An Introduction to Evidence Based Practice N111 T.Shea, RN

Evidence Based Practice Learning Objectives: 1. Define evidence based practice 2. Describe why we use evidence based practice 3. Identify the four elements of a well- formulated clinical question

Crossing the Quality Chasm IOM’s 6 aims to improve the health care system: Health care must be: Safe Effective Patient-centered Timely Efficient Equitable

How Can Nursing Meet Those Aims? By: Increasing the body of nursing knowledge by conducting research Utilizing that research in a clinically relevant manner through evidence based practice

What Is Knowledge? “Knowledge is essential information acquired in a variety of ways, expected to be an accurate reflection of reality, and incorporated and used to direct a person’s actions” (Burns & Grove, 2007, p.13)

How Knowledge is Acquired in Nursing Traditional Methods New Methods Tradition Authority Borrowing Trial and Error Personal Experience Intuition Reasoning Nursing research: “A diligent and systematic inquiry to validate and refine existing knowledge ,and generate new knowledge that influences nursing practice,”(Burns & Grove, 2007, p.20). The application of scientific process to result in evidence based nursing practice

Evidence Based Practice What is Evidence-Based practice (EBP)? It is the integration of best research evidence with the clinical problem, clinical expertise, and patient values

Why do we care about EBP? .

Why Use EBP? Optimal patient outcomes Information accessibility for clinicians Evidence-based resources allow clinicians to make research-based decisions in a time-efficient, patient-focused manner “No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature.” (Institute of Medicine, 2001, p.25) Image retrieved October 5, 2009 from www.enagri.info/images/clipart/6.jpg

Nursing Role in Evidence Based Practice Individual RNs Must know and accept responsibility for: Asking questions Reading literature Understanding Critical thinking Synthesizing info Applying science Image retrieved September 21, 2009 from atchealthcare.com/government.html

Evidence ‘Pyramid’ EBP journals Cochrane DB Systemic reviews 8/4/2019 Evidence ‘Pyramid’ EBP journals Cochrane DB Systemic reviews Clinical Practice Guidelines primary research articles CINAHL, Medline Assoc. websites, textbooks Google Adapted from http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=12113514

Primary Evidence Primary evidence includes the original reports of research studies and are included in journal citation databases: MEDLINE CINAHL

Secondary Evidence Secondary evidence is the analysis of research studies Includes practice guidelines and systematic literature reviews Systematic reviews are known as the highest level of evidence in clinical research Examples: Cochrane Database of Systematic Reviews (CDSR) Database of Abstracts of Reviews of Effects (DARE) National Guidelines Clearinghouse

The National Guidelines Clearinghouse Includes evidence-based practice guidelines from various health centers and organizations. It can be searched by disease, treatment or organization.

Steps to Evidence Based Practice An orderly series of steps that allows a researcher to find the answer to a question Consists of five steps: Identify problem. Gather data. Analyze data. Use the findings. Evaluate outcomes.

Steps to Evidence Based Practice 1. Identify the problem/question What do you want to do . . . Improve practice? Update knowledge? Validate a policy or procedure? Plan a new program/therapy/goal?

Steps to Evidence Based Practice PICO: the Anatomy of the Clinical Question: Patient characteristics (Who) Intervention being considered (What) Comparison intervention (What else) Outcome of clinical interest (How)

Steps to Evidence Based Practice Four elements of a clinical question Who is the focus of the question? What is the intervention being done to the patient/population? How does the intervention affect the patient/populations? What could be done instead?

Steps to Evidence Based Practice An example question : “In a 55-year-old man with a 35-year-old history of chronic smoking, would the administration of bupropion as compared to a nicotine replacement therapy (NRT) be a better therapy in causing long-term abstinence from smoking?” Can you identify each PICO component?

Steps to Evidence Based Practice 2. Gather evidence Run your subject search Medline, CINAHL Locate other sources of information Consideration of hospital policy & procedures Clinical expertise Cost effectiveness Chart reviews Patient preferences

Steps to Evidence Based Practice 3. Examine the evidence and critically evaluate the literature Which research applies best ? How strong or weak is the research? Is this research relevant to the clinical scenario? Image retrieved September 21, 2009 from www.thoughtcrimez.com/.../gallery_photos.html

Steps to answering Clinical Questions using the Medical Literature 4. Apply the evidence + clinical experience + the patient's preferences 5. Evaluate patient outcomes

What is Evidence Based Practice (EBP) A step-by-step, dynamic process used to solve clinical problems EBP solves problems by applying Best research data Best clinical judgment and expertise Clinical history and physical assessment Patient preferences and values

Review with an example: Systematic Meta-analysis for Betadine vs Review with an example: Systematic Meta-analysis for Betadine vs. Chlorhexidine gluconate (Miller, Rajender, Umscheid, & Williams, 2008). Result: The use of chlorhexidine for skin antisepsis, instead of povidone-iodine, would result in significant reductions in hospital-acquired infections Data: 9 randomized controlled clinical trial studies used for meta-analysis PARTICIPANTS: Adults receiving topical antisepsis prior to surgery, blood cultures, and vascular catheter insertion INTERVENTIONS: Chlorhexidine gluconate COMPARISONS: Povidone-iodine OUTCOMES: Positive surface cultures after skin preparation, surgical site infections, catheter site colonization, catheter-related sepsis

Research Tutorials CINAHL Medline EBSCOhost CINAHL.com EBSCOhost http://support.epnet.com/training/tutorials.php CINAHL.com Online training http://www.cinahl.com/library/library.htm Medline EBSCOhost PubMed Online training http://www.nlm.nih.gov/bsd/disted/pubmed.html

References Burns& Grove (2007) Understanding nursing research: Building an evidence based practice. St.Louis, MO: Saunders. Institute of Medicine (2001) Crossing the quality chasm: A new healthcare for the 21st century. Washington, DC: National Academies Press. Miller, J., Rajender, A., R., Umscheid, C.A. & Williams, K. (2008). Chlorhexidine versus povidone-iodine in skin antisepsis: A systematic review and cost analysis to inform initiatives to reduce hospital acquired infections. Retrieved October 5, 2009 from www.uphs.upenn.edu/.../2008.04.03%20SHEA%20chlorhexedine%20vs%20betadine%20poster.pdf Sackett D.L., Rosenberg W.M.C., Gray J.A.M., Haynes R.B., & Richardson W.S. (1996). Evidence based medicine: What it is and what it isn’t . British Medical Journal. Jan 13; 312 (7023). 71-2.