Nursing Research Saves Lives and Money

May 16th, 2012

By Jennifer Olin, BSN, RN

In light of the International Council of Nursing’s (ICN) 2012 goal for greater nursing use of evidence based practice I have been writing this week about what exactly EBP is and about how and where the research that builds EBP comes from.

“The use of an evidenced based approach enables us to challenge and be challenged on our approach to practice and to hold ourselves accountable,” said David Benton, ICN CEO. “It allows us to constantly review the way we work and to seek new and more effective and efficient ways of doing things. This allows us to play our full part in the increasing access to effective services and during these times of financial challenge it enables us to use those resources we do have more efficiently.”

Now, I want to tell you about some of the research projects nurses have already investigated and how their outcomes have already provided better care and better healthcare environments for our clients, the nursing community, and the organizations for which we work.

We know that beginning in 2009 the Centers for Medicare and Medicaid Services (CMS) stopped providing reimbursement for care required to battle hospital acquired infections (HAIs). So, for example, if a patient is insured by Medicare and picks up a hospital acquired infection while being treated for something that is covered by Medicare, Medicare will no longer pay for the extra cost of treating the HAI. Instead, the bill must be picked up by the hospital itself since the rules don't allow the hospital to charge it to the patient.

Central LIne Infections

Many hospitals are doing a great job of controlling HAIs but according to an article in Consumer Reportslast year, at least 30 percent of the 99,000 annual hospital-infection-related deaths can be attributed to central line infections. They are bloodstream infections introduced through the large intravenous catheters that deliver medication, nutrition, and fluids to patients in intensive care. And, for those who survive, a central-line infection often means weeks or months of debilitating treatments and side effects.

The watchdog organization explains how for decades physicians considered central-line infections an unavoidable risk of intensive care. However some hospitals report much lower rates than others. This may be where nursing research and EBP has come into play.

At the National Institute of Nursing Research (NINR) they have been investigating how high compliance with “central line bundle” preventive practices can decrease infection rates in the ICU.

Care bundles, in general, are groupings of best practices for a specific disease process that individually improve care, but when applied together result in substantially greater improvement. The central line bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually.

The central line bundle has five key components:

• Hand hygiene.
• Maximal barrier precautions
• Chlorhexidine skin antisepsis..
• Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters
• Daily review of line necessity, with prompt removal of unnecessary lines.

The infections associated with central lines are known as blood stream infections or BSIs. They are extremely expensive to treat and, as stated before, can lead to disability or death. The Institute for Healthcare Improvement has promoted use of a “central line bundle” of clinical practices to reduce the incidence of BSIs associated with central lines.

For this NINR study, the researchers focused on the use of three of the five elements of the bundle: maximal barrier precautions, optimal insertion site, and the daily review of need.

• A survey of 415 ICUs in 250 hospitals across the U.S. found that about half had a written central line bundle policy in place. However, only 45% of these units monitored compliance with this policy. Of these, 38% reported a high (> 95%) compliance rate.
• Among the 312 ICUs that reported BSI rates, lower rates were achieved only for those that had a bundle policy in place, monitored compliance, and reported high compliance with at least one of the three central line bundle elements studied.
• The researchers estimate that an ICU moving from non-compliance to high compliance with at least one of these central line bundle elements could achieve a 38% reduction in BSIs. This result has the promise to reduce the risks associated with central lines, thereby lowering health care costs and improving health outcomes.

Nurse researchers at the Columbia School of Nursing were funded by NINR for this study. They estimate that an ICU moving from non-compliance to high compliance with at least one of these central line bundle elements could achieve a 38% reduction in BSIs. This result has the promise to reduce the risks associated with central lines, thereby lowering healthcare costs and improving health outcomes.

This is a perfect example of nursing research, leading to improvement by evidence based practice. It fulfills the definition of using the resources we have more efficiently in these times of financial challenge. In other words, follow the protocols of the bundle, cut back on BSIs, and save money by not having to pay out of pocket for HAIs.

More Nursing Research Projects

Other prominent nursing research projects that have changed the ways we work include:

• Inadequate Nurse Staffing Increases Risks for Patients – Authored by well known researcher Linda Aiken, PhD, FAAN, FRCN, from the University of Pennsylvania School of Nursing, this study consistently found that higher nurse staffing levels were related to lower patient mortality and increased patient satisfaction. These results have strong implications for hospitals across the country as they work to improve quality of care, earn their healthcare cost reimbursements, and attain such goals as Magnet status.
• Developing an Index to Reduce Pressure Sore Risk – Dr. Nancy Bergstrom, currently at the University of Texas, Houston, began her research on pressure sores while at the University of Nebraska. Dr. Bergstrom has collaborated with Dr. Barbara Braden to develop and test the Braden Scale for Predicting Pressure Sore Risk.

These are just a couple of examples of how nursing research has changed and improved healthcare. So, that little idea at the back of your mind, that problem you see and think to yourself, “there has to be a better way,” –maybe you are that nurse with the better way. It may be a nursing research project in the making. The best improvements, the best methods for care all started with just a little idea.