Evidence-based practice (EBP) guidelines, developed from reviews of published study data, enable practitioners to make the best clinical decisions quickly and provide optimal care to improve patient outcomes. So, why has the uptake of guidelines into clinical practice lagged their availability? Why does care often deviate from guideline recommendations?

Researchers at the Troy University School of Nursing in Troy, Alabama, aimed to answer these questions with a study to identify factors inhibiting or enhancing NP compliance with guidelines. More than 5,000 Alabama NPs were mailed a postcard inviting them to participate in a 45-question online survey; 150 of them submitted responses.

Respondents were asked to select factors in their work setting that were facilitators or barriers to guideline use. The most common facilitator, indicated by 63% of respondents, was easy access to guidelines. Other commonly cited facilitators were support from leadership, free access to the guidelines, in-person education on guidelines, and clinical decision support software.

The most significant barrier to guideline implementation, mentioned by 71% of respondents, was patients with multiple comorbidities; specific disease-focused guidelines can be difficult to utilize safely when patients are taking medications for other illnesses. Other barriers were time constraints, pressure from patients to provide nonrecommended care, insufficient staffing, and inadequate financial resources.

Survey participants' comments clearly indicated that they wanted to incorporate EBP guidelines into their practice. Fifteen respondents requested free or inexpensive access to guidelines, peer-reviewed databases, or clinical decision support programs. Several NPs said they would value paid time off for educational programs, employer-funded journal access, monthly updates from their employers about EBP, coworker discussion groups on how to implement guidelines, and patient education on EBP.

The information collected by the survey on specific facilitators and barriers to use of EBP guidelines can be utilized to improve uptake in many clinical practices and organizations.-Joan Zolot, PA