



How to Navigate
BROWSE
FIND



MENU
Move forward or backward between articles by clicking the arrows.
Click or tap to bring up the Table of Contents.
READ



SHARE

Share articles by clicking on one of the social media icons in the upper right corner of the page.
Use your mouse wheel, keyboard arrow keys, or scroll bar to move up and down in an article.
RNs can initiate evidence-based practice protocols
Bedside nurses are not powerless in implementing evidence-based practice

By
Meaghan O'Keeffe, BSN, RN
Are you a bedside nurse that feels powerless to effect change within your institution? Making an evidence-based practice change isn’t necessarily easy. Barriers such as a lack of time and or institutional support can get in the way of your efforts. But you do have the power to make significant changes in your workplace. Here’s how.
Visit Nurse.com
Advertise with Nurse.com
Contact Nurse.com
© 2021 Nurse.com from Relias. All rights reserved.
1
Identify the problem
2
Conduct a root cause analysis
Do you find yourself complaining about an issue consistently at work? Those are precisely the areas you may be able to influence with evidence-based practice change. Possible areas that may need an EBP change implemented include:
Chronic interdisciplinary communication issues
High level of falls on your unit
Healthcare associated infection
High level of nurse burnout and turnover
3
Conduct a literature review and/or collect institutional data
Root cause analysis is a form of clinical inquiry designed to get to the bottom of a sentinel error. It should never be used as a punitive tactic. Techniques for Root Cause Analysis, published by Baylor University Medical Center in Dallas, Texas, is a helpful overview that covers how to accomplish a productive root cause analysis. One of the techniques posed is “Ask Why 5 Times.”
Example of the “Ask Why 5 Times” Technique
The ORs were overscheduled.
In this instance, a variety of factors played a role in the over-sedation of the patient. Occasionally the rushed pace of the OR may lead to oversights and inadequate communication. A communication handoff tool that requires covering essential details that might otherwise be missed is a possible technique to implement to avoid similar errors. Or, perhaps the overscheduling of ORs contributed to the problem. In that case, your EBP change may be related to improving operating room efficiency and scheduling techniques.
The problem: A patient in the PACU demonstrates severe respiratory depression.
Why?
Why?
They received an excess of narcotics.
Why?
The anesthesiologist medicated the patient prior to transfer and the recovery nurse, not knowing this, also medicated the patient.
Why?
Handoff was rushed and important details got missed.
Why?
There was a backup in the OR and urgency to get to the next case.
The most critical element of EBP change is the evidence. Data and scientific findings are the ammunition you need to bring a clinical issue to light. Create a brief outline to help you organize the information in a written report, including the problem, studies and data you’ve analyzed; results; possible limitations; and a proposal for the kind of program you’d like to implement.
4
Ensure thorough communication with leadership
Even if the executive leadership seems like more of a barrier than a help, continued communication throughout the process of an evidence-based practice change is essential. Without going through the proper chain of command, your efforts will likely be for naught. A well-researched and convincing review of the problem, and a sound proposal for change, will be your greatest ally in garnering nursing leadership support.
5
Communicate with staff
Provide educational materials, clinical reminders and tools, and feedback to staff to keep them engaged and help illustrate how a change can make a difference in their practice. Involve coworkers in data collection and program implementation.
6
Evaluate before and after
If you want to see sustainable change, a thorough evaluation of outcomes before and after the implementation is imperative. This may include a survey, data collection or a chart review. The studies used in your literature review may be a helpful source for evaluation tools.
What is EBP?
The integration of clinical expertise, patient values and the best research evidence into the decision-making process for patient care.
CLINICAL EXPERTISE
PATIENT VALUES
EBP
BEST RESEARCH EVIDENCE
Source: David Sackett, et. al
Search for the perfect MSN program for you
Read More

EDITOR'S NOTE:
Meaghan O'Keeffe, BSN, RN, is a freelance writer.