Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline

The objective of this quality evaluation was to evaluate the changes in public health nursing (PHN) interventions after the implementation of an evidence-based family home visiting (EB-FHV) guideline encoded using the Omaha System. Design and sample This quality improvement evaluation was conducted using a secondary dataset of 27,910 PHN family home visiting interventions from visits to 129 adult clients enrolled in EB-FHV programs in a Midwestern PHN agency. The interventions were documented 12 months before and 14 months after EB-FHV Guideline implementation. The EB-FHV consisted of 94 PHN interventions for 10 Omaha System problems, with electronic health record (EHR) data generated by PHNs during routine clinical documentation. Standard descriptive and inferential statistics were employed in the analysis. Measures The Omaha System was used to compare PHN practice before and after the guideline implementation. Results Documentation patterns revealed that PHNs tailored interventions while also shifting toward the use of the EB-FHV guideline interventions. Ten EB-FHV problems accounted for 96.3% of interventions documented before and 98.5% of interventions documented after implementation. The proportion of interventions before and after EB-FHV by problem differed significantly for all problems except Substance use. Fewer interventions were provided after EB-FHV for the primary problems of Pregnancy and Postpartum, with a shift to more interventions for Caretaking/parenting. Conclusion The PHN documentation after guideline implementation demonstrated adherence to the EB-FHV guideline, while tailoring the evidence-based interventions differentially by problem. Further research is needed to extend this quality improvement approach to other guidelines and populations.