The United States has spent more money on healthcare than any country in the western world, yet they rank 37 in world health outcomes (Kaiser Family Foundation, 2017). The significant contribution to this alarming situation is the poor implementation of evident-based care. Many practices that are routinely implemented in healthcare do not have a solid body of evidence of them. Some even have data that support the claim that they promote adverse outcomes, including 12-hour shifts for nurses, double-check of pediatric medications, vital signs every 2 or 4 hours on stable patients, 2 license checks on discharge. This practice is steeped in traditional instead of best evident, resulting in less than optimum care, poor outcome, and wistful healthcare spending.
No wonder why nurses engage in behaviors that are not supported by evidence yet do not employ evidence-based practices. For instance, nurses used to change IV dressings on hospitalized patients daily despite the lack of evidence to support this practice. However, when clinical trials investigated how often IV dressings should be changed, they discovered that daily changes resulted in more phlebitis than less frequent changes. Nurses even interrupt patients’ sleep, which is crucial for restorative healing to monitor blood pressure and pulse rates, despite the lack of evidence that doing so enhances the detection of possible concerns. Indeed, professionals frequently adhere to outdated rules and procedures without questioning their contemporary relevance, appropriateness, or evidence.
Over the last few decades, there has been an explosion of scientific knowledge to help health professionals in clinical decision-making. Even though this evidence is readily available, the National Academic of Medicine has set a goal for 90 percent of clinical decisions to be backed by timely, up-to-date information based on the best available research by 2020. (Melnyk, & Fineout-Overholt, 2018).
A multicomponent strategy must be in place at every level to overcome the many challenges in the implementation of EBP. Top administrators and directors/managers must “live the talk” by investing in education and skill-building programs for their physicians and thereby fostering a culture and infrastructure in which EBP is the standard of performance and care ( Melnyk, 2016b). Misconceptions about how to adopt practice based on the best available evidence must be rectified, and knowledge and expertise in the field must be strengthened for clinicians to promote the use of EBP. It must also be remembered that for many physicians who did not learn this approach to decision making and the essential ability in their school program, switching to EBP is a behavior change. However, deficiencies can be rectified through an intense EBP continuing education program that helps enhance and maintain EBP beliefs, knowledge, and competence.