Evidence-Based Farm

A Primer on Evidence-Based Practice

By Amy Glasofer, PhD, DrNP, RN, NE-BC

Objectives

• ​Define evidence-based practice (EBP)

• Discuss importance of EBP

• Provide examples of common practices that are not evidence-based

Background

• ​US healthcare expenditure > any other developed country

  (IOM, 2013)

• Americans live shorter lives in poorer health than individuals in other developed countries​

• Preventable medical errors contribute to between 210,000-400,000 deaths per year (James, 2013)

• 3rd leading cause of death in the US (Makary, 2016)​

​

Some Statistics

• ​___% of errors caused by incompetence, ___% caused by competent clinicians working in poorly designed systems with poor uniformity (Riley, 2009)

• EBP is a key strategy to improving system design and practice standardization​

The synthesis of the most relevant and BEST research, clinical expertise, and patient preferences and values in making decisions about patient care

​

(Melnyk & Fineout-Overholt, 2018​)

​

​Some text here about the topic of discussion.

​What is EBP?

Most important step in EBP:

• ​Step Zero: Cultivate a Spirit of Inquiry

  • Requires a culture that allows nurses to consistently question clinical practices​ (Melnyk & Finest-Overholt, 2018)​

Join me on the Evidence-Based Farm

Sacred Cow

Best Guess Zebra

Evidenced-Based Owl

Multiple Choice

Handwashing is indicated before direct contact with patients

Multiple Choice

Incentive spirometry is indicated for post-op abdominal surgery patients

What does the evidence say?

"There was no evidence that IS is effective in the prevention of pulmonary complications"​

"Routine use of IS to prevent atelectasis in ​patients after upper abdominal surgery is not recommended"

Is there any harm in continuing routine use of IS?

​Using national data, for the 9.7 million inpatient surgeries performed annually, the total cost of implementing post-op IS is estimated to be $1.04 billion

Multiple Choice

Pre-operative patients should be kept NPO (nothing by mouth) after midnight

What does the evidence say?

American Society of Anesthesiologists (2017)

Is there any harm in continuing NPO after midnight for pre-op patients?

• Prolonged fasting (> 8 hours) results in

  • Discomfort

  • ​Insulin resistance

  • Muscle wasting

• Pre-operative beverage supplementation

  • ​Improve discomfort

  • Reduce post-op insulin resistance

Noba & Wakefield, 2019; Pimenta & de Aguilar-Nascimento, 2014

Multiple Choice

Vital signs should be taken every eight hours for stable medical-surgical inpatients

What does the evidence say?

"Despite being among the most common hospital practices... current practice cannot be said to be evidence-based. Little is known about which vital signs should be measured routinely and at what frequency."

• ​Compliance with vital sign monitoring policies often poor

• ​Base frequency on early warning scores

​

Is there any harm in continuing midnight q8 hr vital signs for all patients?

Arora & Stewart, 2018

In Conclusion...

Questions?​