Evidence based practice and PICOT question help

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Topic 1: EBP and PICOT

Discuss how you used the three components inherent to Evidence-Based Practice inquiry to direct your clinical question database search

Running Head: PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS PICOT Question Central Line-Associated Infections Courtney Pribonic Kaplan University 3/5/2017 1 PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 2 Introduction Patients hospitalized in intensive care units (ICU) sometimes suffer from central lineassociated infections (CLAI). These illnesses are mostly caused by microorganisms which act on the central venous catheters. As a way of eliminating this adverse effect, evidence based care has implemented various intervention techniques most of which are grouped as a bundle that comprises of various individual activities. This paper seeks to identify a suitable evidence-based care intervention for preventing CLAI among adult patients hospitalized in ICUs. PICOT Question In formulating and developing this research, a systematic review was mainly done on Cochrane database on studies tackling care and maintenance of the CVC published between 2010 and 2017, Scopus, PubMed, and the web of science. This was founded on the PICOT strategy question; “What are the best CLAI-related preventive and intervention measures implemented in adult patients who are hospitalized in an ICU?” The outcomes of the research after analysis presented bundles which included elements such as maximal barrier precautions and hand hygiene. Essentially, these were in the form of multidimensional strategies and programs such as impregnated bandages and catheters as well as the commitment of the staff to keeping facilities infection free (JC et. al., 2011). Treatment of critically ill patients depends on the Central Venous Catheters (CVC) by a significant percentage. For instance, in intensive care units, techniques such as the use of invasive devices and diagnostic procedures are utilized to trigger particular patient PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 3 complications like the health associated infections (HAI). However, there is a significant challenge in the ICU regarding prevention and control of nosocomial infections as a result of microorganisms (Blot, et.al, 2014). These organisms are usually multiresistant and create the need to use broad spectrum antibiotics. Therefore, the invasive procedures used in ICU to some extent complicate the control of infections. In this regard, the central line-associated infection (CLAI) is the major complication that incurs to the central venous catheters. The current intervention procedures for CLAI are in the form of bundles which are used wholesomely. This means that each package is implemented by carrying all the activities included in it and not just selecting a few. One of the commonly utilized technique is the care package. This bundle contains five elements which include; clean skin preparation with chlorhexidine, hand hygiene, avoidance of femoral sites, elimination of unnecessary catheters, and sterile barrier precautions during CVC. As per JC et al. (2011) methodology, the bundle was implemented along with a strong safety culture, education, and organizational strategies. Moreover, during implementation, information was collected for calculating the rates of infection and monitoring the level of adherence to hygiene. The results obtained a 2.d level of evidence. Another intervention is the quality technique which comprises of two different bundles. This particular response also has a strong focus on hand hygiene, and the two bundles included are the CVC insertion and CVC maintenance (Blot, et.al, 2014). CVC insertion has these elements; femoral vein avoidance, skin preparation with chlorhexidine, and maximal sterile barrier. On the other hand, the CVC maintenance bundle comprises of daily checks to ascertain the needs of CVC insertion, connection checking and assessment without the use of needles, and suitable bandage replacement techniques. Blot, et.al (2014) while implementing these interventions, he coupled the elements with educational programs which were PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 4 disseminated via teaching videos, conferences, and surveillance processes. The evidence level attained was 2.d. The study by the Institute for Healthcare Improvement (IHI) as stated by Perin et.al (2016) focused on the significance of implementing all significant elements that are included in all bundles. In this regard, the study proposed that a list is used to monitor and evaluate the applicability of the elements in caring for ICU adult patients. From the study’s finding, it was found that when compliance and adherence to efficient implementation of all items of a bundle is high, the rates of infection within adult patients in ICU reduces significantly. The EBP level of evidence of this research was 3e. This technique is similar to the use of multidimensional approach in preventing CLAI in ICU patients. This includes combining elements from various bundles and applying them at once (Berenholtz, et.al, 2014). In practice, the elements considered most includes combining a bundle of intervention, outcome surveillance, education, infection and feedback rates, performance feedback, and process surveillance. Their level of evidence is often 2.c. This study shows that different types of care bundles can be used as EPB Interventions for Prevention of central line-associated infections in ICU/CCU. However, both of them revolve around having high levels of hygiene. This means that microorganisms responsible for causing various central line-associated infections in ICU such as complications of the central venous catheters are propagated via unhygienic practice (Latif, et.al, 2015). However, it is evidence that the care bundle comprises of elements which are vital for preventing these infections. However, the elements on their own are not highly efficient, and they need to be coupled with strong safety culture, education, enabling organizational strategies, strong staff engagement, and surveillance processes. PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 5 Conclusion The three studies made offer ways to prevent central line-associated infections among patients hospitalized in ICUs. Two of the studies showed that implementation of good care practice leads to a reduction in rates of central line-associated infections in ICU/CCU. In this regard, the best care measures come from the bundle which includes CVC maintenance and insertion and vital strategies such as engagement and education of the staff, surveillance process, and safety culture. These are features associated with the care bundle. Therefore, it is evidence that the care bundle which comprises insertion cleaning with chlorhexidine, femoral site avoidance, strict hand hygiene, and catheter removal as soon as it becomes unnecessary is the best intervention for preventing CLAI among adult patients hospitalized in intensive care units. References Berenholtz, S. M., Lubomski, L. H., Weeks, K., Goeschel, C. A., Marsteller, J. A., Pham, J. C., ... & Yang, T. (2014). Eliminating central line–associated bloodstream infections: a national patient safety imperative. Infection Control & Hospital Epidemiology, 35(01), 56-62. Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line– associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clinical Infectious Diseases, ciu239. JC, O., GL, S., N, S., O’Horo, J., Silva, G., & Safdar, N. (2011, January 1). Anti‐infective locks for the treatment of central line‐associated bloodstream infection: A systematic review and meta‐analysis (Provisional abstract). Retrieved March 6, 2017, from http://onlinelibrary.wiley.com/o/cochrane/cldare/articles/DARE12011007506/frame.html PICOT QUESTION CENTRAL LINE-ASSOCIATED INFECTIONS 6 Latif, A., Kelly, B., Edrees, H., Kent, P. S., Weaver, S. J., Jovanovic, B., ... & Berenholtz, S. M. (2015). Implementing a Multifaceted Intervention to Decrease Central Line– Associated Bloodstream Infections in SEHA (Abu Dhabi Health Services Company) Intensive Care Units: The Abu Dhabi Experience. infection control & hospital epidemiology, 36(07), 816-822. Perin, D. C., Erdmann, A. L., Higashi, G. D. C., & Sasso, G. T. M. D. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Revista Latino-Americana de Enfermagem, 24.
Discussion Board (DB) Participation Rubric Discussion boards (DBs) are what make an online course a course and not an independent study. DBs are vital to demonstrating that the learner has met the expected course level outcomes. Collaboration between peers and your instructor in the DB is an important aspect of the online learning experience and is expected in the course. Any exceptions to the following DB rubric will be at the instructor’s discretion. The purpose of a DB is to stimulate critical thinking in a scholarly manner. Critical thinking consists of synthesis, creating solutions, application to real world situations, and testing, debating, and defending evidence-based solutions. Critical thinking is not repetition of assigned reading material. Outside research of the literature is a vital part of the DB. Posts need to be substantive. This means that responses such as "I agree" or "great post" do not meet grading rubric requirements. Initial posts for each discussion question (DQ) is due no later than Saturday of the unit week. The initial post must be an answer to the DQ topic, not a comment on other posts. Initial posts for each DB must also include a minimum of three peer-reviewed citations. Citations must include outside sources and no more than one citation from assigned course readings may be used each week. Additionally, comments should also include a citation to support assertions. While the eCollege discussion board tool limits the ability to use APA formatting (e.g., hanging indents), posts must include the required elements of an APA intext citation and list of references. Initial post timeliness Inappropriate Below Average Average Above Average 1 2 3 4 Provides an initial post on or after Sunday. Score Weight Final Score N/A N/A Provides an initial post by Saturday. 15% 0,00 Does not post responses to others. Posts one comment per Discussion topic. Posts 2 comments per Discussion topic on separate days. At least one comment includes a citation. Posts more than 2 comments per Discussion topic on separate days (resulting in total participation on three different days throughout the discussion). At least two comments include a citation. 10% 0,00 N/A Participates, but does not post anything that encourages others to respond to the posting. Attempts to motivate the group discussion. Frequently attempts to motivate the group discussion. 5% 0,00 Submission does not relate to the topic. Answers some question/topics with some clearly stated opinions. Supports post using text only. Answers all questions with opinions and ideas that are stated clearly. Supports post using text and at least two peer-reviewed sources. Answers all questions with opinions/ideas creatively and clearly. Supports post using several outside, peerreviewed sources. 35% 0,00 APA Format Major errors or no APA format used. Minor errors with APA format. Rare errors with APA format. No errors with APA format. 10% 0,00 Spelling/ Grammar/ Formatting/ Mechanics Significant errors in spelling and/or grammar. Major flaws in writing mechanics and formatting. Poor spelling and grammar are apparent. Uses Standard American English with rare errors and misspellings. Consistently uses Standard American English with no misspellings. Appropriate mechanics and formatting. 10% 0,00 Length Submission does not meet length requirements. N/A N/A The initial post is at least 200 words. This does not include repeating the DB question or the citations and references. 15% 0,00 100% 0,00 0 ##### Additional comment requirement Engagement Content Quality Initial Response Final Score Percentage Total available points = 4 Instructions: First enter total points possible in cell C15, under the rubric. Next enter scores (between 0 and 4) into yellow cells only in column F. Low Rubric Score High 3,5 4,0 2,5 3,49 1,7 2,49 0,0 1,00 Grade points Low 0 0 0 0 Percentage High 0 0 0 0 Low 90% 80% 70% 0 High 100% 89,99% 79,99% 69,99%

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wambuiguama
School: New York University

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Running Head: USING EVIDENCE-BASED PRACTICE IN QUESTION SEARCH

Using Evidence-Based Practice In Question Search

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Date

1

USING EVIDENCE-BASED PRACTICE IN QUESTION SEARCH

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Using Evidence-Based Practice In Question Search

Efficient Evidence-based practice incorporates three essential components to improve
the practice’ outcomes and the nature of the care that is administered. These components are
research which is also referred to as external evidence, internal evidence also known as
clinical expertise, and patient preference.
In finding appropriate literature for the PICOT q...

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Anonymous
Tutor went the extra mile to help me with this essay. Citations were a bit shaky but I appreciated how well he handled APA styles and how ok he was to change them even though I didnt specify. Got a B+ which is believable and acceptable.

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