Making the Case for Evidence-Based Practice

Evidence-based practice gives nurses a way to put theory into action to make sure an intervention has the desired outcome by evaluating the research and following it. However, implementing changes in practice to follow the evidence isn’t always a simple task.

“Sometimes we do things the way we are taught, and we don’t always know why,” notes AORN Senior Perioperative Practice Specialist Amber Wood, MSN, RN, CNOR, CIC, FAPIC. “Really we need research studies to prove if a practice really is the best practice.”

To find this evidence, Wood points to AORN guidelines. “We do the heavy lifting for nurses to get evidence-based approaches by sifting through all of the studies to find what is relevant for our practice.”

Recommended approaches for identifying evidence in practice guidelines was established by the National Academy of Medicine in 2011 to suggest how guideline developers follow standards such as rating evidence to collect only the highest evidence whenever possible, such as from randomized controlled trials.

Since 2011, AORN has followed these recommendations to provide perioperative nurses with the highest quality evidence to support safe perioperative care. “We are holding our guidelines to a higher standard,” Wood says.

Accessing the Evidence

There are several ways Wood suggests nurses can access this high-quality evidence for perioperative practice. 

1. Within Every Guideline

Each of AORN’s guidelines provides evidence citations within a recommended practice statement. For example, in the Guideline for Environmental Cleaning, it is recommended that an interdisciplinary team “Identify high-touch objects and surfaces to be cleaned and disinfected.” This recommendation is supported with five research studies that have been appraised by the AORN nurses who authored the guideline to ensure the supporting research articles meet AORN’s standards for evidence.

These references can be accessed through the electronic version of the guidelines published in AORN’s eGuidelines Plus, formerly called the Facility Reference Center, or through the print version of the guidelines published in Guidelines for Perioperative Practice.

2. In Evidence Tables

A separate evidence table for each AORN guideline is posted on AORN’s website as a downloadable PDF to allow anyone to review the evidence supporting AORN best practices and share it with colleagues. Each table lists every reference citation noted within a guideline and notes information about the individual study, such as control and sample size (if relevant to the study). Brief conclusions from the study are also provided.

3. In Implementation Resources

AORN’s Guideline Essentials comprise a collection of implementation resources for each guideline, such as gap analyses, educational materials and other resources to support a guideline being implemented into practice. One important tool in these implementation resources for each guideline is a Key Takeaways document that outlines new practices based in evidence in an updated guideline. These takeaways provide an easy way to see guideline updates so practices can be revised with the latest evidence.

4. Guideline Update Webinars

Each time a guideline is updated with new evidence, the nurse who is lead author on the guideline revision presents a webinar to outline the updates. The recording of the webinar and the slides used in the presentation are posted on AORN’s website with education tools so you can share evidence updates with your team.

Putting Evidence into Practice

Often, the need for discussion about evidence driving a practice can come up during patient care and having the evidence within reach can be valuable. Wood says there are common practice scenarios where being familiar with the latest evidence-based practice can be beneficial for the patient and the team.

One good example is covering the sterile field. “For a long time, the only way we could think about protecting the sterile field was to watch over it as it remained uncovered to prevent contamination,” Wood shares. “However, new research identified a reduced risk for contamination when the sterile field was covered during times that the field was not being used. This new evidence helped us to identify safe practices for covering the sterile field, which are included in our Guideline for Sterile Technique.”

She says health care professionals are beginning to challenge what evidence-based practice is. “The pendulum is swinging from best clinical judgement to highest level of evidence.”

However, in some cases, the evidence is not there yet, Wood notes. “That’s why nurses are well-positioned to not only understand the evidence out there but to help support research studies to close the evidence gap by engaging new studies to build our understanding of safe patient care practices.”

Those attending AORN Global Surgical Conference & Expo, March 28–April 1 in Anaheim, Calif., can learn more about the latest evidence-based revisions to AORN guidelines, including changes on surgical attire, sterilization and other hot topics.

Related Resources

AORN Journal: Translating Evidence into Practice: How Advanced Practice RNs Can Guide Nurses in Challenging Established Practice to Arrive at Best Practice.