Evidence-Based Change Process in Pediatric Nursing

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Table of Contents

Discovery
Summary
Translation
Implementation
Evaluation

Discovery

The topic and the nursing practice issue related to this topic

The topic is the performance of an ECG for pediatric patients with primary complaints of Chest pain in the emergency room within the first 10 minutes of arrival. The nursing practice issue is that RNs are usually in charge of performing the ECG.

The rationale for the topic selection and the scope of the problem

The American Heart Association recommends all patients in the emergency room setting with symptoms of heart-related issues receive an initial ECG in the first 10 minutes of presentation. However, there are many cases when this essential test has been delayed due to various reasons. It is crucial to develop specific guidelines and standards according to which this recommendation will be followed firmly for pediatric patients in the mentioned setting.

Summary

The practice problem and PICOT question

PICOT question:

P=Population of patients: pediatric ages 8-18 years with a primary complaint of Chest pain in the emergency room.
I=Intervention: Perform ECG within the first 10 minutes of arrival.
C=Comparison: Compare ECGs within 10 minutes of arrival to ED and delayed ECGs.
O=Outcome: Decrease cardiac events in pediatric patients.
T=Timeframe: 6 months.

Other sources used for data and information

Tabner, A., Jones, M., Fakis, A., & Johnson, G. (2021). Can an ECG performed during emergency department triage and interpreted as normal by computer analysis safely wait for clinician review until the time of patient assessment? A pilot study. Journal of Electrocardiology, 68, 145–149.

Jain, P. G., & Chaouki, A. S. (2018). The use of electrocardiography in the emergency department. Clinical Pediatric Emergency Medicine, 19(4), 317–322.

The sources contain significant findings on the necessity of performing ECG in the emergency room as soon as possible.

The main findings from the systematic review and the strength of the evidence

The findings suggest that in many cases, physicians and nurses tend not to follow the recommendation of performing ECK for pediatric patients within 10 minutes after arrival at the emergency setting. They pay more attention to collecting anamnesis, which may result in insignificant patient outcomes.

The evidence is reliable, given that the sources appeal to the most recent trends in the framework of healthcare and suggest many significant solutions. The reviewed sources also demonstrate a great extent of generalizability as the investigations have a broad scope and appeal to many particular cases.

Evidence-based solutions for the trial project

The essential solution is to develop mandatory guidelines and standards that will oblige healthcare professionals to perform ECG for pediatric patients within 10 minutes after arrival at the emergency setting.

Translation

Care standards, practice guidelines, or protocols to support the intervention planning

The initial value is patient-centered caring, which implies putting a client’s needs first place. This is visible from the fact that the current approach toward performing ECG for pediatric patients with possible heart-related issues in the emergency room setting will be advanced with the described intervention. Then, the clinic’s administration should pay attention to ECG scheduling so that the interests of all patients can be taken into account.

Stakeholders and their roles and Responsibilities in the change process

Head of the emergency department (project surveillance)
Nurses-managers (schedule and standards development)
Physicians (ECG performance)
Nurses (ECG performance, reporting)

The nursing role in the change process

I will be responsible for reporting measurable outcomes of the project.

Stakeholders by position titles

The head of the emergency department will give permission to implement the changes and supervise the trial. Nurses-managers will develop updated standards and arrange the project’s schedule. Nurses and physicians will follow the new obligatory rules and report results.

Cost analysis needed prior to a trial

The benefit-cost analysis will be needed; managers will do calculations while IT specialists will provide the necessary data.

Implementation

The process for gaining permission to plan and begin a trial

The request will be sent to the head of the emergency department to implement the changes related to the issue of cardiac events in the emergency room setting. An exhaustive action plan – as well as an evidence-based report on the benefits – will be provided to them as well. They will decide upon the appropriateness of the project.

The plan for educating the staff about the change process trial

During the initial stages of the project, the staff will obtain manuals on the updated standards regarding ECG performance. Then, seminar nurses-managers will be organized. The staff will pass a specific test before starting the trial.

The implementation timeline for the change process

Start time: November 1, 2022; end time: May 31, 2023.
Month 1: Staff education, preparing the necessary standards.
Month 2: Technical implementation of the standards; testing staff.
Month 3-5: Practice that follows the new standards; reporting.
Month 6: Gathering the results, data comparison, outlining further directions.

The measurable outcomes based on the PICOT

The measurable outcome is the decreased number of pediatric patients who have heart-related issues in the emergency room setting. This will be measured using the nurses’ reports.

Forms for recording purposes during the pilot change process

No specific forms will be needed.

Resources available to staff during the change pilot

Manuals on the updated standards.

Meetings of certain stakeholders throughout the trial

No meetings will be necessary throughout the trial.

Evaluation

The outcomes of the trial

RNs will fix their practice in the reports regarding telemedicine patients.

The next steps for the use of the change process information

A possible expansion of the standards toward adults and the elderly population.

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