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Asking a Searchable, Answerable Question

Asking a Searchable, Answerable Question. Evidence-Based Practice in Clinical Practice. Crossing the Quality Chasm. 5 Core Competencies ( Summit on Healthcare Profession Education ) Employ evidence-based practice Provide patient-centered care Apply quality improvement

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Asking a Searchable, Answerable Question

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  1. Asking a Searchable, Answerable Question Evidence-Based Practice in Clinical Practice

  2. Crossing the Quality Chasm 5 Core Competencies (Summit on Healthcare Profession Education) • Employ evidence-based practice • Provide patient-centered care • Apply quality improvement • Work in interdisciplinary teams • Utilize informatics

  3. Research… • Asks, “Does it support what we are doing?” • Generates new theory, support, evidence

  4. Evidence-Based Practice • Asks, “What is the research telling us?” • Asks, “What is known about a certain subject?” • Helps us make decisions about the type of care being provided

  5. 5 Steps PICO • P – Patient or Population • I – Intervention or Interest • C – Comparison Intervention or Group • O – Outcome Note: You can use this method without a Comparison

  6. Levels of Evidence Level 1 • From a systematic review or meta-analysis of randomized control trial (RCT) or EB clinical practice guidelines based on systematic reviews of RCT Level 2 • From at least one well designed RCT

  7. Levels of Evidence Level 3 • From at least one well designed controlled trial without randomization Level 4 • From a well-designed case control and cohort studies Level 5 • From a systematic review of descriptive and qualitative studies

  8. Levels of Evidence Level 6 • From a single descriptive or qualitative study Level 7 • From the opinion of authorities and/or reports of expert committees

  9. Evidence Books • Less reliable (become outdated quickly) • Landmark books are okay

  10. Scenario – Asian Man A 40 year-old Asian man is admitted to the GI unit after three days of severe nausea and vomiting. His medical and social histories are benign; the only drug he is taking is acetaminophen, 1 gram T.I.D., for a backache, reportedly attributed to a vigorous workout 3 days ago. The patient was found to have a hepatitis B infection, for which he will receive appropriate treatment. The patient's wife tells you she has heard that Tylenol can cause liver problems, and she wonders if, given his diagnosis, her husband should ever take this drug in the future.

  11. Scenario – Infant Temps You notice that infants with cardiac disease seem to experience more respiratory effort and discomfort when temperatures are taken rectally versus axillary. You believe that axillary temperatures are just as accurate as rectal temperatures if done correctly.

  12. Scenario – Carrots Parents have begun to ask you if their kids will become obese by eating baby carrots. They watched a TV program about a boy, a body builder, who refused to eat carrots because he believed they were too high in sugar.

  13. Scenario – Ligament Displacement You notice an increasing trend in children diagnosed with annular ligament displacement. Because you are concerned with their safety, you discuss the situation with the healthcare team at the clinic and discover that this is not an abuse issue. You therefore wonder what has led to the increase in cases and are suspicious of an activity at the local fall carnival where parents pull their children through a pumpkin “tunnel.”

  14. Scenario – Children & Healthcare You care for a group of children newly diagnosed with cancer. You notice certain characteristics about this group that seem to influence how they interact with their healthcare team and engage their healthcare plan. You wonder if there is evidence that may assist you, and other members of the healthcare team, understand these children more fully.

  15. Forming a Therapy Question Scenario: P • Middle aged Asian male with hepatitis – what is the effect of… I • acetaminophen compared to… C • Ibuprofen O • on liver function

  16. Forming a Diagnosis or Diagnostic Test Question Scenario: • Are (I) Axillary temps, • compared to (C) Rectal temps, • more accurate in diagnosing (O) fever in • (P) Infants with cardiac disease? What is the topic of focus?

  17. Forming a PreventionQuestion Scenario: • In (P) Adolescent teens, does the eating of • (I) carrots or baby carrots compared to • (C) broccoli (or other low-glycemic vegetable) increase the risk of • (O) high blood sugar?

  18. Forming a Prognosis Question Scenario: • In toddlers who have (P) annular ligament, • does (I) intervention • influence (O) displacement?

  19. Forming a Scenario: Meaning Scenario: • How do school aged children (P) • with newly diagnosed cancer (I) • Perceive hospitals, nurses, etc. (O) What is the interest?

  20. Content Validity • Formulate a well built question • Determine the type of study design that would best answer the question • Using PICO, search keywords or subjects • Combine and further limit searches by English/human/gender/age • Apply inclusion/exclusion criteria

  21. References Fineout-Overholt, E., Baldwin, C. M., & Greenberg, E. A. (2004). Using evidence-based practice for clinical decision making in the holistic nursing process. Retrieved March 21, 2006, from http://www.ahna.org/Portals/4/docs/Research/Evidence%20Based%20Practice.pdf Melnyk, B. & Fineout-Overholt, E. (2004). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins. National Guideline Clearinghouse. (2006). Retrieved March 21, 2006, from http://www.guideline.gov/

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