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

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.

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.

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.” Source: Sigma Theta Tau International, 2006 EPB Study Compliments of Zynx Care

ANCC Magnet Journey

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

3 Primary Barriers in the Implementation of EBP 1.Time 2.Empowerment 3.Knowledge

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. Challenge: Time

Source: Sigma Theta Tau International, 2006 EPB Study Challenge: Time 1.Time 2.Analysis 3.Accessibility Why is it difficult for nurses to utilize evidence in their practice? Compliments of Zynx Care

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.

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

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

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.

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?

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

Accessibility of Information References within Clinical Documentation Systems

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

Partnerships Professional Associations

Partnership ZynxCare 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

Evidence-based interdisciplinary plan of care and clinical documentation content and content management designed 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 ZynxCare: Evidence-Based Practice for the Interdisciplinary Team

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

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

Vital Signs Frequency Performance Measures supporting the interdisciplinary care team

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

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

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

References Carlson, CL & Plonczynski DJ. (2008) Has the BARRIERS Scale changes nursing practice? An integrative review. Journal of Advanced Nursing. 63(4), 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), 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) Wells, N, et al. (2007) Nursing research internship: Enhancing evidence-based practice among staff nurses. Journal of Nursing Administration. 37(3),