Comprehensive Severity Index (CSI)

The purpose of this paper is to present an analysis of a quantitative article using Melnyk & Fineout-Overholt’s (2015) rapid critical appraisal (RCA) for a randomized clinical trial. Topics included are the validity of the research, results of the research and how the information can be applied to the clinical care of my own patient population.

Evidence Based Practice is crucial to support care provided to patient. It is imperative to get evidence base on proven clinical practice that provides valuable insights about human health and illness as per Polit and Beck (2017). The researcher must pick a topic to be research on and A PICOT question formulated. These questions help as a guidance on the research. The researcher then check to see what can be retrieve that are of importances to topic. In most case narrowing of the questions may help. The levels of evidence are important because it help with identifying hierarchy of evidence. The higher the Hierarchy of evidence the better evidence base information.

Knowledge discovery and data mining is a process that can be used to glean important insights and develop useful, data-driven models from collected healthcare data. The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies. PBE methods collect and analyze a comprehensive set of patient, treatment, facility, and outcome variables, enabling the study of comparative effectiveness among

Evidence-based practice is an approach used by health care professionals to continually use current best evidence-based research to make ethical and reliable decisions regarding patient care. “Research to promote evidence-based practice is becoming more and more a part of the regular work of health care leaders” (Grand Canyon University, 2015, p. 1). However, it is important to determine the difference between solid research and flawed research that provides unreliable inferences. Evidence-based research includes focusing on a clinical question; and includes the review and incorporation of several studies to strengthen the results of the new study (Grand Canyon University, 2015). Roddy et al. and Ganz et al. articles will be assessed to determine if the recommended changes were backed by solid research that warrants changes in a hospital.

According to Stevens (2013), the call to develop and implement evidence-based practice (EBP) within all healthcare disciplines is fueled by legislative demands for improvement in standard medical metrics such as mortality and morbidity. However, increasing demands by the public for evidence related to the metrics and outcomes of such concepts as quality of life illustrate what may be more important to the client (Stevens, 2013). This client-directed focus has resulted in patient-centered outcomes research (PCOR) (Stevens, 2013). "The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information

NICE (2014) defines its clinical guidelines as recommendations, which are systematically-developed, on how healthcare professionals should care for a condition or conditions of patient. On the best available evidence, these recommendations are based (NICE 2014). Grol (2010) emphasizes the fact that to improve patient care, efforts are being made on evidence-based guidance, which is one way to do this. NICE guidelines are developed with methodological rigour using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument (Rapu & Matthews 2014). This instrument was designed as to assess, across the spectrum of health, the quality of practice guidelines (Brouwers et al. 2010). Furthermore, it provides guideline development directions and gives information that should be contained in guidelines (Brouwers et al. 2010). Established above, it provides a structure

The International Classification of Diseases, Tenth Revision (ICD-10) has been in development since 1983 to replace the outdated Ninth Revision (ICD-9) that has been in use in the U.S. for over 35 years (Giannangelo, 2015). Due to the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulation published in 2009, the Clinical Modification (ICD-10-CM) will replace ICD-9-CM Volumes 1 and 2, and the Procedure Coding System (ICD-10-PCS) will replace ICD-9-CM Volume 3 for all HIPAA transactions effective October 2015 (Giannangelo, 2015). These new code sets accommodate new procedures and diagnoses and allow for greater specificity in clinical documentation (Centers for Medicare & Medicaid Services [CMS],

These discoveries prompted change and allowed the National Institute of Health and Clinical Excellence (NICE), to set standards to reduce unnecessary detriment to patients. Many tools were introduced to assist in the consistency and accuracy of observations of patients’ physiological conditions. ViEWS (VitalPac Early Warning Score) is a standardized and high-tech scoring system that helps recognize and respond to deteriorating patients. It is the basis of the newest warning system, appropriately named National Early Warning System or NEWS (Featherstone, Prytherch, Schmidt & Smith, 2010).

Measures used to evaluate the outcome of the evidence-based practice (EBP) change will be reviewing quarterly dashboard data. To ensure inter-rater reliability, the infection control nurse, and only the infection control nurse, will monitor ongoing efforts of data collection of CAUTI, and be an integral part of the feedback loop responsible of giving on-sight feedback to clinicians and team members. Also, the infection control nurse along with other team members will revisit the literature to see if any new knowledge focused triggers will be considered. The quarterly dashboard will inform of outcome indicators which may, or may not, affect the process indicators. Process and outcome indicators will be used for improvement purposes within the unit. The quarterly dashboard report also allows questions to be asked by team members and stakeholders, which stimulates more discussion and advanced thought toward quality improvement of the EBP change. The dashboard will assist in

Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned

Formulation of the research question guides the type of data collection for the study and states what the study will ‘hypothesise’ (Polit and Beck, 2010). The CASP tool acknowledges that clearly-focused research question will describe the population studied, the intervention given and the outcomes considered (SPH, 2006). The research question in the SR is clearly formulated. The population of patients studied were general and critically ill hospital patients, the intervention was a SR and outcome to be assessed was about the safety of the CPOE and clinical decision support systems or CDSS (CDSS is a computerised medication prescription system) based on hierarchy of outcome measures (kindly refer to table 2 of SR) within ICU settings. Likewise, in the NR, the population of patients studied were general and critically ill patients, the analysis was done via a NR and the purpose of the study was to assess the results of CPOE on clinical and surrogate outcomes in hospitalised patients in both general and critical care settings.

Evidence based practices are important to explore for various diseases so that their efficacy level can be determined and medical staff can be trained accordingly. Particularly speaking in the context of chronic diseases, evidence based practices are to be evaluated with the joint efforts of multiple healthcare institutions so that it can bring benefits to the overall healthcare industry.

The purpose of a systematic review is to attempt to find, evaluate and synthesize high quality research relevant to the research question. A systematic review uses carefully developed data collection and sampling procedures that are put in place in advance as a protocol. (Polit, 2012). A systematic review must contain the following: a clear inclusion and exclusion criteria, an explicit search strategy, systematic coding and analysis of included studies, and a meta-analysis if possible. (Hemingway & Brereton, 2009). Systematic reviews are conducted by nurse researchers to avoid reaching incorrect or misleading conclusions that

The model is guided and standardized by the Perioperative Nursing Data Set (PNDS) consisting of a variation of elements such as nursing diagnosis, interventions, and outcomes (King and Sapnas, 2007) assisting nurses to utilize evidence-based practice in providing, safe, efficient patient care. The primary goal is to optimize the patient’s surgical outcome using evidence-based best practice measures in order to provide safe and effective patient care (See Appendix A).

Evidence-based practice (EBP) in nursing means making decisions about patient care on the basis of best, current, standardized practice and guidelines. According to an article, written by Dr. Kathleen Stevens, the development of evidence-based practice (EBP) is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care (Stevens, 2013). The author also mentioned in her article that the intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care,