Slide 1 How to Use Research to Change

Practice?

We Will Show You How We Did It !!

Janet King RN BSN CGRN

June Guarente MS RN CGRN

Carol Shea RN BSN CGRN

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Slide 2

Objectives

Participants will :

Describe related research terms.

List steps using research to change practice.

Discuss possible projects that use research to change

practice.

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Slide 3

Research Terms

• Nursing Research

o A systematic inquiry designed to develop trustworthy

evidence about issues of importance to the nursing

profession, including nursing practice, education,

administration and informatics.(Essentials of Nursing Research 2010)

• Evidence Based Practice

o Nursing practice that uses research findings to guide

decisions, actions, interventions and policies.

(Nursing Administration 2005, Vol 20, No 3 pp)

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Slide 4

Research Terms

Research Utilization

o Nurses use evidence from research to guide their practice

Attend a research presentation

Journal clubs

Attend a research poster presentations at National SGNA

Conference

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Slide 5

Sources of Current Research

• Journals

o Peer Reviewed

Professional Organizations

o SGNA

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Slide 6

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Slide 7

Steps to Help Guide

Changing Practice with Research

Define the problem

List supports for the project

Lists obstacles to implementation

List resources

Set a timeline

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Slide 8

Defining the Problem

Our problem

Changing the practice of using Demerol (Meperidine) for

procedural sedation to using Fentanyl

A problem in your setting

A practice in your unit that does not follow current research

or standard of practice

Please write down a problem that you have encountered

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Slide 9

Supports for the ProjectPhysicians and nurses

We identified a core group to work with us

Administration Project time

We set aside time to complete each phase of the project

Money

We did not require any direct funds

Approval

We received approval from our multidisciplinary Endoscopy Committee

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Slide 10

Hospital wide support at MGH

Jeanette Ives Erickson MS RN FAANSenior Vice President

for Patient Care and Chief Nurse MGH

Encourages the development of evidence based practice at the bedside

Supports Collaborative Governance

“Nursing Research Committee”

Promotes Nurse Researchers who provide mentoring and guidance to those developing research projects

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Slide 11

Your Project

Please list supportive individuals in your unit

Will you need project time?

Will you need any financial support?

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Slide 12

Obstacles

Physician preferences

Nurse preferences

Time to work on project

Physical constraints

Access to resources

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Slide 13

Obstacles We Encountered

Opposition to the project

MD’s

RN’s

Time to work on the project

Planning

Gathering data

Analyzing results

Working on presentation for staff

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Slide 14 What Obstacles Might

You Encounter?

Please list obstacles to your own project

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Slide 15

Resources Researchers in your

institution MD’s

RN’s

Research assistants

Other disciplines Pharmacists

Social Workers

Respiratory Therapists

Child Life Specialists

Library Librarian

Internet Journal searches

On-line professional discussion

forums

Survey Monkey

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Slide 16

Resources

Resources we used

Librarian

MD helped with analysis

of data

Nurse Researcher

Survey Monkey

Pharmacist

What resources are

available to help

you?

Please list

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Slide 17

Timeline for Project

Start date of the project

End date of the project

Determine what else needs to happen and when

Keeps you focused

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Slide 18

Time Line

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Slide 19

Developing a Timeline

Please start a timeline for your project

Start date

End date

What needs to happen and when

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Slide 20

Summary of Our Project

It began with an article ……..

“Why are We Still Using

Meperidine (Demerol) for

Conscious Sedation?” (Daniel, et al 2009 SGNA Journal)

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Slide 21

Summary of Our Project

• This led to literature search for additional information

• The literature revealed: Fentanyl more appropriate for certain populations

Renal Failure Elderly Taking MAOI’s

Fentanyl has shorter ½ life Fentanyl acts faster & is cleared more rapidly

½ life of Normeperidine (Demerol’s metabolite) is 14-21 hrs

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Slide 22

Project Outline

Goal = 30 patients

Pre procedure CAS review

Patient survey post procedure

Chart review post procedure

Staff survey Prior to start of project

October 2012

After project was completed

April 2013

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Slide 23

Data CollectionChart review

Pre & post BP

Length of Stay (LOS) in Recovery Room

Patient survey To determine patient comfort during procedure

To screen for nausea & vomiting post procedure

2 Questions Asked to Patient:

1.“Do you feel you received adequate pain relief during your colonoscopy?”

2.“Did you experience any nausea or vomiting today?”

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Slide 24

Project Results

30 patients

Staff survey pre and post

Chart review

Patient survey

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Slide 25

Staff Survey Results

First survey

October 2012

Effectiveness of

Demerol & Fentanyl

for PS

60 responses0

10

20

30

40

50

60

70

Demerol Fentanyl

Somewhat effective

Effective

Very Effective

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Slide 26

Staff Survey Results Second survey

April 2013

Effectiveness of Demerol & Fentanyl for PS

49 responses

Fentanyl demonstrated increase in Effective & Very Effective categories

0

10

20

30

40

50

60

70

Demerol Fentanyl

Somewhat effective

Effective

Very Effective

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Slide 27 Staff Survey Comparison

October 2012 vs April 2013

0

10

20

30

40

50

60

70

Demerol Fentanyl

Somewhat effective

Effective

Very Effective

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10

20

30

40

50

60

70

Demerol Fentanyl

Somewhat effective

Effective

Very Effective

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Slide 28 Staff Survey Results:

Level of Comfort Using Fentanyl

0

10

20

30

40

50

60

70

October April

Not comfortable

Somewhatcomfortable

Comfortable

Very comfortable

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Slide 29

Chart Review Results

Fentanyl

3/30 low BP

Measured as 20% from baseline

Demerol for previous case

13/30 had low BP

2 patients had low BP both cases

2/13

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Slide 30

% Low BP: Demerol vs Fentanyl

0

5

10

15

20

25

30

35

40

45

%Low BP

Demerol

Fentanyl

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Slide 31

LOS in RR

Fentanyl

59 min

Prior Demerol

69 min

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Slide 32

Fentanyl vs Prior Use of Demerol

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Slide 33

Additional Data

30 patients who

received Demerol

during a 1 week

period at CRP

72 min average

LOS in RR

0

10

20

30

40

50

60

70

80Demerol in thepast

Fentanyl now

Demerolrandomlypicked

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Slide 34

Patient Survey Results

Do you feel you received adequate pain relief

during your colonoscopy today?

1/30 c/o some discomfort

Did you experience any nausea or vomiting

today?

0/30 had n/v

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Slide 35

Our Project Summary

Fentanyl demonstrated to be effective for pain

control with less side effects and decreased

LOS in RR

Staff felt fentanyl just as effective & had

increased comfort using Fentanyl as a result of

project

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Slide 36

SummaryAs nurses we need to stay current

Journals

SGNA website

Educational conferences

Annual meeting

Local chapter meetings

Using evidence based practice to change practice in our own units can sometimes be a challenge

Utilizing a step by step approach and developing a timeline can assist you to implement a process improvement project of your own

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Slide 37

Questions?

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Slide 38

What about you?

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Slide 39

References Daniel, K. & Schmelzer, M. (2009). Why are we still using

Meperidine (Demerol) for conscious sedation? Gastroenterology Nursing , 32(4):298-301.

Dzeletovic, I., et al (2013). Impact of fentanyl in lieu of meperidine on endoscopy unit efficiency: a prospective comparative study in patients undergoing EGD. Clinical Endoscopy, 77 (6) 883-887.

P. Polit, D., Beck, C. (2010). Essentials of Nursing Research-Appraising Evidence for Nursing Practice. Philadelphia:Walters Kluwer/Lippincott.

Turkel, M., Reidinger, G. Ferket, K., Reno, K.(2005). An Essential Component of the Magnet Journey. Nursing Administration, 29 (3) 254-262

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