COMMENTARY

Evidence-Based Practice vs Doing It the Way We've Always Done It

Bernadette Melnyk, PhD, RN, CPNP/PMHNP

Disclosures

March 24, 2016

Outdated Practices in Nursing

Bernadette Melnyk, PhD, RN, CPNP/PMHNP

When patients go to the hospital or enter a healthcare setting, they have an expectation that the care they receive will be guided by sound knowledge and the best evidence. But that is not always the case. Sure, physicians, nurse practitioners and other healthcare professionals are treating patients to the best of their abilities. However, to suggest that state-of-the-art, evidence-based healthcare is the rule of the day in all systems is a fallacy.

Many traditional, "we have always done it this way" methods of practice are perpetuated in clinical care, despite scientifically supported knowledge that points to more effective practices. Clinicians, take note: Some of these dated practices include:

  • Recording vital signs every 4 hours at night on stable patients, despite their need for undisrupted sleep for recovery.[1]

  • Treating asthmatic children with nebulizers in the emergency department, instead of administering a bronchodilator with a metered-dose inhaler and spacer.[2]

  • Removing urinary catheters only upon a physician order to do so, although the removal of catheters according to a nurse-driven protocol is more efficient and may prevent urinary tract infections.[3]

  • Not performing delirium screening on patients in the intensive care unit (ICU). This failure costs $4-$16 billion annually, because delirium affects up to 80% of ICU patients.[4]

  • Using a back-lying position for women in labor during pushing and birth of the baby.[5]

  • Continuous fetal monitoring during labor. Intermittent auscultation is preferred for low-risk women.[6]

  • Continuing the practice of 12-hour nursing shifts, when findings from research indicate adverse outcomes for nurses and patients.[7]

These examples provide a snapshot of the significant gap between the knowledge that is being produced through research and what is actually happening in practice. The evidence-based approach is not catching on as fast as necessary to reach the Institute of Medicine recommendation that 90% of healthcare decisions will be evidence-based by 2020.[8] Practicing the "way it has always been done" vs the way it needs to be done is a major barrier to improving healthcare quality and patient outcomes, and controlling costs.

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