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Response to peer discussion board-150 words-1 reference within 5 years-NURSING JOURNALS ONLY.There is a large push for evidence-based practice to become the main foundation of all clinicalpractices and clinical decision making. In order to provide the best up to date quality careevidence-based practice must be used. By the year 2020 90% of clinical decisions will besupported by accurate timely and up-to-date clinical information and will reflect the bestavailable evidence (Boswell& Cannon 2017). Though it is ideal to have evidence-base practicedriving health care practices there are many obstacles in the way of changing the culture ofhealth care practices. There are many obstacles to change such as resistance to change fromstaff available resources to support changes lack of support and training from mentors andresearch findings incompatible with the realities of their practice (Johnston Coole Feakes Whitworth Tyrell & Hardy 2016 p. 392).Working at Shands Hospital in Gainesville Florida there is most definitely a strong push forthe best quality of care through evidence-based practice. Each unit throughout the hospital hasa clinical leader. The units clinical leaders main job description is to assure the unit is clinicallyusing practices that are evidence-based. The main obstacle that I have found on my unit hasbeen research findings incompatible with the realities of their practice (Johnston et al. 2016 p.392 ). Working on such a high acuity unit in the cardiovascular intensive care unit a lot ofevidence-based hospital driven policies and practices have had to be adjusted specially to fit ourunit. Hospital wide practices have had to be adapted because certain practices do not apply tothe realities and acuity of our unit. One main example is the MEWS assessment. The modifiedearly warning score (MEWS) is an example of a physiological track and trigger system designedto identify patients at risk of clinical deterioration in order to provide a timely response torequest appropriately-trained nursing or medical staff to assess the patient and provide anyinterventions required (Harris 2013 p.432). MEWS is an extremely useful tool on floor units but on my particular unit a majority of our patient population have such a high baseline MEWScore. If following our hospital protocol for our patients MEWS we would be constantly callingphysicians and bringing them to the bedside. Our patients have extremely high acuity which isone of the reasons they are in the intensive care unit. Our physicians are aware of the acuity ofour patients and therefore the hospital wide MEW score does not really apply to our unit. Wehad to adjust the triggers of the MEW Scores of when to notify a physician. On the floor aMEWS of 4 a physician is notified and needs to come assess the patient but in the CICU thescore for when a physician has to come to bedside was adjusted to a 6. MEWS is just one ofthe many obstacles present in implementing evidence-based practices on our unit. There aremany obstacles to implementing evidence-based practices in our clinical practices but it isimperative that we adjust or policies and practices to reflect the research found in order toprovide the best quality care.Answer rating (rated one time)

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