Evidence Based Practice Alice Knott, RN November 11, 2008

Evidence Based Practice EBP ≠ Research Research - Investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts. Research - Investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts. Merriam- Webster Dictionary Evidence Based Practice (EBP)- Is a thoughtful integration of the best available evidence coupled with clinical expertise. Evidence Based Practice (EBP)- Is a thoughtful integration of the best available evidence coupled with clinical expertise.

Forms of Research Conceptual Driven Research Designed to influence the thinking of the health care provider, not necessarily action. e.g. What is the difference between withdrawing and withholding a therapy? e.g. What is the difference between withdrawing and withholding a therapy? Decision Driven Research Designed to investigate the application of scientific knowledge to a new practice, policy, procedure, or intervention. Designed to investigate the application of scientific knowledge to a new practice, policy, procedure, or intervention. e.g. How will NCBH initiate palliative therapies?

Selection of a Topic Problem-focused triggers Problems identified by staff through QI, risk assessment, benchmarking data, financial data, or current clinical problems. Problems identified by staff through QI, risk assessment, benchmarking data, financial data, or current clinical problems. e.g. We are chronically understaffed. Is Quadramed an accurate measurement tool for staffing? e.g. We are chronically understaffed. Is Quadramed an accurate measurement tool for staffing? Knowledge focused triggers Staff integrate published or presented scientific data from nursing organizations or federal EBP guidelines Staff integrate published or presented scientific data from nursing organizations or federal EBP guidelines e.g. Heparin lock vs. saline lock

Are there clinical guidelines? Where to look? 1. Federal guidelines: guideline.gov 2. AHRQ.gov 3. CDC. gov 4. AACN.org: Protocols for Practice 5. SCCM.org 6. Cochrane.org 7. Professional journals, etc.

Five Easy Steps to EBP Define the problemDefine the problem Collect the evidenceCollect the evidence Critical appraisalCritical appraisal Integrate the evidence with patient factors to make decisions and actionsIntegrate the evidence with patient factors to make decisions and actions Evaluate the whole processEvaluate the whole process

Getting Started Develop a team Develop a team Clearly state the problem Clearly state the problem Identify specific outcomes: Identify specific outcomes: patient, staff, fiscal Develop a time line Develop a time line

Define the Problem Is this problem… Is this problem… High risk? High risk? High volume? High volume? High resource utilization? High resource utilization? Is it worth our time to resolve? Is it worth our time to resolve?

Collect the Evidence Review of the Literature Electronic Database Search -Electronic Database Search - Journals, Clinical studies, meta-analyses, integrative literature reviews, and existing EBP guidelines Use web resources for EBP guidelines. Use web resources for EBP guidelines. Classify the articles Classify the articles Establish Levels of Evidence Establish Levels of Evidence

Critical Appraisal Levels of Evidence Level I: meta-analysis of a many RCTs (Randomized Controlled Trial) Level I: meta-analysis of a many RCTs (Randomized Controlled Trial) Level II: At least 1 well designed RCT Level II: At least 1 well designed RCT Level III: A controlled study without randomization* Level III: A controlled study without randomization* Level IV: Non-experimental descriptive studies* Level IV: Non-experimental descriptive studies* Level V: Reports or opinions from respected authorities Level V: Reports or opinions from respected authorities *Most commonly used in nursing studies

Apply New Knowledge Initiate the new practice or protocol Initiate the new practice or protocol Gather the data Evaluate the data Assess outcomes Accept, modify or reject practice Re-assess as needed Publish, present or disseminate findings