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I do not entirely disagree with you on the fact that it is not that simple. I think there needs to be a transparency of what evidence-based practices and QI projects that are being utilized in the care of the patient. There needs to be a revision of the admission consent forms to include these procedures and the possibility that the data could be used in the future to improve patient care.
I understand your point of view, but I do believe there needs to be a middle ground with the consent and transparency of policies and procedures. With the changing models of patient-organization, hospitals should take this opportunity to revise and revamp how informed consent is presented to patients. As suggested by Campbell & Parsi (2017), hospitals should try to employ a non-traditional approach to a traditional concept by expanding how information is delivered to patients. For example, while EBP and EBQI may not need to be regulated by informed consent, it should be explained to patients the there are specific practices and procedures that are being implemented into their daily care and can be used later for further improvement. As I had stated, while I do not feel there is a need for informed consent for EBQI, I do feel there is a need for transparency.
Campbell, K., & Parsi, K. (2017). A New Age of Patient Transparency: An Organizational Framework for Informed Consent. Journal Of Law, Medicine & Ethics, 45(1), 60-65. doi:10.1177/1073110517703100
I definitely agree with you on the point of delaying patient care with having to obtain consent for every individual EBP and EBQI initiative. I really feel this additional consent is over the top and unnecessary when EBP is trying to improve patient outcomes with relatively non-invasive techniques. I still stand by my initial response of supporting these initiatives to be covered under the admission consent.
I am arguing the fact that there does not need to be informed consent for EBQI projects. EBQI is systematic and guided by data collected through QI activities that are meant to build on patient safety, outcomes, and satisfaction. Patients admitted to the hospital, they give consent for treatment, and I believe this permission covers any QI projects that patients may be involved in during their length of stay. QI projects focus on solving clinical problems, which is beneficial to clinical outcomes. QI is performed by clinicians, collecting data that can improve patient care and is not as invasive as clinical research, where an individual enrolled in a clinical trial (Melnyk & Fineout-Overholt, 2015). When a patient enters into a clinical trial, where there needs to be patient involvement, such as taking new medications or having blood work done, there needs to be informed consent. It is on the contrary with EBQI; it could be unethical to withhold treatments and processes that will be beneficial to patient outcomes. For example, an EBQI project that has been in place in my ICU is the importance of mouth care in ventilated patients. The mouth care kit has a set number of swabs and chlorhexidine mouthwash for a 24hr period to be used to prevent ventilator-assisted pneumonia (VAP). Since implementing this project, there has been a significant decrease in the incidence of VAP. The difference in an EBQI project like this one versus a research project from an ethical standpoint would be the fact that in the EBQI project, there is not a control group and an experimental group.
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.