Improving Healthcare Quality, Patient Outcomes, and Costs with Evidence-Based Practice
Evidence-based practice (EBP) is a process of using the best available scientific evidence, along with clinical experience and patient preferences, to make informed decisions about patient care. EBP is essential for improving healthcare quality, patient outcomes, and costs, as it helps nurses to provide holistic, effective, and safe care based on the most up-to-date knowledge.
What is EBP and Why is it Important?
EBP is not a new concept in nursing. It was first introduced by David Sackett and his colleagues in 1996, who defined it as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” (1). EBP involves asking a clear question about a patient’s issue, acquiring the best evidence from relevant sources, appraising the quality and validity of the evidence, applying the evidence to clinical practice, and assessing the outcomes of the intervention (2).
EBP is important for several reasons. First, it ensures that nurses are using the most current and reliable information to guide their practice, rather than relying on tradition, opinion, or personal beliefs. Second, it helps nurses to deliver patient-centered care that is consistent with the patient’s values and expectations. Third, it improves patient outcomes by reducing variations in practice, preventing errors, and enhancing quality and safety. Fourth, it reduces healthcare costs by eliminating unnecessary or ineffective interventions and promoting efficient use of resources (3).
How to Implement EBP in Nursing
Implementing EBP in nursing requires a systematic approach that follows five steps: ask, acquire, appraise, apply, and assess (2). These steps are summarized below:
– Ask: Formulate a clear and focused question about the patient’s issue and determine the desired outcome. For example, “What is the best way to manage pain in patients with osteoarthritis?”
– Acquire: Search for relevant and credible evidence from various sources, such as clinical articles, guidelines, protocols, or databases. For example, use keywords such as “pain management”, “osteoarthritis”, and “nursing” to find articles on PubMed or CINAHL.
– Appraise: Evaluate the strength and quality of the evidence using tools such as the Johns Hopkins Evidence Level and Quality Guide or the Research Evidence Appraisal Tool. For example, check if the article is from a peer-reviewed journal, has a clear research question and design, has a large and representative sample size, has valid and reliable measurements, has appropriate statistical analysis, has minimal bias and confounding factors, and has relevant and significant results.
– Apply: Integrate the evidence with your clinical expertise and the patient’s preferences to make a decision about the intervention. For example, consider if the intervention is feasible, acceptable, ethical, legal, and suitable for your patient’s condition, needs, values, and expectations.
– Assess: Monitor and evaluate the outcomes of the intervention using measures such as patient satisfaction, symptom relief, functional status, quality of life, or cost-effectiveness. For example, use tools such as pain scales or questionnaires to assess if the intervention has improved your patient’s pain level and mobility.
Examples of EBP in Nursing
There are many examples of how EBP can improve healthcare quality, patient outcomes,
and costs in nursing. Here are some examples:
– Use of oxygen therapy for patients with chronic obstructive pulmonary disease (COPD): A systematic review of randomized controlled trials found that oxygen therapy can reduce mortality and hospitalization rates for patients with COPD who have low blood oxygen levels (4). Based on this evidence,
nurses can provide oxygen therapy for these patients to improve their survival and quality of life.
– Management of angina for patients with coronary artery disease (CAD): A meta-analysis of randomized controlled trials found that angiotensin-converting enzyme (ACE) inhibitors can reduce mortality and morbidity for patients with CAD who have angina (5). Based on this evidence,
nurses can prescribe ACE inhibitors for these patients to prevent complications such as heart attack or stroke.
– Prevention of alarm fatigue for nurses in intensive care units (ICUs): A qualitative study of nurses’ experiences found that alarm fatigue can cause stress,
burnout,
and errors for nurses who work in ICUs (6). Based on this evidence,
nurses can implement strategies such as adjusting alarm settings,
prioritizing alarms,
and delegating alarm response to reduce alarm fatigue and improve patient safety.
Conclusion
EBP is a vital process for nursing practice that can enhance healthcare quality,
patient outcomes,
and costs. By using EBP,
nurses can provide holistic,
effective,
and safe care based on the best available scientific evidence,
clinical experience,
and patient preferences. EBP can also help nurses to keep up with the rapid changes in healthcare and to advance their professional development and leadership.
Works Cited
1. Sackett, David L., et al. “Evidence based medicine: what it is and what it isn’t.” BMJ, vol. 312, no. 7023, 1996, pp. 71-72.
2. Dang, Deborah, et al. Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. 3rd ed., Sigma Theta Tau International, 2022.
3. Melnyk, Bernadette Mazurek, and Ellen Fineout-Overholt. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 4th ed., Wolters Kluwer, 2019.
4. Long, Hannah L., et al. “Home oxygen therapy for adults with chronic lung disease.” Cochrane Database of Systematic Reviews, vol. 11, no. CD010238, 2020.
5. Bangalore, Sripal, et al. “Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin–angiotensin–aldosterone system inhibitors involving 158 998 patients.” European Heart Journal, vol. 33, no. 16, 2012, pp. 2088-2097.
6. Cvach, Maria M., et al. “Nurse experiences with clinical alarms in intensive care units: a descriptive qualitative study.” Intensive and Critical Care Nursing, vol. 57, no. 102775, 2020.
