EVIDENCE-BASED PRACTICE

EVIDENCE-BASED PRACTICE Author: Debra S. Hall, MSN, RN,C, CCRN Clinical Nurse Researcher University of Kentucky Hospital

AUTHOR University of Kentucky Hospital

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

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 University of Kentucky Hospital

“…Evidence-based practice is a state of mind…a constant process of inquiry.…Why am I doing it this way? Is there evidence that can guide me to a better outcome?…”(Foster, 1999) University of Kentucky Hospital

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 University of Kentucky Hospital

RESEARCH • A systematic scientific process that generates new knowledge or validates existing knowledge University of Kentucky Hospital

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 University of Kentucky Hospital

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

PERFORMANCE IMPROVEMENT • Focuses on the achievement of human performance goals • Focuses on the performance of the individual and person-specific goals University of Kentucky Hospital

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

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 University of Kentucky Hospital

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 University of Kentucky Hospital

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 University of Kentucky Hospital

The aim of evidence-based practice (EBP) is to reduce wide variations in individual clinician’s practices, eliminating worst practices, and enhancing best practices, thereby reducing costs and improving quality. University of Kentucky Hospital

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 University of Kentucky Hospital

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? University of Kentucky Hospital

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 University of Kentucky Hospital

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) University of Kentucky Hospital

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 University of Kentucky Hospital

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 University of Kentucky Hospital

Link problems, interventions & outcomes by • using standardized classification systems & language • identifying potential interventions & activities • selecting outcome indicators University of Kentucky Hospital

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. University of Kentucky Hospital

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 University of Kentucky Hospital

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

Design practice change by: • defining the proposed change • identifying needed resources • planning an implementation process • defining outcomes University of Kentucky Hospital

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 University of Kentucky Hospital

Implement & evaluate the change in practice by: • pilot study demonstration • evaluate process & outcome • decide to adapt, adopt, or reject practice change University of Kentucky Hospital

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 University of Kentucky Hospital

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 University of Kentucky Hospital

EVIDENCE-BASED PRACTICE