Project Outcomes From Implementation of the EBP Changes
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� A practice change to early ambulation in the ICU led to a 2.7 reduction in ventilator days (11.6–8.9) and no ventilator associated pneumonia.
� With the implementation of a pressure ulcer prevention nursing standardized procedure on a medical-surgical unit, the acquired pressure ulcer rate was significantly decreased from 6.07% to 0.62% 1 year later.
� Comprehensive education of congestive heart failure patients led to a 14.7% reduction in hospital readmissions.
� After implementation of family centered care on the pediatric unit, 75% of parents perceived the overall quality of care as excellent compared to 22% pre-implementation.
� The percentage of mothers not supplementing their breast milk with formula increased from 61.7% to 71.1% after the evidence-based baby friendly hospital initiative was implemented.
� After implementation of a nurse-initiated pain protocol in the emergency room (ER), wait time for pain medication decreased from 46 minutes to 13 minutes and length of stay in the ER also decreased from 120 minutes to 91 minutes.
DISCUSSION Findings support the positive impact of implementing the ARCC Model on clinicians’ EBP beliefs and a dramatic in- crease in EBP implementation in those who participated in the project. Organizational culture at the hospital shifted greatly toward system-wide EBP. Most important, as a result of imple- menting ARCC, there were multiple improvements in patient outcomes.
The establishment of a cadre of EBP mentors is cen- tral to building an organizational culture of EBP and im- plementing evidence-based care. The EBP mentors in this study garnered the knowledge and skills needed to successfully implement and evaluate EBP changes within the hospital as well as to work with their colleagues in creating an EBP culture in which to deliver high-quality evidence-based care. These findings affirm that culture eats strategy and assists clini- cians in making EBP the social norm within a system (Mel- nyk, 2016b). Without a culture and environment that supports EBP, high-quality evidence-based care will not sustain (Melnyk, 2016a).
Numerous healthcare systems and hospitals throughout the United States and globe have implemented the ARCC Model in their efforts to build and sustain an EBP culture and environ- ment in their organizations. As a part of building this culture, position descriptions have been created or changed to include responsibilities as an EBP mentor. For example, at The Ohio State University Wexner Medical Center, the primary responsi- bility of the clinical nurse specialists throughout the healthcare system is to serve as EBP mentors for point of care staff in improving patient outcomes. Part of this role is ensuring compliance with the EBP competencies for advanced practice nurses (Melnyk, Gallagher-Ford, & Fineout-Overholt, 2016; Melnyk, Gallagher-Ford, Long & Fineout-Overholt, 2015).
Research is needed to further confirm the advantages of using particular EBP models in real-world practice settings, including how implementation of these models impact both clinician, leader and patient outcomes (Dang et al., 2015). Com- parative effectiveness studies that evaluate the benefits of in- dividual models as well as combining models also are needed. Those hospitals and systems who use an EBP model to guide implementation of evidence-based care should document their experiences and outcomes in order to better understand the model’s usefulness in facilitating EBP and share this impor- tant information with others who might use the model (Gra- ham, Tetroe, & KT Theories Research Group, 2007). Return on investment by including cost outcomes also should be eval- uated. WVN
LINKING EVIDENCE TO ACTION
� The ARCC Model is an evidence-based system- wide model for advancing the implementation and sustainability of EBP.
� A key strategy in the ARCC model is the develop- ment of a critical mass of EBP mentors who assist point of care clinicians in the consistent imple- mentation of evidence-based care.
� Use of ARCC EBP mentors enhances the EBP be- liefs and EBP implementation of clinicians and strengthens the EBP culture of an organization.
� An organizational culture of EBP is central to sup- porting sustainable high quality evidence-based care.
� Implementation of the ARCC Model can substan- tially improve patient outcomes.
Author information
Bernadette Mazurek Melnyk, Associate Vice President for Health Promotion, University Chief Wellness Officer, Dean and Professor, College of Nursing, Professor of Pediatrics & Psychiatry, and College of Medicine, The Ohio State Univer- sity, Columbus, Ohio; Ellen Fineout-Overholt, Mary Coulter Dowdy Distinguished Professor of Nursing, College of Nurs- ing & Health Sciences University of Texas at Tyler, Tyler, Texas; Martha Giggleman, Healthcare Consultant & Advocate Liver- more, California; Katie Choy, Senior Director, Nursing Practice and Education, Washington Hospital Healthcare System, Fre- mont, California
8 Worldviews on Evidence-Based Nursing, 2017; 14:1, 5–9. C© 2016 Sigma Theta Tau International
Original Article Address correspondence to Dr. Bernadette Mazurek Melnyk,
The Ohio State University, 145 Newton Hall, 1585 Neil Avenue, Columbus, OH 43210; Melnyk.15@osu.edu
Accepted 16 September 2016 Copyright C© 2017, Sigma Theta Tau International
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doi 10.1111/wvn.12188 WVN 2017;14:5–9
Worldviews on Evidence-Based Nursing, 2017; 14:1, 5–9. 9 C© 2016 Sigma Theta Tau International
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