOL, abstract, introduction,
    methods and references to manuscript
  • Update literature search using same search terms
    and databases for only new years
  • Update introduction if new literature
  • Update references as needed
  • Change future tense to past tense in introduction
    and methods
  • Draft results

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
41
Step 16 Report Writing (continued)
  • Write discussion
  • Contrast your findings to literature cited
    findings
  • Specify your limitations
  • Write conclusions
  • Include the so-what factor
  • Based upon the results of this research and the
    evidence in the literature, the hospital standard
    of care or SOP or nursing practice has been
    modified from xx to xxx
  • Based upon the results of this research and the
    evidence in the literature, care delivery has
    been modified from xx to xxx
  • As a result of this research patient outcomes xxx
    has xxxx

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
42
Step 17 Dissemination of Findings
  • One per study
  • Manuscript
  • Poster
  • Podium presentation
  • Update RC research outcomes table
  • Dissemination of findings
  • How research findings impacted standard of care,
    care delivery and patient outcomes

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
43
Contact Kgabelsperoni_at_smartneighborhood.net to
request permission for use
44
Last Step REJOICE IN YOUR ACCOMPLISHMENTS
  • Authors Happy Hour

Karen Gabel Speroni, 2011 Contact
Kgabelsperoni_at_smartneighborhood.net to request
permission for use
45
SUMMARY
  • Before submitting to the IRB
  • Write the protocol as if it were the manuscript
  • Include an abstract with headings
  • Write 1 - 1.5 page introduction
  • From an evidence based practice perspective,
    results of this research can be used by
    administration to xxxxxxx
  • Summarize literature search including specifying
    search terms, years searched and databases
    searched
  • Draft the table shells that guide THE END / how
    you will present your data

46
SUMMARY (continued)
  • After the research has been completed
  • Copy FROM PROTOCOL, abstract, introduction,
    methods and references to manuscript
  • Update literature search using same search terms
    and databases for only new years
  • Update introduction if new literature
  • Change future tense to past tense in introduction
    and methods
  • Draft results

47
SUMMARY (continued)
  • Write discussion
  • Contrast your findings to literature cited
    findings
  • Specify your limitations
  • Write conclusions
  • Include the so-what factor
  • Based upon the results of this research and the
    evidence in the literature, the hospital standard
    of care or SOP or nursing practice has been
    modified from xx to xxx
  • Based upon the results of this research and the
    evidence in the literature, care delivery has
    been modified from xx to xxx
  • As a result of this research patient outcomes xxx
    has xxxx

48
Speaker Contact Information
  • Karen Gabel Speroni, PhD, RN
  • Director, Nursing Research Chair, Research
    Council
  • Inova Loudoun Hospital
  • Inova Fair Oaks Hospital
  • Chair, Nursing Research Council, Shore Health
    System
  • Clinical Scientist, Institutional Review Board
  • Inova Research Center
  • George Mason University
  • Chesapeake Research Review
  • E-mail kgabelsperoni_at_smartneighborhood.net

48
49
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