In this turbulent era of healthcare reform, organizational success will be defined in terms of collaborative teams delivering evidence-based, patient-centered care which results in safe, high quality patient outcomes (IOM, 2010). The development of evidence-based practice (EBP) knowledge and skills, design of EBP infrastructures, and promotion of a widespread EBP culture is a strategy that can effectively thrust organizations toward achieving these goals (Melnyk & Fineout-Overholt, 2015). In light of the importance placed on promoting EBP in nursing, there is a gap in the literature identifying effective organizational EBP models that provide a foundation for which evidence-based clinical care is developed and supported (Flodgren, Rojas-Reyes, Cole, & Foxcraft, 2012).
This presentation describes the ongoing journey within a large academic health system to create a culture in which EBP flourishes. The design of an infrastructure where nursing quality and EBP have a natural synergy was a key strategy in creating the new EBP paradigm. An important tactic in our journey was the sound integration of EBP into the role of the Clinical Nurse Specialist (CNS). The CNS has a strong link to clinical practice and is linked to the daily challenges faced by the direct care nurse. They have the have the skill set to evaluate the current body of literature and determine if there is sufficient evidence to support practice change. In addition, the CNS is able to lead EBP change through their work with interdisciplinary teams, formulating policies and procedures, and measuring process and outcomes (Campbell & Profetto-McGrath, 2013; Melnyk, Gallagher-Ford, & Fineout-Overholt, 2016). The CNS’s were realigned to report to Health System Nursing Quality, Research, EBP Department. This realignment created a structure that promoted the translation of evidence into bedside practice while aligning with specific quality initiatives at the unit level to improve outcomes. The CNS job descriptions were redesigned to incorporate the EBP competencies assigned to the Advanced Practice Nurse and these competencies are incorporated into their annual performance evaluations.
Specific EBP implementation strategies as well as key steps for successful development and support of EBP experts and leaders will be discussed: (1) creation of an EBP strategic plan; (2) a key leadership role dedicated to EBP; the Associate Director of EBP Standards and Practice; (3) the development of a cadre of EBP mentors who are immersed in EBP across the health system; (4) re-design of our shared governance councils to include a Research, EBP & Innovation Council where EBP mentors are selected to serve as mentors on all shared governance councils to promote EBP and ensure decisions are based on evidence and best practices (5) creation of a collaboration site to house our fluid EBP database; (6) quarterly EBP mentor meetings to sustain engagement and update mentors on initiatives across the medical center; (7) CNS membership on the policy and procedure committees.
Outcomes from this innovative infrastructure redesign inclue: (1) nurse driven CAUTI protocol; (2) CLABSI protocol; (3) skin to skin in the labor and delivery operating room; (4) nasal CPAP suctioning protocol in the NICU; (5) implementation of the ABCDE Bundle in the ICU setting; (6) implementation of the Yale Swallow Protocol; (7) creation and implementation of care coordinator role.
Creating an infrastructure that supports and nurtures the EBP process and structure is essential in achieving safe, high quality patient outcomes (Melynk & Fineout-Overholt, 2015). Nurse leaders are key individuals to redesign systems within their health care organizations to promote EBP and attain positive outcomes.
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