Evidenced Based Practice

The interventions and practice considered as a result of evidence- based practice, by the National Guideline Clearinghouses for hand hygiene recommendation in prevention and control of healthcare associated infections in Massachusetts are: Hand washing and hand antisepsis using a non-antimicrobial and water, antimicrobial soap and water, and alcohol based-hand rub, receiving input from heath care workers regarding the products that are being used, providing healthcare workers with skin care products, educating the healthcare workers and observing their practices, and having administrative support.

These are similar to my facility’s policies, except that they do not recommend the use of non-antimicrobial soap. The recommendations and practices for hand washing and hand antisepsis similar to my facility are: hands need to be washed with soap and water when visibly soiled with blood or other bodily fluids, before and after eating, and after using the rest room.

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Alcohol based hand rubs can be used to decontaminate hands when hands are not visibly soiled, in clinical situation such as: before coming in direct contact with the patient, before donning sterile gloves for procedure like insertion of foley catheter, prior to starting an intravenous catheter, after removing gloves, when going form a contaminated body site to a clean site, after contact with inanimate objects and surfaces in patient environment.

My hospital policy follows the same recommendation for use of alcohol based hand rubs except in situations where patients have a suspected or confirmed diagnosis of Clostridium difficile because hand rubs are ineffective against spore-forming pathogens. The facility policy also states that appropriate hand hygiene must be performed at the beginning of a shift and before leaving the facility.

According to the National Guideline Clearinghouse, the use of antimicrobial impregnated wipes could be used as another alternative to washing hands with non antimicrobial soap and water, but cannot be substituted for antimicrobial soap and alcohol based hand rub as it is not as effective. My hospital policy does not recommend the use of antimicrobial impregnated towelttes to health care works, but recently I found out that they do provide alcohol based wipes to our patient.

The recommendations for hand hygiene techniques according to the National Guideline Clearinghouse for hand washing is to rub hands vigorously with soap for at least fifteen seconds, covering all surfaces of the hand and fingers and then wash thoroughly with water. However according to my hospitals’ policy the recommended time for antiseptic hand washing is forty to sixty seconds. The recommended time to decontaminate hands with alcohol based hand rubs is twenty to thirty seconds or until dry, which is similar to the National Guideline Clearinghouse.

The recommendations for selections of hand hygiene products by the National Guideline Clearinghouse that are similar to my facility policies are: to have products that are efficient and have a low irritancy potential, obtain input from the staff regarding the feel, fragrance, and skin tolerance, provide staff members with hand lotions to minimize occurrence of contact dermatitis associated with hand washing or hand antisepsis.

According to my hospital’s policy, only soap/detergent from wall mounted dispensers is to be used for routine hand washing, bar soaps are not acceptable. The policy does not permit the use of personal lotions in patient care area as they are a potential media for bacterial growth and because most lotions are not compatible with chlorhedine gluconate.

Our hospital staff members are educated on a regular basis about the importance of hand hygiene in prevention of infection to patient and self, and advantages and disadvantages of different methods of hand hygiene techniques. Our administration is involved in analyzing and evaluating hand hygiene compliance and implementing programs that help staff members adhere to hand hygiene practices. The nurses in my facility do follow the evidence based guidelines for proper hand hygiene.

The activities in my practice setting that demonstrate the use of evidence based practice for hand washing techniques are: readily accessible alcohol based hand rubs at the entrance of every patient cubicle and in every operating suite, availability of antimicrobial soap and wash sinks within close proximity of patient care area and outside every operating room, availability of motion activated soap dispensers, availability of motion activated paper towel dispensers, availability of hand lotions compatible with chlorhexidine gluconate hand wash products, educating and encouraging patients and family members to ask health care workers if they followed proper hand hygiene recommendation prior to taking care of them, and reminding staff by using phrases like: gel in gel out; don’t give the bugs a free ride, at the nurses’ station and outside patients’ room.

According to the article “How to establish evidenced-based change in acute care settings” by Len Bowers, (2012) getting research finding into practice was not a simple approach, instead it had many barriers accompanied to it (Bowers, 2012, p. 4). According to me the most important barriers are: lack of adoption by opinion leaders on the team, lack of desire for change, insufficient time and resources, organization rigid and not open to change. The barriers that apply to my facility are lack of desire for change, and insufficient time and resource. For most nurses it is getting past the powerful phrase of, “that’s the way we have always done it”.

Most nurses are comfortable practicing in nursing care the traditional way, and when there is a change in their routine it becomes tough for them to adapt. Lack of desire to change among nurses may be due to the reluctance of believing that results from research study is safer than traditional practice and experience, which can be overcome by proper staff education. Nurses should be informed of the benefits that their patient, their institution and they can get by implementing evidence-based practice, like increased efficiency in patient care and personal and professional satisfaction. Educating nurses about research is very important, especially when we have nurses with different educational backgrounds.

Lacks of time to read, understand and implement research findings are very limited to our nurses, due to workload pressure and pressure from higher ups regarding productivity hours. One of the ways this can be taken care of is to have administration support nurses by providing them with sufficient time for activities that promote evidence based practice and a strong evidenced based culture. According to the author change is important to make improvement in client care, which can be accomplished by proper guidance, by sustaining energy and enthusiasm among staff members. (Bowers, 2012, p. 4). According to the article “Embedding a culture of Evidence-Based Practice” by Fitzsimons and Cooper, J (2012).

The authors emphasize the four main aspects of strong leadership on getting research into practice: Visible leadership and support, Mentorship, Outcomes feedback, and Shared governance. (Fitzsimons & Cooper, 2012, p. 7) According to the article some of the barriers to implementing evidence- based practice are lack of time, education and the support to make the changes, which can be overcome by senior nurses in ideal positions who are strong advocates of evidence based practice and also provide resources like time, education, access to mentors and even help in funding evidence based practice at conferences.

Mentorship is another significant factor in introducing evidence based practice. (Fitzsimons & Copper, 2012, p. ) Mentors display a passion for evidence based practice and exhibited strong leadership qualities of interacting with front line staff responsible for implementing them. Providing staff members with feedback related to patient care helped leader effectively engage staff in evidence based practice and helped with professional growth among the staff members. Shared governance helps leaders give their staff members the opportunity to engage themselves with practice improvements and share the best practice across the unit. Evidence based practice is important to nursing because it promotes safe and efficient nursing care, improves patient outcomes, is cost effective, mproves patient and staff satisfaction and helps nurses become more independent in their practice.

Evidence- based practice in important in today’s health care industry as reimbursement is based on patient satisfaction and if treatments provided for the patient lacks evidence based practice, hospitals stand the risk of not being paid by the insurance companies. Of the four factors associated with implementation of successful evidence based practice, the most significant factor, according to me, is visible leadership and support. Leadership provides a strong foundation for motivation among the staff members and sets the stage for commitment rather than mere compliance.

Senior nurses in leadership positions are excellent clinicians, natural mentors and personal advisors to younger nurses. According to the article “Implementation of an evidence-based guideline on fluid resuscitation” lessons learnt for future guidelines. Due to limited nationwide experience in implementation of evidence- based pediatric guideline on first choice fluid resuscitation in hypovolemia. (Tabbers, et al. 2009) The author’s investigated fluid prescribing behaviors at three different levels 1) guideline development, 2) after guideline development, and 3) after active implementation. (Tabbers, et al. 2009) They were successful to identify potential barriers and facilitate implementation guidelines.

The authors at every point developed and brought about changes in implementation strategies, keeping in mind the barriers identified in order to be cost effective and upgrade implementation effects. Results included remarkable changes after guideline development and propagation. The use of crystalloids by neonatologist increased significantly to 100% and also by pediatric intensivists to 88 – 100%. There was also a decline in the uses of synthetic colloids by pediatric intensivists to more than half of what it was being used and the use of albumin by neonatologist declined to 0%. (Tabbers, et al. 2009) The authors conclude to say implementation strategies should aim at solving identified barriers in order to successfully implement guideline and also be cost effective during active implementation..

This article is evidence based practice because the authors are trying to understand the effectiveness and comparative effectiveness of fluid prescribing behaviors and help practitioners to make informed decisions about healthcare and promote better quality care in pediatric patients. The recommendations of this article are proper implementation strategies and keeping cost in mind during implementation. The recommendations in this article address timely and proper intervention to avoid further complication. Conclusion: it is clear that Evidenced-Based practice is one of the most important developments in nursing profession. Studying and comparing different aspect of implementing evidenced based practice, identifying and overcoming barriers to implementing evidenced based practice in order to improve patient outcome.

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