Informatics

application in
evidence-based
nursing practice
Cabanela De villa
Caoctoy Dela Cruz
Comboy
Introduction
• Evidence-based practice is
a method that was
established out of an
intention to promote the
standard and minimize the
cost of healthcare delivery. 
 Application

• Due to continuously • Integrating technology to • The adoption and implementation

changing technological knowledge could aid in the approaches of recording in the
breakthroughs, informatics is early prediction and electronic health record will be
becoming more prevalent in prevention of potential augmented by standardizing nursing
our field. complications. language.
 Overview of Evidence-Based Practice

Evidence-based practice (EBP) was

introduced in the 1970s by Dr. Archie
Cochrane.
 Overview of Evidence-Based Practice

EBP is based on the premise that health professionals should not base practice on
tradition and belief but on information grounded in research.

EBP is not synonymous with research.

-Research focuses on discovery.

- EBP focuses on application.
 Six steps of EBP

Search for the best evidence

Integrate evidence with
Cultivate a spirit of inquiry clinical expertise and
client/family preferences

Ask clinical questions Critically appraise evidence

Implement, evaluate outcomes

of intervention
 Identifying a clinical

EBP involves: 01 Problem

Searching the literature and

02 critically evaluating research

evidence

Determining appropriate
03 interventions

EBP Integrates research, theory and

practice
 Evidence- Based
Practice
• EBP is "the conscientious, explicit, and judicious use of
theory-derived, research-based information in making
decisions about care delivery in consideration of individual
needs and preferences"
• Key concepts of EBP
- Best evidence
- Expertise
- Patient values
• Careful review of research findings according to
guidelines.
• De-emphasizes ritual, isolated, and unsystematic clinical
experiences, options, and tradition as basis for practice
 Question
Which of the following is NOT
considered to be a key

concept of EBP?

A. Best evidence

B. Patient values

C. Provider expertise

D. Traditional practices
 D. Traditional
Answer: practices

Rationale: EBP de-emphasizes ritual, unsupported practices, and tradition and

focuses on research- supported interventions that considers patients' desires and
needs and provider expertise
 Evidence-Based
Nursing
• Some sources for EBP information/guidelines

- Cochrane Collaboration/Cochrane Database of Systematic Reviews,

network that helps health care providers make informed decisions
about health care

• Agency for Healthcare Research and Quality (AHRQ)-maintains

database of evidence-based clinical practice guidelines
 Evidence-Based Nursing
Evidence-Based Nursing-(cont.)
- Too much focus on EBP could result in "cookbook care" and loss of
"art" of nursing.
- Lessening of attention to holistic care.
- Health care reimbursement might drift exclusively to interventions
substantiated by "evidence."
- Not all health care practices can or should be
based on science (What about "care"?).
• Consensus agreement that EBP in nursing should consider all types
of evidence (not just RCTs), as well as clinical experience, patient
experiences and desires, and relevant local organizational influences
 Practice-Based
Our Center
Evidence
• PBE is a relatively new concept in nursing and health care.

• Based on the observation that many interventions have limited formal

research support.

• PBE recognizes the importance of the environment in determining

practice recommendations.

• Premise of PBE is that large data bases should be reviewed or "mined"

to gather data on quality and effectiveness.
 OurConclusion
Center

Nursing informatics is a field that is

rapidly expanding.
COMPUTER GENERATED
NURSING CARE PLAN
Gretchen Marie Caoctoy
BS Nursing 1
 Computer Generated Nursing Care Plan

◦ Is a product of Nursing Informatics systems capable of

comparing actual assessment finding of a patient entered
to the system versus a preset database/programs that has
built in care plans.
Advantages of Computer Generated
Nursing Care Plan
◦ Can import certain patient data (i.e. recoded vital signs) as part of nursing assessment from
other areas of the system
◦ Uniformity of nursing diagnoses throughout a healthcare facility
◦ Provides a ready selection of nursing interventions based on diagnoses
◦ Accessibility of the NCP for evaluation.
◦ Time Saver
◦ Space Saver
Disadvantages of Computer Generated
Nursing Care Plan
◦ Nursing Diagnoses may be limited to the current database version of a specific EHR system
◦ May be difficult for less tech savvy nurses
◦ Computerized NCPs are only as good as the actual patient assessment of the nurse utilizing
the system.
◦ Risk of total data loss if system crashes.
EHRs with Computer Generated NCPs
◦ Cerner – hospital management system
◦ Pointclickcare – specializes in elderly care facilities
◦ AllScripts – hospital management system
◦ eClincalWorks – hospital management system
◦ MediTech – hospital management system
◦ *Indra – available in PH
NCM 110 Comboy, Cshayne
R.

Critical
Pathways
Nursing Informatics
 Definition

Critical Pathway
aka. integrated pathway, multidisciplinary pathway, care pathway, managed care plans, clinical
pathway

is multidisciplinary plans of best clinical practice for

specified groups of patients with a particular diagnosis that
aid the co- ordination and delivery of high quality care.
1
To improve the patient care

2
To maximize the efficient use of
resources Purpose of
3
Critical
Pathway
To help identify and clarify the
clinical processes

4
To support clinical effectiveness ,
clinical audit and risk management
 Goals of Critical Pathways

One Two

Eliminate prolonged lengths of Reduce mistakes, duplication of

stay arising from effort and omission
inefficiencies, allowing better
use of resources
 Goals of Critical Pathways

Three Four

Improve the quality of work Improve communication with

for service providers patients as to their expected
course of treatment
 Goals of Critical Pathways

Five Six

Identify problems at the Facilitate quality

earliest opportunity and correct management and an
these promptly outcomes focus
 Four Components

Categories of care or
Timeline activities and their
interventions

Intermediate and
Variance record
long-term outcome
criteria
 Educate and obtain support from
physicians and nurse, and
Guideline for establish a multidisciplinary team.

development and
implementation
Identify potential obstacles to
implementation.
 Use Quality improvement methods
and tools
Guideline for
development and
implementation
Determine staff interest and
select Clinical Pathways to
develop.
 Collect Clinical Pathway data and
medical record reviews of practice
Guideline for patterns.

development and
implementation
Conduct literature review of clinical
practice guidelines
 Develop variance analysis system
and monitor the compliance with
Guideline for documentation on Clinical

development and Pathways.

implementation
Use a pilot Clinical Pathway for 3
to 6 months; revise as needed.
 Benefits of Critical Pathways

Help reduce Help improve

Provide explicit Optimize the
variations in clinical outcomes;
and well-defined management of
patient care Help improve and
standards for resources
(by promoting even reduce patient
care
standardization) documentation
 Benefits of Critical Pathways

Help empower Help improve Expected to help

Provide a
patients; Help communications reduce risk;
baseline for
manage clinical between different Expected to help
future
risk care sectors reduce costs
initiatives
 Potential Problems or barriers

Don't respond well Suit standard

May appear
Risk to unexpected conditions better
to discourage
increasing changes in a than unusual or
personalized
litigation patient's condition unpredictable
care
ones
 Potential Problems or barriers

Require commitment Need to ensure

from staff and variance and
Problems of May take time to
establishment of an outcomes are
introduction of be accepted in the
adequate properly recorded,
organizational
new technology workplace
audited and acted
structure upon.
 Thank You
For Listening
Clinical
Practice
Guidelines
DE VILLA, YISHAY P.
Clinical Practice Guidelines

Statements that include recommendations

intended to optimize patient care that are
informed by systematic review of evidence
and an assessment of the benefits and
harms of alternative care options.
- Institute of Medicine (2011)
Why do we need
guidelines?
Why do we need CPGs?

There are a lot growing evidence of unexplained and inappropriate

variations in clinical practice.
Concern that further limitations in resources will affect the
delivery of high quality health care.
Clinicians have difficulty assimilating evolving scientific evidence
into practice.
Aims to facilitate more consistent, effective and efficient practice
and improve health outcomes for patients.
CPGs Building block, (IOM, 2011)

Patient care
recommendations
backed up by
graded evidence

Considerations of
Updated as new
patient
evidence
preferences and
becomes
important
available
subgroups.

Developed by a Transparent
Systematic
multidisciplinary process that
review of the
group of experts minimizes bias
available
and pertinent and conflicts of
evidences
stakeholders interest
Who needs guidelines?

Doctors
Nurses
Decision makers
Patients
Public
Process for Clinical Guideline content
development

Initiate
Create a draft CPG
Form draft to final CPG
Dissemination and implementation
Maintenance
Guideline Adaptation

Systematic approach to the endorsement

and/or modification of a guideline(s)
produced in one cultural and organizational
setting for application in a different context.
Adaptation may be used as an alternative to
de novo guideline development, e.g., for
customizing an existing guideline to suit the
local context.
Guideline Adaptation
The ADAPTE Collaboration

Is an international collaboration of CPG

researchers, developers, and
implementers.
Their main aim is to develop and validate
a genetic adaptation process that will
foster valid and high-quality adapted
guidelines as well as the user’s sense of
ownership of the adapted guideline.
Adaptation Phase

There are 3 main ADAPTE steps :

Step 1
Search and selection of source CPGs Health questions
(PIPOH)

Step 2
Agree II Instrument

Step 3
External Review
(Departmental Consensus)
CPG Scope: PIPOH Model

Patient
Intervention
Professionals
Outcomes
Health care settings
Evidence Pyramid
Assessing the quality of any CPG

AGREE II Instrument
A generic tool designed
primarily to help guideline
developers and users assess the
methodological quality of
guidelines.
23 key items in 6 domains
2 global rating items
Assessing the quality of any CPG

AGREE II Domains
1. Scope and purpose
2. Stakeholder Involvement
3. Rigour of Development
4. Clarity and presentation
5. Applicability
6. Editorial independence
Assessing the quality of any CPG

Finalization Phase
External review – target audience of the guideline
Once the panel has decided on the adaptation of
their guideline, the next step is to send the
adapted guideline to those who will be affected by
its uptake (i.e., the users, including any
practitioners who would use the guideline in
practice or any patient affected by the guideline).
Hospital official CPGs:

2 separate Documents
1. Clinician’s version
- Accessible from ALL points-of-care for the hospital
staff
- Details of evidence-based recommendations for
management (with only references to the other
document)
Hospital official CPGs:

2. Methodologist’s Version
- Accessible from libraries of e.g, Department of
Medicine, CPG Committee, QMD Authorship group,…etc.
(Reference for replication & Documentation)

- Detailed descriptions of the CPG Adaptation process

with ALL relevant data.
Dissemination and
Implementation
Dissemination of CPGs:

Full CPG Documents published on websites – Integrated into

HCO’s Health information system (HIS) & Electronic Medical
Records (EMRs)
Implementation Tools
o Quick Reference Guide
o Clinical Algorithms
o Clinical Pathways
o Patient Information
o Gantt chart for dissemination & implementation
o Audit and Research Rs.
Implementing Guidelines

If CPG’s are to have a positive impact on patient care

outcomes, they must be implemented and incorporated
into everyday clinical practice.
The Identification of any barriers to implementation, and
strategies for overcoming them, will form an essential
part of discussions at CPGs Subcommittee/Adaptation
group meetings.
E-JOURNALS
in
NURSING
WHAT IS AN E-JOURNAL AND ITS 59

PURPOSE IN NURSING?
• E-journal, also know as, Electronic Journals
• It is a type of journal that can be accessed using any
electronic devices such as tablets, computers, phones, and so
on.
• The purpose of e-journal in nursing is it makes all the data
and documents much more easier and accessible
everywhere.
ADVANTAGES OF E-JOURNALS IN 60

NURSING
• It makes it easy for the nurses to quickly write and
document stuff.
• And also with the use of electronic devices, it’ll be much
more easier to do some research.
DISADVANTAGES OF E-JOURNALS 61

IN NURSING
• Since it uses technology, not everyone can adapt to this
method quickly. There are some people who’s struggles to
understand the use of these devices.