Examples of care that is not based on evidence are not that hard to find, noted Melnyk, a long-time consultant with health systems on implementation of evidence-based practice and a former member of the U.S. Preventive Services Task Force. It’s not uncommon for children suffering asthma attacks to receive a drug to open their airways with a nebulizer in an emergency room, when research has shown that using a metered-dose inhaler with a spacer instead leads to fewer side effects, less time in the emergency room and lower likelihood for hospitalization. And patients with depression typically receive an antidepressant prescription and nothing else despite research-based evidence that cognitive behavior therapy is more effective than medicine for mild to moderate depression.
The Institute of Medicine (IOM) issued a report in 2003 calling for health professional education programs to include evidence-based care among five core competencies. The IOM has set a goal that 90 percent of all patient-care decisions be based on evidence by 2020.
A survey of nurses in 2005 conducted by a different research group suggested that the profession wasn’t ready then to adopt evidence-based care.
“Now, in 2012, they believe in it and they’re ready for it," said Melnyk, also associate vice president for health promotion at Ohio State. “But there are so many barriers that continue to exist in our healthcare system and our educational system.
“Another disconcerting finding in our survey was that a substantive number of nurses said their leader or manager is resistant to evidence-based practice. What I’ve seen as a consultant is a lot of leaders and managers will say they want their clinicians to deliver evidence-based care, but they don’t walk the talk. If leaders do not role model evidence-based decision-making and they are not providing tools, education and resources for their clinicians to get the knowledge and skills they need to consistently implement this, it’s probably not going to happen nor will it be sustained."
