EBP skills and data-driven clinical decision making.

The 2010 report by the Robert Wood Johnson Foundation's Initiative on the Future of Nursing in collaboration with the Institute of Medicine calls for nurses to practice to the full extent of their education and training. One recommendation from the report is to expand opportunities for nurses to lead and diffuse collaborative improvement efforts (Institute of Medicine of the National Academies, 2010, p. 2). Nurses should be able to lead and manage interdisciplinary collaborative efforts to conduct research, improve practice environments and health systems to improve health outcomes and reduce healthcare cost. To achieve such expectation, there is a need for a nursing workforce with high levels of proficiency in evidence-based practice skills for data-driven clinical decision making to improve health outcomes. This also includes decisions that can affect the working environment of the nurse that facilitates a culture of patient safety.

Fineout-Overholt and Johnston (2007) defined data-driven decision making as the use of data from published research, unpublished research, outcomes management initiatives, quality initiatives, or implementation projects to drive health care decisions. Nurses need to have an understanding of basic outcomes and the role it plays in improving healthcare. Outcomes refer to a patient's responses to treatment in a healthcare context (Doran & Sidani, 2007). Outcomes in healthcare are often tied to regulatory and reimbursement issues such as The Joint Commission and Centers for Medicare and Medicaid Services (CMS) where data are often collected at point of care by nurses (e.g. core measures). The data is then analyzed and decisions are made by administrators or quality group within the organization which may directly or indirectly affect nursing practice.

For nurses to effectively participate in the discussion table when decisions are made that may affect nursing practice, knowledge of outcomes data is critical for a meaningful input and participation in the decision making process. The nursing workforce should be well-versed in outcome measurements and basic outcome evaluation principles. Nurse sensitive outcomes (e.g., patient satisfaction with pain management and patient education, functional status, symptom control, pressure ulcers, falls, and intravenous infiltrations) are increasingly important for nursing to articulate the role nursing plays in improving quality in patient care. Information obtained from measurements of these nurse sensitive outcomes allows nurses to negotiate practice changes based on data.

Evidence-based practice (EBP) skills can provide the foundation for data-driven clinical decision making competency expected from the nursing workforce. Proficiency in database searching skills, direct access to evidence-based resources, implementation of evidence-based practice interventions, evaluation of effectiveness of implemented evidenced-based interventions, and evaluation of outcomes are EBP skills. Understanding of how to collect data, the ability to enter data into a database, and analyze data using simple statistics is important. Use of research knowledge feeds into decision-making and practice (Nutley, Walter, & Davies, 2003).

Fostering EBP skills that supports data-driven decision making should be a collaborative effort between nursing and organizational management with the goal of improving quality patient care. Demand for safety, quality, and effective health care calls for the engagement of nurses in EBP to improve patient outcomes. A nursing workforce that are consumers of research knowledge facilitates research knowledge translation into practice which then will facilitate data-driven clinical decision making to improve health outcomes.

References

Doran, D. M., & Sidani, S. (2007). Outcomes-focused knowledge translation: A framework for knowledge translation and patient outcomes improvement. Worldviews on Evidence Based Nursing, 1, 3-13. doi: 10.1111/j.17416787.2007.00073.x

Fineout-Overholt, E., & Johnston, L. (2007). Evaluation: An essential step to the EBP process. Worldviews on Evidence-Based Nursing, 1, 54-59. doi: 10.1111/j.1741-6787.2007.00081.x

Institute of Medicine of the National Academies (2010). The future of nursing: Leading change, advancing health. Report recommendations. Washington, DC: National Academies Press.

Nutley, S., Walter, I., & Davies, H. T. O., (2003). From knowing to doing: a framework for understanding the evidence-into-practice agenda. Evaluation, 9, 125-148.

Ludy Llasus, PhD, APN, NP-C