Bringing Evidence to the Stretcher Side

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Excerpt

Evidence-based practice (EBP) is an expectation for health care clinicians. Although we do not yet have evidence upon which to base all practices, the volume of evidence is large and growing daily. So much so that not only is the sheer volume of evidence overwhelming but there is the dilemma of whether the evidence is of adequate quality to influence practice as well. There is also the quandary of contradictory evidence. Most clinicians do not have the time or the foundation of knowledge necessary to review and evaluate all of the evidence. Fortunately, there are many groups devoted to evaluating evidence and making recommendations via EBP guidelines.
The Advanced Emergency Nursing Journal website (www.AENJournal.com) has long had a menu of “Guidelines & Scientific Statements” to direct readers to EBP resources for emergency care. However, many EBP resources are created by other specialties, even though they contain valuable guidance for emergency care. To address these issues, the Advanced Emergency Nursing Journal has established a repository of abstracted EBP guidelines on the journal website and pertinent guidelines from nonemergency care sources are included. The repository is easy to access via a large red banner located near the top of the web page, titled “Evidence Based Practice Guidelines for Emergency Care.” Each guideline has been abstracted to extract the most salient points for emergency care; links to the full documents are also included. The collection is growing so let us know about additional guidelines of interest to advanced practice registered nurses in emergency care.
The process for creating EBP recommendations has grown increasingly sophisticated over the past 25 years. Initially, many EBP documents' evidence included a numerous expert opinions or “this is the way we do it.” Now the scholarly rigor for guideline development has intensified considerably. In 2008, the United States Congress requested that the Institute of Medicine (IOM) identify the best methods for the creation of trustworthy guidelines (Agency for Healthcare Research and Quality [AHRQ], 2017). Subsequently, in 2011, the IOM released Clinical Practice Guidelines We Can Trust, which identifies eight standards for guideline development (see Table 1). Recently, the National Guidelines Clearinghouse (NGC) developed an instrument, the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS), to assess and rate compliance with the IOM standards for clinical guideline development. Beginning this year, the NGC will display this assessment with the guidelines on the Guidelines.gov website (AHRQ, 2017). Now, in addition to serving as a repository for guidelines developed by many different organizations, the AHRQ will provide objective information about the quality of the content.
There will always be challenges associated with providing the most up-to-date evidence-based care possible. However, we know it is worth the effort. Our patients expect, and deserve, no less from us.
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