LAS VEGAS – Nurse practitioners should take ownership and accountability for driving quality improvements and provide transformational leadership to encourage evidence-based practice changes, according to two speakers at the National Association for Pediatric Nurse Practitioners 2015 meeting.

“In today’s busy healthcare climate, clinicians are facing growing demands to meet quality of care metrics and financial quotas from management who are not healthcare trained,” Jennifer Disabato, DNP, CPNP-PC, AC, of the University of Colorado College of Nursing in Aurora, told The Clinical Advisor. “Nurse practitioners [NPs] can become leaders within their teams to identify problem areas and assemble small workgroups to determine potential solutions.”

In 2001, the Institute of Medicine (IOM) outlined six goals for changing the healthcare environment in its “Crossing the Quality Chasm” report: ensuring that healthcare is safe, effective, patient-centered, timely, efficient and equitable.

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In a second publication, the “Report on the Future of Nursing,” the organization also supported expanding opportunities for nurses to lead collaborative improvement efforts within healthcare teams and to enable nurses to lead changes that advance healthcare.

“We’re hoping to help NPs not only get a better understanding of how to use evidence to guide practice but also how NPs can lead that change and measure those outcomes,” said Bonnie Gance-Cleveland, PhD, RNC, PNP-BC, also of the University of Colorado. “We want to focus on prevention and behavior change. Let’s eat healthier. Let’s be more active. Let’s decrease risky behaviors and take the focus away from simply writing a prescription.”

Considering practice resources, patient preferences

Creating an evidence-based practice moves beyond simply using results of a research study in an aspect of your nursing practice. It involves integrating the best available research evidence with the clinical expertise within your practice and also patient and family values to drive better clinical decision making.

“If you have a patient come into your clinic and it’s very clear that they don’t agree with something and they don’t want a specific treatment, it doesn’t matter if the latest study showed it was better than another treatment,” Disabato emphasized.

The first step is to ask whether evidence supports your current practice, according to Disabato and Gance-Cleveland. If the answer is no, this is an opportunity to start a performance improvement project. To evaluate the quality of currently available evidence, clinicians should ask five questions:

  1. Was the study randomized?
  2. Was the control group appropriate?
  3. Was follow-up long enough follow up to determine effects of an itnervention?
  4. Were all subjects were accounted for at the end of the study?
  5. Were the instruments used to measure outcomes valid and reliable?