Essentials of Evidence-Based Practice Essay

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Essentials of Evidence-Based Practice Essay

The Assignment (Evidence-Based Project) Part 3A: Critical Appraisal of Research Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3. Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented. Part 3B: Critical Appraisal of Research Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research. Use order # 225984 and # 225699 as reference for this assignment. And I will upload the template to use to complete the assignment. Essentials of Evidence-Based Practice Essay

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Essentials of Evidence-Based Practice: Critical Appraisal of Research on the Prevention of Device-Associated Hospital Infections

Part A: Critical Appraisal of Research Articles Matrix

Full APA formatted citation of selected article.

Article #1

Article #2

Article #3

Article #4

Araujo da Silva, A.R., Marques, A.F., Biscaia di Biase, C., Zingg, W., Dramowski, A., & Sharland, M. (2018). Interventions to prevent urinary catheter-associated infections in children and neonates: A systematic review. Journal of Pediatric Urology, 14(6), 556.e1-556.e9. https://doi.org/10.1016/j.jpurol.2018.07.011

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: A systematic review of barriers and facilitators and strategic behavioural analysis of interventions. Implementation Science, 15(44), 1-22. https://doi.org/10.1186/s13012-020-01001-2

Blot, K., Bergs, J., Vogelaers, D., & Blot, S. (2014). Prevention of central line-associated bloodstream infections through quality improvement interventions: A systematic review and meta-analysis. Clinical Infectious Diseases, 59(1), 96-105. https://doi.org/10.1093/cid/ciu239

Wang, H., Tong, H., Liu, H., Wang, Y., Wang, R., Gao, H., Yu, P., Lv, Y., Chen, S., Wang, G., Liu, M., Li, Y., Yu, K., & Wang, C. (2018). Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: A systematic review and network meta-analysis. Annals of Intensive Care, 8(71), 1-12. https://doi.org/10.1186/s13613-018-0416-4

Evidence Level *

(I, II, or III)

Level I

Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

There is not one mentioned in the article. Implicitly, CAUTI in neonates and children are preventable through specific evidence-based interventions.

Not stated in the article. Implicitly, knowledge of barriers and facilitators is crucial in planning interventions for the prevention of CAUTI.

Not explicitly stated in the article. Implicitly, quality improvement (QI) initiatives will help reduce the incidence of CLABSI.

Not mentioned in the article but implied. Coating the central lines used in intensive care may have a role in preventing central-line infections acquired in the hospital setting.

Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

A systematic review.

Inclusion criteria: publication between 1995 and 2017, quantitative studies, qualitative studies, time series analyses, non-controlled and controlled before and after studies.

Exclusion criteria: abstracts, expert opinions, notes, letters, case series, and reviews.Essentials of Evidence-Based Practice Essay

A systematic review.

Inclusion criteria: publication from 1995 onwards, empirical qualitative studies, empirical quantitative studies, articles reporting barriers/ facilitators, publication in English.

A systematic review and meta-analysis

Inclusion criteria: publication between 1995 and 2012, participants to be adult ICU patients with central line catheters, and English language publications only.

A systematic review and network meta-analysis.

Inclusion criteria: publication before July 2017, publication in all languages.

Sample/Setting

The number and characteristics of

patients, attrition rate, etc.

Sample: n = 6 studies

Setting: Electronic research databases.

Sample: n = 25 studies

Setting: England (NHS)

Sample: n = 43 studies involving 584 ICUs.

Setting: Electronic research databases.

Sample: n = 33 RCTs with a total n = 10,464 patients.

Setting: Electronic research databases.

Major Variables Studied

List and define dependent and independent variables

Independent variable: CAUTI prevention intervention.

Dependent variable: CAUTI incidence in neonates and children.

Independent variable: Barriers or facilitators

Dependent variable: Development of CAUTI.

Independent variable: QI interventions

Dependent variable: Development of CLABSI.

Independent variable: Central catheter coating with an antimicrobial.

Dependent variable: occurrence of CRBSIs

Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

PRISMA model

· COM-B model

· Theoretical Domains Framework (TDF)

· Behavior Change Wheel (BCW)

· Behavior Change Techniques Taxonomy (BCTTv1)

· Random-effects meta-analysis with the DerSimonian-Laird estimator.

· Higgins I² test

· Meta-regression

· Univariate analysis

· PRISMA protocol

· Mantel–Haenszel method

· Cochrane Q and I-square tests

· Higgins-Thompson method

· Brooks–Gelman–Rubin diagnostic.

Data Analysis Statistical or

Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

· Multimodal strategy (4 studies)

· Periurethral cleaning (1 study)

· Barriers: environment, beliefs, knowledge, social influences, memory, and attention.

· Interventions for CUTI reduction = 11

Stronger CLABSI risk reduction for trials with care bundles (p = 0.026).

· Significant differences in the rate of CRBSIs per 1,000 catheter days between antimicrobial-coated and standard CVCs (p = 0.008).

Findings and Recommendations

General findings and recommendations of the research

A multimodal strategy for CAUTI reduction in neonates and children is effective.

Effective CAUTI prevention strategies target social, environmental, and motivational influences.

QI interventions contribute to the reduction of CLABSI. Therefore, QI measures should be used to prevent the occurrence of CLABSI as a HAI.

Antimicrobial-impregnated central catheters were associated with a reduced rate of CRBSIs per 1,000 catheter days. CVCs should therefore be coated with an antimicrobial.

Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

This research is very useful for streamlining clinical practice.

Its strength is that it is providing the highest level of evidence for CAUTI prevention as a systematic review. The limitation is that the sample of only 6 studies was quite small, possibly impacting validity and reliability.

The risk associated with the implementation of the study recommendations is that the cost of hospitalization may go higher because of the multimodal strategy measures. Essentials of Evidence-Based Practice Essay

The feasibility of use in practice is high for the recommendations.

The study builds on available evidence-based practice (EBP) knowledge.

Its strength is its high evidentiary value as a systematic review. Its limitation is not being an original primary study.

The risk of implementing the study findings is a lack of specificity that may make the interventions unsuccessful.

It is feasible to implement the measures in practice.

This study is valuable for clinical practice.

Being a systematic review and meta-analysis, its strength is the high evidentiary value. Its limitation is being a filtered research project.

There is no foreseeable risk in implementing QI initiatives.

Practical application of the recommendations is feasible.

The study has a lot of value in building the body of knowledge for EBP.

Its strength as a systematic review and network meta-analysis is in the fact that it offers the highest possible evidence for antimicrobial-impregnated central catheters. The limitation is that it is not original but filtered research.

The main risk of implementing the study recommendations is antibiotic resistance.

Nevertheless, the implementation of the findings is feasible in clinical practice.

Key findings

Multimodal strategy is effective in reducing CAUTI in neonates and children.

CAUTI prevention strategies target social, environmental, and motivational influences.

QI initiatives improve outcomes when it comes to CLABSI prevention.

Antimicrobial-impregnated central catheters prevent CRBSIs.

Outcomes

Lower rates of CAUTI in children and neonates.

Mitigated barriers and augmented facilitators to CAUTI prevention measures.

Lower CLABSI rates with the implementation of QI measures.

Lower rates of CRBSIs.

General Notes/Comments

The research findings help to build EBP knowledge (Melnyk & Fineout-Overholt, 2019).

The study improves clinical practice by recommending evidence-based interventions (Melnyk & Fineout-Overholt, 2019).

This study is important in terms of EBP (Melnyk & Fineout-Overholt, 2019).

The study improves evidence-based practice (Melnyk & Fineout-Overholt, 2019).

Part B: Narrative Critical Appraisal of Research

Device-associated hospital-acquired infections are a major burden to healthcare systems across the world. They are a quality improvement issue with the rates of these infections such as CAUTIs, CLABSIs, and CRBSIs serving as quality benchmarks for healthcare organizations. The four studies critically analyzed in the matrix above present enough evidence for several interventions that can reduce and prevent the rate of occurrence of these hospital-acquired infections or HAIs. What is even more significant is the realization that all the four studies are systematic reviews and meta-analyses. This means that they are providing the highest level of evidence possible for the efficacy of these interventions. For this reason, here is a synopsis of the best practice recommendations as presented by these four peer-reviewed articles:Essentials of Evidence-Based Practice Essay

The utilization of a multimodal strategy in combating CAUTI rates in pediatrics is effective in reducing CAUTI in neonates and children (Araujo da Silva et al., 2018). In other words, this is a bundled or multipronged approach.
Effective CAUTI prevention strategies should target social, environmental, and motivational influences as a priority (Atkins et al., 2020). This is where barriers and facilitators are found.
High-threshold evidence exists to support the fact that QI initiatives improve outcomes when it comes to CLABSI prevention (Blot et al., 2014). All healthcare settings with critical care units should therefore have protocols for QI as a matter of course.
Using antimicrobial-impregnated central catheters is effective and efficient in preventing CRBSIs (Wang et al., 2018). This should be a consideration to replace the conventional central venous catheters or CVCs.

References

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Essentials of Evidence-Based Practice Essay

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