Enhancing Evidence-Based Practice Integration Into Clinical Practice: Using Policy as a Tool for Culture Change in a Large Urban Academic Medical Center

Abstract

Purpose: This article describes how a large urban medical center was able to enhance the integration of evidence-based practice in the clinical environment by reconfiguring its approach to policy and procedures documentation.

Project description: Leaders at a large urban medical center observed that numerous nursing practice documents lacked a base of evidence. No standard process existed for building staff awareness of the evidence-based underlying practice, and there was uneven knowledge of evidence-based practice in the milieu. To address the problem, a team of Clinical Nurse Specialists developed a novel policy establishing procedures for document review, formal structures for policy assignment, and rigorous standards for the development and sharing of evidence tables.

Outcome: The proportion of nursing guidance documents connected to evidence tables increased from 45% to 77% in the first year and a half following implementation. The change has enabled streamlining and consolidation of nursing practice guidance documents and has led to significant increases in engagement with clinical inquiry at the bedside.

Conclusion: A policy specifically requiring evidence to be incorporated into nursing practice guidance documents can help enhance the understanding and uptake of evidence-based practice in a complex clinical environment. Clinical Nurse Specialists played a vital role in facilitating this organizational culture change.