Why should perioperative RNs care about evidence-based practice? - Statistical Data Included

AORN Journal, July, 2000 by Suzanne C. Beyea

During the last decade, evidence-based practice has become a buzz phrase in health care. Providers, insurers, and patients all ask, "What is the evidence, and is this the best practice based on research?" In the current health care environment, clinicians constantly strive to enhance the quality and value of patient care while reducing costs. When clinicians use research findings and the best evidence as their foundation for clinical decision making, the outcome is evidenced-based practice.

Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.(1) When clinicians make health care decisions for a population or group of patients using research evidence, this definition can be expanded to evidence-based health care. Evidence-based health care cannot occur unless health care professionals are skilled in reading, critiquing, and synthesizing research findings. Making patient care decisions using this information and one's clinical expertise enhances health care providers' ability to provide best practice.

USING EVIDENCE TO MAKE CARE DECISIONS

In today's health care environment, all clinicians must clearly understand and interpret the pertinent evidence before providing care. Clinicians must ask the difficult questions related to the risks and benefits associated with costly interventions or treatments. Health care consumers and insurers demand state-of-the-art treatment as well as research findings that demonstrate its effectiveness. Every procedure and step related to the procedure must be carefully considered for their contribution to health outcomes. Clinicians can no longer rely on the reasoning "This is the way we have always done things" or "This is the way I learned how to do this."

Nurses must be leaders in providing evidence-based health care. Without a strong commitment to using evidence to guide decisions, nursing will lose credibility as a profession. Nurses need to carefully assess the evidence and provide cost-effective care that achieves the most positive outcomes. Scientific knowledge must provide the foundation for those care decisions. Health care consumers are already questioning the appropriateness of paying for unproven interventions. Meanwhile, insurers are making reimbursement decisions based on the efficacy of specific interventions, regardless of the discipline that provides the service.

ASKING THE RIGHT QUESTIONS

Perioperative nurses are well positioned to lead efforts in evidence-based practice. Nurses in surgical settings collaborate with all health care team members and have many opportunities to identify potential clinical problems and issues and question customary practices. Nurses can begin the process of using evidence to guide practice by simply asking the following questions.

* Who determined the basis for this treatment?

* What was the rationale for making that decision?

* What are the clinical implications of this practice?

* Why are we doing this, and why are we doing it this way?

* Could it be done better, more efficiently, and more cost-effectively?

* Are these the highest achievable outcomes?

Asking and answering these questions can help nurses find solutions for troubling clinical questions as well as improve existing practice that may appear to be within acceptable parameters. Many examples in the nursing and health care literature demonstrate how the status quo is potentially injurious to patients and expensive to the health care system.

Nurses have improved health care quality and reduced costs by simply asking, "Why do we do things that way?" A classic example is a meta-analysis conducted to estimate the effects of heparin versus saline flushes on maintaining patency, preventing phlebitis, and increasing duration of peripheral intermittent IV devices. The results of this analysis provided evidence that saline flushes could be used to maintain patency, prevent phlebitis, increase the duration of these devices, and save between $109 and $218 million.(2) Consequently, research utilization has led to the wide adoption of saline flushes in clinical practice, thus improving care, reducing costs, and decreasing risks. Just imagine the outcomes if nurses had never asked, "Why do we use heparin as a flush?"

Research pertaining to nursing care after cardiac catheterization is another example of how asking questions about a process can result in positive patient outcomes. More than 500,000 cardiac catheterization procedures are performed in the United States each year.(3) A number of arbitrary traditions for post-catheterization care include eight to 12 hours of bed rest, head elevation restrictions, and limb immobilization. Long periods of bed rest can result in back pain and urinary retention and substantially increase the cost of care and decrease efficiency.(4)

When first questioned about the rationale for a long duration of bed rest, physicians often responded that was the way they were trained. Subsequently, research exploring the risks versus benefits of various periods of bed rest demonstrated that, in many clinical situations, three hours is an adequate period of bed rest to achieve hemostasis.(5) This change increased patient comfort, decreased costs and lengths of stay, and improved the efficiency of busy diagnostic centers. When this clinical innovation is implemented nationwide, not only are the potential costs savings note-worthy, but patients also will avoid prolonged periods of bed rest and the resulting complications.