According to Margaret Titler evidence-based practice (EBP) is the "conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions." (Titler, 2008).
Best evidence includes evidence from randomized controlled trials, qualitative research, case reports, scientific principles, and expert opinion.
When enough research evidence is available and random trials have been conducted then practice should be decided by the outcomes of research, clinical expertise and positive patient improvement.
Examples of evidence-based practice are nurse-driven indwelling foley removal. Agency guidelines should include an indication for foley insertion along with indications for continued use. Urinary tract infections (UTIs) are one of the leading healthcare-associated infections.
The primary goal in the prevention of catheter-associated urinary tract infections (CAUTI) is to insert a Foley only when medically appropriate and remove a Foley when no longer medically appropriate. Nurse-driven protocols have been shown to improve patient care, and as nurses are continually at the patient bedside, they are more aware as to when the Foley is no longer medically necessary.
Our hospital has a CAUTI assessment team that evaluates the necessity of the Foley of each patient every day and removal of the Foley by the bedside nurse without a physician order if the Foley is no longer meeting medical necessity protocols.
Another example of evidence-based practice would be the use of Curos Caps to prevent central venous catheter-related infections. According to the Centers for Disease Control and Prevention, "central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system" (Healthcare-associated Infections, 2016).
A study cited by the Journal of the Association of Vascular Access reported "The implementation of the port protector cap system resulted in lower infection rates compared with an alcohol swab technique. Our results indicate that consistent use of the caps in tandem with strict compliance does influence CLABSI rates." (Ramirez, Lee, & Welch, 2012).The use of Curos Caps (alcohol impregnated catheter hub cap) to cap off all open catheter hubs, IV line catheter hubs, and IV j-loops not in use significantly decreases CLABSI's.
Our ICU did an audit for one month before use of Curos Caps and one month after implementation of Curos Caps. We found while not using Curos Caps the unit had 4 CLABSI infections and while using Curos Caps the unit had zero infections. The CLABSI prevention team used information from evidence based practice in addition to our own unit study and implemented Curos Caps to be used on all lines at all times.
My nursing care changes daily with the studies provided by evidence based practice findings. It is hard to teach an old dog new tricks and just becasue a nurse has been doing something for her whole career does not mean it is sound medical practice. Evidence based practice needs to guide everything we do and when new tricks are learned they need to be implemented and adhered to in order to provide the best care to our patients and improve patient outcomes.