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.

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 units clinical leaders 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.

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