Using Immersion Technique to Implement Evidence Based Practice and Improve Nurse-Sensitive Patient Outcomes

Purpose:
A Southern US healthcare system did not have an EBP infrastructure. Staff implemented research without a comprehensive literature review. The majority of nurses were unfamiliar with EBP. NDNQI data indicated that nursing-sensitive indicators were out of the ranges anticipated for the settings.

Significance:
Implementation of EBP protocols has been demonstrated to improve nurse-sensitive indicators, falls, pressure ulcers, and UTI. Processes to speed the acquisition of knowledge regarding EBP can have a dramatic positive impact on nurse-sensitive indicators and alter the culture of nursing long-term.

Strategy and Implementation:
Immersion technique was selected to introduce the EBP and build a system-wide support structure. Data collected on nurse sensitive patient outcomes was the baseline/monitor for driving the project forward. In 2007, RNs representing each of a healthcare system's 9 regions and specialties-rehabilitation, community, risk, & informatics met for a 1-day Health System EBP Seminar. The RNs worked as a team to build their EBP knowledge base and support structure. A timeline was set to develop 3 EBP protocols. This newly formed EBP Advisory Team then attended a 3-day EBP workshop. The Team discussed EBP at meals, participated in presentations, met EBP experts, & networked with peers implementing EBP. At the end of immersion the team had selected 3 clinical problems to address. This initial immersion was followed by meetings every 2 weeks for 20 months building the EBP environment. The immersion process resulted in a confident EBP Team who now lead EBP implementation in their region/specialty.

Evaluation:
4 EBP protocols were developed & implemented–Falls, Parenteral Promethazine, UTI Prevention, and Pressure Ulcers in a healthcare system that did not have system-wide evidence based protocols prior to the immersion. Changes in clinical outcomes demonstrate the positive impact of the protocols.

Implications for Practice:
Immersion is an effective technique for developing an EBP infrastructure and driving improvements in nurse-sensitive indicators at rural, urban,& suburban hospitals; rehabilitation; and LTC. Nurse-sensitive indicators demonstrate that EBP has a positive, sustained impact on patient outcomes.