Evidence-based Practice for Quality Improvement- Sampling

Situation: You are a DNP raduate  who is functioning in an education position in a large teaching medical center that is university-affiliated. You are concerned that the IV catheter insertion technique and orientation program currently being used with new registered nurses is not as effective as other methods.

1. What the plan for improvement. What will you do?

2. How to perform a systematic review of the evidence on this subject

3. How to design a new clinical practice guideline for the facility once the systematic review is complete

Evidence-based Practice for Quality Improvement- Sampling

The Plan for Improvement

            The IV catheter insertion is an everyday procedure essential for intravenous therapy, which is an effective and fast-acting way of administering medications or fluid during an emergency or when patients are unable to take their medications orally. Correct insertion of an IV catheter is important due to the risk of complications such as dislodgement, extravasation, occlusion, and phlebitis. The complications increase the risk of pain and failure to successfully deliver medication and catheter-related bloodstream infections (Simpson & Zersen, 2023). Therefore, it is important that healthcare providers, especially nurses, are well equipped with the necessary knowledge and skills on the most effective insertion techniques to increase patient safety.

            In the current case, the insertion techniques and orientation program being utilized is not effective as other methods hence the need for a change. I intend to initiate a quality improvement project that seeks to implement evidence-based interventions that will be more effective than the current interventions. I intend to conduct data analysis on the current technique used and identify weaknesses and negative effects on patient care and outcomes. A quality improvement project must support the need for change by identifying how the current status quo does not meet the needs of the facility and patients and the need for change. The proposed change must be supported by evidence to ensure that it will be more effective. I intend to write a proposal recommending new changes and the adoption of EBP to improve outcomes and increase patient safety. I intend to incorporate the views of the nurses on the current technique and the implementation program. I will also conduct research on evidence-based techniques and other interventions that are more effective and efficient than the current practices.

How to Perform a Systematic Review of the Evidence on the Subject

            A systematic review has a high level of evidence, as illustrated in the evidence-based pyramid. Therefore, a well-conducted systematic review is a feasible solution that keeps health clinicians updated and ahead on contemporary evidence-based medicine (Tawfik et al., 2019). To obtain an adequate and high level of evidence, one must follow certain steps to ensure they obtain relevant and adequate evidence. The recommended steps include framing the question, identifying the relevant work, appraising the studies’ quality, summarizing the evidence, and interpreting the evidence obtained.

            The first basic step in conducting a systematic review is framing the research question and identifying the objectives of the review. According to Tawfik et al. (2019), the research question for a systematic review should be feasible, novel, interesting, ethical, and relevant. One can formulate the research question by using two major tools, including PICO and SPIDER. The PICO tool is recommended for quantitative evidence synthesis and clinical trials, while the SPIDER tool is recommended for qualitative and mixed-method searches. The tools can also be combined to enable a comprehensive search based on time and resource limitations. After formulating a research question, preliminary research and idea validation is recommended to ensure the validity and duplication of questions that have been addressed. The preliminary search can be completed by simply searching various databases such as PubMed or Cochrane. Current guideline recommends that two databases be used for a systematic review (Tawfik et al., 2019).

            Another basic step is developing inclusion and exclusion criteria. The inclusion and exclusion criteria can be based on various factors such as year of publication, study setting, language, availability of the full article, research topics, and other relevant factors and study purpose. According to Owens (2021), an exhaustive search can be completed through a three-step process involving predetermining relevant databases and key terms to be used, searching the keywords and index terms across all the appropriate databases, and expanding the search by extending the search to the reference list in the previous studies. A systematic review is usually a complex process involving hundreds or thousands of articles. The adoption of electronic data management products in a systematic review is recommended to organize and analyze the information retrieved due to the potential to increase the review process’s efficiency and the review’s accuracy (Tawfik et al., 2019).

            Evaluating the risk of bias in the included studies is also essential to ensure the validity of the evidence obtained. Tools such as the Cochrane Rob Tool should be used to evaluate bias. The quality of the studies can be assessed by subjecting the studies to more refined quality assessment using general critical appraisal guides and other designed based quality checklists. A summary of the evidence should then be obtained. Data analysis should comprise tabulation of the study characteristics, quality of the studies and effects, and the statistical methods. There should also be an exploration of heterogeneity and its sources. Interpretation of the findings would include a discussion of the gathered evidence comprising the validity, strengths, and weaknesses and the potential bias of the review (Tawfik et al., 2019). After interpretation, a conclusion should be made based on the evidence obtained. The conclusion based on evidence determines the appropriateness of the recommended evidence-based change or intervention.

Designing A New Clinical Practice Guideline for the Facility

            Clinical guidelines can be described as systematically developed statements that are intended to influence decisions (Tetreault et al., 2019). The statements or recommendations can only be acceptable and adopted to influence clinical practice if they are informed by a systematic review of the literature and are developed using a rigorous methodology. The quality of the evidence obtained is a great determinant of the effectiveness of the recommendations in improving clinical practice. The recommendations must address the current problem faced in clinical practice for them to be relevant and acceptable. It is also essential to involve the impacted stakeholders to increase acceptability.

            There are various steps that must be taken in designing and developing a clinical practice problem. The process starts with topic identification. After topic selection, there would be a panel selection where all the impacted stakeholders would be involved, and their interests would be disclosed to ensure no conflict of interest. The most important step is document development, which comprises five major steps. Designing clinical practice guidelines requires stating the specific objectives, the role, and the scope of the document. Questions that should be asked when designing the guideline include the purpose of the guideline, targeted procedures or interventions, clinical objectives, target patient population, potential benefits, and expected outcomes. After the concerns are addressed, the next step is constructing the guideline by making a recommendation. The recommendations should be supported by evidence from the systematic review. Following the recommendations is an internal and external review that should be conducted to determine whether the recommendations made are feasible, acceptable, and consistent.


Owens, J. K. (2021). Systematic reviews: a brief overview of methods, limitations, and resources. Nurse Author & Editor31(3-4), pp. 69-72. https://onlinelibrary.wiley.com/doi/abs/10.1111/nae2.28

Simpson, S. E., & Zersen, K. M. (2023). Incidence and type of peripheral intravenous catheter complications documented in Hospitalised dogs. Journal of Small Animal Practice64(3), 130-135.


Tawfik, G. M., Dila, K. A. S., Mohamed, M. Y. F., Tam, D. N. H., Kien, N. D., Ahmed, A. M., & Huy, N. T. (2019). A step-by-step guide for conducting a systematic review and meta-analysis with simulation data. Tropical Medicine and Health47(1), 1–9. https://tropmedhealth.biomedcentral.com/articles/10.1186/s41182-019-0165-6

Tetreault, L., Nater, A., Garwood, P., Badhiwala, J. H., Wilson, J. R., & Fehlings, M. G. (2019). Development and implementation of clinical practice guidelines: an update and synthesis of the literature with a focus on application to spinal conditions. Global Spine Journal9(1_suppl), 53S-64S. https://journals.sagepub.com/doi/pdf/10.1177/2192568219831689

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