Evidence Based Practice

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The subject of evidence-based practice is discussed in this paper beginning with a definition of the term taken from our text by Blais and Hayes (2011). I discuss the way in which we care for intravenous lines as an example of a procedure done at our hospital that uses evidence-based guidelines like those listed on the National Guideline Clearinghouse website to reduce central line associated blood stream infections. A summary of an article demonstrating the use of a solution of chlorhexidine and alcohol is used as an example of a practice that was changed as a result of evidenced-based practice. Although the policy and procedures at our facility reflect practices that are done as a result of evidence-based practice, I do point out the practice we have of routinely replacing peripherally inserted central catheters (PICC’s) on patients admitted from other facilities or a private home as a practice that should be further investigated. The discontinuation and re-insertion of a peripherally inserted central catheter just because it’s from “the outside” is not evidence-based reasoning for this practice. The conclusion of this paper is a synopsis of an article taken from the April 2011 issue of Critical Care Nurse which points out common and current practices of critical care nurses that are done as a matter of tradition or “sacred cows” and that current research shows that evidence-based practice and not tradition is the best nursing practice. Evidence-based practice is proven to provide better nursing care and optimal patient outcomes. Evidence Based Practice

The process of bringing together theory, clinical decision-making and knowledge of research processes results in what is known as evidence-based practice (Blais & Hayes, 2011). In our hospital many of the nursing duties we perform are a result of evidence based practice. One nursing task that is done based on evidence-based practiced in our hospital is in the care and maintenance of our central venous catheters including subclavian, internal jugular, percutaneously inserted central catheters (PICC), femoral lines and all tunneled and non-tunneled catheters including Hickman, Pass-Ports, Port-A-Caths and dialysis catheters to help decrease our percentage of central line associated blood stream infections (CLABSI). The policy and procedure for peripheral intravenous (IV) and central line insertion site care at Sunrise Hospital complies with the guidelines and recommendations listed on the website for the National Guideline Clearinghouse (National Guideline Clearinghouse [NGC], 2009). These guidelines are a result of a cumulation of information from electronic databases, a review of previously published guidelines by the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) and computerized literature searches using PubMed (NGC, 2009). The NGC guidelines and recommendations for preventing and monitoring central line-associated bloodstream infection (CLABSI) are divided into 3 sections; before insertion, at insertion and after insertion. Each section gives the best practice that should be carried out by the nurse and other healthcare providers for the prevention and monitoring of CLABSI. For example, the pre-insertion recommendation for hospitals is to “ensure that all healthcare personnel involved in catheter insertion and maintenance complete an educational program regarding basic practices to prevent CLABSI before performing these duties” (NGC, 2009). Our facility complies with this guideline in its policy for central venous catheters (CVC) which states that, “an RN who places a PICC line must be an RN who’s completed a competency assessment and completed a comprehensive educational program for PICC line insertion which has been approved under the Nevada State Board of Nursing continuing education”(Sunrise Hospital and Medical Center [SHMC], 2010, p. 5). The “at insertion” section of the...
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