Response BLOG: OBSERVATION OF EBP

Kenia Jazmin Murillo

Dec 15 5:46pm| Last reply Dec 15 9:01pm

Reply from Kenia Jazmin Murillo

When Evidence-Based Practice Is Done Right and When It Falls Short

When I was working through an agency at a long-term acute care hospital (LTAC), one of the things that mattered most to me was bedside shift report (BSR). As an agency nurse, I often walked into assignments where I did not know the patients at all, so being able to physically see the patient while report was being given made a huge difference. Putting a face to the patient immediately helped me understand who the nurse was talking about and gave me a clearer picture of what my shift might look like.

Unfortunately, working agency also meant that many times I received patients who were not presented well. Bedside shift report gave me the opportunity to hold the off-going nurse accountable in real time. Together, we could check that lines were intact, feeding tubes were patent, Foley catheters were not kinked, IVs were not running dry, and that the patient was clean and dry. Having “four eyes” on the patient during report often revealed issues that may have otherwise gone unnoticed. On more than one occasion, this process led to the initiation of a Rapid Response, something that very likely would have been delayed if bedside shift report had not been used.

From a theoretical standpoint, this aligns with nursing frameworks that emphasize clinical judgment, professional accountability, and the integration of evidence with patient-centered care. Nursing theory supports the idea that nurses are responsible not only for task completion, but also for ongoing assessment and advocacy at the bedside, which is foundational to evidence-based practice (McEwen & Wills, 2022). Bedside shift report operationalizes these theoretical principles by making assessment, communication, and accountability visible and actionable.

Although BSR is considered standard practice now, I still encountered facilities that did not consistently enforce it. At this LTAC, I happened to be there during the transition to mandatory BSR, and I was able to witness firsthand how leadership played a major role in making it successful. Management was present during shift change, listening to and observing nurses give report, and they rounded sometimes unexpectedly until BSR became muscle memory rather than an option. Over time, this approach significantly reduced complaints about “unfinished” or “not done” nursing tasks, reinforcing accountability and improving teamwork.

I genuinely loved going to work at that facility because it was one of the few places where I saw leadership fully embrace evidence-based practice and do the hard work necessary to demand and sustain change. The benefits of bedside shift report improved communication, patient safety, and nurse accountability were clearly visible in daily practice, aligning with what the evidence consistently supports (White et al., 2024).

That said, even in a setting where EBP was strongly supported, there were still areas where evidence was not fully applied. One of those areas was alarm management and alarm fatigue. At this LTAC, alarm parameters were locked, and all patients were held to the same limits regardless of diagnosis. This became especially problematic for our COPD patients, who routinely had oxygen saturations of around 88% while sleeping. With alarms set to trigger for any saturation below 90%, monitors would alarm continuously throughout the night.

Over time, this led to alarm fatigue. Staff became desensitized and often ignored the alarms because they “knew” it was probably the COPD patient alarming again. The real danger, however, was that this assumption was not always correct. There were moments when staff delayed responding because they believed the alarm was non-actionable, when in fact it was another patient deteriorating. This highlights how lack of evidence-based alarm customization can unintentionally increase patient risk.

Current evidence supports individualized alarm parameters and nurse-driven alarm management strategies to reduce alarm fatigue while maintaining patient safety (White et al., 2024). Unfortunately, due to limited organizational buy-in and lack of evidence translation at the time, this was an area where meaningful change did not fully occur.

Reflecting on this experience reinforced for me that evidence alone is not enough. When leadership supports EBP, stays visible, and holds staff accountable, change can happen and it can stick.

 

References:

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2024).  Translation of evidence into nursing and healthcare (4th ed.). Springer.

McEwen, M., & Wills, E. M. (2022).  Theoretical basis for nursing (6th ed.). Wolters Kluwer.