Evidence Based Practice

Contents

Executive Summary:

Practice Change Description

Need for practice Change

Barriers to implementation and its mitigation:

Bibliography

Executive Summary of Change in Practice in Respiratory Ward Report

This is a report on the changes that are to be implemented in a respiratory ward for self-management of Asthma. This is a critical task that needs to be undertaken with utmost care since it will have an effect on the quality of life for the patient and reduce recurring hospital admission. This will reduce the burden on the healthcare ecosystem sparing scarce and valuable resource to be deployed in other critical sectors. The change in practice that will be implemented will be introduction of a module of comprehensive patient education that includes aspect of self-management of asthma that includes a customized and personalized work action plan. The implementation of the patient education program will have to be complemented by a rigorous training program of the healthcare professionals involve. These programs have been reported to improve clinical outcome. The challenges to implementation and how to mitigate them have been discussed.

Practice Change Description

Supported self-management of patients who are suffering from asthma is a critical need that needs to be scientifically assessed based on existing evidence and implemented with appropriate care. This issue will be discussed in this report which will look into effecting a change in practice with respect to self management of asthma. This change will be based on available evidence based on review of current best practices and innovations as reported in scientific literature. There is an enormous number of literature available reporting the various ways self management can be improved with enhanced clinical outcome that reduces further hospitalization and improves quality of life of the patients. It is important to critically evaluate this huge body of work and distill the intelligence for implementation in my ward. This will allow for implementation of best practice when it comes to self management of asthma. After a thorough literature review is performed, it was observed that evidence suggests few positive actions lead to enhanced clinical outcomes in patients who are suffering from asthma. These actions will be chosen for implementation as change in practice in my respiratory ward where I am the RN to ensure improved quality of life for the patients and reduced subsequent hospitalization.

The most important change that would be implemented in my respiratory ward will be with regards to use of self education and training (McDonald & Gibson, 2006). According to a widely cited paper the most effective way to improve outcome in terms of self management of asthma is the approach of active engagement of patients that is coupled with training and motivation of professionals who are part of the organization that works on well being of patients and where self-management is given premium importance (McDonald & Gibson, 2006). Numerous randomized clinical trials support the paradigm that self-education is vital to improve clinical outcome (Moudgil, Marshall, & Honeybourne, 2000) (Stevens, Wesseldine, & Couriel, 2002). Hence I will focus on this aspect as the bedrock of the change I am going to implement in my practice at the respiratory ward. It has been reported that quality self-management education that includes an aspect of behavioral strategies lead to enhanced adherence of a regimen of inhaled corticosteroids (Bailey, et al., 1999). Hence each patient in my ward will have to undergo a mandatory educational module that is intended to aid in their long term wellbeing. This is not possible without adequate training of professionals and healthcare providers who are part of the ecosystem. As reported in literature as evidence of successful self management, precision educational intervention and associated training of stakeholders will be the focus of change in practice (Janson, McGrath, Covington, Cheng, & Boushey, 2009).

An important component of education is the creation and internalization of customized and individualized action plan that has to be accepted and implemented by the patient in their daily life. There may be several components of the action plan including a behavioral intervention to remember usage of regular medication and keep a regular supply of inhalers. It is necessary to educate the patients about the nature of attacks including factors like self monitoring of symptoms and peak flow. The patient needs to be made aware of symptoms and the process of airflow obstruction. Hence the self management education should also include components critical information sharing with the patient, self-monitoring as discussed review by medical professionals and caregivers at regular interval (Jones, 2008). The stakeholders involved with the ecosystem should be adequately trained by professionals including the correct way to impart this education that is of vital importance to the patients. This is an important aspect of the change I am planning to the practice of providing care to the asthma patients. The healthcare professionals should not only undergo training but this training should be at regular intervals to acquire and maintain the skills and competence necessary to deliver this kind of education for self-management of patients.

The successful implementation of this kind of self-management program and relevant education depends on development of a collaborative environment between provider of healthcare service and the patient. It is mainly the duty of the caregiver to create this kind of positive environment. Hence the caregiver will have to be adequately trained as mentioned (Gibson, Powell, & Wilson, 2002). The care giver and stakeholders are numerous and this is a big ecosystem. The stakeholders include respiratory therapists, nurses who care for the patient, pharmacists and obviously the physicians. Hence the training should be holistic and include all the stakeholders of the ecosystem. All these different stakeholders of the provider ecosystem should be involved dissemination of education and reinforce the education of self-management at every available opportunity. It a reported has been reported that a written action plan that is comprehensive including aspect of self-monitoring and is coupled with regular review by medical professionals reduces the risk of hospitalization significantly. Hence to improve patient outcome I would like to implement this significant change in the respiratory ward where I work.

Need for Practice Change

Globally the prevalence of asthma is increasing by as much as fifty percent every ten to fifteen years (Global Asthma network, 2018). The need for change in the practice of providing healthcare is observed to be self-evident following a comprehensive review of existing literature. The patients require less hospitalization and they experienced enhanced quality of life. Current practice in my respiratory ward not implement these vital approaches like education in self management and training of healthcare professionals (Grady, 2014) as discussed in the previous section. There are various benefits of implementation of these programs. It considerably enhances the functional capacity of the patients. It also reduces the unnecessary use of healthcare services (Grady, 2014). It needs to be kept in mind that health care services are critical resources and the reduction in its use will lead to more rational distribution of services in critical domains. If properly implemented, the change in practice will lead to improved clinical outcomes like enhanced adherence to medication and inhaler regimen, lead to fewer outbreaks of symptoms that will significantly improve the quality of patients’ life. There have also been reports that physician education in this aspect is vital along with other stakeholders to achieve the desired outcome enhanced clinical outcome (Jones, 2008). As mentioned in the previous section the education of the patients should be customized and personalized that will have a greater impact.

The customization of the patient education should take into account the more vulnerable sections of the patient population. It has been reported that smokers are less adherent to inhaler regimens. If the medical report of the patient reveals a history of smoking, his self management plan and associated education should focus on the aspect of inhaler adherence and its importance. Other vulnerable sections include children and adolescents (Cicutto, 2003). It has also been reported that self management program considerably improves outcome in children and adolescents. Several studies in the cochran’s airways group and Cochran’s schizophrenia group report clinical trials as evidence for this hypothesis (Harshani Jayasinghe, Christopher, Ahad, ason, Haydn, & Brian, 2020). Meta-analysis of these trials reveal that improvement of lung function and measures of self efficacy is considerably higher in groups involved in self-management and associated education compared to the usual care group. These are instances that provide evidence of how a personalized self management plan will lead to significantly improved clinical outcome (Janson, McGrath, Covington, Cheng, & Boushey, 2009). This underscores the need for the change in practice as suggested in the previous section.

Barriers to Implementation and Its Mitigation

There are several barriers to the successful implementation of the change in practice suggested in this report. There is a need to be aware of these barriers in order to successfully mitigate these issues (Roberts, Velsor-Friedrich, & Keough, 2018). There are several challenges to implementation of the protocols related to patient education and education of professionals related to the healthcare ecosystem. Staff education is an important barrier to successful protocol implementation coupled with work load. Healthcare ecosystem is an extremely busy environment where time is really a precious commodity. Hence to take out the time to carry out the necessary training is a challenging task. Considering the fact that there needs to be training of multiple stakeholders who are professionals in the healthcare ecosystem makes the task even more arduous.

Also there is rapid turnover in any organization that makes training of new recruits a constant affair which puts a huge strain on resources like time and money which makes this an expensive undertaking (Roberts, Velsor-Friedrich, & Keough, 2018). Also there are numerous initiatives being undertaken by various departments and these initiatives may compete against each making the task even more difficult. There is also a tendency to not fully trust the patient’s ability to self-manage which creates a negative effect on the successful implementation of the change in practice that is important for enhanced clinical outcome. Also the personalized action plan of the self-management education program needs regular interaction and review by medical professionals. This may create scheduling conflict given the time constraint and the extreme busy schedule of the medical professionals.

In order to mitigate these challenges smart approaches need to be adopted. The first and foremost challenge is the need to explain the importance of these changes in practice. It is vital to explain and sensitize all the stakeholders of the healthcare ecosystem including providers and patients about the long term benefits of education of the patients and the training of the professionals.

This will reduce the psychological barrier that is one of the main barriers to the implementation of these programs. Once the providers and the patients are convinced of the need for implementing this change, the remaining barriers and challenges are easier to mitigate and manage. The time and resource constraint is the next major challenge to be addressed. There has to be smart approaches to mitigate these challenges. The domain of telemedicine has made tremendous strides in the last decade. Implementation of telemedicine will reduce the considerable time and resource burden in the aspect of provider and patent interaction and regular review of their personal action plan review. There has to be an optimization of schedule based on agile operations management paradigm. The turnover of professionals needs to be smartly managed. There is a need to design and implement of an optimized training protocol that will quickly bring the new recruits up to speed so that there is a reduced lag in the quality of service. These are the intelligent approaches that are needed to be adopted in order to mitigate the said challenges.

Bibliography for Change in Practice in Respiratory Ward Report

Bailey, W., Cohler, C., Richards, J., Windsor, R., brooks, M., Gerald, L., et al. (1999). Asthma Self management. Arch intern Med , 2422-2428.

Cicutto, L. (2003). Review: self management education improves outcomes in children and adolescents with asthma. Evidence-Based Nursing .

Gibson, P., Powell, H., & Wilson, A. (2002). Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev .

Global Asthma network. (2018). The global asthma report. Global Asthma network.

Grady, P. A. (2014). Self-management: a comprehensive approach to management of chronic conditions. American journal of public health , 25-31.

Harshani Jayasinghe, K. C., Christopher, B., Ahad, A., ason, T., Haydn, W., & Brian, S. (2020). Asthma Self-Management Education with Either Regular Healthcare Professional Review or Written Action Plan or Both in Adults: A Cochrane Review. American Journal of Respiratory and Critical Care Medicine .

Janson, S., McGrath, W., Covington, J., Cheng, S., & Boushey, H. (2009). Individualized asthma self-management improves medication adherence and markers of asthma control. American Academy of Allergy, Asthma & Immunology , 840-846.

Jones, M. (2008). Asthma Self-Management Patient Education. RESPIRATORY CARE , 778-786.

McDonald, V., & Gibson, P. (2006). Asthma self-management education. Chron Respir Dis , 29‐37.

Moudgil, H., Marshall, T., & Honeybourne, D. (2000). Asthma education and quality of life in the community: a randomised controlled study to evaluate the impact on white European and Indian subcontinent ethnic groups from socioeconomically deprived areas in Birmingham, UK. Thorax , 177-183.

Roberts, E., Velsor-Friedrich, B., & Keough, V. (2018). Implementation of an Asthma Self-Management Education Guideline in the Emergency Department, . Advanced Emergency Nursing Journal , 45-58.

Stevens, C., Wesseldine, L., & Couriel, J. (2002). Parental education and guided self-management of asthma and wheezing in the pre-school child: a randomised controlled trial. Thorax , 39-44.

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