Evidence Based Poster
Instructions for Evidence Based Poster
1-2 slide PowerPoint with the following components:
· Significance of identified problem and brief background information in this case frequent readmission to detox center. Patient with substance abuse issues and frequent readmissions.
· PICO Question ( SEE ATTACHED PICO QUESTION)
· Recommendations from evidence based on the literature reviewed- must give recommendation summarized from minimum of 10 articles, why it is relevant in practice, and one example of how it can be used in clinical practice.
· Completed
Appendix G with reference page
(which I have and is attached for you to use).
EvidenceBased Practice Poster
Presenter: ______________________ Date: ___________
PICO Question: _________________________ Total Points: ___
Category 4 3 2 1
Significance/Backgrou
nd to the Problem
PICO Question
Identification
In-depth
coverage of
topic, topic is
relevant to
nursing practice
research-
based
information,
outstanding
clarity,
PICO
question
complete
Good coverage
of topic, topic is
appropriate to
nursing practice
basis in sound,
research-based
information,
PICO question
complete
Minimal
coverage of
topic, topic is
appropriate to
nursing practice,
PICO question
complete
Minimal to no
coverage of
topic, topic is
not relevant to
nursing practice,
not based on
research-based
information,
PICO
incomplete/ or
not included
Literature Appraisal
(
Appendix G)
Minimum of 10
peer-reviewed
full text articles
written in last 5
years or less. All
articles are
relevant to EBP
problem and
provides clear
evidenced based
recommendation
s.
Minimum of 10
peer-reviewed
full texted
articles written
in 5 years or
less. 8-9 articles
relevant to EBP
problem and
provides clear
evidenced based
recommendation
s.
Minimum of 10
peer-reviewed
articles, full
texted articles,
articles written
in more than 5
years. 7-8
articles relevant
to EBP problem
and provides
clear evidenced
based
recommendation
s.
Less than 10
peer reviewed
full texted
articles written
in 5 years or
less. Less than 7
articles relevant
to EBP problem
and provides
clear evidenced
based
recommendation
s.
Project
Recommendations
Clear and
concise
summary of
evidenced based
recommendation
from appraisal
of articles. Two
recommendation
s to answer
PICO
question.
Clear and
concise
summary of
evidenced based
recommendation
from appraisal of
articles.
One
recommendation
to answer PICO
question.
Recommendatio
ns lacks
concision or may
be irrelevant to
PICO question.
One
recommendation
to answer PICO
question.
Recommendatio
n lacks
relevance to
PICO question,
or none given.
References
(Submitted with
Appendix G)
Reference page
in Word
document typed
in 12 font, APA
format for each
article.
Reference page
in Word
document typed
in 12 font, APA
format for each
article.
Missing
references.
Reference page
in Word
document, typed
in 12 font, APA
format incorrect.
Missing
references.
Reference page
not included.
Slide (Poster)
Appearance
Attractive, easy
to
interpret,
pleasing colors
with high
contrast,
slide
presentation
well-organized,
excellent use of
bullets, and
graphics which
enhance the
presentation of
the content
Attractive, easy
to interpret,
pleasing colors
with good
contrast, slide
presentation
organized, good
use of bullets,
and graphics
which enhance
the presentation
of the content
Attractive,
difficult to
interpret,
pleasing colors
with high
contrast, slide
presentation
disorganized,
bullets, and
graphics detract
from the content
Unattractive,
difficult to
interpret, poor
color choice and
slide contrast,
slide
presentation
unorganized,
bullets, and
graphics detract
from the content
Grading Scale:
20 points = 100%
19 points = 98%
18 points = 96%
17 points = 93%
16 points= 90%
15 points = 87%
14 points = 84%
13 points = 81%
12 points = 79%
11 points = 77%
10 points = 75%
09 points = 73%
08 points = 70%
07 points = 68%
06 points = 66%
05 points = 64%
1. What is the problem?
The revolving readmission of patient of patient on detox treatment in the hospital are on the rise. This worksheet is meant to identify problems that lead to continuous readmission of those patient with substance abuse undergoing detox treatment.
Revolving around the hospital doors for readmissions means treatment goals are not reached. If left untreated, patients flood the hospitals depleting resources. This also will increase the cost of treatment that may not be possible for the relatives to pay.
3.
What is the current practice?
Current practice entails encouraging patients to gradually stop substance abuse with medical help in case of withdrawal symptoms, after which patients are discharged and educated on substance abuse and further detox treatment prescribed for them.
4.
How was the problem identified?
(Check all that apply)
(X)Safety and risk-management concerns
(X)Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness)
(X)Unsatisfactory patient, staff, or organizational outcomes
(X)Variations in practice within the setting
· Variations in practice compared to community standard
· Current practice that has not been validated
(X)Financial concerns
5. What are the PICO components?
P – (Patient, population, or problem)- increase readmission in detox treatment for substance abuse.
I – (Intervention)- proper education of patients in detox for substance abuse and ensuring that they are not able to re access the substance of abuse
C – (Comparison with other interventions, if foreground question)- compare outcomes of patients who have been properly educated and taken through the gradual process of detox treatment to before when there was no precise patient education or when patient were made to abruptly stop substance abuse.
O – (Outcomes are qualitative or quantitative measures to determine the success of change)- because now the patient is well educated, we expect the number of readmissions of patient on detox for substance abuse to reduce by thirty days.
6.
Initial EBP question
❑ Background ❑ Foreground
What are the possible reasons for the revolving readmissions of patients on detox for substance abuse to the hospital? How can the readmissions of those patients be minimized?.
Johns Hopkins Nursing Evidence-Based Practice
Appendix B: Question Development Tool
Johns Hopkins Nursing Evidence-Based Practice
Appendix B
Question Development Tool
© 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
7.
List possible search terms, databases to search, and search strategies.
Detox treatment
Reasons for readmissions for patients on detox
Substance abuse
8.
What evidence must be gathered?
(Check all that apply)
(X)Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase)
(X)Standards (regulatory, professional, community)
· Guidelines
(X)Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences)
· Position statements
9.
Revised EBP question
(Revisions in the EBP question may not be evident until after the initial evidence review; the revision can be in the background question or a change from the background to a foreground question)
Does proper education of patients and gradual rehabilitation and detox treatment have impact on readmission of patients on detox for4 substance abuse.
What will we measure?
(structure, process, outcome measure)
How will we measure it?
(metrics are expressed as rate or percent)
How often will we measure it?
(frequency)
Where will we obtain the data?
Who will collect the data?
To whom will we report the data?
Number of patient on detox readmitted after proper education and gradual rehabilitation regime has been completed.
The number should be lower than the previous cases.
Total number of readmissions of patient who have received proper education and process of rehabilitation for substance abuse, divided by total number of readmission for patients on detox for substance abuse multiplied by hundred.
After every thirty days
From hospital data base, with permission to access the information
Researchers selected for data collection
Research coordinator
References
Reducing readmissions to detoxification: An Interorganizational network perspective. (1, April). PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029096/
Directions for Use of the Question Development Tool
Purpose
This form is used to develop an answerable EBP question and to guide the team in the evidence search process. The question, search terms, search strategy, and sources of evidence can be revised as the EBP team refines the EBP question.
What is the problem, and why is it important?
Indicate why the project was undertaken. What led the team to seek evidence? Ensure that the problem statement defines the actual problem and does not include a solution. Whenever possible, quantify the extent of the problem. Validate the final problem description with practicing staff. It is important for the inter-professional team to take the time together to reflect, gather information, observe current practice, listen to clinicians, visualize how the process can be different or improved, and probe the problem description in order to develop a shared understanding of the problem.
What is the current practice?
Define the current practice as it relates to the problem. Think about current policies and procedures. Observe practices. What do you see?
How was the problem identified?
Check all the statements that apply.
What are the PICO components?
P (patient, population, problem) e.g., age, sex, setting, ethnicity, condition, disease,
type of patient, or population
I (intervention) e.g., treatment, medication, education, diagnostic test, or best practice(s)
C (comparison with other interventions or current practice for foreground questions; is not applicable for background questions, which identify best practice)
O (outcomes) stated in measurable terms; may be a structure, a process, or an outcome measure based on the desired change (e.g., decrease in falls, decrease in length of stay, increase in patient satisfaction)
Initial EBP question
A starting question (usually a background question) that is often refined and adjusted as the team searches through the literature:
· Background questions are broad and are used when the team has little knowledge, experience, or expertise in the area of interest. Background questions are often used to identify best practices.
· Foreground questions are focused, with specific comparisons of two or more ideas or interventions. Foreground questions provide specific bodies of evidence related to the EBP question. Foreground questions often flow from an initial background question and literature review.
List possible search terms, databases to search, and search strategies.
Using PICO components and the initial EBP question, list search terms. Terms can be added or adjusted throughout the evidence search. Document the search terms, search strategy, and databases queried in sufficient detail for replication.
What evidence must be gathered?
Check the types of evidence the team will gather based on the PICO and initial EBP question.
Revised EBP question
Often, the question that you start with may not be the final EBP question. Back- ground questions can be refined or changed to a foreground question based on the evidence review. Foreground questions are focused questions that include specific comparisons and produce a narrower range of evidence.
Measurement plan
Measures can be added or changed as the review of the literature is completed and the translation planning begins:
· A measure is an amount or a degree of something, such as number of falls with injury. Each measure must be converted to a metric, which is calculated before and after implementing the change.
· Metrics let you know whether the change was successful. They have a numerator and a denominator and are typically expressed as rates or percent. For example, a metric for the measure falls-with-injury would be the number of falls with injury (numerator) divided by 1,000 patient days (denominator). Other examples of metrics include the number of direct care RNs (numerator) on a unit divided by the total number of direct care staff (denominator); the number of medication errors divided by 1,000 orders.
Running Head: STRATEGIES TO REDUCE READMISSION TO DRUG DETOXIFICATION
1
STRATEGIES TO REDUCE READMISSION TO DRUG DETOXIFICATION
3
|
Strategies to reduce readmission to drug detoxification Student’s name Institutional affiliation |
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|
Date: 2 3/01/2021 |
EBP Question: What are strategies to reducing frequent readmission to drug detoxification? |
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|
Article Number |
Author and Date |
Evidence Type |
Sample, Sample Size, Setting |
Findings That Help Answer the EBP Question |
Observable Measures |
Limitations |
Evidence Level, Quality |
||||||
| 1 |
Childress, Hole, Ehrman, Robbins, McLellan, & O’Brien. 1 9 93 |
Mixed method study |
· N/A |
Based on this study, healthcare sectors are responsible for establishing programs that reduce patients’ readmission beyond demographics and effort documentation. Nurses are supposed to replicate the initial treatment method through NIDA programs. |
Nurses should ensure the comprehensive growth of drug testing. |
Lack variety of recommendations that is applicable across the globe. |
Level 5 Quality B |
||||||
| 2 |
Bear, Anderson, Manson, Shore, Prochazka, & Novins. 201 4 |
Single research study. |
The study took place in Alaska Native for readmission of patients affected by alcoholism. The sample involved 3 8 3 adults in Alaska. |
Within a year, Forty-two percent of 383 patients were readmitted to the hospital. The challenges of finance and family instabilities also contributed to patients’ readmission. |
Nurses should be an integral part of the assessment of standard behavior health. The rate of readmission to people can be also be reduced by developing clinical protocols that facilitate detoxification aftercare and treatment and adaptive functioning. |
The mostly involves reliability depending on the researchers’ interpretation and not mostly from the research method. |
Level 5 Quality A |
||||||
| 3 |
Rachlis, Kerr, Montane & Wood. 2009 |
N/A |
The study was based on individuals who inject drugs (IDU) and fail to adhere to medical advice (AMA). There is active drug use in hospitals that leads to a high rate of ignoring AMA. The research shows that people who inject drugs are additive and need to provide education programs on adhering to medical treatments. |
Individuals unable to abstain should not be reprimanded but rather supported through education programs. |
Small size sample |
Level 3 Quality B |
|||||||
| 4 |
Peterson, Liu, Xu, Nataraj, Zhang & Mikosz. 2019 |
Systematic Literature review. |
A sample size of 1, 6 58 affected by opioid overdose |
The study focused on readmission of patients affected by opioid overdose with ninety days. More than a quarter of patients diagnosed with a high overdose on opioids are readmitted with the first ninety days of their first treatment. |
To emphasize strategies to address mental health conditions and comorbid physical. |
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| 5 |
Reif, Acevedo, Garnick, & Fullerton. 201 7 |
Single research method. |
A sample of 30,439 was used between eighteen and sixty-four years. |
More than sixty-seven percent of substance use disorder patients lack medication-assisted treatment (MAT) follows up after fourteen days of treatment. Additionally, thirty-nine percent of patients are readmitted for primary negative health conditions after ninety days of receiving medications. |
Healthcare facilities should ensure provision for Medication-assisted treatment (MAT). The study indicates that the Medicaid program should be restructured to reduce barriers to MAT and prevent patients’ readmission due to health admissions. |
Level 3 Quality A |
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| 6 |
Spear 2014 |
Mixed method study |
A sample size of 18,278 among thirty-two counties in California. |
The study’s finding is that efficient networks between the healthcare facility and the patient lead to a low readmission rate. Additionally, detox’s continuity of care services also leads to a low readmission rate. High costs associated with continuous and constant care treatment prevented most patients from seeking medication. A person’s health continues to worsen until visiting a health facility is not an option. |
Establish an affordable healthcare insurance policy to ensure each individual can afford care services. |
The study at the end invites other researchers to come up with more findings for patients’ readmission. The process means the researchers in this study might bias the population in the size sample used. |
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| 7 |
Regenstein & Andres. 2014 |
Systematic literature review |
Study on the effects of Medicare on readmission. No sample size |
Many proliferation measures have been put in place to reduce readmission of patients in the United Stated through Medicare. Although patients covered under Medicare also experience hospital readmission due to social several social-economic statuses. The study indicates that substance abuse comorbidities, postdischarge care environments, and medical non-compliance is the main reason for readmission of patients. |
More measures with the Medicare program should be included, such as funding for follow up measures o patients addicted to drugs use. |
The study’s main limitation only focused on patients prone to hospital readmission and covered by Medicare in the United States. |
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| 8 |
Marks, L. R., Munigala, Warren, Liss, Liang Schwarz & Durkin. 2020 |
220 admission of individuals with opioid use disorder (OUD) and analysis of Medication for opioid use disorder (MOUD) |
Sixty-four percent of the MOUDs were involved with a high parenteral antimicrobial therapy rate. The involvement of treatment without medication continuation on discharge does not reduce readmission among OUD patients. Additionally, methadone for detoxification also does not eradicate readmission of patients. |
Care treatments among OUD patients should continue after and before discharge. |
Small sample size |
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| 9 |
Van den Berg, Van den Brink, Kist, Hermes & Kok. 2015 |
Single method research |
132 elders who are alcohol-dependent |
Sixty-seven of the sample size was readmitted within the first year of receiving treatment. Lectures and education programs predicted a low rate of readmission. The study shows that alcohol-addicted patients among the older population are highly prone to readmission. |
More education and lectures addressing the effects of alcoholism should establish and embrace in any society across the globe. |
Small sample size. |
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|
10 |
Sufrin, Sutherland, Beal, Terplan, Latkin & Clarke. 2020 |
The setting is in the United States. 22 prisoners in six county jails. |
Twenty-six percent of women all the women jailed in the United States, according to the study, inject drugs OUD. Abuse of drugs in jails in the United States is controlled through withdrawal. Individuals, particularly the pregnant, are discontinued from receiving treatments at postpartum. Additionally, withdrawal to control patients with an opioid is against the medical guidelines. |
People jailed in the United States receive essentially denied access to medication or receive less quality care, leading to a high readmission rate. United States government should establish hospitals in jails to enhance prisoners’ care delivery. |
Small sample size and lack of recommendation. |
Attach a reference list with full citations of articles reviewed for this EBP question
Bear, U. R., Anderson, H., Manson, S. M., Shore, J. H., Prochazka, A. V., & Novins, D. K. (2014). Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People. Drug and alcohol dependence, 140, 168-174.
Childress, A. R., Hole, A. V., Ehrman, R. N., Robbins, S. J., McLellan, A. T., & O’Brien, C. P. (1993). Cue reactivity and cue reactivity interventions in drug dependence. NIDA research monograph, 137, 73-73.
Marks, L. R., Munigala, S., Warren, D. K., Liss, D. B., Liang, S. Y., Schwarz, E. S., & Durkin, M. J. (2020). A comparison of medication for opioid use disorder treatment strategies for persons who inject drugs with invasive bacterial and fungal infections—the Journal of infectious diseases, 222(Supplement_5), S513-S520.
Peterson, C., Liu, Y., Xu, L., Nataraj, N., Zhang, K., & Mikosz, C. A. (2019). US national 90-day readmissions after opioid overdose discharge. American journal of preventive medicine, 56(6), 875-881.
Rachlis, B. S., Kerr, T., Montaner, J. S., & Wood, E. (2009). Harm reduction in hospitals: is it time?. Harm Reduction Journal, 6(1), 19.
Regenstein, M., & Andres, E. (2014). Reducing hospital readmissions among Medicaid patients: a review of the literature. Quality Management in Healthcare, 23(4), 203-225.
Reif, S., Acevedo, A., Garnick, D. W., & Fullerton, C. A. (2017). Reducing behavioral health inpatient readmissions for people with substance use disorders: do follow-up services matter?. Psychiatric Services, 68(8), 810-818.
Spear, S. E. (2014). Reducing readmissions to detoxification: an inter-organizational network perspective. Drug and alcohol dependence, 137, 76-82.
Sufrin, C., Sutherland, L., Beal, L., Terplan, M., Latkin, C., & Clarke, J. G. (2020). Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: results from a national surveillance study. Addiction, 115(11), 2057-2065.
Van den Berg, J. F., Van den Brink, W., Kist, N., Hermes, J. S., & Kok, R. M. (2015). Social factors and readmission after inpatient detoxification in older alcohol‐dependent patients. The American journal on addictions, 24(7), 661-666.
The Use Of Epidural Injection For
Back Pain In The Elderly
Background
Information
• 30% of patients in the United
States with back pain are over
age 65.
• Epidural steroid injections are
usually administered to the
elderly patients.
• Epidural steroid injections ease
pain temporarily by decreasing
the size of stressed nerve
roots.
Problem Area
• Concerns in the use of
epidural steroid injection
because of the side-effects.
• Complications may include
immobility, leg swelling, and
adrenal necrosis of the hip.
• Complications like immobility
end up causing loss of muscle
strength and bone weakening.
Recommendations
• Using alternative pain
medication therapies such as
NSAIDS.
• Using exercise and physical
therapy as alternative means.
• Using psychological
techniques like Cognitive
Behavioral Therapy as
alternative means.
Why The
Recommendations
Are Relevant
• The recommendations are
effective in treatment of the
pain.
• They are less harmful since
they have less-serious side-
effects.
Example In
Clinical Practice
• Prescribing NSAIDs to reduce
the back pain in the elderly.
• Use of physical activity to
boost strength and avoid
recurrence of back pain.
• Talking to the patient to
identify negative and
unhealthy behaviors and
replace them with healthy
ones.
Measurement
Outcome
• Comparing the complications
in the number of patients who
received epidural injections
and those who received
conventional treatment like
NSAIDs.