Continuing to Challenge Practice to Be Evidence Based

Abstract

E nsuring that we provide safe, evidence-based, cost-effective care to all patients is an assumption of today's health care system. All patients and health care providers should expect a health care system that is committed to preventing harm and improving patient care by having clinicians use evidence-based safe practices.1 The call for evidence-based practice (EBP) was made in the hallmark publication of the Institute of Medicine's report "To Err Is Human" more than a decade ago. Feature Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice. (Critical Care Nurse. 2015;35[2]:39-50)

Maintaining Your Momentum: Moving Evidence Into Practice

“…It's time to change the culture in our critical care units to a culture that embraces the translation of evidence into daily practice. 24 Thomas Paine 37 said in 1776, "a long habit of not thinking a thing wrong gives it a superficial appearance of being right. .…”

“…Critical care nurses are in an optimal position to lead practice, moving traditions "out to pasture" and embracing EBP interventions. 1,2,12,[19][20][21][22][23][24] Through the multiple presentations and publications on these sacred cow practice traditions, clinical experts have challenged each of us to critically examine our practice and ensure that we are current, that our care is evidence based. This series is being retired because few new practice traditions or topics are arising.…”

“…When asking questions is encouraged, traditions in practice can be challenged, providing an opportunity to advance learning and practice through a culture that embraces EBP. [19][20][21][22][23][24] Ensuring that critical care nursing practice is based on the current best evidence supports a culture of safety, helping achieve the goal of excellent care for every patient, every time.…”

“…A total of 30 nursing practice intervention traditions and current evidence related to them have been presented. [19][20][21][22][23][24] The real challenge now lies with you, the critical care nurse. Are you practicing by current best evidence in your daily practice?…”

“…That presentation was the eighth in a series of presentations and articles that challenge critical care nurses to examine the evidence used to guide nursing practice interventions. [19][20][21][22][23][24] Almost a decade of practice traditions have been reviewed, and current evidence to support practice has been shared through this series of presentations and articles by experts to enhance practice knowledge and action. A total of 30 nursing practice intervention traditions and current evidence related to them have been presented.…”