title: Sacred cow gone to pasture: a systematic evaluation and integration of evidence-based practice.
abstract: BACKGROUND
  Sacred cows (SC) are old habits in practice, considered routine and above dispute, regardless of evidence to the contrary.
  
  
  OBJECTIVE
  This is the first known report that aims to conduct a systematic evaluation of practices that have been described in the literature as SC and strategies for planned implementation of evidence-based practices (EBP).
  
  
  METHODS
  A large, complex, academic medical center department of nursing compared SC to EBP. Nurses systematically reviewed and rated the degree to which current practices adhered to best-evidence versus SC. This initiative, "Sacred Cow: Gone to Pasture," was developed, structured, and implemented according to the Iowa Model of Evidence-Based Practice to Promote Quality Care, as well as Everett Rogers' Diffusions of Innovations Theory. Implementation of EBP followed a phase plan using the Implementation Strategies for Evidence-Based Practice to help to support adoption and integration.
  
  
  RESULTS
  Review of organization-specific policies and procedures and reports of actual practices revealed that SC persist, even in a center internationally recognized as a leader in EBP. The SC initiative caught the attention of busy clinicians, and raised awareness of SC and the importance of adherence to EBP. The SC initiative resulted in policy and practice changes and sparked new EBP and research, resulting in numerous improvements, including a significant decline in catheter-associated urinary tract infections and shifting from basins to commercially prepared cloths for patient bathing.
  
  
  CONCLUSIONS
  A strategic approach is crucial to eliminating SC and integrating EBP. This report calls nurses globally to action, to identify and abandon ineffective healthcare practices. Further research should compare and test the efficacy of implementation strategies, in particular how to sustain EBP in clinical settings.
authors: Associate Research Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors: Kirsten
authors: K
authors: Hanrahan
authors: Michele
authors: M
authors: Wagner
authors: Grace
authors: G
authors: Matthews
authors: Stephanie
authors: S
authors: Stewart
authors: Cindy
authors: C
authors: Dawson
authors: Joseph
authors: J
authors: Greiner
authors: Jean
authors: J
authors: Pottinger
authors: Paula
authors: P
authors: Vernon-Levett
authors: Debra
authors: D
authors: Herold
authors: Rachel
authors: R
authors: Hottel
authors: Laura
authors: L
authors: Cullen
authors: Sharon
authors: S
authors: Tucker
authors: Ann
authors: A
authors: Williamson
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D055318:Evidence-Based Nursing / Q000458:organization & administration*; D006801:Humans; D009732:Nursing Care / Q000458:organization & administration*; D009937:Organizational Objectives; D016134:Organizational Policy; D015397:Program Evaluation; D014481:United States
keywords: evidence-based practice; health care