Preventing and Treating Skin Injuries

Evidence-based vs. best practice: Here’s the difference.

You’re sitting in a meeting, discussing why certain outcomes are not being achieved, when someone states that evidence-based practice (EBP) must be used. EBP is still top of mind when talk turns to the impact of malnutrition on skin health and then to best practice. You wonder, what’s the difference between evidence-based and best practice?

If you’re confused, you’re not alone. Although the terms have been around for years, clear distinctions between the two descriptions of scientific clinical practice remain elusive.

Here’s the difference: Evidence-based practice is research-based practice that has been shown effective through rigorous scientific evaluation. Best practice typically does not undergo the same scientific evaluation—those processes used in research to validate the assessment or effectiveness of practice.

Rather, best practices are generally accepted, standardized techniques, methods or processes that have proven themselves over time. Because they lack the complex evaluation process typically seen in EBP, people often are slow to adapt to, and adopt, these practices.

For research to be called evidence-based practice it must be

  • studied using appropriate scientific methodology
  • replicated with consistent results in more than one geographic or practice setting
  • recognized in scientific peer-reviewed journals by one or more published articles
  • followed up with implementation guidelines.

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Evidence-based practice must also produce specific outcomes consistently.

It’s important to keep in mind that what is regarded as a best practice can blossom into a full clinical study. It then has the potential of growing and expanding into evidence-based practice.

A case in point: In my own practice at a magnet hospital, we began to wonder if we were looking at the skin health through the wrong lens—one that was near-sighted rather than long-term.

We had looked to evidence on preventing pressure injuries, upgraded our mattresses, put turning protocols in place, and used EBP in our nursing protocols. We found that research targeted only certain issues—the impact of protein and hydration on skin health, for example—rather than a total approach for keeping skin healthy.

We realized that we were simply chasing skin breakdown and missing an opportunity to promote maintaining skin health. We decided to put into place a trial focusing on the patients’ intake of protein supplements and specific vitamins and minerals. We started moisturizing twice a day during rounds and set up hydration stations.

After 90 days, we saw a reduction in skin breakdown. After a year, the medical floor where we started the trial saw zero skin injuries. This became best practice in this department, and other departments took notice. We shared our outcomes and best practice through poster presentations at conferences, which drew the interest of attendees.

As best practices spread, researchers started to study this nationwide. Scientific rigor will help determine whether this best practice of sustaining skin health can be replicated and scaled in different types of care settings.

The next time you’re engaged in a conversation about evidence-based practice, ask yourself: Is there truly evidence or is this best practice? Such inquiries can open minds to potential research, which in turn can drive more evidence in clinical practice.

Routsi Lee

Bio: Martie L. Moore, RN, MAOM, CPHQ, is chief nursing officer at Medline Industries, Inc.