How to Arrange and Rearrange so the Pieces Fit Barriers to Implementation of Evidenced Based Practice

1. How to Arrange and Rearrange so the Pieces FitBarriers to Implementation of Evidenced Based Practice Vicki Good, RN MSN CCNS CENP Director of Nursing Practice Cox Healthcare System Springfield, MO

2. Objectives • Define implications of Evidence Based Practice to the Magnet Journey • Identify barriers preventing staff nurse engagement in Evidence Based Practice. • Demonstrate processes to overcome actual and perceived barriers to Evidence Based Practice.

3. The Challenge . . . • Average period of time between discovery of better treatment and implementation in patient care is 17 years. • When staff consult others within their own professional discipline, they used 67 sources of data before changing practice. • The barriers to implementing Evidence Based Practice have not changed through the years.

4. Challenge: Need for Information “The findings of the 2006 Evidence-based Practice Research Study suggest that most nurses consistently need to find, access and provide care based on EBP. Nearly 2 in 3 (64%) indicate that this need arises at least weekly and 9 in 10 (90%) say it happens at least occasionally.” Compliments of Zynx Care Source: Sigma Theta Tau International, 2006 EPB Study

5. ANCC Magnet Journey

6. ANCC 14 Forces of Magnetism • Quality of Nursing Leadership • Organizational Structure • Management Style • Personnel Policies & Programs • Professional Models of Care • Quality of Care • Quality Improvement • Consultation & Resources • Autonomy • Community & Healthcare Organization • Nurses as Teachers • Image of Nursing • Interdisciplinary Relationships • Professional Development

7. 3 Primary Barriersin the Implementation of EBP • Time • Empowerment • Knowledge

8. Challenge: Time • No protected time at work to read, review, or implement Evidence Based Practice. • Most productivity standards now include all nursing time whether in direct patient care or in meetings, etc. • Home time is “reserved” for non-work related activities, especially with younger worker.

9. Time • Analysis • Accessibility Challenge: Time Why is it difficult for nurses to utilize evidence in their practice? Compliments of Zynx Care Source: Sigma Theta Tau International, 2006 EPB Study

10. Empowerment • Perception that nursing lacks authority and cooperation of medical staff and/or administration to change practice. • Staff nurse participation in approval of policy/procedures, research, etc.

11. Knowledge • Interpreting statistical/technical language • Skill & confidence • Access & knowledge of internet and library resources • Study by Wells, et al 2007, 76% never searched the internet; 58% never searched Medline • Lack of access to experts in Evidence Based Practice

12. How to overcome Barriers? Make Evidence Based Practice a part of every day life of the nurse

13. Shared Leadership • As Shared Leadership councils become more mature, require literature reviews for any change in practice, etc. • Empower the Shared Leadership structure to make change in practice. • Involve the Shared Leadership structure/council in the approval of changes to policies and procedures for patient care.

14. Research Internships • 6-9 months in length • Partnership between College/University and Hospital • Monthly or bi-weekly class with a clinical in research • Research project requirement • Graduate credit?

15. Accessibility of Information Direct link for staff to access Evidence Based Practice at their finger tips located in one place.

16. Accessibility of InformationReferences within Clinical Documentation Systems

17. Partnerships • Universities/Colleges • Joint appointments, adjunct faculty, etc • Professional Organizations • Practice Alerts • Industry • Vendors – both pharmaceuticals and equipment/supplies

18. Partnerships Professional Associations

20. PartnershipZynxCare • Zynx and Sigma Theta Tau work collaboratively to support delivery of research and evidence to the bedside • Zynx clients can access educational and consulting resources to support the development of an evidence-based nursing culture • Partnership represents an endorsement of ZynxCare™ from highest level of professional nursing scholarship and leadership

21. ZynxCare: Evidence-Based Practice for the Interdisciplinary Team • Evidence-based interdisciplinary plan of care and clinical documentationcontent and content managementdesigned to support organizations in: • Implementing evidence based practice at the point of care • Standardizing clinical practice between and among disciplines • Efficiently deploying evidence-based content in paper, HTML, or EHR system • Achieving measurable results

22. ZynxCare™ Plan of Care Blue Ribbons: Quality Measures Shared language and coded concepts with ZynxOrder™ Evidence Links

23. Zynx Evidence: CAP - Interdisciplinary Evidence supporting the interdisciplinary care team

24. Vital Signs Frequency Performance Measures supporting the interdisciplinary care team

25. Vital Sign Frequency • Patients with uncomplicated community-acquired pneumonia, no between-group difference in length of stay, mortality rate, number of ICU transfers or discharge destination between VS measurement assessed every 4-6 hours as compared to VS assessment ever 8-12 hours

26. Chest Physiotherapy • For patients with pneumonia, who do not have underlying mucociliary clearance, the use of chest physiotherapy is not supported

27. The Challenge . . . Fit all pieces together for the optimal outcome of the patient in the most efficient way possible for the Registered Nurse . . .

28. References Carlson, CL & Plonczynski DJ. (2008) Has the BARRIERS Scale changes nursing practice? An integrative review. Journal of Advanced Nursing. 63(4), 322-333. Leasure, AR, Stirlen, J, & Thompson, C. (2008) Barriers and facilitators to the use of evidence-based best practices. Dimensions of Critical Care Nursing. 27(2), 74-82. Thompson, C, et al. (2005) Barriers to evidence-based practice in primary care nursing – why viewing decision-making as context is helpful. Journey of Advanced Nursing. 52(4). 432-444. Wells, N, et al. (2007) Nursing research internship: Enhancing evidence-based practice among staff nurses. Journal of Nursing Administration. 37(3), 135-143.