How to Arrange and Rearrange so the

Pieces FitBarriers to

Implementation of Evidenced Based Practice

Vicki Good, RN MSN CCNS CENPDirector of Nursing Practice

Cox Healthcare SystemSpringfield, MO

Objectives

Define implications of Evidence Based Practice to the Magnet Journey

Identify barriers preventing staff nurse engagement in Evidence Based Practice.

Demonstrate processes to overcome actual and perceived barriers to Evidence Based Practice.

The Challenge . . .

Average period of time between discovery of better treatment and implementation in patient care is 17 years.When staff consult others within their own professional discipline, they used 67 sources of data before changing practice.The barriers to implementing Evidence Based Practice have not changed through the years.

Challenge: Need for Information

“The findings of the 2006 Evidence-based Practice Research Study suggest that most nurses consistentlyneed to find, access and provide care based on EBP. Nearly 2 in 3 (64%) indicate that this need arises at least weekly and 9 in 10 (90%) say it happens at least occasionally.”

Source: Sigma Theta Tau International, 2006 EPB StudyCompliments of Zynx Care

ANCC Magnet Journey

ANCC 14 Forces of Magnetism

Quality of Nursing LeadershipOrganizational StructureManagement StylePersonnel Policies & ProgramsProfessional Models of CareQuality of CareQuality ImprovementConsultation & ResourcesAutonomyCommunity & Healthcare OrganizationNurses as TeachersImage of NursingInterdisciplinary RelationshipsProfessional Development

3 Primary Barriersin the Implementation of EBP

1. Time

2. Empowerment

3. Knowledge

No protected time at work to read, review, or implement Evidence Based Practice.

Most productivity standards now include all nursing time whether in direct patient care or in meetings, etc.

Home time is “reserved” for non-work related activities, especially with younger worker.

Challenge: Time

Source: Sigma Theta Tau International, 2006 EPB Study

Challenge: Time

1. Time

2. Analysis

3. Accessibility

Why is it difficult for nurses to utilize evidence in their practice?

Compliments of Zynx Care

EmpowermentPerception that nursing lacks authority and cooperation of medical staff and/or administration to change practice.

Staff nurse participation in approval of policy/procedures, research, etc.

KnowledgeInterpreting statistical/technical language

Skill & confidence

Access & knowledge of internet and library resources

Study by Wells, et al 2007, 76% never searched the internet; 58% never searched Medline

Lack of access to experts in Evidence Based Practice

How to overcome Barriers?

Make Evidence Based Practice a part of

every day life of the nurse

Shared Leadership

As Shared Leadership councils become more mature, require literature reviews for any change in practice, etc.Empower the Shared Leadership structure to make change in practice. Involve the Shared Leadership structure/council in the approval of changes to policies and procedures for patient care.

Research Internships

6-9 months in length

Partnership between College/University and Hospital

Monthly or bi-weekly class with a clinical in research

Research project requirement

Graduate credit?

Accessibility of Information

Direct link for staff to access Evidence Based Practice at their finger tips

located in one place.

Accessibility of InformationReferences within

Clinical Documentation Systems

Partnerships

Universities/CollegesJoint appointments, adjunct faculty, etc

Professional OrganizationsPractice Alerts

IndustryVendors – both pharmaceuticals and equipment/supplies

Partnerships Professional Associations

PartnershipZynxCare

• Zynx and Sigma Theta Tau work collaboratively to support delivery of research and evidence to the bedside

• Zynx clients can access educational and consulting resources to support the development of an evidence-based nursing culture

• Partnership represents an endorsement of ZynxCare™ from highest level of professional nursing scholarship and leadership

• Evidence-based interdisciplinary plan of care and clinical documentation content and content management designed to support organizations in:– Implementing evidence based practice at the point of

care– Standardizing clinical practice between and among

disciplines– Efficiently deploying evidence-based content in paper,

HTML, or EHR system – Achieving measurable results

ZynxCare: Evidence-Based Practice for the Interdisciplinary

Team

ZynxCare™ Plan of Care

Shared language and coded concepts with ZynxOrder™

Evidence Links

Blue Ribbons: Quality Measures

Zynx Evidence: CAP - Interdisciplinary

Evidencesupporting the

interdisciplinary care team

Vital Signs Frequency

Performance Measures

supporting the interdisciplinary

care team

Vital Sign Frequency

• Patients with uncomplicated community-acquired pneumonia, no between-group difference in length of stay, mortality rate, number of ICU transfers or discharge destination between VS measurement assessed every 4-6 hours as compared to VS assessment ever 8-12 hours

Chest Physiotherapy

• For patients with pneumonia, who do not have underlying mucociliary clearance, the use of chest physiotherapy is not supported

The Challenge . . .

Fit all pieces together for the optimal outcome of the patient in the most efficient way possible for the Registered Nurse . . .

References

Carlson, CL & Plonczynski DJ. (2008) Has the BARRIERS Scale changes nursing practice? An integrative review. Journal of Advanced Nursing. 63(4), 322-333.

Leasure, AR, Stirlen, J, & Thompson, C. (2008) Barriers and facilitators to the use of evidence-based best practices. Dimensions of Critical Care Nursing. 27(2), 74-82.

Thompson, C, et al. (2005) Barriers to evidence-based practice in primary care nursing – why viewing decision-making as context is helpful. Journey of Advanced Nursing. 52(4). 432-444.

Wells, N, et al. (2007) Nursing research internship: Enhancing evidence-based practice among staff nurses. Journal of Nursing Administration. 37(3), 135-143.