Evidence Based Practice in Healthcare

This report discusses the importance of evidence based practice in healthcare and its impact on patient safety and quality of care. It covers topics such as quality improvement, situational awareness, patient safety, and clinical leadership. The report emphasizes the need for measuring and evaluating care to enhance patient experience and outcomes. The case scenario of a frail patient highlights the importance of safety measures and the role of clinical leadership in ensuring patient safety.

Evidence base practice

Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Introduction to Quality and Quality Improvement.................................................................1
Situational Awareness and Patient safety...............................................................................3
Introduction to Patient Safety.................................................................................................4
Clinical Leadership.................................................................................................................5
Research & Evidence Based Practice (EBP)..........................................................................6
CONCLUSION................................................................................................................................7
REFLECTION.................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
Quality of care is referred as the extent to which health care services for individuals
maximize the likelihood of desired outcomes of health and are consistent with the existing or
current professional knowledge. Healthcare quality is very important term which encompasses
various aspects of care of patient. It is a care which is safe, patient-centred, efficient, timely,
equitable and effective. Within the health care settings, safety of patient is a crucial aspect of
health care quality. It is very important to measure and evaluate the care provided to patients so
that improvements can be made effectively (Ajay, and et. al., 2016).
This report is based on the clinical case scenario of a frail patient who was 84 years old and
had history of falls. Because of falling from the bed, he was child due to hip fractures. This
report discusses about the evidence related to clinical decision making as well as the
accountability of each individual involved. It covers the information about quality and quality
improvement in the health care practices along with emphasizing on the situation awareness in
patient safety (Brooks, and Peetz, 2017). Apart from this, it includes information about
effectiveness of evidence-based practices to assess the new ways of caring. In addition to this,
clinical leadership, patient safety and quality improvement aspects of providing care are
discussed in the report.
MAIN BODY
Introduction to Quality and Quality Improvement
The quality of care in healthcare relates to interaction between the patients and the health
care providers and the ways in which health system inputs are transformed into health outcomes.
The provided care to the patient must be evidence-based, effective and neither overused nor
underused. The clinical processes are attributable directly to the behaviour of care providers as
well as their measurement can administer critical initiating point in development of methods to
enhance the care get by the patients. Although, the outcomes of health can be informative, there
possibility to be crude quality measure due to inherent predictability in the responses of patients
to healthcare (Carayon, 2016).
Providing quality care to the patient is very important in order to get effective outcomes.
There are some principles based on which the quality of healthcare is measured. One of the
principle is to measure the perceived to quality as well as compared with clinical quality. Apart
1

from this, the quality must be measured at different points in the pathway of patient by health
care system. The evaluation of overall care quality requires to consider quality experience of
patient accumulative process (Connolly, Jacobs, and Scott, 2018). Increasing number of options
for treatment and changing pattern of illness means that maximizing amount of health care
involves an interlinked contact sequence - with various health professionals at distinct levels of
health system - over a long period of time. The measurement of outcomes of health includes
performing different measurements involving measurement of status of health before the
intervention, measurement after to try as well as relate the transformation to intervention.
Health technology assessment is about ascertaining whether or not the health care services
are effective and safe. The prime goals to enhance health care safety, make sure cost effective
treatments are used, take decisions on the treatment more consistently and share the information
to help with decision making. In the patient reported outcomes, outcome measurement in
decision making has an important role (Dekker, 2016). Measuring and evaluating the care is very
important in order to enhance the experience of care of patient, reducing per capita cost,
improving health of population as well as reducing clinician and staff burnout. As stated by the
World Health Organisation, outcome measure is referred as the change in health of a person,
group of individuals or population, which is attributable to interventions. Safety of care measures
pertaining to medical mistakes.
As per the Agency for Clinical Innovation, the patient reported outcomes measures assess
the experience and perception of patient of their health care. This information can administer a
realistic gauge of satisfaction of patient and the real time information for improvement of the
health care services as well as to allow rapid response to the issues determined. The effectiveness
of outcomes of care measures evaluate compliance with the best practice care guidelines and
accomplish outcomes. Apart from this, an efficient utilisation of medical imaging is a significant
outcome measure. Accomplishing the outcomes within healthcare settings is very important, but
the process through which the healthcare systems accomplish them is equally significant (Dixon-
Woods, and Pronovost, 2016).
In relation to the provided clinical scenario related to safety of patient, complex care was
required. An evidence based practice must be provided to the patient so that effective health
outcomes can be obtained. As per the report published by The Health Foundation in year 2015,
evaluation is a crucial part of quality improvement and if it is done well, it can assist in resolving
2

the issues, inform decision making as well as develop knowledge (Evaluation of quality
improvement in health care, 2015). Measuring the quality of care assist in enhancing the patient
experience and delivering effective outcomes. Health care evaluation is the assessment of an
aspect of health care in order to assess that weather it fulfil the objectives. The care aspects
which can be assessed includes efficiency, equity, acceptability and effectiveness. During the
health care intervention, the health care evaluation can be performed so that the outcomes of
evaluation inform ongoing program or can be performed at end of program. For measuring and
evaluating the health care, the objectives must be SMART (Fitzpatrick, and et. al., 2016).
Situational Awareness and Patient safety
In the health care settings, situational awareness includes sensing, gathering, analysing as
well as contextualizing activity and the event to enhance care delivery, performance and
operations of healthcare provider. It is about being aware of whatever is happening or occurring
around. As stated by Jeanne M. Farnan, 2016, although many people consider themselves to be
highly observant, their perception powers are not infallible and they sometimes miss the obvious.
In order to prove exactly the same, invisible Gorilla experiment had developed in which
participants were asked to see a short video of 6 individuals passing around basketball as well as
to count the number of times those people in white shirts passed the ball. In this, nearly half of
the participants failed to recognise seventh person. This means, a lot of things goes on around
people, but they have no idea that they are missing so much (Situational Awareness and Patient
Safety, 2016). In respect to the provided clinical scenario, the frail patient was died due to not
taking safety measures. He was found to be lying on floor due to which he suffered from
fractured hip. Although, the family of the patient asked for bed rails to be put in place. But, due
to less or no awareness of situation and not taken into consideration the safety of patient, he falls
down from the bed. In that situation, patient safety must be considered the first. Loss of
awareness of situation can outcomes in serious compromise to the safety of patient it is not
identified by either the clinical team or individual (Gandhi, Berwick, and Shojania, 2016).
Situation awareness is stated as the perception of components in environment in a volume
of time and space, a comprehension of their meaning as well as protection of their statuses in
near future. Understanding, perception and prediction are the 3 situational awareness levels. In
the clinical practice, it is very important to understand that the care providers must be aware of
the situation. It assists in improving the quality as well as safety of care delivered. The
3

hospitalization hazards involving hospital acquired infections and reactions to therapeutic drugs
affects around 20% of patients (Gauld, 2017). The provided case scenario of frail patient who
was 84 years of age exemplifies how a common issue of safety leads to adverse outcomes. Apart
from this, there are several other issues which threaten the safety of patient including hand
hygiene, inappropriate restraints, infections, medication errors etc. All these are the observable,
visible and tangible errors. Systematizing the situation awareness needs integration into
electronic system as well as cultural change at organisational level. The electronic health record
based solutions like safety focused checklist would require to be available at bedside in mobile
form in order to better addressing the issues associated with safety which might be determined
by observation in the room of patient (Godlock, Christiansen, and Feider, 2016).
Introduction to Patient Safety
As stated in the report published by World Health Organisation in 2019, patient safety is a
discipline in health care which emerged with evolving complexity in the system of healthcare
and the resulting increase of patient harm within the healthcare facilities. It aims reduce and
prevent errors, risks and harm which occurred to individuals during health care service provision.
It is a significant aspect to deliver quality care services. Indeed, a clear consensus is there that
quality services of healthcare across the world must be people-centred, safe and effective. In
order to realise the benefits of good quality of healthcare, the services should be equitable,
efficient, integrated and timely (Patient Safety, 2019). To make sure successful execution of
strategies of patient safety, leadership capacity, clear policies, data to drive safety enhancements,
skilled healthcare professionals as well as effective involvement of individuals in care, all are
required.
As per the data provided by World Health Organisation, the adverse events occur because
of unsafe care is possibly one of the 10 main cause of disability and death in the world. It is
estimated that 1 in 10 individuals harmed when receiving hospital care in the high income
countries. The harm may cause due to range of adverse events. In the hospitals, around 134
million adverse events happen each year in low and middle-income nations because of unsafe
care, outcomes in around 2.6 million deaths (Patient Safety, 2019). It has been estimated in an
another study that around two third of adverse events outcomes from unsafe care as well as the
years lost to death and disability. As many as 4 in 10 individuals are harmed in outpatient and
primary Health Care all over the world. Up to 80 percent of harm is preventable (Wilfley, and et.
4

al., 2017). The errors associated with prescriptions, diagnosis and use of medications are the
most detrimental errors. Investments in declining harm to patient leads to significant savings in
terms of finance and provide better patient outcomes (Green, and et. al., 2017).
There are some situations due to which error takes place within the healthcare settings
including lack of standard procedures, poor communication between health care providers, lack
of involvement of patient, lack of verification prior to medication administration etc. All these
are the factors due to which errors occurs while providing care to the patient and this leads to
impact on the patient safety. In regards of the provided clinical case scenario of patient safety of
a frail patient, not emphasizing on the safety measures by Health Care providers leads to falling
down the patient from bed to floor and this resulted into fractured hip and he died. In that case,
the care providers in the ward was busy and not emphasized properly towards the safety of
patient (Kiani, Masimo Corp, 2016). They put in place the bed rails after asked by the family of
patient. This leads to adverse outcomes in that situation.
Clinical Leadership
The term leadership is mainly associated and related with an interactive process where the
followers are being motivated and influenced by the qualities and attributes of the leaders in
order to empower them to accomplish the specific goals. It has been analyses that clinical
leadership is important and vital concept as it focuses on patients and healthcare in a more vital
way to ensure patient safety and high quality care through applying better healthcare models and
utilising critical thinking (Leadership in Nursing: By Reem Nassar AL-Dossary, 2016).
The clinical leadership has been illustrated as a difficult and multifaceted process that
plays a vital role in influencing and enhancing safe patient culture within a clinical practice by
the way of providing effective support and directions along with collaborating and properly
coordinating all health and care services by the means of effective communication. Apart from
this, clinical leadership comprises of vital skills and attributes like critical thinking and effective
communication which plays a vital role in taking better decisions for safety of patients
(LoBiondo-Wood, and Haber, 2017). Further, the skills and attributes of effective
communication of clinical leadership also ensures better flow and transformation of information
among subordinates to guide and motivate them towards improved healthcare safety to create a
safe patient culture within clinical practice.
5

Beside this, it has been also observed that the Transformational leadership is taken as the
most frequently applied leadership theory in health care sector which best support this culture of
safety as it correlates with high-quality patient care and has a positive patient outcome. It has
been observed that the transformational leadership theory comprises of leadership where a leader
works and perform crucial activities with teams in order to identify all the needed and vital
change for creating a vision which support creation of health culture (Lynn, and Lynn, 2019).
Further, the transformational leadership also includes and proves an effective clinical leadership
to guide the change through inspiration along with effectively executing the change in tandem
with committed members of a group to effectively direct and inspire them towards improved
health and safety of Patients to support safe patient culture within clinical practice.
Further, the there are four factors to transformational leadership that are commonly
known as the “four I's of this leadership theory which includes idealized influence, inspirational
motivation, intellectual stimulation, and individual consideration (Sharma, and et. al., 2018).
These four factors and components of transformational leadership plays a vital role in supporting
safe cultural practises by the way of trusted and good decisions along with inspirational
motivation to encourage and boost team spirit. Beside this, intellectual stimulation encourages
and leads to high level of creativity and innovation to adopt and implicate more safe practises.
Further, the reason behind the fact that transformational leadership best support the safe culture
is based on reason that it leads and support a positive outcome through effective staff engaging
and low staff turnover which decreases inpatient falls and in-hospital infections along with
improving safety and quality of care through reducing patient care errors (Siu, Maran, and
Paterson-Brown, 2016).
Research & Evidence Based Practice (EBP)
The evidence based practice is referred as the conscientious, judicious and explicit
utilization of current evidence in making decisions regarding care of the patient. This means
integrating an individual clinical expertise with available external clinical evidence from
systematic study. It is not only about executing the best evidence to decision making, but also
utilizing skills, experiences and training get by the healthcare professionals as well as taking into
consideration the values and situation of patient (Steenkamp, 2016). Evidence based healthcare
practices is very significant as it aims to administer an effective care available with enhanced
patient outcomes. An evidence based practice promotes the enquiry attitude in health
6

professionals which assist in ensuring that the practices are informed through best available
evidence. Apart from this, evidence based practice also play a significant role in make sure that
finite health resources are utilized wisely as well as that relevant evidence is taken into
consideration when decisions are made regarding funding the health care services (Stomski, and
et. al., 2018).
In providing evidence based and high-quality care, patient centeredness concept is a
significant attribute that gained national prominence with Institute of Medicine Report Crossing
the Quality Chasm: a new system of healthcare for 21st century. It stated patient centeredness as
administering care which is respectful of as well as responsive to individual preferences, values
and needs of patient and make sure that the patient values direct all the clinical decisions
(Swanwick, and McKimm, 2017). Effective communication between patient and care provider
and shared decision making are the main elements of patient centered care. These elements need
that activated, informed and participatory patients as well as family members interact with the
team of patient-centered care that has effective skills of communication and is supported through
a well-organized, accessible and responsive system of health care.
CONCLUSION
As per the above mentioned report, it has been concluded that providing high quality care to
the patients help in improving their health outcomes. It is very important to measure and evaluate
the health care practices so that quality of care can be enhanced and patients are provided with
good experience of care. Proper awareness of situation is very important to ensure the safety of
patient within the health care settings. It is very crucial to provide patient with safe and effective
care so that a safe care environment can be developed around them. Ensuring the patient safety
involves reducing the errors related to medications and treatment. Patient safety is a very crucial
aspect within the healthcare settings that enables the care professionals in delivering high quality
care to the patients and accomplishing effective health outcomes.
REFLECTION
By performing this study in the module, I learnt so many things about the patient safety,
quality improvement and clinical leadership aspects. Apart from these aspects, I also gain
information regarding the areas associated with these. Since, all the individuals are currently
living in pandemic situation going on, it can be said that being a nursing student has had various
7

challenges. There are a number of issues I have had faced because of working in virtual world of
studying. By undertaking the module, I got placement in hospital where I got opportunity to
learn so many things and evolve as a student nurse. It also provided me with the opportunity to
accomplish my goals and objectives of completing the module in an effective way while
improving my knowledge base and learning experiences which could be utilised in my practice.
I learnt that proper awareness of situation is very much necessary so that effective decisions
can be taken and patient safety can be insured. I learnt that within the current health care services
provision, ensuring evidence based health care practices is important. It aims in rendering an
effective care with improved patient outcomes. It also plays crucial role in ensuring that
resources are utilized wisely and an appropriate evidence is taken into consideration while
making the decision. I also got to know about the significance of quality care in getting effective
outcomes. Having proper awareness of situation assist in analysing and contextualizing the
activity to improve the care delivery and performance of health care provider.
The overall learning that I get from the module highly contributed in improving my
knowledge base that will contribute in my future. It enables me in apply this learning in my
future nursing practice that further assist me in delivering high-quality care to the patient and
gaining more improved care outcomes. In addition to this, it also assisted me learning the
significance of clinical leadership in practice. It is a multifaceted process which plays significant
role in influencing and improving the safe patient culture within Health Care settings through
administering support and directions with collaborating and coordinating the care services by
using effective communication. The overall learning assists me ensuring evidence based practice
within the health settings by providing care to patient and taking informed decisions to ensure
high quality health care outcomes. The learning and knowledge which I gained from the module
also contribute in my career growth and development.
8

REFERENCES
Books and Journals
Ajay, V.S., & et. al., (2016). Development of a smartphone‐enabled hypertension and diabetes
mellitus management package to facilitate evidence‐based care delivery in primary
healthcare facilities in India: the mPower Heart Project. Journal of the American Heart
Association, 5(12), p.e004343.
Brooks, S.E. & Peetz, A.B., (2017). Evidence-based care of geriatric trauma patients. Surgical
Clinics, 97(5), pp.1157-1174.
Carayon, P. ed., (2016). Handbook of human factors and ergonomics in health care and patient
safety. CRC press.
Connolly, M., Jacobs, S. & Scott, K., (2018). Clinical leadership, structural empowerment and
psychological empowerment of registered nurses working in an emergency
department. Journal of nursing management, 26(7), pp.881-887.
Dekker, S., (2016). Patient safety: a human factors approach. CRC Press.
Dixon-Woods, M. & Pronovost, P.J., (2016). Patient safety and the problem of many hands. BMJ
quality & safety, 25(7), pp.485-488.
Fitzpatrick, S.L., & et. al., (2016). An evidence-based guide for obesity treatment in primary
care. The American journal of medicine, 129(1), pp.115-e1.
Gandhi, T.K., Berwick, D.M. & Shojania, K.G., (2016). Patient safety at the
crossroads. Jama, 315(17), pp.1829-1830.
Gauld, R., (2017). Clinical leadership: what is it and how do we facilitate it?. Journal of primary
health care, 9(1), pp.5-8.
Godlock, G., Christiansen, M. & Feider, L., (2016). Implementation of an evidence-based patient
safety team to prevent falls in inpatient medical units. MedSurg Nursing, 25(1), p.17.
Green, B., & et. al., (2017). Situational awareness–what it means for clinicians, its recognition
and importance in patient safety. Oral diseases, 23(6), pp.721-725.
Kiani, M.J.E., Masimo Corp, (2016). Patient safety system with automatically adjusting bed.
U.S. Patent 9,226,696.
LoBiondo-Wood, G. & Haber, J., (2017). Nursing research-e-book: methods and critical
appraisal for evidence-based practice. Elsevier Health Sciences.
Lynn, L.A. & Lynn, E.N., (2019). Patient safety processor. U.S. Patent 10,366,790.
Sharma, A., & et. al., (2018) Using digital health technology to better generate evidence and
deliver evidence-based care. Journal of the American College of Cardiology, 71(23),
pp.2680-2690.
Siu, J., Maran, N. & Paterson-Brown, S., (2016). Observation of behavioural markers of non-
technical skills in the operating room and their relationship to intra-operative
incidents. The surgeon, 14(3), pp.119-128.
Steenkamp, M.M., (2016). True evidence-based care for posttraumatic stress disorder in military
personnel and veterans. JAMA psychiatry, 73(5), pp.431-432.
Stomski, N., & et. al., (2018). The influence of situation awareness training on nurses'
confidence about patient safety skills: A prospective cohort study. Nurse education
today, 63, pp.24-28.
Swanwick, T. & McKimm, J., (2017). ABC of clinical leadership. John Wiley & Sons.
9

Wilfley, D.E., & et. al., (2017). Improving access and systems of care for evidence‐based
childhood obesity treatment: Conference key findings and next steps. Obesity, 25(1),
pp.16-29.
Online
Leadership in Nursing: By Reem Nassar AL-Dossary, 2016. [Online] Available Through:<
https://www.intechopen.com/books/contemporary-leadership-challenges/leadership-in-
nursing >.
Evaluation of quality improvement in health care, 2015. [Online]. Available through
<https://www.health.org.uk/publications/evaluation-what-to-consider>
Situational Awareness and Patient Safety, 2016. [Online]. Available through:
<https://psnet.ahrq.gov/web-mm/situational-awareness-and-patient-safety>
Patient Safety, 2019. [Online]. Available through: <https://www.who.int/news-room/fact-
sheets/detail/patient-safety >
10