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

Abstract

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. 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. 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. 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.