Evidence-based practice (EBP) is a process that includes the use of best evidence, clinical expertise and patient preferences when planning care or making decisions. According to professional nursing and organizational standards, all nursing care is to be based on evidence, so it is essential to have nurses proficient at searching for evidence and synthesizing it to make recommendations for practice.
Teaching EBP has only recently become part of nursing curricula; therefore, many nurses working today did not learn the process in their educational programs. Missouri Baptist chose to prepare nurses to use EBP and help others learn through an educational program started in 2008. The program in 2009 and 2010 was delivered during a 10-week period and resulted in either podium or poster presentations at professional conferences by all 15 participating nurses.
The program expanded this year to become an EBP Fellowship delivered over nine months. The EBP Fellowship prepares bedside clinicians as experts in EBP and system-wide change agents for its advancement and sustainability.
There are two phases in the program:
- the first three months — classroom presentations and guided independent work
- remaining months — implementation of the practice recommendation in the clinical area, while monitoring outcomes
Participants have a “hands-on” experience in the total EBP process, from clinical question to practice recommendation, in a mentored, guided manner to improve patient and unit outcomes.
Evidence-Based Fellowship Project Example
Preventing post-operative infection in C-section patients
Paula Brooks, BSN, RN, is working on a care bundle to help prevent post-operative infection in C-section patients. According to national rates, approximately one-third of all infants born at Missouri Bapitst are delivered by C-section. Preventing infection is a major concern for nursing and was identified as an area to investigate by Paula and her manager, Dee Woodside, MSN, RN. Paula’s project is being completed in three phases. The first phase was to identify the most effective solution to use as skin prep before surgery.
The evidence supported the use of chlorhexidine – this phase has already been completed and chlorhexidine is now supplied in skin prep kits. The second phase was to establish a clinical guideline for pre-operative antibiotics and this was developed with David Weinstein, MD, Dennis Bouselli, PharmD, and Janice Setzer, BSN, RN, CIC. The third phase was to establish a product and procedure for skin cleansing for all women in labor – is in progress.
Based on our research, this is the current best practice.