Early Detection Saves Lives

With the approach of October, it's time to remember Breast Cancer Awareness month. Here's some interesting research on postmenopausal cancer risk that was published in the Archives in Internal Medicine.

And although much of that seems out of your control, we know that early detection is in your control. Therefore, in honor of Breast Cancer Awareness month, what better evidence based practice to put into place than one you can do on yourself in your own home.

See you at the race!

ANA likes us, ANA really likes us!*

We've been asked to share our blog with a new networking site at the American Nurse's Association called ANANurseSpace, a protected professional networking site for nurses.

According to Camille Soleil, JD, ANA Director for Special Projects, "Our hope is that it will provide a space for nurses across the country to interact and engage about anything of interest to them, especially ideas and experiences regarding the nursing profession." They hope to make our blog part of a cornerstone for EBP and research discussions for nurses across the US.

So if you happen to be one of those nurses from somewhere other than Oklahoma, we welcome your comments. It's a pilot, so we will see how it goes. Once ANANurseSpace is up and running, I'll post a link.

Don't forget the meeting tomorrow night--see website for details.

*if they gave oscars for blogs, that's the acceptance speech we would use!

WOW--it looks like EBP will be more essential than ever!

Jani Hill was discussing with me the other day that, as of 2008, Medicare would no longer pay for the care of patients whose central lines get infected. We discussed the impact this could have on hospitals which is significant. But actually the change in Medicare policy is much more broadsweeping than either of us knew. Basically, Medicare won't pay the care for any preventable error in the hospital. Think about it: hospital acquired UTI's, drug errors, the list can go on and on. Read about it here: http://www.nytimes.com/2007/08/19/washington/19hospital.html?_r=1&oref=slogin

What does that mean for hospitals? That evidence based practice will no longer be just a part of getting magnet status. Hospitals will have to rely on EBP to ensure they are making a profit. What does it mean for nurses? That they will have to be able to translate EBP into clinical practice and that nurses will have to follow strict procedures to ensure decreased errors. For patients, though, it's possible that it means they will have better care. But could hospitals turn away Medicare patients like they do in some MD offices? I'm not sure of the impact there.

There's probably lots of other meanings out there--what impact do you foresee this change in Medicare having on hospitals, patients and nurses?

Is there a librarian in the house?

Did you know that medical librarians are an important and vital part of the evidence-based practice process? What happens, though, when your healthcare agency might not have access to a library or even a librarian? Can you still search for the evidence?

Many hospitals, during the 1990's downsizing, did away with not only nursing and medical libraries but the librarians that assisted with keeping these healthcare professionals informed. About this same time, hospital information technology departments insisted on increasing security (and rightly so) which tightened computer firewalls such that healthcare professionals didn't have the ability to complete evidence searches within the hospital. So while some staff nurses may see the importance of basing their practice on evidence, most of them no longer have access or expert assistance within their workplace to even look for the evidence.

So what can you do if you are one of the healthcare agencies that may experience this lack of access and expertise? If you do happen to be one of those healthcare professionals, then you do have some options:

1. Learn to search through PubMed but realize you won't really find everything you need.


2. Get familiar with organizations that may offer systematic reviews and best practice guidelines as well as the national clearinghouse for guidelines.


3. Go to the OU Health Sciences Center (located in both OKC and Tulsa) during weekday working hours and the librarians will be happy to assist you with doing some searches on OU's databases (at no charge!).


4. Call other hospital medical libraries that may be located near you and check to see if they are willing to provide similar services as in #3 (most are!).


5. Consult with medical librarians regarding how your healthcare organization might access the literature from the workplace--many academic medical centers will work out contracts with healthcare organizations for access to their databases (although, this is not a cheap endeavor). The Medical Library Association has some helpful information about the plight of medical libraries and how you can be involved (they also offer grants occasionally to support adding medical libraries in facilities).


6. Connect with searches that healthcare professionals across the world are doing. One such handy service is called Connotea (it's a free service). For those of you familiar with del.icio.us, it's like that except for academics. For those of you not familiar with either of those, they are shared bookmarking/tagging sites where you can label an internet article or journal with different labels like "fall prevention" or "needle safety" and then share them. The Connotea link I provided you is the "Get it @ Duke" group. I could be wrong but I think once you sign up anyone can get in the Duke group to see their tags and articles.


7. Realize that other than options #3 and #4, the information you will get will be limited so take care in making practice based decisions (for example, deciding to leave IV's in for 2 weeks based on a small study of 15 people you found on Google Scholar would not be considered evidence-based practice).

Big thanks to Betsy Tonn and Shari Clifton, OUHSC Librarians, who have taught us so much about searching for the evidence at the past two meetings. If you happened to miss these meetings, we'll go over this educational topic again September 11 from 3-5 p.m. at Integris Baptist Hospital Conference Room D (on the concourse level). Cheryl Suttles (Integris Director for Library Services) will also go over searching for the evidence. Since it's at Integris, they can V-tel to most Integris sites. To arrange this, just e-mail Susie (susan.jones@integris-health.com). We look forward to seeing you all there!

Here's a link that many of you requested at the last meeting that has several EBP resources on the OUHSC library page. Please realize, though, that some of these are databases that can only be accessed if you have an OUHSC account (I just realized this).

Sleep: it does a body good!

Hi Everyone!
We hope everyone had a great July 4th holiday and hope you've had the opportunity to get a vacation and, here's the segue, get some sleep.

Did you know that sleep is probably very important in not just our ability to learn but to understand relationships between concepts? Researchers at Boston studied three groups of students and found the group of students that received the longest period of sleep actually learned information better.

To quote Mathew Walker, PhD, "You go to bed with pieces of the memory puzzle, and awaken with the jigsaw completed.”

Here's the link for you to read about it in full detail:
http://researchmatters.harvard.edu/story.php?article_id=1143

One of my freshman college teachers used to tell us that we needed to make sure our head was on our pillows for at least 8 hours each night because we learned by osmosis. At the time, just fresh out of high school chemistry, I thought she was nuts but later realized that the definition she was using was correct.

os·mo·sis [oz-moh-sis,os-]–noun
2. a subtle or gradual absorption or mingling: He never studies but seems to learn by osmosis.

So I've learned a few things here:

1. sleep is good!
2. osmosis really is real!
3. freshman college teachers really aren't crazy!
4. I need to quit finding articles like this in the middle of the night when I can't sleep!

Really, though, think about the application of this study for patients who not only get very little sleep but are very ill, all the while we are trying to teach them about how to prevent ending up in the hospital again (here's how you draw up your insulin, Mr. Smith). The implications for nurses on the floor can be great, especially for those that work odd shifts and may have difficulty with getting enough sleep or with nurses who are working too many hours (and not always at one job).

Again, comments welcomed and encouraged (but then you should go get some sleep)!

Evidence Based Practice--is it still a mystery?

Hi! I just got back from the Case Management Society of America conference where nearly 3,000 case managers met to talk about current practice in beautiful (but hot!) Denver, Colorado. From that conference, I came away with a few things:
(1) Very few people know how to do evidence based practice;
(2) Even fewer know how to do it correctly;
(3)Everyone wants to know how to do evidence based practice.

That final point is a good one but what is deeply concerning are those that think they are doing evidence-based practice when, in fact, they are performing research. Recently in AJN, an article led one to believe that they were doing evidence-based practice in relation to IV dressings when, in fact, they were actually performing a research study. No mention was made of IRB approval. It's also concerning that the evidence that may be used to support an EBP project may not be the best evidence rather the evidence that someone "liked" or supported their position.

So I pose these questions:

• Do the people you work with clearly understand EBP and its differentiation from research?
• Is there a general lack of knowledge in the clinical setting about what EBP is and what it is not?
• Do people know how to find the best evidence?

To post a response, you don't have to be a part of this system so feel free to discuss.

The worst case scenario: When not using evidence produces fatal outcomes

So you've probably heard by now of the terrible event that occurred in a California ER this week where a woman bled to death while her family members stood by helplessly calling 911 for help. First, let's get this straight: if your patients are calling 911 from the ER, there's probably some evidence that a breakdown in communication is occurring somewhere in your organization. Beyond the phone calls, though, it seems like someone vomiting (and vomiting blood, no less) might signal a true emergency. So despite what seemed like overwhelming evidence that this woman was in need of help, nothing was done.

So what do we do about these Failure to Rescues? How do we prevent them? What evidence could have been used so that this didn't happen?

Recently I received in the mail from AHRQ information about Team STEPPS, a set of evidence-based tools to help train clinicians in teamwork and communication skills to reduce risks to patient safety. Many healthcare organizations are beginning to use it but I wonder if any in Oklahoma are using it. Personally, it looks like a great model that could really transform the way we communicate in healthcare.

I'm also curious to know if the fact that these were primary-Spanish speakers in any way influenced how they were treated. It certainly calls up the importance of medical interpretation and cultural competency in our healthcare organizations. Even that is really no excuse since a woman vomiting blood doesn't need much interpretation.

Let's make sure that what happened to Edith Isabel Rodriguez doesn't happen in Oklahoma and actually improves what we can do for patients in desperate need.

1. Have any of you heard about Team STEPPS or know someone using it?
2. Do you think a lack of cultural competency on the healthcare organization's part influenced the care they provided (or, actually, didn't provide)?

Welcome to the SNERC blog

Welcome to SNERC--a group formed this year in Oklahoma with over 200 nurse clinicians and educators. We're excited about the potential that forming this group has for the future knowledge base of nurses within our state as well as the potential to improve outcomes for the patients that we see day-to-day.

Never doubt that a small group of thoughtful, committed
citizens can change the world;
indeed, it's the only thing that ever has.

Margaret Mead

I truly believe that and hope you do as well. Now, why don't you make suggestions for topics related to EBP and Research that you'd like to see on this blog?