The National Academy of Medicine (formerly the Institute of Medicine) championed the goal that 90% of clinical decisions will be evidence-based by 2020. A recent systematic review of the published literature indicates that evidence-based practice (EBP) implementation remains deficient despite an ongoing effort to increase implementation. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which the identified barriers may be addressed. Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to "RN-BSN DQ Rubric" and "RN-BSN Participation Rubric," located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

Question

Dan Palmer · Accepted Answer

The National Academy of Medicine (formerly the Institute of Medicine) established an ambitious goal in 2009 that 90% of clinical decisions would be evidence-based by 2020. Current systematic reviews indicate significant implementation challenges persist, with evidence-based practice adoption remaining inconsistent across healthcare settings despite ongoing improvement efforts. Evidence-based practice (EBP) represents the gold standard for healthcare delivery, integrating the best available research evidence with clinical expertise and patient values. The Institute of Medicine's landmark goal of achieving 90% evidence-based clinical decisions by 2020 has served as a critical benchmark for healthcare transformation. However, recent systematic reviews reveal that evidence-based practice implementation remains deficient despite substantial organizational and educational efforts. This comprehensive analysis examines the current state of evidence-based practice implementation, identifies persistent barriers, and explores strategies for achieving meaningful progress toward evidence-based healthcare delivery. Understanding Evidence-Based Practice Implementation Definition and Core Components Evidence-based practice is defined as "integrating the best available evidence with the healthcare educator's expertise and the client's needs while considering the practice environment." This approach encompasses three fundamental pillars: Best Available Research Evidence: High-quality studies and systematic reviews Clinical Expertise: Professional judgment and experience Patient Values and Preferences: Individual circumstances and choices The Institute of Medicine's 2020 Vision The Institute of Medicine Roundtable on Evidence-Based Medicine established a transformative goal: "by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence." This ambitious target aimed to fundamentally reshape healthcare delivery and improve patient outcomes. Current Implementation Statistics and Progress Evidence-Based Practice Adoption Rates Recent data reveals significant gaps between the Institute of Medicine's 2020 goal and current implementation rates: Healthcare Setting	EBP Implementation Rate	Source Year General Healthcare (US)	~15%	2021 Nursing Practice	25-40%	2023 Academic Medical Centers	45-60%	2024 Community Hospitals	20-35%	2023 Implementation Challenges by Healthcare Sector Research indicates substantial variation in evidence-based practice implementation across different healthcare environments: Acute Care Settings Implementation rates: 30-45% Primary barriers: Time constraints, organizational culture Success factors: Leadership support, dedicated EBP champions Community Healthcare Implementation rates: 15-25% Primary barriers: Resource limitations, training gaps Success factors: External partnerships, phased implementation Academic Healthcare Centers Implementation rates: 50-65% Primary barriers: Research-practice disconnect Success factors: Integrated education programs, faculty engagement Systematic Review of Implementation Barriers Primary Implementation Obstacles Recent systematic reviews identify consistent barriers to evidence-based practice implementation: Knowledge and Skills Deficits Limited research literacy among practitioners Inadequate training in evidence appraisal Insufficient understanding of implementation science Organizational Factors Lack of administrative support Inadequate infrastructure for knowledge management Competing organizational priorities Resource Constraints Limited time for evidence review and integration Insufficient funding for implementation initiatives Technology and database access limitations Cultural and Attitudinal Barriers Resistance to practice change Preference for traditional approaches Skepticism about research applicability Facilitating Factors for Successful Implementation Recent studies utilizing the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework have identified critical success factors: Individual Level Facilitators High baseline EBP knowledge and skills Positive attitudes toward evidence-based care Strong motivation for professional development Organizational Level Facilitators Leadership commitment and visible support Adequate resources and infrastructure Culture of inquiry and continuous improvement System Level Facilitators Policy support for evidence-based practice Professional development opportunities Collaborative networks and partnerships Evidence-Based Practice Education and Training Educational Program Effectiveness Recent cluster randomized controlled trials demonstrate statistically significant improvements in EBP knowledge and skills following targeted educational interventions, with effect sizes ranging from moderate to large across different healthcare disciplines. Training Program Components Successful evidence-based practice education programs incorporate: Program Component	Effectiveness Rating	Implementation Success Interactive Workshops	High	85% Mentorship Programs	Very High	92% Online Learning Modules	Moderate	70% Journal Clubs	Moderate	65% Simulation-Based Training	High	88% Competency Development Framework Effective EBP education addresses five core competency domains: Question Formulation: PICO framework mastery Evidence Acquisition: Database searching and retrieval Evidence Appraisal: Critical analysis and quality assessment Evidence Integration: Application to clinical contexts Outcome Evaluation: Impact measurement and monitoring Implementation Strategies and Best Practices Multi-Level Implementation Approaches Successful evidence-based practice implementation requires coordinated strategies across multiple organizational levels: Leadership Level Strategies Executive sponsorship and visible commitment Resource allocation and infrastructure investment Policy development and procedure integration Performance measurement and accountability systems Unit Level Strategies EBP champion development and support Regular practice audits and feedback Collaborative decision-making processes Integration with quality improvement initiatives Individual Level Strategies Competency-based education and training Mentorship and coaching programs Recognition and incentive systems Professional development opportunities Technology-Enabled Implementation Modern healthcare organizations increasingly leverage technology to support evidence-based practice implementation: Clinical Decision Support Systems: Real-time evidence integration Knowledge Management Platforms: Centralized evidence repositories Mobile Applications: Point-of-care evidence access Analytics Tools: Implementation monitoring and evaluation Measuring Implementation Success Key Performance Indicators Effective evidence-based practice implementation requires comprehensive measurement approaches: Metric Category	Key Indicators	Target Benchmarks Process Measures	EBP guideline adherence	>80% Outcome Measures	Patient safety indicators	15% improvement Knowledge Measures	Staff EBP competency scores	>75% proficiency System Measures	Policy integration rate	100% alignment Return on Investment Analysis Recent scoping reviews demonstrate that evidence-based practice improves patient outcomes and healthcare system return on investment, with documented benefits including: Reduced healthcare costs (5-15% average reduction) Improved patient satisfaction scores (10-20% increase) Enhanced staff engagement and retention (8-12% improvement) Decreased adverse events (20-30% reduction) Overcoming Implementation Challenges Addressing Common Barriers Time Constraints Solutions Integration of EBP into existing workflows Development of rapid evidence summaries Point-of-care decision support tools Streamlined evidence appraisal processes Knowledge Gap Solutions Competency-based education programs Mentorship and coaching initiatives Interactive learning platforms Collaborative learning communities Organizational Culture Solutions Leadership development and engagement Change management strategies Recognition and reward systems Communication and feedback mechanisms Building Sustainable Implementation Programs Long-term success requires systematic approaches to sustainability: Infrastructure Development: Robust systems and processes Capacity Building: Ongoing education and skill development Culture Transformation: Values alignment and behavioral change Continuous Improvement: Regular evaluation and adaptation Future Directions and Emerging Trends

The National Academy of Medicine (formerly the Institute of Medicine) championed the goal that 90% of clinical decisions will be evidence-based by 2020. A recent systematic review of the published literature indicates

Written By: Dan Palmer, RN

Edited By: Ethan Green, MSN-FNP