Recommending an Evidence-Based Practice Change

The collection of evidence is an activity that occurs with an endgame in mind. For example, law enforcement professionals collect evidence to support a decision to charge those accused of criminal activity. Similarly, evidence-based healthcare practitioners collect evidence to support decisions in pursuit of specific healthcare outcomes.

identify an issue or opportunity for change within your healthcare organization and propose an idea for a change in practice supported by an EBP approach.

Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)

Part 4: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:

Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.

Full Answer Section

           
    • Challenges: Can be siloed between departments (e.g., inpatient vs. outpatient), high staff workload, and a tendency to prioritize acute care needs over long-term preventative measures due to resource constraints. Decision-making can be hierarchical.
  • Readiness for Change:
    • Moderate-High Readiness: Leadership supports EBP initiatives, and staff are generally receptive to evidence-based interventions that clearly demonstrate patient benefit and ease workflow.
    • Barriers: Time constraints for training, resistance to changes in established routines, and potential skepticism if solutions aren't perceived as practical or sustainable. We need to demonstrate a clear return on investment (ROI) in terms of patient outcomes and potentially cost savings.
[Image: A modern hospital exterior or an abstract image representing teamwork in healthcare.]
Slide 3: The Problem: Poor Medication Adherence in Heart Failure Current Problem/Opportunity for Change:
  • Issue: Suboptimal medication adherence among heart failure (HF) patients post-discharge, leading to preventable readmissions and poorer quality of life.
  • Circumstances:
    • HF is a leading cause of readmissions, often within 30 days.
    • Complex medication regimens (polypharmacy) are common for HF, making adherence challenging.
    • Patients often feel overwhelmed by discharge instructions, lack understanding of their medications' purpose, or face barriers (cost, side effects, cognitive decline).
    • Current discharge education is often rushed, inconsistent, and not tailored to individual learning styles.
  • Scope: Affects a significant proportion of our HF patient population, contributing to high readmission rates, increased healthcare costs, and diminished patient outcomes.
    • MHS Data (hypothetical): Our 30-day HF readmission rate is 22%, higher than the national benchmark of 18%.
  • Stakeholders Involved: Patients and families, inpatient nurses, pharmacists, physicians (hospitalists, cardiologists, primary care), discharge planners, social workers, insurance payers, and hospital administration.
  • Risks of Change Implementation (General): Staff resistance, increased workload perceived by staff, inadequate training, poor patient uptake, lack of sustained leadership support, and failure to demonstrate measurable improvement.
[Image: A complex web or puzzle, symbolizing the complexity of medication management, or a graph showing rising readmission rates.]
Slide 4: Proposed EBP Change: Enhanced Post-Discharge Medication Education & Follow-Up Evidence-Based Idea for Change:
  • Proposal: Implement a standardized, multi-modal Enhanced Post-Discharge Medication Education and Follow-Up Program for all heart failure patients.
  • Core Components (informed by appraised literature):
    1. "Teach-Back" Method for Medication Education: Nurses deliver discharge medication instructions using the teach-back method to confirm patient/caregiver understanding.
    2. Visual Aids/Simplified Schedules: Provide personalized, simplified medication schedules with pictures, dosage, and purpose in the patient's preferred language.
    3. Pharmacist Consultation (Inpatient): Mandate a dedicated inpatient pharmacist consultation for all HF patients prior to discharge to review medications and address concerns.
    4. Early Post-Discharge Nurse Phone Calls: A registered nurse (preferably a dedicated transition nurse or APN in primary care) will conduct a follow-up phone call within 48-72 hours of discharge to assess medication adherence, address questions, and reinforce education.
  • EBP Approach: This proposal is grounded in a synthesis of evidence from multiple systematic reviews and randomized controlled trials (from Module 4 appraisals) that consistently demonstrate the effectiveness of structured patient education, pharmacist involvement, and early post-discharge follow-up in improving medication adherence and reducing readmissions in chronic conditions like heart failure. While specific interventions vary, the common thread is active patient engagement and continuity of care.

Sample Answer

           

Evidence-Based Practice Change Proposal: Improving Medication Adherence in Heart Failure Patients Post-Discharge

 
Slide 1: Title Slide Title: Enhancing Medication Adherence Post-Discharge: An EBP Approach for Heart Failure Patients Presented By: [Your Name/APN Title - e.g., Clinical Nurse Specialist, Nurse Practitioner] Organization: [Fictional Hospital Name, e.g., Metropolitan Health Systems] Date: July 22, 2025 [Image: A silhouette of a patient and a healthcare provider, with subtle images of a heart or medication symbols in the background.]
Slide 2: Our Organization: Culture & Readiness for Change Metropolitan Health Systems (MHS):
  • Setting: Large, urban academic medical center with 600 beds.
  • Mission: Committed to delivering high-quality, patient-centered care, fostering research, and educating future healthcare leaders.
  • Culture:
    • Strengths: Highly professional, research-oriented, and generally open to innovation demonstrated by numerous quality improvement projects. Strong emphasis on interdisciplinary collaboration within units.