Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

(^66) Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines, Third Edition
■■ Why are we doing this practice, and should we be doing it this way?
■■ Is there a way to improve this practice so that it is more efficient or more
cost-effective?
■■ How can we improve the quality, safety, and cost of our practice?
Practice problems can emerge from multiple sources. Titler et al., in two clas-
sic publications (1994, 2001), identified problem-focused or knowledge-focused
triggers as sources of problems. Problem-focused triggers are those identified by
staff during routine monitoring of quality, risk, financial, or benchmarking data
or adverse events. Knowledge-focused triggers are identified by reading published
reports or learning new information at conferences or professional meetings (see
Table 4.1).
Table 4.1 Sources of Evidence-Based Practice Problems
Trigger Sources of Evidence-Based Practice Problems
Problem-focused Financial concerns
Evidence for current practice questioned
Quality concern (efficiency, effectiveness, timeliness, equity, patient-
centeredness)
Safety or risk management concerns
Unsatisfactory patient, staff, or organizational outcomes
Variations in practice compared with external organizations
Variations in practice within the setting