Evidence-based practice is all the buzz today in health care. If you google “evidence-based practice”, there are multiple references. Wikipedia defines it as “an aim to apply the best available evidence gained from the scientific method to clinical decision making.” It goes on to say that “evidence quality can range from meta-analyses and systematic reviews of double-blind, placebo-controlled clinical trials at the top end, down to conventional wisdom at the bottom.”
It has been said that in order to keep up with the pace of new information becoming available, one must read at least 17 articles per day, every day. Who could possibly keep up that pace!? Let alone, incorporate that information into practice at the same time!! The popular statistic is that it takes on average, 15 years for well-proven science to be incorporated into practice! This could potentially allow proven harmful practices to perpetuate and beneficial practices not be implemented for many, many patients. We have to find a more efficient way.
And yet, this process can be time consuming in itself. Even when a practice has been proven through research, there are variables that may exist that may influence the outcome in a particular patient population. Neonatology is riddled with examples of practices changing without sufficient evidence being available, perhaps benefitting in one aspect but harmful in another. Some had minimal benefit to begin with. Part of the historical reason for this was that neonates are such a vulnerable population for research so evidence in adults and pediatrics was applied to neonates without re-investigation. The best of these examples is the use of oxygen and harmful effects such as retinopathy of prematurity and oxygen free radicals. Therefore, a careful review of the quality of the evidence is merited. There are several scales to rate the level of evidence offered in a recommendation, guideline or policy/protocol. Whenever recommendations for practice are printed or offered, the references used for that practice should be available and consulted for review before these changes are incorporated into our practice. Having just completed editing the latest edition of NANN’s Policies, Procedures and Competencies book, I have spent considerable time combing the literature for research to support our practices in the NICU. While more and more research exists to support nursing practice in the NICU, there is still a dearth of hard science (aka randomized controlled trials) on which to base our practice. Therefore, expert opinion is used as the level of evidence in many cases. Expert opinion, however, comes from many sources. This is actually the weakest level of evidence but includes recommendations from organizations such as NANN or the American Academy of Pediatrics. This grade of “evidence” should not include the opinion of a single experienced professional but rather a consensus of experienced professionals when no research-based evidence exists.
Not everyone can do research and some research is quite time consuming, expensive and difficult. However, we should all keep up with the available evidence. But there has to be a better way than reading 17 articles a day!! Well, there is! There are a variety of sources that seek to compile “best practices” reflected from the available evidence, including research. Some that are particularly useful references in neonatal health care are:
Agency for Healthcare Research and Quality: www.ahrq.gov
The Cochrane Collaboration: www.cochrane.org
Evidence-Based Nursing: www.ebn.bmjjournals.com
National Guideline Clearinghouse: www.guideline.gov
National Library of medicine: www.nlm.nih.gov
A questioning mind is always healthy. Continuing practices because “we’ve always done it that way” is undoubtedly, the worst reason! Even if there are no bad outcomes, questioning why we do it that way or why hospital A does it one way and hospital B does it another leads to investigation. First, check sources for evidence. Does anything exist that leads to answers as to why it should be done one way over another or why it is done in a particular way? Secondly, are those reasons still valid? Is there a better way to do it? If it’s not available in the existing evidence, you’ve just come up with an idea for a research study!