Healthcare providers often discuss best practices and evidence-based practice. When an organization is about to make changes in practice, a common response is "show me the evidence!" However, there's a perception that the term "best practice" is used when a practice lacks enough supporting evidence. Although the terms evidence-based practice and best practice seem to be used interchangeably, are they synonymous, and what implications might they suggest?
By definition, best practice and evidence-based practice differ. Best practices are based on the guidelines and standards supported by benchmarking, professional organizations, government agencies, and quality improvement groups.1,2 Best practices may or may not have rigorous supporting research. Evidence-based practice, on the other hand, "involves the explicit and judicious decision making about healthcare delivery for individuals or groups of patients based on the consensus of the most relevant and supported evidence derived from theory-derived research."2
Some of our perioperative nursing practices, including sterile technique, are best practices but not necessarily evidence-based. For example, best practice is to discard items that fall below the level of the operating table. Common sense tells us that the item may be contaminated, but no evidence suggests that this should always be the case. Yet, best practice dictates we use our surgical conscience and discard these items. The list in the perioperative setting seems to be unlimited: double-gloving; the length of time unused supplies or instrumentation can be left open in the OR; how long items can be left in an autoclave and still be considered sterile; sterile zones on a sterile gown; could an OR be cleaned with bleach and still be as effective as current, more costly disinfectants?
Standards and guidelines exist to provide a consistency in practice for all patients across healthcare organizations. They also exist to provide the same standard of care to every patient. The recommendation is to have instruments wrapped for delivery to the sterile field, but is there evidence that shows instruments provided through just-in-time sterilization practices affect patient outcomes? Is it okay to provide wrapped instruments to the first case of the day and then provide just-in-time sterilization of instruments to subsequent patients?
I'm not suggesting we dismiss all practices that lack supporting evidence. The OR is a highly critical, complex, and time-sensitive area in which clear guidelines are needed to provide efficient, effective, and safe patient care. However, as healthcare reimbursement changes, we might remember that someone may profit and someone may pay when best practices are established; products are developed to support these practices.
We may need to be more mindful of establishing best practices. The implications of defining best practices affect our credibility with other healthcare disciplines, the organization, and the outcomes of our patients.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]
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