Integrating Evidence into Nursing Practice Using a Standard Nursing Terminology

Transkript

1 Integrating Evidence into Nursing Practice Using a Standard Nursing Terminology Kathryn Mølstad, RN, Norwegian Nurses Organisation Kay Jansen, MSN, PMHCNS-BC, DNPc, University of Wisconsin- Milwaukee, College of Nursing Karen Marek, PhD, MBA, RN, FAAN, Arizona State University, College of Nursing & Innovation Gro Naess, MSN, RN, Vestfold University College, Tønsberg

2 Purpose To develop an evidence-based clinical template from a clinical practice guideline on medication management with older adults using the International Classification for Nursing Practice (ICNP ), a standardized nursing terminology.

3 Problem and purpose A known problem that people do not take medication as prescribed. Health problem/risk: Medication - People living at home Assist nurses in identifying patient problems with medication management, promoting prevention, and providing early intervention.

4 What is ICNP? A standardized terminology used to represent the nursing process Assessment (Findings) Diagnoses (Health Status) Interventions Outcomes

5 Clinical practice guidelines Provide evidence for practice Potential to improve quality and safety Bridge the gap - access and implementation of evidence in practice

6 Method Content analysis Data source: Clinical Practice Guideline titled Medication Management of the Community-Dwelling Older Adult Selected from the Agency for Healthcare Research and Quality (AHRQ) Handbook for Nurses on Patient Safety and Quality

7 Results Organized using 7 categories identified by Marek & Antle (2008): Medication Reconciliation Medication Procurement Medication Knowledge Physical Ability Cognitive Capacity Intentional Non-Adherence Ongoing Monitoring

8 Results 28 Assessment Risk Factors 26 Nursing Diagnoses 45 Interventions 14 Expected Outcomes

9 Examples of Assessment Samstemning av medikasjoner: Gjennomgå alle medikamenter med pasienten og pårørende (gamle, nåværende, forordnet, ikke reseptbelagt, alternativ medisin og vitaminer). Vurdere om pasienten tar medikamenter som er forordnet på riktig måte. Medication Reconciliation: Review all medications with patient and / or caregiver(i.e., old, current, prescribed, OTC, herbs, vitamins) Assess medication adherence

10 Examples of Nursing Diagnoses Samstemning av medikasjoner: Sykepleierdiagnoser Risiko for utilfredsstillende medikament håndtering Risiko for polyfarmasi Synonym: Risiko for daglig bruk av mange ulike medikamenter Ikke tilfredsstillende medikamenthåndtering Polyfarmasi Medication Reconciliation: Nursing Diagnosis(es) Risk for Ineffective Medication Management Risk for Polypharmacy Ineffective Medication Management Polypharmacy

11 Examples of Interventions Samstemning av legemidler: Identifisere medisinisk diagnose for hver medikasjon Rapportere om bivirkninger til den som har forordnet eller fastlege Rapportere bekymring om legemidler til den som har forordnet Konsultere omsorgsgiver for evaluering av legemidler Konsultere farmasøyt for evaluering av legemidler Sørge for oppdatert liste med oversikt over aktuelle legemidler og medisinsk diagnoser til primær omsorgsgiver. Gi pasienten en oppdatert legemiddel liste Medication Reconciliation: Identify medical diagnosis for each medication Report adverse drug reactions to prescriber Report medications of concern to prescriber Consult the primary care provider for medication review Consult the pharmacist for medication review Provide list of current medications and medical diagnoses to primary care provider Give the patient a medication card with current medications

12 Examples of Outcomes Samstemning av medikasjoner: Ingen polyfarmasi Tilfredsstillende medikamenthåndtering Medication Reconciliation: No Polypharmacy Effective Medication Management

13 Discussion Mapping to ICNP resulted in a documentation template - includes nursing diagnosis, outcomes and interventions easily shared 85 new concepts were submitted to ICNP Future research International validation

14 Vision: Improve the quality of care and outcomes for patients Bridge the gap between research and clinical practice ----using clinical practice guidelines that can be implemented in everyday practice

15 Reference Marek, K. D. & Antle, L. (2008). Medication management of the community-dwelling older adult. p In Hughes, R.G. (ed.). Patient safety and quality: An evidence-based handbook for nurses. AHRQ Publication No Rockville, MD: Agency for Healthcare Research and Quality.

16 QUESTIONS?