Purpose/Objectives:
Discuss the impact of EBP on clinical practice guidelines and patient management and outcomes. Describe the role of the clinical nurse specialist (CNS) in the appraisal of evidence, translation, integration, and evaluation of evidence.
Significance:
In 2004, chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death in the United States and cost the nation $37.2 billion. It is also projected to be the third leading cause of death by the year 2020.
Background/Rationale:
This CNS student analyzed a veteran hospital's protocol for the management of inpatients with COPD exacerbations. Published guidelines for the management of COPD were examined to discern the relationships between the hospital's COPD protocol and current clinical practice guidelines and evidence-based practices.
Description:
A computerized search of bibliographical databases and guideline resources focused the search. Each article was rated on applicability and feasibility to clinical practice, and the levels of evidence were determined. Results were compared, key areas across evidence were identified, and the status of current practice was analyzed. Evidence for this analysis ranged from articles supporting exacerbation management to entire disease process assessment and planning protocols.
Outcome:
The analysis found that the veteran hospital's protocol lacked any discharge criterion. In contrast, the GOLD Report 2008, American Lung Association 2009, American Thoracic Society 2009, and CHEST 2009 acknowledge standard discharge criteria such as symptomatology, vital signs, oxygen demand, and proper care upon discharge.
Interpretation/Conclusion:
This analysis concludes that multiple discharge criteria supported by level B recommendations are lacking in the current protocol. Therefore, CNS student recommendations were made after comparing current practice with the evidence synthesis. These changes would benefit patients' outcomes, thus preventing unnecessary and costly readmissions.
Implications for Practice:
The role of the CNS facilitates the implementation and adherence to higher-quality protocols. This analysis is an example of how a widely accepted protocol can be improved through interpretation and use of research and other evidence in the clinical setting and shows exactly how a CNS acts as an internal consultant, thus influencing local and global systems.
Section Description
The journal is proud to share the student abstracts accepted for poster presentation at the 2010 National Association of Clinical Nurse Specialists Conference. These abstracts are submitted under a separate, later deadline and therefore did not appear in the journal with the general abstracts. Congratulations to these CNS students and their faculty mentors.