1. QAH HospitalPortsmouth Hospitals NHS Trust9/11/2015Page 1 Stepping up to Evidence Based Practice - Ideas into Action 5 Debra Ugboma January 2010 Implementing Evidence Based Practice and Change

2. QAH HospitalPortsmouth Hospitals NHS Trust Objectives  Ensure you have appraised the evidence in the context of your own clinical setting  Identify local factors that may affect the outcomes of applying the findings  Revisit some of the barriers to implementing EBP  Identify personal and team influences over care and change  Discuss the value of action plans and Gantt charts  What do I need for this session: –Your evidence summary –Your ideas for your plan of action –Worksheet 5

3. QAH HospitalPortsmouth Hospitals NHS TrustPage 39/11/2015 Stepping up to EBP.. Ideas into action Getting involved in audit Implementing EBP dissertations Evidence from others/policy etc. Questioning care, responding to feedback Structured EBP projects Projects into publication! Active involvement in research

4. QAH HospitalPortsmouth Hospitals NHS TrustPage 49/11/2015 A PHT Model? Practice Links Clinical Care Knowledge/Expertise “Permission” Higher Education Links Scholarship Development Resources Skills Development Clinical Managers Multi-professional Team

5. QAH HospitalPortsmouth Hospitals NHS Trust Context  Have you appraised the findings – and answered your question – in the context of your own clinical environment?  Have you considered all the comments and issues raised from team discussions about the proposed change?  Is this a multi-professional issue? It usually is, and so do not forget to consult others and work collaboratively.  These are important before moving further forward

6. QAH HospitalPortsmouth Hospitals NHS Trust Embracing change..  Think about a previous change implemented in your clinical area?  Undertake the activity on worksheet 5 (questions 1-3)

7. QAH HospitalPortsmouth Hospitals NHS Trust Who will Lead, Facilitate and Support? What will each need from the other?

8. QAH HospitalPortsmouth Hospitals NHS Trust The Lead…  Clarify role and responsibilities as the lead  Identify any educational/information/skill needs for staff – how will you convey the message and information and develop skills  Plan the change – Action plan or Gantt chart  Be realistic in your time-scale and what you want people to do  Consider how you are going to evaluate the change and feed- back to staff and into care/practice  You must enthuse, drive, keep positive and keep momentum going  Where are you going to get your support from and what form does this need to take?

9. QAH HospitalPortsmouth Hospitals NHS Trust The Facilitator  Clarify role and responsibilities  Usually adds “weight” to a project  Provide expertise and support planning/implementation  May help with information sharing and developing skills and knowledge  Connections and networking  Problem solving  Enthuse, drive, keep positive and keep momentum going  Regular structured “catch ups” with lead

10. QAH HospitalPortsmouth Hospitals NHS Trust The Supporter  Clarify role and responsibilities  Usually “hands-off” in relation to project (there for the lead and facilitator rather than clinical team)  Resource for Lead and Facilitator  Provide a corporate/global perspective  May support global or resource issues/initiatives  Enthuse, drive, invigorate, keep positive and keep momentum going  Structured “catch ups” with Lead and Facilitator – clinical supervision/action learning models?

11. QAH HospitalPortsmouth Hospitals NHS Trust Top tips.. What works  Small incremental changes  Talking  Involving staff and “taking them with you”  Regular reminders and updates  The right tone  Doing and role modelling  Positive attitude…but…  Being realistic  Knowing it will not be perfect initially  Feedback, encouragement, reward (cakes!)

12. QAH HospitalPortsmouth Hospitals NHS Trust Awareness, Agreement, Adoption, Adherence (Pathman,1996 cited in Friedman et al 2009) Awareness AgreementAdoption Adherence

13. QAH HospitalPortsmouth Hospitals NHS Trust Final word about audit and evaluation  Evaluation or audit of change is important  Not always about tick lists!  Choose most appropriate audit and evaluation method.  Try to use validated tools or get help with designing audit tools  Keep it as simple as possible  Helps to evaluate achievement of EBP  Helps to identify further actions  Feeds back into EBP cycle

14. QAH HospitalPortsmouth Hospitals NHS Trust What if we need money or resources for our EBP project?  If your EBP change is significant, and requires money or resources you will need to discuss this with your line manager in the first instance  You can apply for money through some professional or charitable organisations e.g: –The Florence Nightingale Foundation travel scholarships: http://www.florence-nightingale-foundation.org.uk/scholarships.htm http://www.florence-nightingale-foundation.org.uk/scholarships.htm –The Foundation of Nursing Studies “putting patients first programme”: http://www.fons.org/ahcp_pffunding.asp http://www.fons.org/ahcp_pffunding.asp –The Learning and Development Team can help you with some of these aspects as any application needs thought and care  You may need to write a business plan if there are significant financial implications for the Trust (discuss with your Operational Manager)

15. QAH HospitalPortsmouth Hospitals NHS Trust Start your plan..  At the end of this session, try drafting your plan for implementing EBP. Try it in an action plan or Gantt chart format?

16. QAH HospitalPortsmouth Hospitals NHS Trust It’s a wrap for us and a beginning for you!  These five presentations have hopefully helped to steer you through aspects of the EBP process  Our aim is to set you off on the road to continued and on-going EBP  Please keep in touch about your current and future projects…  For further information contact: Learning and Development Team Debbie Knight, Deputy Head of Nursing and Midwifery Education and Practice Development Debbie.Knight@porthosp.nhs.uk

17. QAH HospitalPortsmouth Hospitals NHS TrustPage 179/11/2015 Resources  Case studies for change/developing practice: http://www.rcn.org.uk/development/practice/clinical_governance/case_studie s#ebp http://www.rcn.org.uk/development/practice/clinical_governance/case_studie s#ebp  Fish! Motivational ideas. Fish! A remarkable way to boost morale and improve results. Stephen Lundin, Harry Paul and John Christiensen.  Foundation of Nursing Studies – Networking and Sharing: http://www.fons.org/ns_projects.asp?sub=sub2 http://www.fons.org/ns_projects.asp?sub=sub2  Intute – helping you find the best websites for study and research: http://www.intute.ac.uk/cgi-bin/browse-keyword.pl?jacs=nmap&id=31462 http://www.intute.ac.uk/cgi-bin/browse-keyword.pl?jacs=nmap&id=31462  PHT Governance and clinical audit: http://pht/Departments/ClinicalAudit/default.aspx http://pht/Departments/ClinicalAudit/default.aspx  PHT Leadership and Management Courses e.g. Managing and leading for the first time, Practical project management: http://phtlearningzone.org.uk/index.php?page=lm http://phtlearningzone.org.uk/index.php?page=lm