of Thoracic Surgeons (2013) provides statistics about adult and congenital
heart surgery and for thoracic surgery patients. Organizations such as these
provide EBP guidelines for various disease entities, allowing subscribers to
review the latest information for protocol development and implementation
within the facility.
Another such organization is the Institute for Healthcare Improvement
(IHI). The IHI is a not-for-profit organization that targets healthcare im-
provements on a global level (IHI, 2013). IHI promotes the concept known
as “bundles” that are defined as a group of disease-specific interventions that
together have a larger impact on prevention of a complication or disease
(Resar, Griffin, Haraden, & Nolan, 2012). As an example, a reduction in the
incidence of ventilator-associated pneumonia (VAP) was proposed through
implementation of five interventions grouped together known as the “ven-
tilator bundle.” VAP is defined as a nosocomial pneumonia that develops
48 hours or longer after a patient has an artificial airway such as a tracheostomy
or endotracheal tube inserted (Centers for Disease Control and Prevention,
2017). VAP is the most serious complication of a three-tier surveillance defi-
nition for ventilator-associated events developed by the Centers for Disease
Control and Prevention (Magill et al., 2013). The mortality rate for patients
diagnosed with VAP ranges from 25% to 40%, and the diagnosis adds an
estimated cost of up to $40,000 to a hospital admission (Greene & Sposato,
2009). The ventilator bundle consists of these strategies: keeping the head of
the bed elevated at least 30 degrees at all times unless clinically contraindi-
cated, daily sedation vacations with assessments of weaning readiness, peptic
ulcer prevention, and deep vein thrombosis prophylaxis (AHRQ, 2011). To
evaluate VAP protocol, based on the ventilator bundle, an outcome could be
to reduce the incidence of VAP by 75%.
In the Magnet Recognition Program (ANCC, 2013), healthcare organiza-
tions are required to provide examples of nurse-sensitive quality indicators
as part of the application process or to maintain Magnet Recognition. There
are 14 components, known as Forces of Magnetism, that exhibit nursing
excellence. Table 18-3 lists these forces. For example, for a healthcare
organization to meet Force 7, Quality Improvement, evidence must show
that nursing staff members participate in CQI activities and that CQI is
perceived to improve care within the facility (ANCC, 2013). In addition,
the organization must provide examples of a change in nursing practice that
occurred as a result of data originating from fiscal, satisfaction, or clinical
outcomes. The following scenario demonstrates how one outcome can be
used to address mandates from the Joint Commission, IHI, and the Magnet
Recognition Program.KEY TERM
Forces of
Magnetism:
Qualities that
exhibit nursing
excellence478 CHAPTER 18 Evaluating Outcomes of Innovations