Creating an Evidence-Based Practice Culture

1. Creating an Evidence-Based Practice Culture

2. Practice supported by research findings and/or demonstrated as being effective through a critical examination of current and past practices What is Evidence-Based Practice?

3. The Process • Four parts to using Evidence Based Info • The Question • The Search • Critical Appraisal • Implementation

4. The Question Who can ask a question? A wise man does not give the right answers, he poses the right questions.

5. The Question Questions Can ~ • Stimulate the brain • Create an exchange • Discover knowledge or issues • Encourage listening • Provide the opportunity for acknowledgment • Lead the process of discovery

6. The Question • How effective is Tylenol at reducing fever? • Do multi-disciplinary rounds improve patient outcomes? • How can I keep my patient from pulling at their lines? • Does relieving a patient’s chest pain minimize the increase in cardiac enzymes? • Are blood draws from an IV as accurate as a venipuncture? • How do we reduce the rate of patients that fall? • Why do we always run out of flushes stocked in pt rooms but always have tons of IV needles? • How many people really get sick from eating runny eggs?

7. Then What? Talk it over with colleagues & leadership Ask more questions • Is Tylenol or Ibuprofen more effective at reducing fever in adults? • Does an older person with heart failure who gains 5 pounds need to be more concerned than a younger person with heart failure? • How do we improve the accuracy of blood draws from IV’s? • Are assistive devices effective in reducing patient falls?

8. The Question Use a functional format i.e. PICO, ECLIPSE • Why? To yield the most relevant and best evidence • Break into groups for formats • Present group examples – • Ask more questions (Kellie, Renae, ME) HELP!!!!

9. The Question: PICO P – patient population I – Intervention of interest or interest area C – comparison intervention or status O – Outcome

10. P - _______________________________________________ I -_______________________________________________ C - _______________________________________________ O - _______________________________________________ Question:

11. The Question: ECLIPS(E) E – Expectation C – Client Group L – Location I – Impact P – Professionals S – Service

12. E - _______________________________________________ C - _______________________________________________ L - _______________________________________________ I - _______________________________________________ P - _______________________________________________ S - _______________________________________________ Question:

13. The Search Find the answer • Policies and Procedures • Unit/Department Specific Protocols • Evidence-based Practice Guidelines • Professional Organizations • St.Luke’sHealth Sciences Library • Online and Hardcopy • Up to Date • Micromedex • EBSCO Host • CINAHL • Medline Plus • ZynxHealth

14. Critical Appraisal Remember to Think- • How much can you trust the source? • Use Evidence Pyramids • How strong is the evidence? • Systematic review/meta-analysis • Studies (randomized, double blind, Cohort, case control) • Peer reviewed article • Journal • Textbook • Wikipedia/Google • Testimonials, Newspapers, Ideas, Opinions • Use a Critical Appraisal Tool • Miser’s Guidelines for Critical Review of Literature • Find on Google • Specific to research you are doing

15. Library: A good place to start Go to: Inside St.Luke’s Clinical Resource/Health Science Library/Other resources Is Tylenol or Ibuprofen more effective at reducing fever in Adult patients?

17. Results of Librarian Search

18. Advisor forum. Acetaminophen vs. ibuprofen as an antipyretic.Hoffman J; Sego S; Clinical Advisor for Nurse Practitioners, 2010 May; 13 (5): 43 (journal article - brief item, questions and answers) ISSN: 1524-7317 CINAHL AN: 2010666447 Persistent link to this record (Permalink): • http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010666447&site=ehost-live • Effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute ischemic stroke PISA, a phase II double-blind, randomized, placebo-controlled trial [ISRCTN98608690]. (eng) By Dippel DW, van Breda EJ, van der Worp HB, van Gemert HM, Meijer RJ, KappelleLJ, Koudstaal PJ, PISA-Investigators, BMC Cardiovascular Disorders [BMC CardiovascDisord], ISSN: 1471-2261, 2003 Feb 6; Vol. 3, pp. 2; PMID: 12657165; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12657165&site=ehost-live • Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. (eng) By Pierce CA, Voss B, The Annals Of Pharmacotherapy [Ann Pharmacother], ISSN: 1542-6270, 2010 Mar; Vol. 44 (3), pp. 489-506; PMID: 20150507; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=20150507&site=ehost-live • Efficacy and safety of over-the-counter analgesics in the treatment of common cold and flu. (eng) By Eccles R, Journal Of Clinical Pharmacy And Therapeutics [J Clin Pharm Ther], ISSN: 0269-4727, 2006 Aug; Vol. 31 (4), pp. 309-19; PMID: 16882099; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16882099&site=ehost-live • Fever management: evaluating the use of ibuprofen and paracetamol. (eng) By Crook J, Paediatric Nursing [PaediatrNurs], ISSN: 0962-9513, 2010 Apr; Vol. 22 (3), pp. 22-6; PMID: 20426354; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=20426354&site=ehost-live

19. GO FORTH AND CONCUR

20. Implementation • All about teamwork • Resources – decide who to go to change or create a policy. • Unit Services Supervisor • Clinical Nurse Specialist • Manager • Clinical Supervisor • Committee representative about presenting to committee • Shared Governance (if only unit specific) • Nurse Practice Council • Nursing and Pharmacy Operations • Nursing Research Council • Nursing Education Council