Sacred Cow Gone to Pasture: Using the Iowa Model for Promoting EBP

Tuesday, 31 July 2012: 1:50 PM

Kirsten Hanrahan, DNP, ARNP1
Sharon Tucker, PhD, RN, PMHCNS-BC1
Laura Cullen, MA, RN, FAAN1
Cindy Dawson, MSN, RN, CORLN2
Joseph Greiner, MSN, RN, CPHQ, FCCS1
Rachel Hottel, MSN, RN, CNOR1
Paula Vernon-Levett, MS, RN, CCRN3
Jean Pottinger, MA, RN, CIC4
Grace Matthews, MSN, RN, BC1
Stephanie Stewart, MSN, RNC1
Michele Wagner, MSN, RN, CNRN1
Ann Williamson, PhD, RN, NEA-BC1
(1)Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA
(2)Ambulatory Care Services, University of Iowa Hospitals and Clinics, Iowa City, IA
(3)Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, IA
(4)Office of Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA

Learning Objective 1: Describe innovative solutions and strategies for systematically eliminating tradition-based practices and replacing with nursing practices based on best evidence.

Learning Objective 2: Discuss implementation of evidence-based practice change using the Iowa Model for Evidence-Based Practice and Implementation Strategies for Evidence-Based Practice.

Quality healthcare depends on the translation of research and other evidence to clinical care. Despite this, many traditional nursing practices have not changed. Old practice habits or sacred cows, those practices considered routine and above dispute, are particularly resistant to change. Innovative solutions and evidence-based strategies are needed to eliminate tradition-based practices and replace with best evidence. Recent published articles regarding sacred cow practices triggered closer examination of those practices in our institution. An initiative titled “Sacred Cow Gone to Pasture” was launched. A systematic evaluation process of each sacred cow practice was initiated and included: an audit of institutional standards, a survey of nurse managers about actual practices, grading performance, making recommendations for change, setting priorities and assigning responsibility. Electronic surveys were distributed through QualtricsTM survey software to 60 nurse managers in a Midwestern large tertiary care center. Surveys were returned from 42 units (30 inpatient and 12 ambulatory clinics) for a 70% return rate. Evaluation demonstrated wide variability in the use of evidence in standards. Use of practices that were evidence-based ranged from 18-100% for each of the 16 practices, whereas implementation of sacred cow practices ranged from 26-87%. Solutions were provided for filling the gaps and sending sacred cows to pasture. The Iowa Model of Evidence-Based Practice to Promote Quality Care has been used to successfully implement multiple EBPs in our institution and internationally. A new model, Implementation Strategies for Evidence-Based Practice was developed to assist EBP project leaders in selecting effective implementation strategies. Strategies are organized to enhance movement through four phases of implementation: creating awareness and interest; building knowledge and commitment; promoting action and adoption; pursuing integration and sustainability, and target two distinct levels: individuals and the organizational system or context. Together, theses models provide a foundation for successful implementation of an EBP practice change.