Response to peer discussion board-150 words-1 reference within 5 years-NURSING JOURNALS ONLY.

There is a large push for evidence-based practice to become the main foundation of all clinical

practices and clinical decision making. In order to provide the best up to date quality care

evidence-based practice must be used. “By the year 2020, 90% of clinical decisions will be

supported by accurate, timely, and up-to-date clinical information and will reflect the best

available evidence” (Boswell& Cannon, 2017).  Though it is ideal to have evidence-base practice

driving health care practices there are many obstacles in the way of changing the culture of

health care practices. There are many obstacles to change such as resistance to change from

staff, available resources to support changes, lack of support and training from mentors, and

“research findings incompatible with the realities of their practice” (Johnston, Coole, Feakes,

Whitworth, Tyrell, & Hardy, 2016, p. 392).

     Working at Shands Hospital in Gainesville Florida there is most definitely a strong push for

the best quality of care through evidence-based practice. Each unit throughout the hospital has

a clinical leader. The unit’s clinical leader’s main job description is to assure the unit is clinically

using practices that are evidence-based. The main obstacle that I have found on my unit has

been “research findings incompatible with the realities of their practice” (Johnston et al. 2016, p.

392 ).  Working on such a high acuity unit in the cardiovascular intensive care unit a lot of

evidence-based hospital driven policies and practices have had to be adjusted specially to fit our

unit. Hospital wide practices have had to be adapted because certain practices do not apply to

the realities and acuity of our unit. One main example is the MEWS assessment. “The modified

early warning score (MEWS) is an example of a physiological ‘track and trigger’ system designed

to identify patients at risk of clinical deterioration in order to provide a timely response to

request appropriately-trained nursing or medical staff to assess the patient and provide any

interventions required” (Harris, 2013, p.432). MEWS is an extremely useful tool on floor units,

but on my particular unit a majority of our patient population have such a high baseline MEW

Score. If following our hospital protocol for our patients’ MEWS we would be constantly calling

physicians and bringing them to the bedside. Our patients have extremely high acuity which is

one of the reasons they are in the intensive care unit. Our physicians are aware of the acuity of

our patients and therefore the hospital wide MEW score does not really apply to our unit. We

had to adjust the triggers of the MEW Scores of when to notify a physician. On the floor a

MEWS of 4 a physician is notified and needs to come assess the patient, but in the CICU the

score for when a physician has to come to bedside was adjusted to a 6. MEWS is just one of

the many obstacles present in implementing evidence-based practices on our unit. There are

many obstacles to implementing evidence-based practices in our clinical practices, but it is

imperative that we adjust or policies and practices to reflect the research found in order to

provide the best quality care.