Research Use in VA Nursing Practice: Six Professional Interviews

Quality Assurance Director: Evidence-Based Practice and Medication Safety

In a telephonic interview with a registered nurse and Master of Public Health (RN, MPH) serving as director of quality assurance at a Veterans Affairs medical center (VAMC), questions were posed concerning how research is found, accessed, and applied for quality assurance purposes. According to this professional, VAMCs typically feature up-to-date medical libraries that can be used by any staff member. The library resources at this VAMC included numerous peer-reviewed journals and Internet access for additional relevant journal articles. In addition, her office had Internet access as well as access to the hospital's intranet — the Decentralized Hospital Computer Program (DHCP) — which links this VAMC with other VAMCs, regional offices, and the VA's Central Office in Washington, DC.

When asked how research was applied in her practice, she noted that her office was responsible for coordinating peer reviews of questionable medical practices identified in the VA's patient incident reporting program; timely research is required in order to evaluate reported practices. Her office was also responsible for risk management at the VAMC, and research concerning best evidence-based practices for reducing medication errors and patient falls was conducted, with findings subsequently implemented at the facility.

An example of this applied research was the distribution of a series of posters for nursing stations highlighting methods for reducing medication errors. The first poster featured the so-called "seven Rs" of medication administration: right patient, right medication, right dosage, right route, right time, right reason, and right documentation. She reported that medication errors were reduced by 50% following the distribution of this poster series.

IT Manager: Technology Research and Patient Confidentiality

In a telephonic interview with an information technology manager at a VAMC, questions were posed concerning how research is found, accessed, and applied in the facility's information resource management division. The IT manager reported that his division was constantly receiving requests for nonstandard IT equipment and coding support that was difficult to fulfill. As a result, the division relies on trade journals to identify new IT equipment that might satisfy the medical center's needs. In addition, the division uses the DHCP to consult with other IT practitioners on issues of shared interest. Because the hospital's medical library does not subscribe to trade journals or other information technology publications, the division also routinely searches the web for commercial IT solutions and the vendors that offer them.

An example of this research being applied in a real-world situation was the adoption of electronic patient health records to facilitate practitioner access to patient information and improve clinical outcomes. Because the VAMC has transitioned to an electronic health records system, the division is also required to ensure that patient confidentiality is maintained and that practitioners do not review records for which they are not authorized. For this purpose, the information resources division researches relevant controlling legislation and VA policies and procedures to ensure the hospital remains in compliance. The IT manager noted that his division remains consistently vigilant regarding IT trends and innovations by researching these issues on the Internet.

QA Nurse and Program Director: Benchmarking and Congressional Liaison Work

In two separate telephonic interviews, questions were posed to a quality assurance nurse (RN) and a quality assurance program director (MPH) at a VAMC concerning how research is found, accessed, and applied in the facility's quality assurance office. The QA nurse reported that she was responsible for benchmarking department-level QA data each month, performing statistical analyses, and publishing the results hospital-wide as part of the VA's quality assurance procedures to comply with Joint Commission requirements. She routinely consulted the Internet and conducted research in the hospital's medical library to identify relevant standards and to review how other medical centers have achieved successful results.

As a concrete example, just prior to a Joint Commission inspection, she learned about a standard requiring a hospital policy for problem resolution. After searching the DHCP, she found a comparable policy in place at another VAMC and was able to publish this policy before the inspection took place.

In response to the same questions, the program director reported that he serves as the hospital's congressional liaison and is responsible for the timely resolution of patient problems, usually on the same day. If a patient's problem is not immediately resolvable, the congressional office is notified by telephone and a written response is provided at the earliest opportunity. The types of complaints received are categorized and tracked by service department — for example, ambulatory care, pharmacy, and nursing units — and these benchmarks are included in the hospital-wide QA report each month. He noted that he occasionally performs research in the hospital's medical library and on the Internet to determine comparable congressional inquiry levels at other VAMCs.