Main Post Week 1
NURS 6052: Essentials of Evidence-Based Practice
Evidence-based practice (EBP) is “a problem-solving approach to clinical practice that integrates the use of best evidence in combination with a clinician’s expertise, along with patient preferences and values, to formulate a plan of care” . Evidence-based practice is utilized to help nurses enhance the quality of health care, therefore reducing the gap between research knowledge and practice.
There have been many instances in my nursing career where I have questioned a procedure or a way we did things and wondered if we were doing it correctly or using evidence-based practice. One recent experience I’ve questioned was a daily sedation vacation on ventilator patients. I work in an intensive care unit (ICU) in a smaller hospital, and within the past year, we have gotten our first pulmonologist on staff. He immediately looked at our protocols for ventilator patients and saw that we did not have anything in place for daily sedation vacations. Before his arrival, I never thought about providing my patient’s with this intervention because our physicians never ordered it or talked about it. The only time we would turn sedation off would be for weaning trials. I immediately started asking “why is this important?”, “how does this help our ventilator patients?”, etc. and researching these questions.
The Institute for Healthcare Improvement (IHI) released a bundle of interventions to help prevent ventilator-associated pneumonia (VAP) in 2010. This bundle included elevating the head of thebed at a 30 to 45-degree angle, peptic ulcer disease prophylaxis, deepvein thrombosis prophylaxis, daily sedation vacations, and regular oral care with chlorhexidine . The research found that “management of sedation can have a more profound effect on the duration of mechanical ventilation and other patient outcomes than can manipulating ventilator modes” .
The book describes PICOT as a guideline for physicians to develop well-worded questions that promote a search for evidence . First, a background question is asked. A background question is a foundational question about a clinical topic . My background question would be: “What is a sedation vacation and how is it beneficial to a patient on a ventilator?” Then you will come up with your PICOT question. PICOT stands for P (patient, population, or problem), I (intervention, prognostic factor, or exposure), C (comparison), O (outcome), and T (time) . My PICOT question would be: “In the ICU, what is the effect of a daily sedation vacation compared to no sedation vacation on ventilated patients over a three-day period?”
Adoption of Evidence-Based Practices
A barrier I foresee inhibiting the implementation of evidence-based practice in my facility would be the physicians and nurses who are older and stuck in their ways. They have performed procedures a particular way for many years and could feel that it has worked for their entire career, so why change it upnow. I believe that many nurses and physicians would embrace the changes in policies and procedures because they would benefit our patients, their outcomes, and it would be considered “best practice.” One way to implement EBP and integrate it into a facility in a positive way would be to train new staff members using EBP.