Article Summary

A clinical situation that I was last involved in where I had directly applied evidence-based data to produce a favorable outcome was in the ICU and involved weaning a patient down off of sedation. The patient was mechanically ventilated and was able to be set up for a weaning trial. The patient’s sedation was propofol and precedex. When the first weaning trial occurred the patient failed due to not being awake enough to take the appropriate breaths needed. I had spoken with the ICU nurse and an educational moment arose when I realized that the patient was still on sedation while we tried to wean them off of the vent.

We spoke about proper weaning of propofol, and the proper weaning of precedex which is 25% every 8 hours, or 0.2 every 8 hours if the dose is <1.0 mcg (Buckley et al., 2021);(Pathan et al., 2021). Failure to wean patients off of precedex appropriately can induce withdrawal-like symptoms similar to ETOH withdrawal presenting with tachypnea, tachycardia, AMS, agitation, combativeness, and more (Buckley et al., 2021);(Pathan et al., 2021). These symptoms of withdrawal can invalidate or fail a patient’s weaning trial, prolonging intubation time and overall hospital stay (Buckley et al., 2021);(Pathan et al., 2021).

Advising the reduction of propofol, and the slow wean of precedex, we were able to wake the patient up appropriately, wean them off of the vent appropriately, and were able to successfully extubate them. If I were to encounter this again, I would treat it as another educational opportunity to teach people about the proper way of weaning. After all, yelling and screaming at people is not how they learn, rather by constructive education and conversation to ensure that they understand is the way to go. References: Buckley, M.S., Smithburger, P.L., Wong, A., Fraser, G.L., Reade, M.C., Klein-Fedyshin, M., Ardiles, T., Kane-Gill, S.L. (2021) Dexmedetomidine for Facilitating Mechanical Ventilation Extubation in Difficult-to-Wean ICU Patients: Systematic Review and Meta-Analysis of Clinical Trials. J Intensive Care Med. 2021 Aug;36(8):925-936. doi: 10.1177/0885066620937673. Epub 2020 Jul 6. PMID: 32627672. Pathan, S., Kaplan, J. B., Adamczyk, K., Chiu, S. H., & Shah, C. V. (2021). Evaluation of dexmedetomidine withdrawal in critically ill adults. Journal of Critical Care, 62, 19–24. https://doi-org.lopes.idm.oclc.org/10.1016/j.jcrc.2020.10.024

Q-2

My personal methodology for staying up to date on current trends in healthcare and evidence-based practice is to review materials as they come up in my day-to-day experiences with patients. This aligns with the recommendations by the American Association of Nurse Practitioners, but they do also recommend finding a source that works for you and is presented in a way that you can understand it quickly and easily (Clinical resources for Nurse Practitioners, N.D.);(How to Stay on Top of Current Trends in Nursing, 2019).

For example, the way I was staying up to date during preceptorship is that when we had an interesting case present, I would review it on a quick reference source such as Up to Date, and was able to review the material and find out the current standard of care. Fortunately, most of the things we have learned these past few years regarding standards of care remain the same, and the review ends up being just a review and not a new learning experience.

Some other recommendations that I will follow are to sign up for major journal articles such as the NEJM or JAMA, in order to be up to date on current guidelines (Clinical resources for Nurse Practitioners, N.D.);(How to Stay on Top of Current Trends in Nursing, 2019). I also purchased a subscription to UpToDate, which has helped out a lot for quick review, and something that I found helpful is that they put out a newsletter each month regarding what’s going on as far as new research or new guidelines that have been proposed.

In order to maintain a work-life balance, I review these resources whenever I have downtime, whether it is at work, or in line at the grocery store, as the addition of smartphones makes it possible to review information anywhere. Reviewing at these times allows me to put the phone down when I am with my family and enjoy my family life as well as keep it separated from work. So far it has worked out really well. References: Clinical Resources for Nurse Practitioners (n.d) American Association of Nurse Practitioners. Retrieved from: https://www.aanp.org/practice/clinical-resources-for-nps How to Stay on top of current Trends in Health Care (2019). Cappella Univeristy. Retrived from: https://www.capella.edu/blogs/cublog/current-trends-in-health-care/

Q-3

Medicine is a constantly advancing field, and the advances have real implications and day-to-day application when it comes to patient care. However, it can be challenging to learn how to apply the newest modalities to deliver patient care when keeping up with a busy practice and a busy life while trying to live a well-balanced life. Medical conferences have long been a place for primary care providers to learn about the latest innovations in patient care. Conferences can be time-consuming but remain a valuable way for NPs to obtain concentrated exposure to emerging diagnostic and therapeutic developments in medicine (Moawad, 2021). For me, this will provide a balance between work and life as I get to do what I love, which is to travel with the family and discover new places while enriching myself and securing my practice. Another way of staying up to date on current practice in medicine is through subscription to professional Journals which offers current and up to date evidence-based practice and incorporate them in management of the different patient condition.

Evidence-based practice (EBP) started as a movement that challenged the public to only pay for the care that is empirically supported as effective. Dr. Archie Cochrane, the founder of EBP, was a strong proponent of using evidence from randomized controlled trials (RCTs) because he believed this process offered the highest and most valuable proof to base clinical practice treatment decisions. Currently, we adopt EBP as part of our clinical practice because it leads to the highest quality of care and the best clinical patient outcome. In addition, the use of current research as the basis for one’s clinical decision and condition management instills a level of confidence and satisfaction in their roles when they engage in EBP (Melnyk & Fineout-Overholt, 2016).

References

Melnyk, B.M. & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare: A guide to best practice (3rd ed.). China. Wolters Kluwer

Moawad, H. (2021, June 15). Staying current in medicine: One certainty in a profession is the practice of every specialty will change throughout the career. Ophthalmology Times, 46(10), 8.

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