Hospitals that struggle with meeting quality and safety goals are also more likely to put evidence-based practice on the back burner. That’s a dangerous, pivotal — and all too common — mistake, experts warn.
In fact, a recent study in Worldviews on Evidence-Based Nursing found that more than half of 276 chief nurse executives polled said evidence-based care is practiced at their organization “not at all” or just “somewhat.”
Not too surprisingly, many of their hospitals reported poor scores on important performance measures, such as falls and pressure ulcers.
“We found that a substantial percentage of hospitals were not meeting national benchmarks for quality and safety,” said researcher Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, Dean of the College of Nursing at The Ohio State University in Columbus, nationally renowned nurse leader and educator, and creator of the 7 point Levels of Evidence EBP (Evidence-Based Practice) rating system.
“As you look at explanations for why 30 to 40 percent of these hospitals aren’t meeting benchmarks on key quality indicators, one key explanation is the low level of evidence-based practice happening in those hospitals.”
Consumed with meeting performance benchmarks, chief nurse executives’ responses suggest evidence-based practice is a luxury their facilities cannot afford to pursue at the moment.
“The chief nurses we surveyed reported that they planned to focus on evidence-based practice as soon as they had a handle on quality and safety,” said study coauthor Lynn Gallagher-Ford, PhD, RN, DPFNAP, NE-BC, director of Center for Transdisciplinary Evidence-Based Practice.
“That’s the disconnect — leaders think it is a competing priority when, in reality, evidence-based practice is the exact mechanism that needs to be integrated in order to achieve and sustain quality and safety.”
According to Dr. Gallagher-Ford, patients who receive evidence-based care have 28 percent better outcomes than patients who do not.
“That’s a big deal,” she said.
Interestingly, most of the chief nurse executives surveyed said they believe in the value of evidence-based practice.
So what’s holding them back?
For starters, it could be other hospital leaders, researchers mused. Without adequate support and understanding from leadership, sustaining a culture of evidence-based practice is nearly impossible. It’s common for hospitals to throw some education at front-line staff but then fail to create leadership champions essential for continued success.
Next, chief nurses may not be receiving the kind of education they need to truly incorporate evidence-based practice. The study also found that nearly half of the chief nurse executives polled were unsure how to measure patient outcomes.
“If we’re graduating nurses with graduate and doctoral degrees who have not mastered evidence-based practice — and a part of that is measuring outcomes of evidence-based practice changes — then we’re not going to have nurse leaders with that knowledge and skill set,” said Dr. Melnyk.
“If these leaders don’t have those skills, how are they going to be able to create the culture and infrastructure that’s needed for their staff to practice evidence-based care in a consistent manner?”
The study recommended chief nurse executives receive education and skill building in evidence-based practice and outcomes management to allow them to implement and role model evidence-based practice.
Until hospitals can convince leadership to support an investment in and a commitment to an evidence-based practice culture, the quality and safety of patient care will suffer, researchers warned.
The study presents an unpleasant look at the reality of the state of evidence-based care in many U.S. hospitals today.
“There’s a public perception that this is what hospitals are already doing,” said Dr. Gallagher-Ford, “and the sad news is, many are not.”
How is your hospital doing with the implementation of evidence-based practice? Are you seeing any correlation between EBP use at the bedside and key quality indicators? Leave us a comment.