Evidence Based Practice

In Sackett et al's (1996, 71-72) definition "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens."

Discharge rounding

Discharge prediction is like being a crystal ball reader. I guess we are good at it as we got a 75% prediction rate. Most of the hospital got 20-40% rate. It has to be a team working with the family. Having said all that, our discharge is percieved to be awful for our staff and families. We recently went to computerized nursing. It is hard to know if someone actually did teach and it was effectivewith the parents. So we are going to concentrate on doing discharge teaching better. I wonder if it is the change in seeing things on paper versus the computer. So once again we overcome our teaching probems. I have to say it really wasn't any different with pen and paper. Some people make sure their families know what to do and others are there just for the day.

Bank Breast Milk

Bank Breast milk seems like a easy subject but it can be complicated. Some states want your nursery to have tissue license to use the donor milk. HBANA guidelines need to be followed. Last Friday we were inspected by the state. We passed but have to fix some things. I think they are using us as the example for other hospitals to follow so we have to be letter perfect.

CNS Shortage

Today I read a post on one of my list serves that a neonatal unit didn't have a Clinical Nurse Specialist. The nurse practitioners did not have time to do clinical education of the other facets of being a CNS. The CNS's job is to be a clinical expert, consultant, researcher, colaborator, and educator. It is an Advanced Practice Nurse job so a master's in nursing is required. Many states require the student to precept for 500 hours. It is not an easy job. So there are not as many CNS's as needed. Headhunters persue all the CNS's I know. They tell me there are not enough CNS's. So young nurses out there can probably have all the CNS jobs they could handle if qualified.

Huddle

What is a huddle? It is the new way we get staff to get information out to everyone. The huddle concept is not new. Business has used it for awhile. At the beginning of the shift someone gets a group together for about 5-10 minutes. Some things we have used aspects of infection elimination bundle, policies, Joint Commission updates, and theory of microsystem. Huddles are dreamed up and put together by staff for other staff. So they can be almost anything. Communication seems to be a major problem. When we work together we can get a lot done.

Cord Blood Stem Cells

A hot topic I have written quite a bit about is Cord Blood Stem cells. The umbilical cord contains blood that normally would be thrown away. This cord blood can be saved only at birth. Their are lots of private cord blood banks. Something new is the National Cord Blood Bank at the New York Blood Bank. Almost 80 diseases are already being treated with cord blood. This miracle source of hemopoitic stem cells should be saved.