EVIDENCE-BASED PRACTICE

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EVIDENCE-BASED PRACTICE

• Author
• Debra S. Hall, MSN, RN,C, CCRN
• Clinical Nurse Researcher

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AUTHOR
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CONTENT

• Definition of Evidence-based practice (EBP)
• Effect of Evidence-based practice
• Implementation of Evidence-based practice within
  a clinical setting

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EVIDENCE-BASED MEDICINE

• A shift in the culture of providing healthcare
  away from basing decisions on opinion, past
  practice, and precedent toward making more use of
  science, research, and
• evidence to guide
• clinical decision-making

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Evidence-based practice is a state of minda
constant process of inquiry.Why am I doing it
this way? Is there evidence that can guide me to
a better outcome?(Foster, 1999)
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EVIDENCE-BASED PRACTICE (EBP)

• The conscientious and judicious use of current
  best evidence to guide health care decisions for
  improving patient outcomes.
• Marita Titler, PhD, RN, FAAN

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RESEARCH

• A systematic scientific process that generates
  new knowledge or validates existing knowledge

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RESEARCH UTILIZATION

• Research Utilization (RU) differs from
  evidence-based practice (EBP) in that, although
  RU also serves to improve the quality of patient
  care,
• it utilizes solely research
• findings as a basis of practice
• to improve patient care

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QUALITY IMPROVEMENT

• The betterment or enhancement of a product or
  service
• This can be achieved by EBP, but is not limited
  to it

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PERFORMANCE IMPROVEMENT

• Focuses on the achievement of human performance
  goals
• Focuses on the performance of the individual and
  person-specific goals

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• Evidence-based practice in the clinical setting
  requires the integration of
• individual clinical expertise
• with the
• best available external clinical evidence from
  systematic research

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INDIVIDUAL CLINICAL EXPERTISE

• The proficiency and judgment that clinicians
  acquire through clinical experience and clinical
  practice leading to more effective and efficient
  patient assessment and diagnoses

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BEST AVAILABLE CLINICAL EVIDENCE

• Clinically relevant patient-centered research,
  scientific evidence, empirical evidence,
  institutional data, and external data that
  indicate how to achieve patient outcomes that you
  wish to achieve

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EBP assists in -

• practicing based on the evidence (rather than
  opinion)
• Accepting clinical guidelines developed by other
  disciplines
• Developing indicator conditions in which the
  management and performance of patient care create
  a difference in patient outcomes

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• The aim of evidence-based practice (EBP) is to
  reduce wide variations in individual clinicians
  practices, eliminating worst practices, and
  enhancing best practices, thereby reducing costs
  and improving
• quality.

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OUTCOMES MANAGEMENT

• Efficacy the results of an intervention applied
  under ideal conditions (RCT)
• Effectiveness the results of an intervention
  applied in the real world fewer controls lack
  of random assignment

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EBP CHANGES THE FOCUS FROM PROCESS TO RESULTS

• What systems or problems are not allowing growth?
  
• What barriers are present that prevent you from
  delivering the quality of care you, and your
  staff, think is needed?

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USE OF EBP IN ANALYSIS OF CARE ISSUES

• Use of specialty beds in patients for skin care
• Evidence supports use of some specialty beds only
  for pulmonary problems

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USING EBP TO EVALUATE THE QUALITY OF CARE

• Obstructive sleep apnea (Sonnad, et al., 2003)
• Cardiac Rehabilitation (Bitzer EM, Klosterhuis H,
  Dorning H, Rose S., 2003)
• Oncology oral care (Stricker Sullivan, 2003)

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THE EBP PROCESS

• Link your use of evidence-based practice to a
  process
• May choose an existing process
• May choose another process commonly used in your
  organization/institution

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• Assess the need for change in current practice by
• including the stakeholders
• collecting internal data about current practice
• comparing internal/external data (benchmark)
• identifying your problem statement/desired state

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• Link problems, interventions outcomes by
• using standardized classification systems
  language
• identifying potential interventions activities
• selecting outcome indicators

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PROBLEM STATEMENT

• There is an increase in requests for nursing
  staff to administer unfamiliar anesthetic and
  sedative agents in the ICU area for procedures
  which affect patient care and staffing.

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DESIRED STATE

• Nursing staff will have guidelines for
  administration of sedatives during procedures and
  extended patient treatment and for care of such
  patients in the critical care area

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• Synthesize the best evidence by
• searching literature related to major issues
• critiquing weighing the evidence
• assessing the feasibility, benefits, and risks

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• Design practice change by
• defining the proposed change
• identifying needed resources
• planning an implementation process
• defining outcomes

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OUTCOME INDICATORS

• Data collected on administration of approved IVP
  drugs by ICU RNs (e.g., frequency)
• Anecdotal reports from staff on administration of
  approved drugs
• No negative patient outcomes with non-approved
  drugs

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• Implement evaluate the change in practice by
• pilot study demonstration
• evaluate process outcome
• decide to adapt, adopt, or reject practice change

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• Integrate maintain change in practice by
• communicating recommendations to stakeholders
• staff education on changes in practice
• integrating changes into standards of practice
• monitoring the process outcomes

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WHAT INFORMATION IS AVAILABLE ON THE WEB ON EBP?

• http//www.ahcpr.gov/
• www.cochranelibrary.com
• http//www.cche.net/usersguides/main.asp
• http//www.shef.ac.uk/scharr/ir/core.html