Fostering evidence-based quality improvement in nursing practice

Nursing professionals are highly skilled experts in their field and make a significant impact on so many lives every day in a fast-paced, safety-critical environment. When it comes to patient care, outcomes, and overall healthcare delivery, evidence-based practice is an essential component in nursing and beyond. It promotes a culture of continuous learning and development, crucial in ensuring that nurses provide effective and efficient care based on the most current research and knowledge available.

Scientific evidence should inform decisions rather than anecdotal narratives, to help phase out outdated practices, increase satisfaction rates, and promote patient safety measures and quality care initiatives.

Unlocking the power of evidence-based nursing

Evidence-based nursing integrates the latest research findings, clinical expertise, and patient values to inform patient care decisions. It emphasizes a more systematic approach over traditional methods or personal beliefs, with a core focus on integrating scientific evidence to support high-quality care. This becomes ever more important as the volume of health information expands at an exponential rate, alongside a proliferation of misinformation.

But how can nurses translate evidence into meaningful and actionable decisions to improve the quality of care at the bedside? It can be a daunting task, but the nursing process is a key focus area for applying evidence in practice.

Practical application

The five phases of the nursing process are designed to deliver patient-focused care and develop critical thinking skills in a systematic way.¹ The theoretical framework can serve as a way of injecting evidence into one’s workflow. A practical implementation of its steps could translate as follows:

1. Assessment: reflection, questioning, description of the problem, and gathering of the latest evidence for relevant data collection.
2. Diagnosis: critical appraisal of the latest data, and relevance of its application to the clinical situation.
3. Planning: goal-setting process to develop a tailored course of action.
4. Implementation: application of evidence-based interventions based on clinical situation to be addressed.
5. Evaluation: results assessment phase to ascertain that evidence promoted quality improvement (QI) outcomes, and/or identify gaps in care delivery processes, leading to enhanced safety protocols that minimize errors and adverse events.

Figure 1: The five phases of the nursing process

From novice to expert, it can help nurses think through a course of action. It works as an iterative process that invites reflection, promotes professional behaviors in an interdisciplinary setting, and fosters evidence-based decision making.²

Quality improvement

Quality improvement (QI) in nursing focuses on enhancing processes, systems, and practices within healthcare settings to optimize patient outcomes and experiences (recovery rates, satisfaction levels, and overall well-being, among others). Nurses play a crucial role in QI initiatives by actively participating in quality assessment activities, suggesting improvements based on their clinical experiences, and collaborating with interdisciplinary teams to implement changes effectively.

The evidence-based approach follows a structured process that includes asking clinical questions, searching for relevant evidence, critically appraising the evidence, applying it to practice, and evaluating outcomes. This systematic approach ensures that decisions are based on the best available evidence and are tailored to meet not only individual patient needs, but also financial goals of the healthcare system, with length of stay and mortality topping the list of performance metrics.³

Impacting the nursing workflow

The spread of too much information, either accurate or false, is referred to as an infodemic. Healthcare is an ever-evolving ecosystem where this prevails. Distinguishing fact from fiction becomes difficult, especially when misleading information is spread on social media. The World Health Organization (WHO) encourages health professionals to evaluate and manage the information they receive more judiciously.⁴ The U.S. Surgeon General also suggests that in addition to continuing education endeavors, using the right clinical decision support (CDS) tool can effectively support the evidence-based decision-making process.⁵

Spotlight on intravenous infusion

As the number of intravenous (IV) medications continues to expand, there is increased likelihood that nurses need to administer multiple IV medications concurrently. Lack of knowledge of a drug is one of the most systemic causes of administration errors when it comes to IV infusion.⁶ Being able to rely on a CDS tool that supports a robust evidence-based approach is key to appropriately identifying parameters such as physical compatibility, chemical stability, and reconstitution, which are essential to safe drug administration interventions.

Conclusion

Nurse-led initiatives can help to reduce unnecessary costs associated with ineffective treatments or preventable complications.⁷ What’s more, implementing evidence-based practice increases nurses’ satisfaction and has been identified as a determining factor in staff retention.⁸

Evidence-based practice and quality improvement are integral aspects of nursing that drive innovation, excellence, and improved patient outcomes. The benefits of embracing these principles into the nursing workflow elevate the standard of care nurses provide, contribute to a culture of continuous improvement within healthcare organizations, whilst addressing health misinformation and ensuring a return-on-investment (ROI) for healthcare facilities.

Learn about evidence-based clinical decision support from Micromedex.

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