Riding the Evidence-Based Practice Wave

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Riding the wave of evidence based practiceIt’s not making as big of a splash as care models like ACOs or the ICD-10 changeover, but the movement toward evidence-based care is having a major impact on clinicians, including those in home health and hospice.

A new study from Ohio State University looks at evidence-based practices (EBP) and recommends 13 competencies for RNs and an additional 11 for APNs. Researchers surveyed national EBP authorities and 80 nurses serving as EBP mentors for the study, which was published in January in Worldviews on Evidence-Based Nursing. The authors urge healthcare organizations to build these skills into job descriptions, orientation programs, performance reviews and promotion protocols as they work to implement or reinforce evidence-based care.

The strong push toward evidence-based practices (EBP) is based on a number of factors:

  • The Institute of Medicine wants 90% of all patient-care decisions to be based on evidence by 2020.
  • The Affordable Care Act calls for reimbursable treatments to follow the US Preventive Services Task force’s recommendations, which are evidence-based.
  • Anecdotal studies have found that nurses are more empowered and satisfied with their roles when engaged in evidence-based practices.

Here are the EBP recommendations for all nurses:

  1. Questions clinical practices for the purpose of improving the quality of care.
  2. Describes clinical problems using internal evidence.
  3. Participates in the formulation of clinical questions using PICOT format.
  4. Searches for external evidence to answer focused clinical questions.
  5. Participates in critical appraisal of pre-appraised evidence.
  6. Participates in the critical appraisal of published research studies to determine their strength and applicability to clinical practice.
  7. Participates in the evaluation and synthesis of a body of evidence gathered to determine its strength and applicability to clinical practice.
  8. Collects practice data systematically as internal evidence for clinical decision making in the care of individuals, groups, and populations.
  9. Integrates evidence gathered from external and internal sources to plan evidence-based practice changes.
  10. Implements practice changes based on evidence and clinical expertise and patient preferences to improve care processes and patient outcomes.
  11. Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups and populations to determine best practices.
  12. Disseminates best practices supported by evidence to improve quality of care and patient outcomes.
  13. Participates in strategies to sustain an evidence-based practice culture.

Here are the additional recommendations for APNs:

  1. Systematically conducts an exhaustive search for external evidence to answer clinical questions.
  2. Critically appraises relevant pre-appraised evidence.
  3. Integrates a body of external evidence from nursing and related fields with internal evidence in making decisions about patient care.
  4. Leads trans-disciplinary teams in applying synthesized evidence to initiate clinical decisions and practice changes to improve the health of individuals, groups and populations.
  5. Generates internal evidence through outcomes management and EBP implementation projects for the purpose of integrating best practices.
  6. Measures processes and outcomes of evidence-based clinical decisions.
  7. Formulates evidence-based policies and procedures.
  8. Participates in the generation of external evidence with other healthcare professionals.
  9. Mentors others in evidence-based decision making and the EBP process.
  10. Implements strategies to sustain an EBP culture.
  11. Communicates best evidence to individuals, groups, colleagues and policy makers.

It’s an ambitious list, but it gives home care agencies a solid, evidence-based foundation on which to build their own EBP programs.

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