By Jennifer Larson, contributor
April 8, 2014 - One of the most effective tools to ensure that you’re always using evidence-based guidelines when seeing patients might already be in your pocket: your smartphone.
Researchers from the Columbia University School of Nursing recently reported that a mobile application helped advanced practice nurses dramatically boost their use of evidence-based guidelines in screening patients for tobacco use and advising them on how to quit smoking.
Having this type of mobile health decision-support system, or mHealth DSS, helped 185 registered nurses enrolled in an advanced practice nursing program to ask their patients about smoking habits in 84 percent of their visits. That’s much higher than the typical 60 percent rate for U.S. patients, per statistics from the Centers for Disease Control and Prevention (CDC).
The mHealth DSS system also helped the nurses boost their rates of guiding patients toward smoking cessation programs.
It just made sense to use this type of technology to help nurses incorporate evidence-based guidelines into their workflow, said lead author Kenrick Cato, PhD, RN.
“One reason that people don’t [always] use guidelines is because it’s hard to keep up with them,” said Cato. “So if you’ve got a tool that can be updated to reflect the latest guidelines, that’s also very helpful.”
The study, “Response to a Mobile Health Decision-Support System for Screening and Management of Tobacco Use,” was published online for Oncology Nursing Forum in late March.
Importance of evidence-based practice
A commonly used definition of evidence-based medicine is “the integration of best research evidence with clinical expertise and patient values,” according to the 2000 report “Evidence-based Medicine: How to Practice and Teach EBM” by D. L. Sackett, et. al.
In "The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas,” which appeared in The Online Journal of Issues in Nursing in 2013, Kathleen R. Stevens, EdD, RN, ANEF, FAAN, noted that the drive to reduce preventable harm in health care has given more weight to the importance of using evidence to inform best practices. The 2001 Institute of Medicine report “Crossing the Quality Chasm” urged health care professionals to join together to transform health care and proposed that a major part of the solution was evidence-based practice.
Given these reports and others, evidence-based practice (EBP) has long been accepted as the right way to go. But that doesn’t mean that it is always the practiced standard of care, according to a January article in WorldViews on Evidence-Based Nursing by Bernadette Mazurek Melnyk RN, PhD, CPNP/PMHNP, et. al. In fact, it often isn’t the standard.
A number of factors are likely behind this phenomenon, including inadequate EBP knowledge and skills and organizational cultures that do not support it, the authors wrote.
And, as Cato said, it can be challenging to keep up with all the latest research. That’s when a mobile device can be especially useful. It can remind people about guidelines or information that they may already know but have temporarily forgotten. Having a program like the one used in the Columbia University study--which provided reminders to the nurses to screen all patients over nine years of age--doesn’t leave anything up to chance.
Mobile reminders can also remove any unintended bias that the clinician might have that may cause them to treat one type of patient differently from another, Cato noted.
“So the very simple idea is that if you can get the clinicians to provide the same evidence-based standard of care, the health disparities…will be greatly reduced and the outcomes will be better,” he said.
The study showed that tobacco use screening did vary by race, gender and who was paying for care. But even so, the screening rate was higher with the tool, suggesting that it “may reduce disparities in screening and management of tobacco dependence in acute and ambulatory care settings.”
Smartphone use increases
The Columbia University research study is just one example of the growing number of ways that nurses and other clinicians are using their mobile devices at work.
According to a 2012 survey by publisher Lippincott Williams & Wilkins (LWW), 71 percent of nurses use a smartphone at work and 66 percent of nursing students are using their smartphones for nursing school.
A survey by Spyglass Consulting Group, released last month, said two-thirds of hospitals report their staff nurses are using their personal smartphones to help them at the point of care. These numbers clearly show that nurses want to use mobile devices and are finding ways to help them improve their workflow, noted Gregg Malkary, founder and managing director of Spyglass.
It’s a trend that will only grow, Malkary said. That means hospital IT departments should make sure they are addressing security issues and that nurses are given access to the type of applications and other technology for their mobile devices that will help them do their jobs. Nurses also should speak up about their needs and preferences.
“Nurses should be heard and be part of the decision-making process,” said Malkary. “They should not have the [decisions] forced upon them.”
Said Cato, “This is your future.”
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