TIGER Standards & Interoperability Collaborative Evidence Based Practice Standards Tutorial

Tutorial Outline Objective Definitions The Practice of Evidence Based Nursing: a. Clinical Questions b. Searching Best Evidence c. Evaluation of Evidence d. Applying Evidence to Practice c. Evaluation Case Study Resources: Evidence Based Centers, Websites, Journals Contact information – TIGER & Authors

Objective At the completion of the tutorial the nurse will be able to describe the process of evidence based nursing practice (EBNP) and it’s related importance to the practice of professional nursing and delivery of quality healthcare . The nurse can identify the process of translating the best available evidence into practice and will be introduced to EBP internet resources. Where is your healthcare record? How many locations have your healthcare record. What needs to be represented in your healthcare record?

Definition: Evidence Based Practice A problem solving approach to practice that involves the conscientious use of current best evidence in making decisions about patient care; EBP incorporates a systematic search for and critical appraisal of the most relevant evidence to answer a clinical question along with one's own clinical expertise and patient values and preferences. 1. Melnyk B, Fineout-Overholt E. Evidence-based Practice in Nursing and Healthcare: A Guide to Best Practice. Philadelphia: Lippincott Williams & Wilkins; 2004.

Definition: Quality The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge http://www.iom.edu/?id=21805

Nursing as a Research Based Profession Current Healthcare Climate Insists on the Wisest Delivery of the Best Clinical Practices and Care: FACTORS: Explosion of Literature Unmet Information Needs Implementation Delays Aging Population Fewer Financial Resources Higher Acuities Fewer Staff Research and Theory for Nursing Practice: An International Journal, Vol. 20, No. 2, 2006 Also University of Minnesota

Definition: Best Practices Best Practices refers to nursing practices that are based on the best research evidence. Synonymous terms include research based practice and research utilization. An application example would be use of an AHRQ Clinical Guideline. http://www.iom.edu/?id=21805

Evidence Based Advocates: 1 Evidence Based Advocates: 1. Institute Of Medicine: Performance Standards: The Institute of Medicines’ efforts include redesigning care delivery and keeping patients safe. The IOM’s global focus is on improved quality and a transformation of 21st century care delivery. The 2003 IOM report “Health Professions Education: A Bridge to Quality” recommends integration of core competencies to include EBP into health professions education. http://www.iom.edu/?id=21805 http://www.ahrq.gov/

Evidence Based Advocates: 2 Evidence Based Advocates: 2. AHRQ: Adoption and Consistency of Performance: The Agency for Healthcare Research and Quality’s mission is to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans. The AHRQ funds evidence based centers and supports the National Guideline Clearinghouse http://www.iom.edu/?id=21805 http://www.ahrq.gov/

Evidence Based Advocates: 3. Specialty Organizations (i. e Evidence Based Advocates: 3. Specialty Organizations (i.e., AACN, NANN, Sigma Theta Tau, ONS): These organizations provide resources for nurses to identify, critically appraise, and use evidence in practice. 4. ANCC Magnet Recognition Program 5. Payers, Payees and Patients!

A Model for Evidence Based Practice Assess Link Synthesize Design Implement/ Integrate/ Evaluate Maintain Not sure about this slide (haven’t added explanation……. It could confuse, however it is the only model I know of that Has the “link” piece which describes selecting in a standardized language Rosswurm & Larrabee, 1999, Sigma Theta Tau Int.

Evidence Based Practice: A 5- Step Process Formulate a well-built question Identify evidence based resources that answer the question Critically appraise the evidence Apply the evidence Re-evaluate the application of evidence University of Minnesota Libray

1. Formulate a Well Built Question: *Construct a specific clinical question using PICO format. P= Patient Population I= Intervention/ Issue of Interest C= Comparison Intervention or Comparison Group O= Outcome (T)= Time Arizona State University

In adult cardiac surgery patients (P), is 1. PICO Example In adult cardiac surgery patients (P), is morphine (I) or fentanyl (C) more effective in reducing postoperative pain? (O) Arizona State University

2. Identify evidence based resources that answer the question Search for an evidence based answer using PICO keywords in critically appraised sources (relevant research). Since some evidence is stronger than others and cannot be regarded equally, evidence hierarchies have been developed which rate the strength of the evidence or grade the recommendations.

2. Identify evidence based resources that answer the question An example of an evidence hierarchy from the U.S. Dept. Of Health and Human Services ( now AHRQ) National Guidelines Clearinghouse: Ia Meta-Analysis of randomized control trials Ib One randomized control trial IIa One well designed control study without randomization IIb One well designed quasi-experimental study III Well designed non-experimental study IV Expert committee reports, expert opinions, consensus statements, expert judgement

2. Identify evidence based resources that answer the question In 1998 Stetler and colleagues made a contribution to the format which impacted nursing. The admissible evidence was expanded to include qualitative studies, quality improvement and program evaluation. Journal of nursing scholarship 2001, 2nd quarter

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