Using Evidence to Improve Outcomes and Achieve Excellence

Principal Investigator:	Jennifer Williams, MSN, RN, NE-BC
Co-Principal Investigators/Collaborators:	Pinkie Hassan (Presenter), Ruth Ling, Ruby Francois, Nancy Kuria, Geraldine Jones, Claudia Smith
Organization:	St. Luke’s Episcopal Hospital

Abstract

Problem

Staff nurses observed that upon arrival to the unit, patients who underwent Uterine Artery Embolization (UAE) were experiencing excruciating pain. A nurse-led team investigated why UAE patients were experiencing uncontrolled pain.

Evidence

Lewin’s change theory¹ has three components: unfreezing, changing and refreezing. Unfreezing was the inadequate pain management identified by staff nurses. Changing included both system and practice changes. Refreezing was the integration of new changes into practice. The Plan-Do-Study-Act (PDSA) rapid-cycle methodology² is a scientific method to change and measure outcomes. Integration of Lewin’s change theory¹, using the PDSA rapid-cycle change methodology², enabled the dissolution of interdepartmental silos that served as barriers to alleviating patients’ pain and answering nurses’ “burning question.”

Strategy

Staff nurses used the PDSA methodology to initiate study of the problem: 1) Assembled an interprofessional team to review literature on pain management post-UAE. 2) Developed a data collection tool to validate nurses’ assumptions and observations. 3) Collected 12 months of retrospective data on patients who underwent UAEs. 4) Aggregated the data and reviewed it with team. 5) Enlarged the size of the interprofessional team. 6) Implemented interdisciplinary process changes.

Practice Changes

1) Pre-procedure nurse will send PCA pump with patient to radiology. 2) Pharmacy will change patient admitting status allowing access to post-procedure pain medication. 3) Radiology nurses will be educated to use PCA pump. 4) Radiology nurses will initiate PCA pump pre-procedure.

Evaluation

Prospective data collection post-implementation demonstrated a reduction in time for PCA pump initiation from 2.07 hours to 0.0 hours.

Results

Patients and families experienced less pain and anxiety, nurses and physicians expressed improved satisfaction with management of patients’ post-procedure pain.

Recommendations

Using the PDSA model as the vehicle to employ change theory enabled nurses to use available evidence to improve outcomes.

Bibliography

• ¹Lewin, K. (1951). Field theory in social science: Selected theoretical papers. New York: Harper & Row.
• ²Moen, R., & Norman, C. (2006). Evolution of the PDSA Cycle. Retrieved on January 11, 2009 at: http://www.xqmp.nl/content/bestanden/evolution_of_the_pdsa_cycle_jul06.pdf