3 Tips to Operationalize Guidelines into Practice

Perioperative nurses know that adhering to evidence-based practice supports optimal patient outcomes. 

However, implementing evidence into practice isn’t that straightforward, as nurses know, shares Diana Wadlund, MSN, CRNP, ACNP-C, CRNFA, a perioperative educator and legal consultant who has watched the guidelines for perioperative practice evolve through her 33 years in practice.

Overcoming Implementation Barriers

“The evidence is not always enough to combat pushback from leadership, physicians and even nurse colleagues who are accustomed to their preferred practice approach,” Wadlund says. 

She describes this pushback as one of the biggest challenges nurses face in ensuring consistent adherence to evidence-based practices outlined in AORN’s Guidelines for Perioperative Practice. Wadlund also shares two other tough barriers to translating evidence into practice.

• Cost of implementation—The time required to create a new policy in accordance with evidence-based guidance, educating staff on these policy changes, purchasing any supporting materials and monitoring practices for adherence can force some to wonder if the costs outweigh the benefits, Wadlund explains. 
• Ignorance to the value of evidence—Hospital administrators may not always be open to discussion about practice changes that adhere to evidence-based guidelines that are recommended but not mandated. 

Tips to Operationalize Guidelines 

Wadlund recommends overcoming these challenges with resources available to save time and money when it comes to implementing evidence-based perioperative practices into standardized workflows. For example, she recently learned about AORN’s Guideline Essentials, which AORN members have free access to. 

“These Essentials complement individual AORN guidelines with implementation resources that streamline efforts to translate evidence into practice,” she shares. 

Here are three ways she has found the Essentials beneficial in her own work:

1. Use prewritten policy templates
   A pre-written policy template is included for each guideline in the Essentials.
   “Rather than spending hours in a conference room shaping a policy from scratch, you can simply download the policy template, pop your facility name in and there you go,” Wadlund shares. 


2. Use education presentation templates
   Creating education resources for nurses and physicians that communicate the evidence-based rationale for a practice change is another time-consuming activity in guideline implementation that can be eliminated by using presentation templates in the Essentials resources.
   
   “These education resources also include case studies that can be very effective in helping staff to understand how a change in practice can support the patient with a better outcome,” Wadlund says.


3. Use evidence from the guideline to inspire an evidence-based model of care
   Sharing specific evidence from the guidelines highlighted in the Essentials can provide helpful material for inservices to reiterate the value of adhering to the evidence in patient care, Wadlund explains. 
   “Reinforcing the evidence through regular communications with staff can build the foundation for a strong evidence-based model for providing patient care.”
   Wadlund stresses that “our practice has to be based in good, sound evidence, not only because it is our duty as perioperative providers but also because it can protect nurses in a legal investigation where the guidelines provide the basis for practicing the established standard of care.”

Where to Start

Starting with policy can be a smart approach, she says, by comparing the policy template in the Essentials to your existing policy.

“By identifying any gaps in practice and looking to the research in the guideline supporting the evidence-based practice, perioperative teams can identify a road map for making changes toward a stronger, evidence-based approach,” Wadlund recommends.

For those naysayers who threaten to drag down this work, she suggests pulling out case studies that connect with a relevant challenge your perioperative team is facing.

“This can put a face on the negative outcomes for the patient and the facility if an evidence-based approach is not achieved.”

Additional Resources

• Log in to access the Guideline Essentials today- FREE for AORN members only.
• Access AORN’s Guidelines for Perioperative Practice.