CP Week 8 Discussion This week you will be working on an evaluation plan that will be attached to your EBP in Week 9. Remember, you are working through thi

CP Week 8 Discussion This week you will be working on an evaluation plan that will be attached to your EBP in Week 9. Remember, you are working through this process–you have a question, you found evidence for support in putting this into practice–you implemented a plan to put this into practice now you are evaluating how it worked in your practice!

Submit your Evaluation Plan to the DB –listed as 1-2-3…  (Remember you are evaluating the change to your practice not the PICOT)

 We used a PICOT question to assist us in our search for evidence–thus making you think there is research involved in your project.  In truth, I can understand the confusion–but the purpose of the PICOT is to assist in your search for support in implementing the change.  Once you have the support then you are evaluating the change not the question. Evaluating and Disseminating the Impact of an Evidence-Based
Intervention: Show and Tell

After the data are gathered and analyzed, it’s time to share what
you’ve learned.

This is the 11th article in a series from the Arizona State University College of Nursing and Health Innovation’s Center for
the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery
of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient pref-
erences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality
of care and best patient outcomes can be achieved.

The purpose of this series has been to give nurses the knowledge and skills they need to implement EBP consistently, one
step at a time. The final article in the series will be published in the September issue.

In the previous article in this series, Carlos A., Rebecca R., and Chen M. completed the
unit-based pilot phase of the
rapid response team (RRT) roll-
out. They found that the RRT
worked well, and they are now
ready to evaluate its impact on
their chosen outcomes. The hos-
pital leadership as well as the staff
had agreed upon the following
outcomes: code rates outside the
ICU (CRO), unplanned ICU ad-
missions (UICUA), and hospital-
wide mortality rates (excluding
do-not-resuscitate situations)
(HMR). Karen H., the nurse from
the Clinical Informatics Depart-
ment, and the pilot unit’s quality
council representative devised
a mechanism to successfully ex-
port the RRT data from the elec-
tronic medical record (EMR) to
a database that would serve as
a repository until the data could
be analyzed. The other depart-
ments collecting RRT outcomes
data have been forwarding their
information to Rebecca and Chen,
who’ve asked Karen for help
in getting this additional data
onto the hospital’s quality dash-
board. Karen suggests that she

and the EBP team meet to discuss
ways to upload all of the data to
one place and create a single com-
prehensive and regularly available
summary of the RRT outcomes.

At that meeting, Karen suggests
that the EBP team work out a plan
with the Quality/Performance
Improvement Department to
analyze the data before they’re
posted on the dashboard, where
they’ll be available to everyone
on the hospital intranet. The EBP
team members share their excite-
ment about taking the next step
in the EBP implementation pro-
cess. But when Carlos contacts
the director of the department,
the director informs him that it
may be impossible for quality/
performance improvement to
take on this project at this time,
as their analysts are already over-
loaded with work. Chen mentions
that she’s heard that university
researchers may be interested in
these kinds of projects, and that
collaboration with a university
might lead to further projects,
which could keep the kind of ex-
citement generated by the RRT
initiative going. Carlos says that
he has some connections at the

local university and offers to dis-
cuss this opportunity with them.

GATHERING AND EVALUATING
THE RESULTS
Carlos calls the dean of research at
the hospital’s academic partner to
inquire about interest in collabo-
rating on the RRT project, particu-
larly from a research perspective.
The dean says there’s a researcher
who is very interested in the pro-
cesses of codes and may want to
get on board with their project.
Carlos asks about data analysis
and interpretation as part of that
collaboration, and the dean replies
that the university has resources
they can use to accomplish that
part of the evaluation process.
Carlos lets Rebecca and Chen
know of this opportunity and
sends an e-mail to Debra P., the
faculty researcher, outlining the
RRT project and asking if she’s
interested in participating. Debra
responds the next day, indicating
her delight to be involved. The
EBP team is excited that they’ll
have this opportunity to partner
with the local university and ac-
complish their goal of performing
data analysis.

56 AJN ▼ July 2011 ▼ Vol. 111, No. 7 ajnonline.com

By Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN,
Lynn Gallagher-Ford, MSN, RN, NE-BC, Bernadette
Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP,

FAAN, and Susan B. Stillwell, DNP, RN, CNE

Carlos discusses the initial RRT
data with Debra, and they ana-
lyze it together. First, they look
at the mean outcomes of CRO,
HMR, and UICUA that were ob-
tained from the real-time RRT re-
ports. When they compare these
outcomes over time, they see that
the mean CRO was reduced, but
that the mean HMR and UICUA
hadn’t changed from baseline.
Debra asks whether there was
any variation in the occupancy
rate over the period of the pilot
rollout; if there was, then the
proportion of patients experienc-
ing codes before and during the
rollout might not be comparable.
When Carlos replies that the oc-
cupancy rate remained consistent,
Debra recommends that they
conduct an independent t test to
see if there’s a statistically signifi-
cant difference between CRO be-
fore and after the pilot phase. They
find that the decrease in CRO is
statistically significant, which
means that the RRT had a posi-
tive effect on this important out-
come that most likely wasn’t a
chance finding. The EBP team
can’t wait to share this great news
with the unit. The team reviews
with Debra the code records and
RRT comments to determine if

there were any RRT processes
that might have had an impact on
UICUA and HMR, and thereby
explain the lack of a change from
baseline. The team also provides
Debra with questions about how
the pilot went (who called the
RRT and why? what challenges
did the RRT face?) that they be-
lieve would be important to ask
the stakeholders during the de-
briefing after the pilot. Debra
says that these questions will be
very helpful as she looks over the
RRT processes. Having them in
mind, she can see if the answers
exist in the current data, if more
data need to be gathered, or if
further questions need to be
asked.

After taking time to reflect on
these processes, the EBP team
works with Debra to revise them.
Debra explains that it’s impor-
tant to plan the hospital-wide
rollout so that all unit managers
and staff are confident they un-
derstand the protocol, processes,
and desired outcomes. They ask
Pat M., the manager of the pilot
unit, and two of her EBP champi-
ons to relate their experiences
with the RRT to the executive
leadership team, the unit manag-
ers’ meeting, and the unit council

leadership meeting. The unit man-
agers were especially glad to hear
Pat’s story and her answers to their
questions.

As the EBP team continues to
discuss plans for a hospital-wide
RRT, Debra’s suggestions for how
to improve the RRT processes in
the larger rollout are easily inte-
grated into the plan. For example,
she proposes a simple way to ex-
amine the outcomes of HMR and
UICUA: since ICU deaths were
included in the HMR data, she
suggests that they ask the Health
Information Management Sys-
tems/Medical Records (HIMS)
Department to compare the ICU
deaths that occurred despite the
presence of an RRT with those
that occurred without an RRT
present. Debra explains to the
team that these data may help
them to have a better picture of
the impact of the RRT on HMR.
She applies the same approach
to UICUA, comparing the ICU
admissions of those who’d been
treated by the RRT with those
who hadn’t. She further explains
how the team can continue to
observe the changes in these two
outcomes over time. The EBP
team is glad to hear that Debra
will continue to help as they col-
lect and analyze these data.

In preparation for the hospital-
wide rollout, the EBP council
confirms that EBP champions
on each unit will be responsible
for working with the educators
to conduct education sessions
about the RRT. Each unit par-
ticipating in the rollout has al-
ready had three in-services on all
shifts, posters put up in the bath-
room and staff lounge, and an
algorithm posted at the unit hub
explaining how to call the RRT.
Finally, nurses and secretaries
from all units are invited to a
meeting at which Debra and the
EBP team answer all questions

ajn@wolterskluwer.com AJN ▼ July 2011 ▼ Vol. 111, No. 7 57

Dissemination Workshop Agenda
Joint session (one hour)

Dissemination: Purposes and Passions
• What outcome do you want to achieve by disseminating

your results?
• Discussion

Methods of Dissemination
• Determine which method of dissemination is the best

match for your message or outcome or both.
• Determine which method capitalizes on your strengths.
• Discussion and demonstration or case study

Breakout sessions (one hour)
Publishing: Who, What, When, Where, and How of Publishing
Presentations: Effective, Fun Presentations People Will Remember

however, says that there’s no way
she can support anyone from her
unit presenting at a conference.
The EBP team informs her that
several manuscripts about the
RRT will be submitted for publi-
cation, which creates the perfect
opportunity for those who wish
to contribute, but who may not
have the budget this year, to sup-
port the presentations.

The EBP team decides to hold
a continuing education workshop
on dissemination. They invite the
EBP council members to come and
bring anyone from their units who
has been involved in the RRT proj-
ect and is interested in contributing
to presentations or publications
about it. In preparing to conduct
this class, the team makes a list
of the aspects of the RRT project
that would be important to in-
clude in a presentation or publi-
cation or both. They work out an
agenda for the workshop (see Dis-
semination Workshop Agenda).
Rebecca, Chen, and Carlos are
excited about sharing the out-
comes of first the pilot and then
the rollout to the whole hospital.
They are thrilled that they’ve
made such a difference in their
hospital’s culture, as well as in
patient outcomes.

MAKING DISSEMINATION PLANS
The EBP council, the educators,
the RRT, and the EBP team, along
with Debra, meet to discuss how
to plan for dissemination of the
project and its results. They dis-
cuss first putting the results of

PREPARING TO DISSEMINATE
THE RESULTS
As the EBP team discusses how
to disseminate the results of their
project, they reiterate their com-
mitment to involve the EBP coun-
cil members, who have made such
a major contribution to the proj-
ect’s success. Debra suggests that
they hold a special meeting with
unit managers to answer their

questions, and to give them an
overview of the dissemination
plan, including the impact it may
have on each unit’s budget. The
meeting with the managers turns
out to be a lively discussion about
the value of dissemination and its
related costs. The managers are
concerned that presenting the re-
sults of the RRT intervention at
conferences is not a budgeted
item for this year; they’re also
concerned about the challenges
these opportunities will present,
such as being able to support the
scholarship of those clinicians
whose work is accepted.

The EBP team helps the unit
managers to understand that each
time a clinician presents an aspect
of the RRT process or outcome,
the unit and hospital get positive
exposure. Eventually most man-
agers agree that dissemination is a
worthwhile investment and com-
mit to be as creative and flexible
with their budgets as possible as
they plan for the next fiscal year.
They discuss how important it
is to support these new learning
and development opportunities
for their staff. One unit manager,

concerning the procedure for
calling an RRT.

After the hospital-wide project
begins, the EBP team asks HIMS
if all is well with the baseline data
and how the outcomes data are
being collected. HIMS informs
them that indeed the staff is doing
a terrific job of entering the data
into the EMR. The initial RRT
reports indicate that the hospital-
wide rollout is going well and that
the RRT protocol is being used
appropriately. When the EBP
team informally interviews EBP
council members, they find that
everyone is seeing the difference
the RRT is making—and not only
in the outcomes. Clinicians, for
example, are experiencing a dif-
ference in how they’re helping
patients avoid those outcomes.
This pleases the EBP team and
they look forward to sharing this
serendipitous finding.

Presentation Tips
• Keep the outcome that you want for your pre-

sentation in mind from the beginning: what do
you want the audience to take away?

• Take care with the background and color
schemes for your PowerPoint slides. Simple
is best.

• Keep your presentation simple, innovative,
and interesting. Don’t overuse animation or
sound.

• Use pictures to enhance, not dominate, the
presentation.

• Keep your time frame in mind: usually one
slide per minute works well.

• Use no smaller than a 20-point font on a slide
if the presentation is for a smaller audience
or room, no smaller than a 28-point font for
larger rooms or audiences.

• Use text on a slide for sharing highlights and
important points, not for everything.

• Revise your presentation at least three to five
times before submission.

• Keep backups of the presentation on a jump-
drive (or two)

• Have fun as your create YOUR presentation—
be unique.

The EBP team reflects on what a

difference just asking and

answering the right question has

made in their hospital.

58 AJN ▼ July 2011 ▼ Vol. 111, No. 7 ajnonline.com

little longer to prepare their man-
uscripts, while their team leaders
call or write the journals they’ve
selected to see if there’s any inter-
est in articles on various aspects
of the RRT. The EBP team reflects
on their initial PICOT question
and on what a difference just
asking the right question and an-
swering it appropriately has made
in their hospital.

Join the EBP team next time as
they complete the hospital-wide
rollout and make the RRT a hos-
pital policy. In so doing, they will
learn how to create system-wide
sustainable change. ▼

Ellen Fineout-Overholt is clinical pro fessor
and director of the Center for the Advance-
ment of Evidence-Based Practice at Ari-
zona State University in Phoenix, where
Susan B. Stillwell is clinical professor and
associate director, Lynn Gallagher-Ford is
clinical assistant professor and assistant
director, and Bernadette Mazurek Melnyk
is dean and distinguished foundation pro-
fessor of nursing at the College of Nurs-
ing and Health Innovation. Contact
author: Ellen Fineout-Overholt, ellen.
fineout-overholt@asu.edu.

may be a good venue for this proj-
ect. They readily discuss sharing
how their transdisciplinary team
worked together to improve out-
comes and other issues from the
project that would interest IHI
participants. They all agree to en-
gage in this discussion further as
the project continues.

Amid all this activity, Rebecca
and Chen remind Carlos that there
are clinicians who would rather
publish than present. Carlos and
Debra meet with those who are
interested in publishing to pro-
vide an overview of the publish-
ing process (see Publishing Tips).
They assure those individuals who
feel they don’t write well enough
to publish in a journal that they’ll
do fine as part of a team.

With plans in hand, the teams
of clinicians begin to prepare their
abstracts or manuscripts. The
presenting teams submit their ab-
stracts to their respective confer-
ences. The writing teams take a

the pilot and then of the hospital-
wide RRT rollout on the hospi-
tal’s intranet. Carlos invites Karen
from clinical informatics to join
them to discuss the possibility of
having an “EBP Corner” on the
intranet, where updates can be
provided for the latest EBP events.
Karen says this is very doable and
that she’ll get back to them in a
couple of days on how to set this
up and how they’ll be able to con-
tribute to it. Carlos agrees to take
the lead for this aspect of the dis-
semination project.

The EBP council, with mentor-
ship from Rebecca and Chen, ex-
presses the desire to present the
RRT project at a professional
meeting. The group decides that
one of the annual EBP confer-
ences across the country would be
the best place to share this proj-
ect. Debra offers to help council
members review the variety of
EBP conferences and discuss
which would be the best match.
She asks them to consider which
audience would like to hear about
their project and where it could
have a meaningful impact. She
offers to join them when they
start to write and then submit an
abstract, and, if it’s accepted, to
help them put together the pre-
sentation. She also shares tips
she’s used that have served her
well (see Presentation Tips).

To the EBP team’s great delight,
the chief nursing officer pops into
the council meeting and tells ev-
eryone that she wants to submit
this project to the American Or-
ganization of Nurse Executives
(AONE) annual meeting. She’s
so excited about the synergy be-
tween leadership and staff that
she believes this is just what par-
ticipants at AONE need to hear.
Carlos asks the members of the
RRT if they’d like to discuss the
possibility of presenting their ex-
perience at the annual Institute
for Healthcare Improvement (IHI)
meeting, which he tells the group

Publishing Tips
• Know the purpose of your manuscript.
• Determine the audience for your manuscript.
• Determine the journal that best matches the purpose of your

manuscript.
• Obtain the author guidelines for this journal.
• Review several journal articles from this journal; noting the struc-

ture of these articles can help with structuring your manuscript.
• Send a query letter to the editor.
• Develop an outline for your manuscript; be as descriptive and

detailed as possible.
• Divide writing the outline among the authors; all authors should

contribute to the manuscript.
• Write, read, rewrite, reread, rewrite, reread, and rewrite your

manuscript. Have others read the manuscript and provide feed-
back; now is the time to get critical feedback to assist in the suc-
cessful submission to a journal.

• Decide on a relevant title that would compel you to read the
manuscript.

• Reread and revise one last time.
• SUBMIT—although rewriting has moved your manuscript toward

perfection, don’t wait for it to be entirely perfect. Expect journal
reviewers to have suggestions and criticism.

• Believe in your message and its benefit to the reader.

ajn@wolterskluwer.com AJN ▼ July 2011 ▼ Vol. 111, No. 7 59

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