Chapter 7. The Evidence for Evidence-Based Practice Implementation

Evidence-based health care practices are available for a number of conditions such as asthma, heart failure, and diabetes. However, these practices are not always implemented in care delivery, and variation in practices abound. Traditionally, patient safety research has focused on data analyses to identify patient safety issues and to demonstrate that a new practice will lead to improved quality and patient safety. Much less research attention has been paid to how to implement practices. Yet, only by putting into practice what is learned from research will care be made safer. Implementing evidence-based safety practices are difficult and need strategies that address the complexity of systems of care, individual practitioners, senior leadership, and— ultimately—changing health care cultures to be evidence-based safety practice environments. Nursing has a rich history of using research in practice, pioneered by Florence Nightingale. 9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated by Nightingale, the nursing profession has more recently provided major leadership for improving care through application of research findings in practice. Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions. Best evidence includes empirical evidence from randomized controlled trials; evidence from other scientific methods such as descriptive and qualitative research; as well as use of information from case reports, scientific principles, and expert opinion. When enough research evidence is available, the practice should be guided by research evidence in conjunction with clinical expertise and patient values. In some cases, however, a sufficient research base may not be available, and health care decisionmaking is derived principally from nonresearch evidence sources such as expert opinion and scientific principles. As more research is done in a specific area, the research evidence must be incorporated into the EBP.