Applications of the Iowa Model of Evidence-Based Practice

Health care is continually changing and searching for ways to improve the care that patients receive today. This is done in order to confirm they not only do they receive the highest quality of care, but also that it is the safest. For Evidence Based Practice (EBP), the Iowa model is a systematic method that explicates how organizations change practice in order to encourage quality care.  The Iowa model was originally a research utilization model.  Since then, it has been updated to embrace more prominence on EBP (Schmidt & Brown, 2019).  To promote quality care, it was renamed the Iowa model of evidence-based practice.   When using this model, there are many questions that need to be considered such as: “Is there a sufficient research base?”, “Is the topic priority for the organization?” and “Is change appropriate for adoption of practice?”.  When nurses ask and address these questions, many of the same issues are also addressed in the Stetler model which include, the need to gather research, identify achievable outcomes, applying the research to nursing practice, and evaluation of the application of research practice (Schmidt & Brown, 2019). 

In the peer-reviewed article “Efforts of a Unit Practice Council to implement practice change utilizing alcohol impregnated port protectors in a burn ICU”, Martino et al. (2017) used the Iowa model during their evidence-based practice research.  Per Martino et al., studies have shown that central line associated bloodstream infections (CLABSI) are among the deadliest healthcare associated infections.  Their burn intensive care unit (BICU), had higher rates of CLABSI than the National Healthcare Safety Network CLABSI rate for burn centers that averaged 3.7 infections per 1,000-line days.  The BICU averaged 17.7 infections per 1,000-line days in 2008, 16.8 in 2009, and 8.3 in 2011 (Martino et al., 2017).  Due to this high infection rate, Marino et al. decided to investigate why they had higher CLABSIs.  It was determined that higher rate of CLABSIs was a priority for their unit. They wanted to figure out why they had such a high incidence and what was causing the higher rates compared to the National Healthcare Safety Network. 

To address this issue, the BICU looked to the Army Nurse Corps’ Patient Caring Touch System of Care (PCTS). PCTS was designed to decrease clinical variances by adopting best practice to improve the quality of care provided to their patients (Martino et al, 2017).  Nurses on the BICU implemented interventions such as: using alcohol impregnated port protectors, increased frequency of central line changes to decrease dwell time from seven to five days; mobile cart was stocked with CVC supplies that could be accessible to clinicians during placement; CHG dressing changes were performed daily (Martino et al., 2017).  Data was collected weekly for observational audits, members of the infection control committee conducted surveillance of the central line bundles along with identification and reporting of CLABSIs. Once all data was collected, it was discovered that implementing alcohol impregnated caps decreased the number of CLABSIs on their unit.  Martino et al. used the Iowa based model for their research. They identified the increased number of CLABSIs on the unit was a priority, there was sufficient research base, and it was appropriate for them to adopt the use of alcohol impregnated caps on their unit to decrease CLABSIs.  

Beal and Smith (2016) used the IOWA model as well in their article “Inpatient Pressure Ulcer Prevalence in an Acute Care Hospital Using Evidenced-Based Practice”.  Their goal was to decrease the prevalence of hospital-acquired pressure ulcers (HAPU) at Maine General Medical Center in Augusta, Maine.  Per Beal and Smith (2016), the annual mean of pressure ulcers in 2005 was 7.8%.  The study was performed over a ten-year period.  Beal and Smith recognized the need and priority to decrease the incidences of HAPUs, there was enough research base, and the methods were appropriate to implement the practice into the facility.  They wanted to discover ways to decrease the occurrences of HAPUs in their hospital.  Maine General Medical Center set goals to increase the Braden score assessment from 85% to 100% upon admission, increase obedience with implementation of pressure ulcer prevention from 15% to 100% and increase documentation of interventions from 15% to 100% (Beal and Smith, 2016).  In order to assist in achieving their goals, in-services were provided on issues with compliance and what is considered best practice based on National Pressure Ulcer Advisory Panel (NPUAP).  A qualitative survey was also performed at the hospital.  It was discovered that there was poor communication, lack of time and knowledge and inadequate equipment on the unit which all assisted in the increase of HAPUs. After this was discovered, in-services, staff meeting on best practice, monitoring through chart reviews and adequate equipment was provided (Beal and Smith, 2016).  The operating room established a policy for pressure ulcer prevention (PUP) using memory foam and gel pads, skin assessments before and after the patient was in the prone position, and a four-person transfer process when moving a patient to prevent shearing.  Over the ten-year span, there was a decrease in HAPUs from 7.8% in 2005 to 1.2% and 1.4% for 2012-2014 (Beal and Smith, 2016). 

In summary, the IOWA model is used to help explain how organizations change their way of practice to provide high quality patient care.  EBP is essential in nursing to implement best practices and to stay up to date about new medical protocols.  Both Marino et al., (2017) and Beal and Smith (2016) used the IOWA model during their studies.  Both identified the priority and need for the change. With the key component of having enough research and the appropriateness of the practice, evidence practice will be a success.

References

• Beal, M.E., & Smith, K. (2016). Inpatient pressure ulcer prevalence in an acute care hospital using evidence-based practice, 13(2), 112-117. doi: 10.1111/wvn.12145
• Martino, A., Thompson, L., Mitchell, C., Trichel, R., Chappell, W., Miller, J., Allen, D., Salinas, E. (2017). Efforts of a unit practice council to implement practice change utilizing alcohol impregnated port protectors in a burn ICU, 43, 956-964. doi:10.1016/j.burns.2017.01.010
• Schmidt, N. A. & Brown, J. M. (Eds.). (2019). Evidence-based practice for nurses: Appraisal and application of research (4th ed.). Burlington, MA: Jones & Bartlett