Learning Objective #1: explore interplay of knowledge resources and clinical experience in appropriation of standardized work descriptions for EBP

Learning Objective #2: challenges and opportunities when standardized work descriptions are integrated and built into everyday tools like the electronic patient record from perspective of EPB

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The ongoing study ‘Standardized Work Description' follow introduction of clinical nursing procedures as part of a comprehensive, electronic knowledge infrastructure in a health care organization. Standardized work descriptions are guidelines that incorporate new evidence in practical work and give direction for development of nurses' knowledge and skills to support evidence-based practice in a patient centric workflow. Clinical experience, evidence from patients and research is necessary to ensure quality care and patient safety and converge with goals for evidence-based practice. The repository of standardized work descriptions was initially developed to facilitate clinical skills training for nursing student, and is now introduced to community health and hospitals.

This presentation will report on the consolidation of the repository of standardized work descriptions of approximately 300 procedures with a pool of in-house procedures. Specifically we have explored nurses' negotiation of versions of the in-house and standardized procedures to reduce the variation but include necessary hospital specific additions and changes before they “authorize” or recommended a new practice. As part of this process to re-design and customize the electronic repository for their purposeful use, the participants draw on different resources. The resources come into play in interactions and trade-offs between formalized, highly abstract knowledge, shared understanding and examples of possible situations to use the knowledge, but also systemic routines expressed as collective expertise and personal experiences. In addition we will report on how the consolidated repository of standardized work descriptions are used to facilitate changes in practices, and as part of the clinical documentation since they implement the system in their knowledge infrastructure with a link to the nursing part of their electronic patient record system. As such we can explore leadership strategies to evidence-based practice when knowledge and guidelines are built into and used as part of everyday tools.