Guest Author - Lorraine Hover
When you hear the term Evidence-Based Practice (EBP) do you get scared? Do you feel like there is no way you could conduct research or make evidence-based recommendations? Guess what? You can and you should! Quality care begins with you and all care should be based on evidence-based interventions. You can make it happen and help your unit or facility do it as well! Let's look at what EBP is and how to use research to help improve the care you give to patients.
Historically nurses were considered to be “hand-maidens” of doctors. Time has certainly changed this perspective for the better. Today's nurses are expected to have critical thinking skills, be able to use research, and to continually seek out education to advance skills, knowledge and use of evidence-based nursing interventions. EBP is the standard for current nurses in all aspects of nursing. Nursing's knowledge base is continually expanding with increasing nursing-based research.
Using research to improve your own personal practice and that of your unit or facility is not as hard as you might think or fear. Let's review a common scenario in which nurses lead the way to quality patient outcomes through research and evidence-based interventions for practice.
You are a nurse on a general unit and notice an increasing number of falls. You bring up your concern during a staff meeting and the rest of the nurses agree with your observation. The manager appoints you to look into the matter. After finding volunteers to work with you your committee begins by looking at incident reports of falls over the past 6 months. A trend appears: most falls are occurring in the later evening, approximately 2000-2400 (8 p.m. to midnight). The committee takes an even closer look at such variables as medications, diagnoses, surgical status, use of oxygen, distance from nursing station and staffing levels during incidents. The next trend is obvious, over 95% of falls occur in patients receiving Lasix PO or IV between 1800-2000 (6 p.m. to 8 p.m.). No other variable shows any statistically significant trend. A search of recent articles and research on Lasix administration, fall prevention and medication pharmacology is conducted. Your committee brings the findings to your manager. Following your facility's procedure for recommending and implementing a new policy the staff is educated and the new policy is implemented. The policy changes time of Lasix administration to earlier in the day in patients without an indwelling catheter and unless medically contraindicated. Six months later the committee reviews incident reports regarding falls and discovers a 75% reduction in falls.
You may be thinking “What does this have to do with research and EBP?”. What you and your fellow staff members have done is a research study. You have taken the following steps:
1. Identified the potential problem: falls.
2. Conducted a retrospective case study by reviewing falls for the past 6 months.
3. Reviewed literature on fall prevention as well as pharmacology and administration of Lasix.
4. Developed recommendations regarding Lasix administration and fall prevention.
5. Presented findings and evidence-based recommendations regarding fall prevention and administration of Lasix.
6. Obtained medical staff and facility approvals.
7. Implemented the new policies through staff education.
8. Reassessed the effects and made further recommendations as needed.
9. The policy remains in effect and continues to be monitored as part of continuous quality improvement.
How is that research? Research does not have to include multi-million dollar corporations or FDA approval process. What this real unit did was the process needed to conduct research and implement EBP standards to improve patient outcomes. The review of current literature is an essential step for EBP. When research is examined through keying in on the primary variables of falls and medications recommendations made will be based on research and evidence, not opinion.
What concerns are facing your unit or facility? Is there something you can look into and develop evidence-based data and recommendations regarding? If you are the manager or department head, how can you empower your staff to identify concerns and develop evidence-based policies and procedures?
All of us have the knowledge to be able to identify patient care concerns be it in communication, documentation, medication delivery or any number of care issues. Whatever challenges you and your unit face being open to the simple steps of identification, data review, literature search, evidence-based recommendations and facility approval you are empowered to be a leader of change and a champion of excellence. Together, we can build the knowledge base of nursing and build evidence-based interventions for quality outcomes for those we provide care.