Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes. In many hospital EDs across the country, children with asthma are treated with albuterol delivered with a nebulizer, even though substantial evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. Nurses even disrupt patients’ sleep, which is important for restorative healing, to document blood pressure and pulse rate because it’s hospital policy to take vital signs every two or four hours, even though no evidence supports that doing so improves the identification of potential complications.
So begins an article in the November issue of AJN, the first in a new series we are running to highlight the way’s evidence-based practice (EBP) changes what nurses do at the bedside—and saves lives. The authors point out that every day nurses perform dozens of actions and procedures without ever really asking whether the way they are doing them is the best way, or whether or not they are even helping patients by performing these actions.
While it’s true that no one will ever get anything done if it’s not possible to take certain basics of patient care on faith, it’s also true that much of what gets done is simply not supported by the available research. EBP is not just another buzzword useful for administrators who want to sound up-to-date and want to harass you with in-service training; EBP is quickly being acknowledged as the force that will drive meaningful health care reform, simultaneously improving patient care as it lowers costs. The authors have this to say:
The Institute of Medicine has set a goal that by 2020, 90% of all health care decisions in the United States will be evidence based, but the majority of nurses are still not consistently implementing EBP[evidence-based practie] in their clinical settings.
You can read the article here. But tell us: what practices, minor or major, are you unsure about when it comes to their cost or their true efficacy? And is your hospital applying EBP to change any of these practices? Are you?