QI, EBP & Research: Knowing the Difference

Yvonne Wesley RN PhD FAANRBMC, Faculty Liaison

2011

ObjectiveUpon completion of this 90-minute session,

participants will be able to:Differentiate quality improvement, evidence

based practice and researchIdentify similarities and sources of confusion

among quality improvement, evidence based practice and research

Compare essentials of quality improvement, evidence based practice and research

Why We Do What We Do

Patient Care

QI EBP Research

Differentiate Purpose

QI EBP Research

Purpose

Improve Patient Care

Change Practice

Generate New Knowledge

SimilaritiesScholarly Process

Method Sample Data Collection IRB

ResultsImplicationDissemination of Results

Sources of ConfusionHuman Subjects

Amount of risk or benefit to participantsConfidentiality/AnonymityGeneralizabilityAbility to get published.

ComparisonQI EBP Research

Method PDCA Level of Evidences

Qualitative, Quantitative

Sample Unit level Patient population

Representative

Human Subjects

? IRB ??IRB Need IRB

Data Collection

Evaluation Search & Appraise

Validity

Results Improve process

Impact Add to body of knowledge

Implications Process change

Practice change Understanding change

Dissemination

Unit/Agency Practice standards

Scientific community

Dimitroff, LJ. (2011, April). Comparing and contrasting nursing research, evidence-based practice, and quality improvement: a differential diagnosis. Capital District Nursing Research Alliance 7th Annual Conference

Shirey MR, Hauck SL, Embree JL, Kinner TJ, Schaar GL, Phillips LA, Ashby SR, Swenty CF, McCool IA. (2011). Showcasing differences between quality improvement, evidence-based practice, and research. Journal of Continuing Education in Nursing, 42(2):57-70.

Hospitals pursuing Magnet designation must understand and respect the distinctions between QI, EBP, and research.

Do not confuse one approach for the other. Hospitals should facilitate distinct, yet

collaborative, venues to cultivate QI, EBP, and research initiatives

QI/PI/TQI/CQI The purpose of QI is to improve internal

processes and practices within a specific patient group or organization

QI protocols are less formal and rigorous and may change throughout the course of a QI project.

Data collection in QI is usually rapid cycle and uses minimal to moderate time and resources.

Shirey et al. (2011).

Evidence-Based PracticeThe purpose of EBP is to evaluate evidence

along a continuum to identify the strongest or best evidence to guide nursing practice within an organizational setting and with a specific patient population

EBP interventions are stricter and more prescriptive than QI protocols, yet they are not as strict as research protocols.

EBP data collection may not be rapid cycle and involves varying resources.Shirey et al. (2011).

ResearchThe purpose of research is to generate new

knowledge within the broader scientific community to produce knowledge that is generalizable beyond the study sample

Research study generally have tight controls for extraneous variables to provide confidence that outcomes occur as a result of defined intervention and not chance

Research is not rapid cycle and involves the use of resources that may vary according to scope of the study

Shirey et al. (2011).

ExamplesQuality Improvement

Improving the discharge time of patients Improving Documentation of Critical Lab Values Reduce the time between when a provider writes an

order (antibiotic) and when the patient receives the order

Decrease infections associated with central venous catheters

Improve patient satisfaction Decrease pressure sores with the use of pressure

dressings

The UAB Center for Nursing ExcellenceUniversity of Alabama at Birmingham Hospital

Examples

Evidence Based Practice Assessing the Standard for Chemotherapy induced

nausea and vomiting Listening to Bowel Sounds Best Practice for Tracheotomy Dressing Positioning in the OR to prevent pressure ulcers Early Mobilization to prevent pneumonia

The UAB Center for Nursing Excellence

ExamplesNursing Research

symptoms clusters of patients with congestive heart failure

if women delay reporting symptoms of heart attack more than men

if location from hospital impacts follow up treatment of breast cancer patients

quality of life outcomes in heart transplant patients from pre transplant to 5 years post transplant

The UAB Center for Nursing Excellence

SummaryThere are differences between quality improvement, evidence based practice , and research

Similarities among the 3 can be a source of confusion for the novice

Essentials components of each include:

• Purpose• Rigor/Control [QI

Research] • Dissemination

Suggested Readings Shirey MR, Hauck SL, Embree JL, Kinner TJ, Schaar GL, Phillips LA,

Ashby SR, Swenty CF, McCool IA. (2011). Showcasing differences between quality improvement, evidence-based practice, and research. Journal of Continuing Education in Nursing, 42(2):57-70.

Dimitroff, LJ. (2011, April). Comparing and contrasting nursing research, evidence-based practice, and quality improvement: a differential diagnosis. Capital District Nursing Research Alliance 7th Annual Conference

Krugman, M. (2008). Is it research, evidence-based practice, or a quality improvement project? Journal for Nurses in Staff Development. 137-139.

Hedges C. (2006). Research, evidence-based practice, and quality improvement. AACN Advanced Critical Care, 17(4), 457-9.

Beyea, SC, & Slattery MJ(2006). Evidence-Based Practice in Nursing: A Guide to Successful Implementation ©2006 HCPro, Inc