The ACE center provides a focal point for evidence-based practice activities, including education and interdisciplinary research projects. Projects and investigations are concentrated on two facets: (a) basic and professional level workforce development for EBP; and (b) the study of the processes and outcomes within evidence-based quality improvement. Studies investigate research synthesis, translation of evidence into practice, and healthcare provider and organizational change. A short description of representative projects and research follows.
ACE Star Program of Translational Research
This ongoing model development expands and tests a model for understanding evidence-based practice. The study of EBP is essentially the study of transforming knowledge produced through primary studies and moving this through adoption of the knowledge into a basis for clinical decision-making. Using the ACE Star Model as a framework, our program of translational research investigates phenomena associated with EBP, including summarizing evidence, clinical guideline development and uptake, organizational culture, and outcome measures. The initial project in this timely program of research was Evaluation of Systematic Reviews Published in Nursing Literature: A Replication, that pointed out a need for more rigorous systematic reviews in nursing. A second project investigates the factors associated with uptake of clinical practice guidelines.
ACE Star Model of Knowledge Transformation
Developed in 2004, the ACE Star Model is configured as a simple 5-point star; it explains how knowledge is transformed at five major stages, starting from primary research, and continuing through the stages of evidence summary, translation, integration, and evaluation. This model places nursings previous scientific work within the context of EBP and is proving useful for examining the EBP process, roles in EBP, and research methods with which to investigate EBP. Adopted by scores of hospitals across the nation as part of their journey to excellence, the ACE Star Model forms a foundation for developing workforce competencies, organizing projects, and employing EBP in clinical settings. Influenced by Imogene King, we continue to evolve the ACE Star Model as a theory, combining concepts of knowledge transformation with elements of communication, mutual goal setting, and systems theory.
Improvement Science Research Network
The Improvement Science Research Network is a unique infrastructure founded in October 2009. The National Institute of Nursing Research (NINR) and the National Institutes of Health provided $3.1 million to build the infrastructure for large-scale, interprofessional, improvement research projects. It is the first national research network that focuses on testing improvement strategies. The ISRNs primary mission is to accelerate interprofessional improvement science in a systems context across multiple hospital sites. We used lessons learned from CTSAs, PBRNs, and even the 1990s critical care initiative called the "Thunder Project" to design the Network. The commonality across these translational science entities is emphasis on academic-practice partnerships for rapid knowledge development. With its arrival, the ISRN fills a national gap in improvement science, creating a central structure upon which to build a sustainable, comprehensive network for testing which improvement approaches work in healthcare settings. The Improvement Science Research Network is comprised of national members, the Network Coordinating Center and a Steering Council. A unique technology infrastructure connects the Network and supports the conduct and dissemination of improvement research studies. Further details are available at www.ISRN.net.
AHRQ Health Care Innovations Exchange
The ACE center is a partner in the development and maintenance of the AHRQ Health Care Innovations Exchange. Participating as part of the Westat, Inc. project team, we continue to expand this comprehensive online program to accelerate development and adoption of innovations in health care delivery. The Innovations Exchange aims to increase awareness of innovative strategies and activities among health care providers in a timely manner through offering a set of searchable innovation profiles, quality tools, learning opportunities to enhance rapid adoption, and networking opportunities. Further details are available at http://www.innovations.ahrq.gov/.
Building Team Performance for Patient Safety: TeamSTEPPS®
TeamSTEPPS® is the standardized federal program for healthcare team training. The new teamwork system optimizes team performance in order to resolve communication breakdowns, known to be a major contributing factor to sentinel events in patient safety. Seen as a premier example of moving evidence into practice, this evidence-based teamwork system advances quality, safety, and efficiency of patient care by improving communication and other teamwork skills among healthcare professionals. As part of the National Implementation of TeamSTEPPS project, the Department of Defense (DoD) and the Agency for Healthcare Research and Quality (AHRQ) ACE has partnered to build a national support network to move this effective system into healthcare agencies and professional education and to study its impact.
Small Troubles, Adaptive Responses: Fosterning a Quality Culture in Nursing
Funded: Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative. Co-PIs Kathleen R. Stevens, RN, EdD, FAAN and Robert L. Ferrer, MD, MPH
This study aims to improve nursing units quality and efficiency. The study will investigate whether a program designed to address small problems encountered by nurses in patient care will drive large improvements in safety, quality, and efficiency. The analysis applies a logic model specifying the pathway from inputs to actions to intermediate outcomes such as new problem solving strategies to ultimate outcomes such as improved nursing quality benchmarks and reduced adverse events.
Consensus on EBP in Practice & Education
The purpose of this project is to establish a national basis for developing competencies in EBP for nurses. Through multiple iterations, panels of experts engaged in consensus formation regarding EBP competencies that should be integrated into nursing education and practice roles. The consensus is published in Essential Competencies for Evidence-Based Practice in Nursing. This work guides incorporation of EBP skills and content into nursing education programs and into clinical nursing. Health care agencies have used the Essential Competencies as the basis for developing the EBP 'leg' of clinical career ladders and performance standards. Extension and evolution of the competencies continues. Information for purchasing the latest edition of Essential Competencies for Evidence-Based Practice in Nursing (Stevens, 2009) is available from ACESTAR@uthscsa.edu.
ACE Evidence-Based Practice Readiness Inventory (ACE-ERI)
The ACE-ERI was developed through methodologic research studies in response to a national need for assessment approaches in nursing competencies. Using the foundation built in the Essential Competencies work, the self-report instrument was developed and utilized by all levels of nurse clinicians, educators, and students. Psychometrics studies involving over 1,500 participants demonstrated the strength of the ACE-ERI in terms of reliability and validity. Offered primarily as an online survey, the ACE-ERI has been used in hospitals and schools of nursing across the country to benchmark progress in EBP competencies.
Implementation of Evidence-Based Clinical Practice Guidelines in a Veterans Population
PI: Paula Clutter. A study of CPG uptake, this work was completed through collaboration with VERDICT to examine factors associated with uptake of evidence-based guideline implementation in healthcare agencies.
Demonstation Project: Ventilator-Associated Pneumonia (VAP): Improving Outcomes Through Best Practice Implementation
Contracted by TriService Research Grant, BAMC and Wilford Hall nurse teams developed, implemented, and are evaluating impact of best practice in VAP. The ACE Star Model was used to organize this quality improvement project.
Education and Service
Summer Institutes on EBP
ACE sponsors ongoing interdisciplinary education programming at the national Summer Institutes for Evidence-Based Practice. Noted EBP leaders are featured in this unique coordinated-curriculum conference. Funded for multiple years by the Agency for Healthcare Research and Quality, the Institute is coupled with graduate level course studies. Summer Institutes are held annually in July in San Antonio. Each year, the Institute is accompanied by an assortment of pre-conference and post-conference workshops and sessions to meet the expanding needs for professional development. Further information is available at www.acestar.uthscsa.edu.
Graduate Study in EBP
Formal coursework, intermediate and advanced, is offered through the UTHSCSA graduate program, suited to masters, pre-doctoral, and postdoctoral study. Students may become ACE Scholars; the focus of work is individualized.
Presentations, Workshops, & Course Work in EBP
Multiple venues are offered for professional development in EBP. Students and faculty are invited to join the ACE Speakers bureau to receive training, materials, and handouts for EBP presentations.
Resources for Teaching EBP
Available from ACE is a growing set of resources that are useful in teaching EBP. These include self-study modules on topics such as Essentials of EBP, PowerPoint slides with lecture notes on Essentials of EBP, sample learning assignments and essay criteria, and bibliography of recommended readings.
Quality and Safety
Services are available to assist clinical agencies as they establish best practice, improve quality, and enhance safety in clinical care. Health care agencies and nurse managers may contract such services. With Magnet Recognition status a high priority for many agencies and with curricula calling for integration of EBP into courses, faculty and students will likely become involved in establishing best practices. ACE provides resources and assistance to initiate/link research with best practice.
Because the nature of EBP is interdisciplinary we seek multidisciplinary representation across all ACE projects. ACE services to establish best practices are available to health care agencies. Students may engage in coursework related to many of the projects.