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Erik Samarpan
The Real Issue- What is evidence based practice?

The newest "buzz term"- "evidence based practice". We all read it. From JC to INS, CDC, ONS, etc.

What does it really mean?

Institutions develop policies which they state are based on best practice, or evidence based yet if they do not follow standards found in INS, or recommendations made by ONS or CDC.....what choice do we have as nurses, except to follow those policies?

Many institutions will use the rationalization " our experience has been......" or "our ID committee has determined....."

An example of this is; INS and others suggest that a CHG dressing, whether it be Biopatch or a CHG impregnated TSM, should be used. There has been documented research and outcomes data to remove doubt as to efficacy of their use yet many infusion centers claim that their practice is based on best outcomes and evidence based practice models....but they obviously arn't walking the talk and still do not use CHG, other than as skin preps.

Any thoughts? 


This is much more than just a

This is much more than just a buzz word or phrase. It is a major paradigm shift in our approach to making patient care decisions. You can find many textbooks on the subject, but the most concise information can be found in the Chapter on Evidence-Based Practice in the new edition of the INS textbook.

You must follow your written policies. But you also have an obligation to advocate for evidence-based practices to enhance patient safety when you feel your current policies are outdated or inaccurate. All standards and guidelines have the same issue - by the time the work is published, there will always be newer studies providing new information. So your committees may be looking at the newer studies to use for their policies. For instance, the current CDC document was released in 2002. Current INS standards in 2006 but the work to collect the evidence actually begins well before the actual publication. Your example supports what I am saying. The use of Biopatch was an unresolved issue in 2002 for the CDC and the CHG-gel TSM dressing was not even on the market at that time. So you must use the recommended processes created the PICO question (patient, intervention, comparison, and outcome), to do literature searches, properly appraise the new literature and then make practice decisions from that process.


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

Evidence Based Practice

Is neither new nor a buzz word.  The problem is that many, including INS, want their opinion to count as evidence.  Witness the senseless concern over air embolism with PICC removal.

Evidence-based practice is exactly what it sounds like.  However, for the large majority of decisions clinicians must make, there is no (real) evidence, so, one must rely on the experience-based opinion of experts.  However, you should always understand that this is a second-best way to decide, just sometimes the best availabble.

Chlorhexadine is another example.  I have yet to see any good evideince for routine use of chlorhexidine at dressing change, so we do not do it.  However, it makes sense to me to use it for immunosuppred pts and for recurrtent line infections, so we do.  I would change my practice in a heartbeat if there were (good) evideince.

BTW, I pretty much don't even glance at "research" sponsered by the manufacturer, or anyone else with a fnancial interest, it is just automatically suspect.

Draping is another example.  There is no good evidence I am aware of to support head-to-toe draping for PICC insertion, and it does not make any sense.  The study originally cited by the CDC in 2002 compared a control group to a study group with several changes, including cap, gown, and "large area" drape as I recall.  Other studies since have found no benefit.

The easy test for evidence-based pratice is to ask yourself, "why do I do it this way".  If it is because the policy or some expert says so, then you are not practicing based on evidence (at least not directly) (the policy or expert opinion may be based on evideince, or it may not be, you don't know).  If it is because Smith and Jones found 17% fewer complication in their 208 study then it is evidence based.  But, don't get your hopes up, almost nothing you (or the rest of us) does is evidence based.

Once nurses can and do buld a base of research on which to base nursing practice we and our patients will be much better off, and nursing can leave the dark ages.


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