I interviewed my medical-surgical clinical instructor, Joan Widmer, about her experience conducting research regarding nasal specimens for the Influenza A/B screen. Her “ah ha” moment occurred when she was discussing her frustration with an emergency department physician regarding the difficulty of obtaining a nasal specimen for the Influenza A/B screen and the usual negative test results. The physician suggested that she use a spritz of saline into the patient’s nares prior to obtaining a nasal specimen. Joan then used this technique for the next two patients that needed an Influenza A/B screen and both patients came back positive for Influenza and neither had difficulty with the specimen collection technique. Later on, Joan conducted a brief review of the literature to see if there was previous examination about specimen collection technique and did not find any study specifically relating to that topic. However, she did read that moisture is key to maintaining cellular viability, which is important when testing for a virus. She searched for the evidence relating to her clinical question by using MedLine, Cinahl and Cochrane Center for Registered Control Trials. She did not find any articles that assessed the use of a nasal atomizer to reduce the incidence of false negatives for Influenza tests. Although, she found five articles that compared the use of nasopharyngeal aspirate to nasal swab specimens for the detection of Influenza or other upper respiratory viruses. Joan decided her patient population would be a convenient sample of patients that would present to Catholic Medical Center (CMC) Emergency Department with upper respiratory symptoms, Monday through Firday between 7:00 am and 11:00 pm, for which an ED provider ordered an Influenza A/B rapid screening test. Patients had to speak English and be over the age of 18. She developed this clinical question: Does the installation of sterile normal saline into the nares by a nasal atomizer reduce the incidence of false negatives in the identification of Influenza A or B virus via immunochromatographic testing (rapid screening test)? Once Joan had finished reviewing all of the abstracts from her database searches, she obtained full articles that were pertinent to her own research. The studies were evaluated for study quality using the evaluative methodology developed by Melnyk and Fineout-Overholt in their book, Evidence-Based Practice in Nursing. Joan examined the studies for various criteria such as: method of data collection, randomization if applicable, the number of subjects in the study, study control of bias and statistical analyses applied to the data. She began her process of designing the practice improvement by drafting a project proposal to test this new technique against the existing specimen collection technique as well as developing a study protocol. She then applied for and received funding to test this technique and presented everything to the IRB for her hospital. Once she had approval to proceed, she was able to train a handful of Registered Nurses to consent and test patients as of Monday, December 7th. Patients that meet the study criteria will be approached by a trained RN to see if they are interested in participating in the study. This project will proceed through the end of March or until 85 patients have been tested. Therefore, she has not been able to implement the practice improvement yet. She determined the number of study participants with a pre-study power analysis that considered the number of Influenza A/B screens between December 1, 2015 and March 31, 2016, within the CMC Emergency Department. Depending on the project outcomes, decisions will be made accordingly to adjust clinical practice. When searching for literature myself,
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The articles that I found compared nasopharyngeal aspirate and nasal swab specimens for the detections of viral respiratory infections in hospitalized patients. Nasopharyngeal aspirate was considered the gold standard among all of the studies due to the greater sensitivity of detecting viral influenza viruses. This research is credible, because there is linkage between the recommendations and the evidence supporting it. The likelihood of good patient outcomes was considered. She has used a pre-study analysis to determine that there is an estimated number of positive screens (10%) and a projected increase in positive screens of
The articles that I found compared nasopharyngeal aspirate and nasal swab specimens for the detections of viral respiratory infections in hospitalized patients. Nasopharyngeal aspirate was considered the gold standard among all of the studies due to the greater sensitivity of detecting viral influenza viruses. This research is credible, because there is linkage between the recommendations and the evidence supporting it. The likelihood of good patient outcomes was considered. She has used a pre-study analysis to determine that there is an estimated number of positive screens (10%) and a projected increase in positive screens of