Evaluation of an Educational Intervention to Improve Inpatient - - PowerPoint PPT Presentation

Implementation and Evaluation of an Educational Intervention to Improve Inpatient Nurses’ Knowledge of Inhaler Technique

Alyssa Wislander, DNP , ACNP , CPNP

Introduction – Alyssa Wislander, DNP

 Associates Degree from Blackhawk College  Bachelor’s of Science degree from University of Iowa  Master’s Degree at University of Illinois in Chicago – Acute

Care Nurse Practitioner

 Post-Master’s Degree at University of Illinois in Chicago –

Pediatric Nurse Practitioner

 Doctorate of Nursing Practice, University of Illinois at

Chicago

Doctorate of Nursing Practice

 Translate evidence based care into practice  Systems based leadership  Changing demands of the nation’s complex health care

system, higher standards of quality care and concerns

• ver patient safety

 Nursing moving in the direction of doctoral practice the

same as pharmacy, physical therapy, psychology, dentistry, medical doctorate, and audiology

Doctorate of Nursing Practice

 Practice doctorate requires utilizing evidence based

practice

 Assessing “normal” practice and applying evidence based

practice

 Increase quality health care  Decrease patient errors  Improve patient outcomes  Decrease readmissions  Reassessing after initiating change of practice

Nature and Scope

 COPD and asthma account for the largest proportion of

lung disease in the United States1

 Uncontrolled COPD and asthma result in significant

economic burdens1,2

 Nurses are the first-line educators for inpatients with

these diagnoses

 Inpatient nurses are shown to lack inhaler competence3  Web based educational interventions have been effective

in improving nursing knowledge of inhaler technique4

Purpose of Project

This project was implemented to increase

inpatient nurse knowledge and competence

• f hand-held inhaler technique to improve

COPD and asthma patient teaching and clinical outcomes

Synthesis of Literature

 Databases reviewed: CINAHL,

PubMed (2006-2016), GOLD guidelines (2011) and Asthma Guidelines (NAEPP , 2011)

 GOLD guidelines and NAEPP

guidelines recommend assessment

• f inhaler technique with each

visit5,6

 COPD and asthma patients have a

high rate of inhaler misuse leading to mismanaged disease and increased economic burden7

 Nurses are not able to demonstrate

inhaler technique competently3

 Web-based education is successful

in reducing inhaler misuse with inpatient nurses4

 Nurses report enjoying

convenience and flexibility of

• nline education, modules, audio-

visual and text4

Recent data

 A project performed by recent

UIC students found nurse self assessment of inhaler knowledge is not congruent with demonstrated ability3

 These nurses found a high rate

• f inhaler misuse (82 and 92%)

when assessed via demonstration

 Furthermore, McVey & Slana,

also UIC students, utilized this data to implement a web-based educational intervention for inpatient nurses

 This intervention proved to

successfully decrease inhaler misuse with inpatient nurses(from 78% to 30%)4

Local considerations

 Midwestern community based hospital with 150

beds

 No current assessment or education of inpatient

nurses on inhaler technique

 This hospital was invested in nurse-led patient

education to improve patient outcomes

 Utilizing the evidence of acceptability and

efficacy of online learning, current web-based educational resources were utilized to implement this project

Process

 27 inpatient nurses were part of project  Evaluated nurses knowledge level of MDI (metered dose inhaler)

and DPI (dry powdered inhaler-Diskus device) inhalers via demonstrated checklist provided by Lippincott

 Nurses completed evidence based on-line educational

intervention on inhaler technique

 Intervention was provided by an educational system already

part of the hospital education system, however not currently utilized for inhaler teaching

 Nurses were re-evaluated with the same checklist 1 month post

education

 Likert questionnaire assessed perception, ease of use, change

in nursing practice

Evaluation Criteria

 Outcome evaluation included demonstrative

knowledge before education with MDI and DPI compared to knowledge post education

 Data analysis included the quantitative paired t-

test

Project Outcomes

Errors centered on proper breathing techniques

 Misuse rates pre-intervention

were 53% and 56% for MDI and DPI respectively

Improvement was appreciated in all areas

 Misuse rates decreased to 5%

(p<0.001) and 10% (p<0.001) after viewing the educational intervention

Nursing Perception

 Nurses felt module had a positive impact on

patient outcomes

 Reported regularly using the information  Nurses felt empowered to positively influence

patient education

 Reported ease of use with on-line education  Low percentage of nurses reported wanting a

demonstrative video to augment the education

Recommendations

 Utilize education for inhaler technique as a yearly

competency and expand to other departments

 Encourage nursing practice change to include education of

inhaler use system wide

 Encourage nurses to assess patient inhaler competency for

all COPD and asthma inpatients with every visit as recommended in the practice guidelines

 Assess inhaler competency effectiveness longitudinally for

evidence of decreased COPD readmissions and decreasing economic burden

Limitations

 Small study – 27 nurses  Assessed nurses during working hours – may have

been distracting

 The web based education did not have a video

demonstration which would have augmented education of nurses with different learning styles

Reporting of Project Outcomes

 Currently working on manuscript for submission to Journal

• f Nursing Administration for publication

Acknowledgements

 Genesis Health System  Genesis Illini  Bette Wigand, RN, MS – Hospital committee member  University of Illinois at Chicago  Susan Corbridge, PhD, APN, FAANP and Catherine Ryan,

PhD, APN, CCRN, FAHA – committee members

 Kathleen Sparbel, PhD, FNP-BC and Catherine Tredway,

MS, MBA, BA, RN – manuscript assistance

References

1.

Centers for Disease Control. (CDC). What is COPD? 2015. http://www.cdc.gov/copd/. Accessed January 11, 2015.

2.

Centers for Disease Control and Prevention. (CDC). Asthma’s impact on the nation.

• 2014. http://www.cdc.gov/asthma/. Accessed January 11, 2015.

3.

DeTratto K, Gomez C, Ryan CJ, Bracken N, Steffen A, Corbridge SJ. Nurses’ knowledge of inhaler technique in the inpatient hospital setting. Clin Nurse Spec. May/June, 2014: 156-160.

4.

McVey A, Slana, J. Improving nurses’ knowledge of inhaler technique in the inpatient hospital setting through web-based education. Unpublished data. 2015.

5.

Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013: 187(4): 347-365.

6.

National Heart and Lung Blood Institute. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program. Washington, DC: US Department of Health & Human Services; 2007.

7.

Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. 2011; 26(6): 635-642.