NR 505 WEEK 7: RECOMMENDATION FOR AN EVIDENCE- BASED PRACTICE CHANGE( EBP CHANGE RECOMMENDATION)

Introduction +Sickle cell disease and pain management +Topic to be discussed +Practice Issue +PICOT Question +Literature Review +Recommendations Practice Issue +Area of interest +Sickle cell disease +Management of acute pain episodes +Practice issue and how it relates to NP practice +Impacts on health outcomes Sickle cell disease…. +Discovered in 1910 +Increasing global health problem +Patients suffer from acute and chronic pain +Patients are often under medicated due to high opioid tolerance +Frequent emergency department visits that lead to hospital admissions NP Practice and healthcare outcomes +Do no harm +Frequent hospital visits +Poor patient care +Poorer health outcomes +Comorbid diagnoses +Anxiety +Depression +Poor quality of life PICOT Question +P (population)- Adult patients with sickle cell disease +I (Intervention) Does the use of an individualized care plan help with acute pain management +C (Comparison) Compared to those with standard emergency room pain management +O (Outcome) Improved pain regulation and decreased rate of admission +T (Time frame) Over a 6-month trial period +PICOT question: In adult patients with sickle cell disease, does the use of an individualized care plan help to guide acute pain control and improve pain regulation and decrease the rate of admission over a six-month period? Literature Review +10 articles reviewed +Implementation of an individualized pain plan vs. standard management +Common themes +Insight and perspective Literature Review +Provider resistance +Facilitators and barriers +Collaboration among specialties +Knowledge gap +Patient input +”Expert patient” +Most important resource to care +Extremely knowledgeable about oneself Literature Review +Was the admission rate decreased???? +Literature shows patients are admitted an average of 4 times per year +Average length of stay in the emergency department decreased +Reduction in high utilization group +30-day readmission rate decreased +Significant cost savings to the hospital Literature Review +This topic has not been widely trialed +Small institutions +Small participant groups +Mostly trialed in pediatric setting +Shown to be successful +Keeping the plan in the medical record Recommendations +Recommended practice change +Sickle cell patients should be medicated as an individual and not per a standard protocol +Better patient outcomes +Reduction in admission rates +Provider comfort medicating patients with higher dosages of opioids Recommendations +Key stakeholders +Health care Providers +Health insurance companies +Drug companies Recommendations +Fit, feasibility and appropriateness +Does this recommendation add value? +Does it improve clinical outcomes +Would it improve patient or provider satisfaction +Would it reduce the cost of care +Would this change improve unit operations