Evidence Based Practice--is it still a mystery?

Hi! I just got back from the Case Management Society of America conference where nearly 3,000 case managers met to talk about current practice in beautiful (but hot!) Denver, Colorado. From that conference, I came away with a few things:
(1) Very few people know how to do evidence based practice;
(2) Even fewer know how to do it correctly;
(3)Everyone wants to know how to do evidence based practice.

That final point is a good one but what is deeply concerning are those that think they are doing evidence-based practice when, in fact, they are performing research. Recently in AJN, an article led one to believe that they were doing evidence-based practice in relation to IV dressings when, in fact, they were actually performing a research study. No mention was made of IRB approval. It's also concerning that the evidence that may be used to support an EBP project may not be the best evidence rather the evidence that someone "liked" or supported their position.

So I pose these questions:

• Do the people you work with clearly understand EBP and its differentiation from research?
• Is there a general lack of knowledge in the clinical setting about what EBP is and what it is not?
• Do people know how to find the best evidence?

To post a response, you don't have to be a part of this system so feel free to discuss.

The worst case scenario: When not using evidence produces fatal outcomes

So you've probably heard by now of the terrible event that occurred in a California ER this week where a woman bled to death while her family members stood by helplessly calling 911 for help. First, let's get this straight: if your patients are calling 911 from the ER, there's probably some evidence that a breakdown in communication is occurring somewhere in your organization. Beyond the phone calls, though, it seems like someone vomiting (and vomiting blood, no less) might signal a true emergency. So despite what seemed like overwhelming evidence that this woman was in need of help, nothing was done.

So what do we do about these Failure to Rescues? How do we prevent them? What evidence could have been used so that this didn't happen?

Recently I received in the mail from AHRQ information about Team STEPPS, a set of evidence-based tools to help train clinicians in teamwork and communication skills to reduce risks to patient safety. Many healthcare organizations are beginning to use it but I wonder if any in Oklahoma are using it. Personally, it looks like a great model that could really transform the way we communicate in healthcare.

I'm also curious to know if the fact that these were primary-Spanish speakers in any way influenced how they were treated. It certainly calls up the importance of medical interpretation and cultural competency in our healthcare organizations. Even that is really no excuse since a woman vomiting blood doesn't need much interpretation.

Let's make sure that what happened to Edith Isabel Rodriguez doesn't happen in Oklahoma and actually improves what we can do for patients in desperate need.

1. Have any of you heard about Team STEPPS or know someone using it?
2. Do you think a lack of cultural competency on the healthcare organization's part influenced the care they provided (or, actually, didn't provide)?

Welcome to the SNERC blog

Welcome to SNERC--a group formed this year in Oklahoma with over 200 nurse clinicians and educators. We're excited about the potential that forming this group has for the future knowledge base of nurses within our state as well as the potential to improve outcomes for the patients that we see day-to-day.

Never doubt that a small group of thoughtful, committed
citizens can change the world;
indeed, it's the only thing that ever has.

Margaret Mead

I truly believe that and hope you do as well. Now, why don't you make suggestions for topics related to EBP and Research that you'd like to see on this blog?