By Betsy Todd, MPH, RN, CIC, AJN clinical editor
by karen eliot/via flickr
In a series of articles in AJN, evidence-based practice (EBP) is defined as problem solving that “integrates the best evidence from well-designed studies and patient care data, and combines it with patient preferences and values and nurse expertise.”
We recently asked AJN’s Facebook fans to weigh in on the meaning of EBP for them. Some skeptics regarded it as simply the latest buzzword in health care, discussed “only when Joint Commission is in the building.” One comment noted that “evidence” can be misused to justify overtreatment and generate more profits. Another lamented that EBP serves to highlight the disconnect between education and practice—that is, between what we’re taught (usually, based on evidence) and what we do (often the result of limited resources).
There’s probably some truth in these observations. But at baseline, isn’t EBP simply about doing our best for patients by basing our clinical practice on the best evidence we can find? AJN has published some great examples of staff nurses who asked questions, set out to answer them, and ended up changing practice.
- In a June 2013 article, nurses describe how they devised a nurse-directed protocol that resulted in fewer catheter-associated urinary tract infections (CAUTIs).
- A 2014 article relates how oncology nurses discovered the lack of evidence for the notion that blood can only be transfused through large-bore needles. These nurses were able to make transfusions safer and more comfortable for their patients.
A spirit of nursing curiosity drove these projects, and inquiry is the heart of EBP. The process itself can foster a sense of teamwork, trust, and investment in the care we provide. What if nurses were to lay claim to EBP as a way to shape and control our practice in this chaotic time of health care changes?
There is a major revolution in healthcare happening and it is kind of a beautiful bureaucratic shove in the right direction. Joint Commission is driving the Evidenced Based Safety Standards required by CMS and then followed by healthcare insurance companies, all from the PPACA (Obamacare). These standards are coming form research filtered through and supported by the IHI, IOM, ECRI, RWJF to satisfy the Triple Aim: Better care, improved health of the population, lower per capita costs. And it is working. Billions are being saved, healthcare is moving back into the communities, more have access to prevention and chronic disease management, and hospitals are accountable for outcomes. The process is amazingly moving along despite having to turn the huge ship of American healthcare delivery around to avoid the iceberg it was headed into.
The numbers showing the reductions in CLABSI, CAUTI, VAP, HAIs, and all of the alphabet soup that reflects reduction in illness, suffering and costs for our patients are impressive.
Nurses need to understand and drive the safety standards that protect their patients and their own bodies. President Obama just directed OSHA to begin assessing hospitals for their patient handling practices and adoption of safe patient handling programs, with the power to levy fines of $7-70,000 per facility.
Nurses must get involved in the creation of a healthcare system that reflects the nursing ethical and clinical ideals we were all taught: prevention, education, safety, compassion and the best science-based care for all people.
As with any law born of politics and compromise to get it passed, the process has many flaws. The gaps, non-therapeutic practices and mistakes will need to be fixed and redesigned. However it is headed in the right direction. Nurses need to be aware, educated on the regulations and politics and be the major player in the implementation and improvements.
Reblogged this on The 21st Century Nurse.
It seems that Core measures and evidence based practices are usually tied to what is and/or is not compensated by insurance or medicare.