1. QI, EBP & Research: Knowing the Difference Yvonne Wesley RN PhD FAAN RBMC, Faculty Liaison 2011

2. Objective Upon completion of this 90-minute session, participants will be able to: Differentiate quality improvement, evidence based practice and research Identify similarities and sources of confusion among quality improvement, evidence based practice and research Compare essentials of quality improvement, evidence based practice and research

3. Why We Do What We Do

4. Differentiate Purpose

5. Similarities Scholarly Process Method Sample Data Collection IRB Results Implication Dissemination of Results

6. Sources of Confusion Human Subjects Amount of risk or benefit to participants Confidentiality/Anonymity Generalizability Ability to get published.

7. Comparison Dimitroff, LJ. (2011, April). Comparing and contrasting nursing research, evidence-based practice, and quality improvement: a differential diagnosis. Capital District Nursing Research Alliance 7th Annual Conference

8. Shirey MR, Hauck SL, Embree JL, Kinner TJ, Schaar GL, Phillips LA, Ashby SR, Swenty CF, McCool IA. (2011). Showcasing differences between quality improvement, evidence-based practice, and research. Journal of Continuing Education in Nursing, 42(2):57-70. Hospitals pursuing Magnet designation must understand and respect the distinctions between QI, EBP, and research. Do not confuse one approach for the other. Hospitals should facilitate distinct, yet collaborative, venues to cultivate QI, EBP, and research initiatives

9. QI/PI/TQI/CQI The purpose of QI is to improve internal processes and practices within a specific patient group or organization QI protocols are less formal and rigorous and may change throughout the course of a QI project. Data collection in QI is usually rapid cycle and uses minimal to moderate time and resources. Shirey et al. (2011).

10. Evidence-Based Practice The purpose of EBP is to evaluate evidence along a continuum to identify the strongest or best evidence to guide nursing practice within an organizational setting and with a specific patient population EBP interventions are stricter and more prescriptive than QI protocols, yet they are not as strict as research protocols. EBP data collection may not be rapid cycle and involves varying resources. Shirey et al. (2011).

11. Research The purpose of research is to generate new knowledge within the broader scientific community to produce knowledge that is generalizable beyond the study sample Research study generally have tight controls for extraneous variables to provide confidence that outcomes occur as a result of defined intervention and not chance Research is not rapid cycle and involves the use of resources that may vary according to scope of the study Shirey et al. (2011).

12. Examples Quality Improvement Improving the discharge time of patients Improving Documentation of Critical Lab Values Reduce the time between when a provider writes an order (antibiotic) and when the patient receives the order Decrease infections associated with central venous catheters Improve patient satisfaction Decrease pressure sores with the use of pressure dressings The UAB Center for Nursing Excellence University of Alabama at Birmingham Hospital

13. Examples Evidence Based Practice Assessing the Standard for Chemotherapy induced nausea and vomiting Listening to Bowel Sounds Best Practice for Tracheotomy Dressing Positioning in the OR to prevent pressure ulcers Early Mobilization to prevent pneumonia

14. Examples Nursing Research symptoms clusters of patients with congestive heart failure if women delay reporting symptoms of heart attack more than men if location from hospital impacts follow up treatment of breast cancer patients quality of life outcomes in heart transplant patients from pre transplant to 5 years post transplant The UAB Center for Nursing Excellence

15. Summary

16. Suggested Readings Shirey MR, Hauck SL, Embree JL, Kinner TJ, Schaar GL, Phillips LA, Ashby SR, Swenty CF, McCool IA. (2011). Showcasing differences between quality improvement, evidence-based practice, and research. Journal of Continuing Education in Nursing, 42(2):57-70. Dimitroff, LJ. (2011, April). Comparing and contrasting nursing research, evidence-based practice, and quality improvement: a differential diagnosis. Capital District Nursing Research Alliance 7th Annual Conference Krugman, M. (2008). Is it research, evidence-based practice, or a quality improvement project? Journal for Nurses in Staff Development. 137-139. Hedges C. (2006). Research, evidence-based practice, and quality improvement. AACN Advanced Critical Care, 17(4), 457-9. Beyea, SC, & Slattery MJ(2006). Evidence-Based Practice in Nursing: A Guide to Successful Implementation ©2006 HCPro, Inc