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Chuck Mercer, RN, emergency charge nurse at CHRISTUS St. Francis Cabrini in Alexandria, La., cites his department’s fax report as an example of a best practice.

At the Heart Institute of CHRISTUS Spohn Hospital Corpus Christi – Shoreline, clinical nurse specialist Sherry Gilman, RN, MSN, CNS, CCRN, and her colleagues knew that patients discharged from the hospital after a cardiac event are at high risk of a second one and that the American Heart Association has identified five primary indicators that can decrease that risk. So Gilman and her colleagues collected data and evaluated the unit’s performance on those indicators.

“We looked at our practices and saw that there were three where we were about 50%,” Gilman says. “We took a multidisciplinary approach to reconstruct all that we do, involving all the different units, to actually change our practice. We wanted to be the best at this.”

To Gilman, this is an example of best practice: looking at what experts like the AHA have said, examining current practice and results, making changes and evaluating those results, and implementing changes that produce the desired outcome.

Nurses are undertaking similar efforts across the country. But while most are familiar with the term best practice, “it’s not clear that everyone means the same thing,” says Rhonda Anderson, RN, MPA, FAAN, CHE, chief operating officer at Banner Good Samaritan Medical Center in Phoenix. “People throw the term around, and there’s no consistent definition.”

At the Seton Healthcare Network in Austin, Texas, best practice means “tactics that seem to yield results better than what we find in other places,” says Joyce Batcheller, RN, MSN, CNAA, senior vice president and chief nursing executive. “You take the learning and tactics someone already has done and see if it can transfer to another area and produce similar results.”

Best practice can’t be based on opinion or anecdote, says Mary Lopez, RN, MSN, director of critical care telemetry and dialysis services at Community Regional Medical Center in Fresno, Calif. “If it isn’t measured and compared to a benchmark and you donhave consistent outcomes that improve performance, it’s not best practice,” she says. “The challenge is to measure against that benchmark and try to exceed it.”

Community Regional Medical Center, for example, tracked ventilator-associated pneumonia rates and evaluated procedures to see which ones changed outcomes.

Chuck Mercer, RN, emergency charge nurse at CHRISTUS St. Francis Cabrini in Alexandria, La., cites his department’s fax report as an example of a best practice. To admit an ED patient to the hospital, the one-page, comprehensive report is faxed, with a copy of orders, to the appropriate unit, which then has 30 minutes to admit the patient. The report decreased admitting time by 90 minutes the first week, Mercer says, and this in turn has increased patient satisfaction.

Pat McCarthy, RN, MS, manager of nursing education at the Veterans Affairs Palo Alto (Calif.) Health Care System, says a best practice depends on variables like the type of equipment used and the patient population. For instance, health care professionals consider different factors when treating geriatric patients than treating children.

Another term common these days is evidence-based practice, and nurses have different views on how the two are related.

“There is a lot of confusion and overlap with the two concepts, and they are often used interchangeably,” says Cathy Rick, RN, CNAA, FACHE, chief nursing officer for the Department of Veterans Affairs. “But there is a fine distinction between them. Evidence-based practice is research-based, grounded in scientific inquiry and evaluation. It might be used for a best practice. But a best practice may be a cutting-edge innovation that hasn’t been proved yet.”

“Evidence-based is doing what has worked in the past,” McCarthy says. “It can be the same as best practice, but not necessarily. The best practice is the outcome of the evidence.”

For example, a group of nurses at the Palo Alto VA explored the literature on taking accurate blood pressures. “We were hit with the realization that we sometimes go onto autopilot and don’t always follow the recommended steps,” McCarthy says. “We wrote up a 15-question quiz and put it in our internal newspaper for nurses to take.” The exercise led to a more evidence-based procedure.