title: Continuing to challenge practice to be evidence based.
abstract: Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice.
authors.affiliation: Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts. marybeth.makic@uchealth.org.
authors.forename: Mary Beth Flynn
authors.initials: MB
authors.lastname: Makic
authors.affiliation: Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Carol
authors.initials: C
authors.lastname: Rauen
authors.affiliation: Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Kimmith
authors.initials: K
authors.lastname: Jones
authors.affiliation: Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Fisk
mesh_terms: D064648:Critical Care Nursing / Q000458:organization & administration*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D018570:Risk Assessment; D014481:United States