Spreading the word: How a healthcare organization
is promoting evidence-based practice among frontline nurses

Number 22, April 2009

Healthcare organizations across the country are seeking ways to incorporate high-quality research evidence into clinical practice. At Hamilton Health Sciences (HHS) – an organization that includes five hospitals and other facilities serving more than 2.2 million residents – a nursing committee has come up with a unique tool to promote, reinforce, reward, and track evidence-based practice among nursing staff.

 
The HHS evidence-based nursing committee is made up of frontline nurses and representatives from other nursing roles and services, and has links to McMaster University. One of its main activities is the use of an abstracted research journal – namely, Evidence Based Nursing (EBN) – to help ensure that nurses stay abreast of best practices. The journal, published quarterly by BMJ Publishing Group Ltd., reviews a range of international medical journals and publishes abstracts of the best research along with an expert commentary on its clinical application.

 
The committee uses a standardized process to evaluate and disseminate findings from the EBN journal. The first step is to assess the relevance of the abstracts to the hospitals’ programs, using a rating process. Studies or reviews that meet or exceed a certain score are passed along to the contact person at the appropriate clinical program or programs.

 
The contact person then determines whether or not the findings are relevant to the particular program and if so, if the findings have already been incorporated into clinical practice. If they haven’t, the contact person is asked if the findings should be implemented into the program. “A response back from the contacts triggers one of two replies from the committee,” explains committee co-chair Jennifer Wiernikowski, Chief of Nursing Practice. “We either send a letter congratulating nurses and the program for following evidence-based practice, which is most often the case, or we send a letter suggesting categories of implementation interventions.”

  
Most of the disseminated abstracts are on very specialized topics and are applicable in narrow segments of practice. However, one particular abstract on the use of skin cleansing agents prior to peripheral intravenous insertion caught the attention of several committee members. The HHS’s policy in this area was not explicit, and practices varied. “Instead of just disseminating the abstract,” says Ann Mohide, committee co-chair and associate professor at McMaster University’s School of Nursing, “we decided to undertake a project on the issue, because it had such a broad application across sites and services.”

 
The committee surveyed more than 300 nurses and found that less than 75 per cent of them followed the proper skin cleansing regime. In response, several interventions to change practice were carried out and communicated to staff. “We made the policy more explicit, used pictorial reminders that the policy was research-based, and displayed posters on the survey results at different HHS sites,” notes Mohide.

 
A follow-up survey showed that a substantially higher percentage of staff reported using the proper cleanser. “It was a difficult and time-consuming process,” says Mohide, “but very effective in changing practice.”

 
This project is only one of dozens of abstracts disseminated each year. Between January 2005 and January 2006, 79 EBN articles were rated by the committee and 34 were disseminated. Replies from clinical experts were received on 60% (23) of the articles disseminated. Of these, 87% of clinical staff noted that the evidence in the abstract was indeed relevant to the program and 70% of the practices were already being implemented in HHS clinical practice. The committee is currently evaluating 2007-2008 data and is planning to create a prospective database to ensure that important outcomes of the process are recognized and enhanced.

 
The use of the abstracts is having positive impacts at the organizational level as well. By gathering data on abstracts sent and responses received, the committee has proof that evidence-based practice is indeed being implemented at HHS. This information is particularly useful now that evidence-based practice is one of the standards required for hospital accreditation.

 
Wiernikowski believes that the committee’s work, along with other factors such as the hospital’s recent designation as a Registered Nurses Association of Ontario “Best Practice Spotlight Organization,” has helped enshrine a culture of evidence-based practice in the organization.

For more information contact Jennifer Wiernikowski at Jennifer.Wiernikowski@jcc.hhsc.ca.