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• Evidence-Based Practice

Evidence-based practice is a systematic process perioperative nurses can use to research findings to improve practice. It answers the commons questions, "What is the best way to do this? What evidence supports my reason?"

Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.(1) When clinicians make health care decisions for a population or group of patients using research evidence, this definition can be expanded to evidence-based health care. Making patient care decisions using current information and one's clinical expertise enhances health care providers' ability to provide best practice. (2)

Evidence -  A Critical Aspect of Providing Care
In today's health care environment, all clinicians must clearly understand and interpret the pertinent evidence before providing care. Clinicians must ask the difficult questions related to the risks and benefits associated with costly interventions or treatments. Health care consumers and insurers demand state-of-the-art treatment as well as research findings that demonstrate its effectiveness. Every procedure and step related to the procedure must be carefully considered for their contribution to health outcomes. Clinicians can no longer rely on the reasoning "This is the way we have always done things" or "This is the way I learned how to do this." (2)

Perioperative Nurses Lead Efforts in Evidence-based Practice
Nurses in surgical settings collaborate with all health care team members and have many opportunities to identify potential clinical problems and issues and question customary practices. Nurses can begin the process of using evidence to guide practice by simply asking the following questions.

• Who determined the basis for this practice? 
• What was the rationale for making that decision? 
• What are the clinical implications of this practice? 
• Why are we doing this, and why are we doing it this way? 
• Could it be done better, more efficiently, or more cost-effectively? 
• Are these the highest achievable outcomes?

Asking and answering these questions can help nurses find solutions for troubling clinical questions as well as improve existing practice that may appear to be within acceptable parameters. Many examples in the nursing and health care literature demonstrate how the status quo is potentially injurious to patients and expensive to the health care system. (2)

Perioperative Nursing & Evidence-based Practice - The Connection
A traditional nursing action that is too commonly performed is dry shaving with a safety razor. This is an example of an inappropriate hair removal technique that results in micro-abrasions and colonization by microorganisms. The AORN recommended practices suggest that if hair needs to be removed, an electric clipper or depilatory is less abrasive and harming to the skin. (3)

Another example, specific to ambulatory care settings is research exploring the risks versus benefits of various periods of bed rest. This research clearly demonstrated that, in many clinical situations, three hours is an adequate period of bed rest to achieve hemostasis following cardiac catheterization. This change increased patient comfort, decreased costs and lengths of stay, and improved the efficiency of busy diagnostic centers. When this clinical innovation is implemented nationwide, not only are the potential cost savings noteworthy, but patients also will avoid complications associated with prolonged periods of bed rest. (4)

Using Evidence-base Practice to Address Issues
In the perioperative arena, there are a number of issues and practices that should challenge nurses to seek evidence. After invasive procedures, for example, nurses take vital signs every 15 minutes during the first hour, every 30 minutes during the second hour, and every hour during the next four hours. Have you ever questioned:

• the origin of that practice, 
• whether that practice is based on evidence or someone's opinion, 
• if frequent vital signs are the most effective monitoring approach after surgery, or 
• the percentage of postoperative complications actually detected using frequent vital sign measurement?

This ritualistic practice is just one of many that nurses need to consider more carefully. In fact, little is known about the origin of frequently checking patient vital signs and whether it is the most effective approach to detecting postoperative complications; however, an incredible number of resources are committed to this practice each day. (2)

Evidence-based Practice Improves Patient Care and Nursing Care
Many perioperative practices should and must be questioned. Think about the rituals nurses perform each day without questioning their origin or benefit. In the OR, nurses perform a number of activities that may no longer be necessary. Other clinical practices that need an evidence-base include counting instruments, hand-washing and scrub times, use of shoe covers and cover gowns, skin preparation and positioning devices. Undoubtedly, every nurse has wondered or asked, "How effective is this practice?" or "Why am I doing this?" (2)

Nurses must be leaders in providing evidenced-based patient care. Without a strong commitment to using evidence to guide decisions, nursing will lose credibility as a profession. Using clinical expertise as well as research evidence to plan and deliver care for a patient or a population leads to evidence-based practice. Remember to ask everyday, "Is this the best way to meet this patient's needs?"

NOTES

1) D L Sackett et al, "Evidence-based medicine: What it is and what it isn't," British Medical Journal 312 (Jan 13, 1996) 71-72.
2) S. C. Beyea, (2000). "Why should perioperative RNs care about evidence-based practice," AORN Journal, 72(1), 109-111.
3) AORN Standards, Recommended Practices & Guidelines. AORN, Inc. (2001)
4) J. Mah, H. Smith, L. Jensen, "Evaluation of 3-hour ambulation post cardiac catheterization." Canadian Journal of Cardiovascular Nursing 10 no 1-2 (1999) 23-30.