1. QAH HospitalPortsmouth Hospitals NHS Trust 9/3/2015Page 1 Stepping up to Evidence Based Practice - Ideas into Action 4 Debra Ugboma January 2010 Interpreting the Evidence and Developing a Plan

2. QAH HospitalPortsmouth Hospitals NHS Trust Objectives  Provide pointers for reading and organising your literature  Identify some resources for helping you critique the literature  Consider factors and influences in preparing for change  Have a go at appraisal using a structured critiquing tool.  What do I need for this session: –Worksheet 4 –A paper you have identified from your literature search –A critique/appraisal tool (access during the session)

3. QAH HospitalPortsmouth Hospitals NHS Trust I have my literature.. What now?  Review and read the information you have found  Start with the abstracts which will help indicate if you need to access the complete paper  Don’t waste time reading things that are not relevant  Access Journals electronically where-ever you can  Read with consideration of the hierarchy of evidence, and with your question, firmly in mind.  Do you have any systematic reviews or meta-analyses? Keep these to one side.

4. QAH HospitalPortsmouth Hospitals NHS Trust Reading and Appraising… Unless or until you are confident in critiquing the findings of literature/evidence... Read papers first of all, then appraise more fully (with an appropriate tool)… As you become more experienced you will be able to appraise at first (well maybe second) reading!

5. QAH HospitalPortsmouth Hospitals NHS Trust Sorting out the language…  Do you know your NNT from your p value?  What’s a QUALY?  What is the difference between a systematic review and a meta-analysis? Try this useful website which helps to explain some of the terminology: http://www.whatisseries.co.uk/whatis/http://www.whatisseries.co.uk/whatis/

6. QAH HospitalPortsmouth Hospitals NHS Trust Reading and appraising..  Keep any systematic reviews and meta-analyses in a secure place – these are often valuable in answering your question, and helping you find further evidence.  Organise the rest of the literature; consider the “traffic light system”: –Green = very useful, highly relevant, the article answers the question more or less directly –Amber = may/will be useful, has some relevance, some aspects help answer the question –Red = does not appear useful, not relevant to the topic, does not help to answer the question

7. QAH HospitalPortsmouth Hospitals NHS Trust Page 79/3/2015 Look at the evidence? Quality and availability of evidence Ideally less than 5 years old Generalisable? From a range of sources? Peer reviewed for research derived? Are limitations acknowledged? Any potential conflict of interest?

8. QAH HospitalPortsmouth Hospitals NHS Trust Page 89/3/2015 Appraising the evidence  Is it already appraised? i.e. is it linked to a new policy/national guidance, someone’s EBP project etc.  Find an appraisal tool. The CASP website is a good starting point: http://www.phru.nhs.uk/Pages/PHD/resources.htm..http://www.phru.nhs.uk/Pages/PHD/resources.htm  Or try the research/EBP text books  Trisha Greenhalgh – “How to read a paper” is also good (book or series of articles) for medical research and statistics  Enlist someone to help you? Share the workload

9. QAH HospitalPortsmouth Hospitals NHS Trust Using the appraisal tool..  Choose the right tool for the job e.g. qualitative research studies, cohort studies, reviews etc. CASP has tools for all of these.  Aveyard and Sharp (2009) also has a useful chapter on appraising the evidence and some good resources (chapter 6)  You may need to use different tools for different of papers.  Use the tool as a template  To allow for comparison, try using the headings of the tool in a table format and review each paper in turn, keeping short notes.

10. QAH HospitalPortsmouth Hospitals NHS Trust Appraising Clinical Guidelines  The RCN has a very helpful series of web-pages: http://www.rcn.org.uk/developm ent/learning/learningzone/clinic al_skills/clinical_guideline_deve lopment/appraisal_and_adaptat ion http://www.rcn.org.uk/developm ent/learning/learningzone/clinic al_skills/clinical_guideline_deve lopment/appraisal_and_adaptat ion

11. QAH HospitalPortsmouth Hospitals NHS Trust Having a go at appraisal…  Undertake the activity on worksheet 4 (remember you will need to repeat this process with your key papers).

12. QAH HospitalPortsmouth Hospitals NHS Trust Answering the question..  Can you answer your question?  Does the evidence support your idea for action or proposed change?  Is there more searching to do or are you happy to progress?  Write a summary or short fact sheet – this will help you present the information to colleagues and get ready for implementation?

13. QAH HospitalPortsmouth Hospitals NHS Trust Getting ready for change…  Who do you need to talk with, and discuss the potential change?  Who could lead the change?  Who could facilitate the change?  Who could support the change? Is the Team ready for change? Yes How do you know? No What do you need to do to prepare them?

14. QAH HospitalPortsmouth Hospitals NHS Trust Page 149/3/2015 Leading and Facilitation Facilitation Who is responsible ? What facilitation skills do they have? Is responsibility explicit? What time has been allocated? Who can they go to for help? How “up for it” is the team?

15. QAH HospitalPortsmouth Hospitals NHS Trust Page 159/3/2015 Context and culture What else is going on? How big a change is this? What resources are going to be needed to maintain the change? Who are your supporters? Who may be your detractors? How important will this be perceived?

16. QAH HospitalPortsmouth Hospitals NHS Trust Getting ready for change..  What does the evidence say you should do?  Discuss with larger team and gain their ideas  Give opportunity for discussion and debate  How big a change is this for you?  Involve other members of multi-professional team  Provide a background information/fact sheet  Undertake a SWOT analysis to help identify potential opportunities and threats  Who might lead this?

17. QAH HospitalPortsmouth Hospitals NHS Trust Planning for change..  Begin to identify what needs to be done!  Discuss proposed change at team meetings/after ward handovers  Identify your Lead/Driver(s)  Identify your Facillitator and Supporter  What resources are required?  Do you need to prepare anything e.g. documentation, signage  Do you need to audit first?

18. QAH HospitalPortsmouth Hospitals NHS Trust A note about toolkits..  Many Government or national policy initiatives often come along with a “Toolkit” to help with implementation e.g. Protected mealtimes, Essence of Care.  With new policy or key national changes in particular, remember to look for one of these as they can make life a lot easier!

19. QAH HospitalPortsmouth Hospitals NHS Trust Page 199/3/2015 Resources  Aveyard, H. and Sharp, P., 2009. A beginners guide to evidence based practice in health and social care, Maidenhead: Open University Press (chapter 6)  CASP Website for critiquing tools: http://www.phru.nhs.uk/Pages/PHD/resources.htmhttp://www.phru.nhs.uk/Pages/PHD/resources.htm  Essence of care toolkit: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/docu ments/digitalasset/dh_4127915.pdf http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/docu ments/digitalasset/dh_4127915.pdf  Greenhalgh, T., 1997, How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses), Br Medical Journal, Sep 13 315(7109):672- 675  Greenhalgh, T., 1997, How to read a paper: Papers that go beyond numbers, Br Medical Journal, Sep 20 315(7110):740-743  Parahoo, K., 2006, Nursing Research: Principles processes and issues, Basingstoke: Palgrave Macmillan.  RCN – Developing Clinical Guidelines http://www.rcn.org.uk/development/learning/learningzone/clinical_skills/clinical_guidelin e_development/appraisal_and_adaptation http://www.rcn.org.uk/development/learning/learningzone/clinical_skills/clinical_guidelin e_development/appraisal_and_adaptation  What is Series: http://www.whatisseries.co.uk/whatis/ http://www.whatisseries.co.uk/whatis/