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1. NR 328 Evidence Based Practice Improving Diagnostic Safety
NR 328 Evidence Based Practice Improving Diagnostic SafetyNR 328 Evidence Based
Practice Improving Diagnostic SafetyPart 1 1. Follow these guidelines when completing this
assignment. Speak with your faculty member if you have questions. 2. Please make sure you
do not duplicate articles within your group. 3. The paper will include the following: a.
Clinical Question (30 points/15%) 1. Describe the problem: What is the focus of your
group’s work? 2. Significance of problem: What health outcomes result from your problem?
Or what statistics document this is a problem? You may find on websites for government
or professional organizations. 3. Purpose of the paper: What will your paper do or describe
b. Evidence Matrix Table: Data Summary (Appendix A) – (60 points/30%) Categorize items
in the Matrix Table, including proper intext citations and reference list entries for each
article. 1. References (recent publication within the last 5 years) 2.
Purpose/Hypothesis/Study Question(s) 3. Variables: Independent (I) and Dependent (D) 4.
Study Design 5. Sample Size and Selection 6. Data Collection Methods 7. Major Findings
(Evidence) c. Description of Findings (60 points/30%) Describe the data in the Matrix
Table, including proper intext citations and reference list entries for each article. 1.
Compare and contrast variables within each study. 2. What are the study design and
procedures used in each study; qualitative, quantitative, or mixed method study, levels of
confidence in each study, etc.? 3. Participant demographics and information. 4. NR 328
Evidence Based Practice Improving Diagnostic SafetyInstruments used, including reliability
and validity. 5. How do the research findings provide evidence to your clinical problem, or
what further evidence is needed to answer your question? 6. Next steps: Identify two
questions that can help guide the group’s work. d. Conclusion (20 points/10%) Review
major findings in a summary paragraph. 1. Evidence to address your clinical problem. 2.
Make a connection back to all the included sections. 3. Wrap up the assignment and give the
reader something to think about. e. Format (30 points/15%) 1. Correct grammar and
spelling 2. Include a title and reference page 3. Use of headings for each section: o Problem o
Synthesis of the Literature ? Variables ? Methods ? Participants ? Instruments ? Implications
for Future Work 4. Conclusion 5. Adheres to current APA formatting and guidelines 6.
Include at least two (2) scholarly, current (within 5 years) primary sources other than the
textbook 7. 3-4 pages in length, excluding appendices, title and reference pages. NR 328
Evidence Based Practice Improving Diagnostic SafetyORDER NOW FOR CUSTOMIZED,
PLAGIARISM-FREE PAPERSFor writing assistance (APA, formatting, or grammar) visit the
APA Citation and Writing page in the online library Part 2 Give one example of a data

2. collection method used in one of the studies identified in the RUA project. What variable
was this method used to measure? RUA: Analyzing Published Research Guidelines Evidence
Matrix Table Arti cle Reference s 1 (SA MP LE ART ICLE ) Smith, Lewis (2013), What should
I eat? A focus for those living with diabetes. Journal of Nursing Education, 1 (4) 111112. 1 2
3 4 5 Purpose Hypothesis Study Question(s) How do educational groups effect dietary
modifications in patients with diabetes? Variables Independent( I) Dependent(D ) D-Dietary
modifications I-Education Study Design Quantitative Sample Size & Selection N- 18
Convenience sample-selected from local group in Pittsburgh, PA Data Collection Methods
Focus Groups Major Finding(s) and education improved compliance with dietary
modifications. EVIDENCEBASED CARE SHEET National Patient Safety Goals (The Joint
Commission, 2018): Reporting Critical Results of Tests and Diagnostic Procedures What We
Know › The Joint Commission (TJC) is an independent, not-for-profit organization
responsible for accrediting and certifying nearly 21,000 healthcare organizations in the
United States(2) • TJC evaluates healthcare organizations (e.g., ambulatory care facilities,
behavioral health facilities, acute care hospitals, critical access hospitals [i.e., rural health
facilities with ? 25 beds and patient lengths of stay of ? 96 hours], home health agencies,
long-term care facilities, laboratory services, clinician offices providing outpatient surgery)
to verify that they consistently provide high quality, safe, and effective health care(2) –
Healthcare organizations are evaluated according to standards that are developed with
input from healthcare providers and other professionals, consumers, experts in certain
subject matters, focus groups, and governmental agencies(2) – TJC standards are based on
current research findings; new standards that are added must be readily measureable, meet
or surpass current healthcare regulations, positively affect health outcomes, and relate
either to quality of health care or patient safety(2) › NR 328 Evidence Based Practice
Improving Diagnostic SafetyTJC National Patient Safety Goals (NPSGs) were established in
2002.(3) Each year TJC provides a list of NPSGs intended to improve patient safety(3) • TJC
examines sentinel event reports (i.e., reports of unexpected healthcare events that result in
serious physical or psychological injury or death), healthcare databases, and medical safety
literature to create a list of NPSGs(2,3) – Some NPSGs are newly created and some are
maintained from the previous year(1) – There are no new NPSGs for year 2018(1) Authors
Carita Caple, RN, BSN, MSHS Cinahl Information Systems, Glendale, CA Hillary Mennella,
DNP, ANCC-BC Cinahl Information Systems, Glendale, CA Reviewers Debra Balderrama, RN,
MSCIS Clinical Informatics Services, Tujunga, CA Nursing Executive Practice Council
Glendale Adventist Medical Center, Glendale, CA Editor Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA June 1, 2018 • Each NPSG contains specific
elements of performance (EP; i.e., implementation requirements) that are measureable
evidence- and expert-based strategies for achieving the NPSG(3) • Healthcare organizations
that do not satisfactorily adopt the safety practices associated with the NPSGs risk losing
TJC accreditation(1,3) • When the majority of healthcare organizations have satisfactorily
adopted the safety practices associated with an NPSG, the NPSG is incorporated into TJC
accreditation standards(1,3) › TJC has identified improving the effectiveness of
communication among caregivers in hospitals, critical access hospitals, and laboratories as
goal 2 effective January 1, 2018(3) • NPSG.02.03.01 requires hospitals, critical access

3. hospitals, and laboratories to improve the reporting of critical results of tests and other
diagnostic procedures in a timely manner(3) –NR 328 Evidence Based Practice Improving
Diagnostic SafetyA critical result (also referred to as a critical value) is a laboratory value or
other diagnostic test result that is significantly outside the range of values considered
normal and could be life threatening if not immediately corrected (e.g., a serum potassium
Published by Cinahl Information Systems, a division of EBSCO Information Services.
Copyright©2018, Cinahl Information Systems. All rights reserved. No part of this may be
reproduced or utilized in any form or by any means, electronic or mechanical, including
photocopying, recording, or by any information storage and retrieval system, without
permission in writing from the publisher. Cinahl Information Systems accepts no liability
for advice or information given herein or errors/omissions in the text. It is merely intended
as a general informational overview of the subject for the healthcare professional. Cinahl
Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 level that is either
significantly decreased [e.g., 2.9 mEq/L] or significantly increased [e.g., 6.0 mEq/L])(4) –
The purpose of NPSG.02.03.01 is to ensure that critical results are communicated to the
healthcare clinician within an agreed-upon time period so that treatment can be promptly
initiated(3) – Delays and inaccuracies in reporting critical results can result in significant
patient harm and death due to treatment delays and errors(5) –NPSG.02.03.01 is comprised
of the following 3 EPs:(3) – Healthcare organizations must develop written procedures that
– define the parameters for critical results. TJC has not set definitive parameters for critical
results and expects that determination to be made by individual organizations(3) –
determine by whom and to whom critical results are reported(3) – Critical results should
never be communicated to an answering service or left in a message on an answering
machine(6) – TJC requires documentation that critical results were communicated to the
physician(3) – determine the time period within which critical results must be reported;
this is assessed from the time the results are available, not the time the specimen was
obtained(3) – Repeat testing of critical values is commonplace but might not be clinically
useful. Researchers who reviewed critical value results from 86 laboratories reported that
repeated results were rarely considered significantly different. For 10% of laboratories,
repeat testing took an additional 17 to 21 minutes, and 20% of laboratories reported at
least 1 adverse patient outcome as a result of a delayed result(4) – Healthcare organizations
must implement the procedures(3) – Delays and inaccuracies in reporting critical results
can result in significant patient harm and death due to treatment delays and errors. In a
review of the literature, the authors note that failure to communicate critical results are
laboratory errors. Laboratory and other personnel must be educated to notify the
appropriate healthcare clinician if a test result meets the definition of a critical result. NR
328 Evidence Based Practice Improving Diagnostic SafetyDocumentation and
communication processes for reporting must be audited on a regular basis to ensure quality
improvement(5) – Healthcare organizations must evaluate how well the organization is
reporting critical results within the set time period(3) › Recommendations for creating a
procedure to meet NPSG.02.03.01 include the following:(6) • Develop a list of critical
results, including upper and lower parameters for laboratory results(6) • Provide clear
protocols to determine who is to be notified of critical results and by what method (e.g.,

4. telephone, pager)(6) • Determine the time period within which the critical results are to be
reported(6) –The time period will vary according to the department and test performed
(e.g., serum troponin levels to be reported within 30 minutes; evidence of deep vein
thrombosis to be reported within 2 hours)(6) • Require that critical results are verbally
repeated by the person being notified(6) • Document the date and time the critical results
were communicated to the healthcare clinician(6) • Perform periodic audits to evaluate if
critical results are being reported to the appropriate healthcare clinician within the
established period of time(6) What We Can Do › Learn about TJC’s NPSG.02.03.01 so you can
accurately assess areas in which your healthcare organization needs to improve
communication of critical results; share this information with your colleagues › Collaborate
with members of your administrative team and TJC accreditation team to develop
procedures that will enhance compliance with TJC guidelines and further promote patient
safety with regard to improving the communication of critical results Coding Matrix
References are rated using the following codes, listed in order of strength: M Published
meta-analysis SR Published systematic or integrative literature review RCT Published
research (randomized controlled trial) R Published research (not randomized controlled
trial) RV Published review of the literature RU Published research utilization report QI
Published quality improvement report L Legislation C Case histories, case studies PGR
Published government report G Published guidelines PFR Published funded report PP
Policies, procedures, protocols X Practice exemplars, stories, opinions GI General or
background information/texts/reports U Unpublished research, reviews, poster
presentations or other such materials CP Conference proceedings, abstracts, presentation
References 1.NR 328 Evidence Based Practice Improving Diagnostic SafetyThe Joint
Commission. (2017). 2018 National Patient Safety Goals presentation. Retrieved March 17,
2018, from https://
www.jointcommission.org/2018_national_patient_safety_goals_presentation/ (G) 2. The
Joint Commission. (2018). About The Joint Commission. Retrieved March 17, 2018, from
https://www.jointcommission.org/about_us/ about_the_joint_commission_main.aspx (GI)
3. The Joint Commission. (2018). National patient safety goals (NPSG). 2018 hospital
accreditation standards. Oakbrook Terrace, IL: The Joint Commission. (GI) 4. Lehman, C. M.,
Howanitz, P. J., Souers, R., & Karcher, D. S. (2014). Utility of repeat testing of critical values:
A Q-probe analysis of 86 clinical laboratories. Archives of Pathology & Laboratory Medicine,
138(6), 788-793. doi:10.5858/arpa.2013-0140-CP (R) 5. Piva, E., Sciacovelli, L., Pelloso, M.,
& Plebani, M. (2017). Performance specifications of critical results management. Clinical
Biochemistry, 50(10-11), 617-621. doi:10.1016/ j.clinbiochem.2017.05.010 6. Satiani, B., &
Kiser, D. (2010). Timeliness in notification of critical vascular laboratory test results is part
of quality assurance. Journal for Vascular Ultrasound, 34(4), 189-191. (R) EVIDENCEBASED
CARE SHEET Preoperative Communication to Improve Patient Safety What We Know ›
Enhancing patient safety is of great importance to numerous private, public, and
government healthcare organizations and to health insurers, hospital administrators,
healthcare providers, and the general public(4,5,7,8,9) • Approximately 44,000–98,000
deaths attributed to preventable medical errors occur in the U.S. every year, according to a
report by the Institute of Medicine (IOM)(5) › The fast pace and rapid turnover that are

5. characteristic of an operating room (OR) combined with passive responses or silence from
staff members contribute to preventable medical errors and wrong-site
surgery(4,5,7,8,9,11,16) • National standards and organizational policies are necessary to
enhance and foster preoperative communication among all staff members to improve
patient safety › • One of The Joint Commission (TJC) National Patient Safety Goals (NPSGs)
for 2016aims to enhance patient safety through improved communication.(4) (For
information regarding NPSGs, see the series of related Evidence-Based Care Sheets) •
NPSG.02.03.01 requires hospitals to report critical results of tests and diagnostic
procedures on a timely basis by developing and implementing written protocols for
managing test results and evaluating the timeliness of reporting of critical test results › In
addition, TJC Universal Protocol, which applies to all surgical and nonsurgical invasive
procedures, is intended to prevent mistakes in surgery, including those involving the wrong
site, wrong procedure, and wrong person. Healthcare organizations that are accredited by
TJC must implement and follow a “time-out before procedure” policy to enhance
preoperative communication among staff members and mitigate patient Authors Hillary
Mennella, DNP, ANCC-BC Cinahl Information Systems, NR 328 Evidence Based Practice
Improving Diagnostic Safety