The National Guidelines Clearinghouse and several databases including Cochrane Reviews, EBSCO and OVID, are available to help clinicians assess the evidence. In addition to these resources, several organizations, such as the Agency for Health Care Research and Quality, the CDC, the Institute for Healthcare Improvement, the Joanna Briggs Institute, and the Nursing Society’s Worldviews on Evidence-Based Nursing are other helpful sources.

If you find that no evidence is available to guide decision making around a specific clinical issue, then consider conducting research that measures clinically applicable outcomes, Gance-Cleveland suggested.

An improvement-science model to help clinicians determine what changes to make and test intended outcomes is the Plan-Do-Study-Act (PDSA) cycle state.

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Making SMART objectives & establishing practice teams

When clinicians iterate through the PDSA cycle to create a quality improvement project, the SMART acronym is useful for determining specific goals and target outcomes of the practice changes. Goals should be specific, measurable, attainable, and realistic with a set timeframe (SMART).

“Implement changes into your practice based on your resources and families’ resources and preferences, but also make sure you are evaluating the outcomes of those changes on your practice,” Gance-Cleveland said. “If it’s not measurable, then we’re not getting anywhere.”

“Following quality indicators over time takes the focus away from assigning individual blame and places accountability on the system,” Disabato added.

Tracking outcomes enables clinicians to use the data generated to support requests for additional resources and financial support from their organization. An added benefit is that this data can also be used to improve awareness among clinicians and practice staff about existing discrepancies in care and which areas have room for improvement.

Be sure to form practice teams that involve more than just the advanced practice NPs, Gance-Cleveland urged. “Including the support staff makes them more energetic about their job. They report more satisfaction when they feel like they’re doing a better job and being asked to participate,” Gance-Cleveland said.

“We encourage health systems and organizations to take practice-improvement projects as an opportunity to get advance practice nurses involved, because it will increase job satisfaction and employee retainment,” Gance-Cleveland said.


  1. Disabato J, Gance-Cleveland B. #115. “Improving patient outcomes in pediatric primary and acute care.” Presented at: NAPNAP 2015. March 11-14, 2015; Las Vegas.

Disclosures: Bonnie Gance-Cleveland received grant support from the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services, but does not necessarily represent the official views of AHRQ. Jennifer Disabato has no disclosures.