Purpose:
The purpose was to explain a clinical nurse specialist (CNS)-led innovative strategy to promote a culture of evidence-based practice (EBP) in the intensive care unit (ICU).
Significance:
Basing nursing practice on evidence is a goal of healthcare, but the literature identifies numerous challenges to implementing and sustaining EBP.
Design:
An initial focus is developing an organizational culture that supports the process for nursing EBP. The CNS has the skill to lead this change and improve patient outcomes.
Methods:
The process described was implemented in a tertiary center with 152 ICU beds in 8 specialty units with diverse patient populations and varying needs. The CNS led the development and implementation of a Rules of Evidence Committee for ICU. The goal of the committee is to use evidence to improve the care in the critical care (CC) population. The committee included CC physician, nursing representatives from each ICUs, respiratory therapist, CC nurse administrator, and school of nursing faculty. Ad hoc members added to a multidisciplinary approach (pharmacist, engineer, enterostomal therapist, informatics specialist) and attended meetings based on project need. Evidenced-based practice projects were identified from a literature review. The CNS led the initial projects involving the committee representatives in all stages of the process. Unit representatives were key in disseminating EBP protocol information to staff.
Findings:
Evidenced-based practice protocols have been implemented with ongoing monitoring. Comparisons measures of preintervention to current outcome demonstrated improvements: (1) ventilator-associated pneumonia decreased from 8 to 5 (rate/1,000 ventilator-days), (2) average mechanical ventilation days decreased from 7.4 to 6.8 days, (3) head of bed elevation more than 30 degrees increased from 30% to 99%, (4)daily sedation interruption compliance increased from 0% to 75%, and (5) blood conservation methods have been introduced in all units.
Conclusions:
This innovative approach improved patient outcomes and also provided a method to educate staff on EBP. The committee representatives have become advocates for EBP and serve as innovators for change and EBP on their units.
Implications for Practice:
The CNS-driven project can be initiated to provide staff with skill in EBP to create change. The next goal is to have the committee representatives identify and lead the EBP projects with assistance from the CNS.