Provide two examples, with supporting evidence, of how resources are used to support evidence-based clinical decision-making in autonomous nursing practice.
Access to available evidence-based practice is an essential part of providing autonomous nursing practice at FF Thompson Hospital. This is validated by the electronic access nurses have to literature, best practice, updated pharmacological requirements, and current standards of practice. Thompson provides multiple sources for nurses to support their practice. These sources are available through our own intranet system, which can also be accessed at home through the use of Citrix. The intranet homepage has a specific link for nurses, which provides a multitude of resources for autonomous practice. Lippincott, an evidence-based electronic procedure manual providing step-by-step procedures, videos, tests, and patient education, is available instantly to our nursing staff through our intranet. The Nursing Practice Council has adopted clinical procedures detailed Lippincott's evidence based clinical procedures manual integrating them through the use of links in our policy manager system, to provide fluid and consistent information to nurses, giving them the independence to practice safely and confidently. A perfect example of this process is the Thompson Policy and Procedure regarding Blood Product Administration. The Nursing Practice Council discussed the importance of evidence-based practice with blood transfusion, identified areas for improvement, cross-referenced Thompson's current policy, and aligned it with the evidence-based procedure in Lippincott. The link to Lippincott was created within the electronic policy and procedure platform, which gives nurses direct access to the current practice within seconds. Lippincott's procedural platform allows input and update of hospital-specific procedures under a tab called "Critical Notes" (See exhibit EP14.1). Thompson nurses have been educated to identify this tab and read these procedures specific to the hospital to provide direction to stay within their scope and hospital requirements.
Exhibit EP14.1, Blood and Blood Product Transfusion & Administration Policy & Procedure
Exhibit EP14.2, Lippincott Procedures showing critical notes.
Exhibit EP14.3 - Nursing webpages
Example 2 OBiX, the Electronic Health Record, used for primary documentation in Obstetrics and the Nursery, employs embedded evidence-based normal findings (norms) for the initial newborn assessment and ongoing assessments. When a newborn is admitted, the initial assessment is completed by the RN. By hovering the mouse over the area of assessment the nurse can display the norms for that body system. Any deviance from normal is documented as a comment (Exhibit EP14.3)
Exhibit EP14.4
In the ongoing assessment of the neonate, documentation is done by selecting each body system and choosing "Criteria Met" or "Criteria Met Except" (Exhibit EP14.4). For each body system, the two following drop-down lists display the norms and the exceptions commonly seen (Exhibit EP14.4 and EP!4.5).Because the norms and variances are embedded in the documents, the nurse always has assurance that assessment parameters are clear and any variances can be noted by the provider and other nurses. The program includes a simple search component which allows users to search on the word "variance" and pull up any note which contains that word. Users are able to quickly view the clinical assessment variances without having to scan the entire note. Variances from the norms are used as needed to support clinical decision making as they:
Exhibit EP14.5
Exhibit EP14.6
Exhibit EP14.7