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 over 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 States 1  Uncontrolled COPD and asthma result in significant economic burdens 1,2  Nurses are the first-line educators for inpatients with these diagnoses  Inpatient nurses are shown to lack inhaler competence 3  Web based educational interventions have been effective in improving nursing knowledge of inhaler technique 4

Purpose of Project  This project was implemented to increase inpatient nurse knowledge and competence of hand-held inhaler technique to improve COPD and asthma patient teaching and clinical outcomes

Synthesis of Literature  Databases reviewed: CINAHL,  Nurses are not able to demonstrate PubMed (2006-2016), GOLD inhaler technique competently 3 guidelines (2011) and Asthma  Web-based education is successful Guidelines (NAEPP , 2011) in reducing inhaler misuse with  GOLD guidelines and NAEPP inpatient nurses 4 guidelines recommend assessment  Nurses report enjoying of inhaler technique with each convenience and flexibility of visit 5,6 online education, modules, audio-  COPD and asthma patients have a visual and text 4 high rate of inhaler misuse leading to mismanaged disease and increased economic burden 7

Recent data  A project performed by recent  Furthermore, McVey & Slana, UIC students found nurse self also UIC students, utilized this assessment of inhaler data to implement a web-based knowledge is not congruent educational intervention for with demonstrated ability 3 inpatient nurses  These nurses found a high rate  This intervention proved to of inhaler misuse (82 and 92%) successfully decrease inhaler when assessed via misuse with inpatient demonstration 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 Improvement was breathing techniques appreciated in all areas  Misuse rates pre-intervention  Misuse rates decreased to 5% were 53% and 56% for MDI and (p<0.001) and 10% (p<0.001) DPI respectively 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 of 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 Centers for Disease Control. (CDC). What is COPD? 2015. 1. http://www.cdc.gov/copd/. Accessed January 11, 2015. Centers for Disease Control and Prevention. (CDC). Asthma’s impact on the nation. 2. 2014. http://www.cdc.gov/asthma/. Accessed January 11, 2015. DeTratto K, Gomez C, Ryan CJ, Bracken N, Steffen A, Corbridge SJ. Nurses’ 3. knowledge of inhaler technique in the inpatient hospital setting. Clin Nurse Spec. May/June, 2014: 156-160. McVey A, Slana , J. Improving nurses’ knowledge of inhaler technique in the 4. inpatient hospital setting through web-based education. Unpublished data. 2015. Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, 5. management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013: 187(4): 347-365. National Heart and Lung Blood Institute. Expert Panel Report 3: Guidelines for 6. the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program. Washington, DC: US Department of Health & Human Services; 2007. Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized 7. patients with asthma or COPD. J Gen Intern Med. 2011; 26(6): 635-642.