1. Getting evidence into practice Early Clinical Career Fellowships Masterclass 29 th August 2013 Annette Thain Annette.thain@nes.scot.nhs.uk

2. Learning Outcomes 1.Understand the aim Knowledge into Action is to support the implementation of evidence in practice 2.Know what sources to use for different types of evidence 3.Identify knowledge management tools and techniques to support you to get evidence into practice 4.Know where to get help and advice for you and your colleagues

4. Average time from research initiation to application of findings/treatments is... 17 years

6. Knowledge into Action review help practitioners to apply knowledge to frontline practice. embed use of knowledge in healthcare improvement. support practitioners and managers to translate knowledge into better health outcomes, i.e. safe, effective, person- centred, efficient care.

7. What is Knowledge into Action? evidence based practice knowledge translation knowledge implementation implementation science “The move beyond simple dissemination of knowledge to actual use of knowledge” Straus, et al (2009)

8. From Accessing to Applying Knowledge in NHS Scotland Knowing 66 libraries 116 library staff 12 million + resources Doing How much of this gets used in a meaningful way to improve safe, effective, person-centred care? http://www.knowledge.scot.nhs.uk

9. Knowledge as process Know-what Journals MEDLINE Cochrane reviews Reports Know-where Systems Processes Local context Know-who Service users Practitioners Teams Practice Experience Research Know-how: Actionable Relational Organisational

10. Knowledge as process Actionable knowledge Checklists Pathways Mobile apps Relational use of knowledge Communities of Practice Social networking Social learning Organisational enablers Backing at national and board level Tests of change to demonstrate impact Knowledge broker Know-how: Actionable Relational Organisational

11. Discussion Discuss examples from your practice of – actionable knowledge ie ways of presenting knowledge – social/relational use of knowledge ie examples of communicating and sharing Feedback one example of each

12. Transfer of Knowledge into Quality Patient Care Clinical Knowledge (Evidence Based Practice): MEDLINE, Cochrane etc Improvement Knowledge: SPSP experience, etc Know-What Know-How Quality Patient Care Doing the right thing Doing it right Clinical Decisions Process/System Changes Adapted from: Glasziou, P et al. Can evidence-based medicine and clinical quality improvement learn from each other? 2011. BMJ Qual Saf 20 (suppl 1): i13-i17

13. Mnemonic – the practical activities to support the cycle Question What do you need to know? Source Where will you look? FindWhat words will you use? EvaluateIs the information ‘good’? CombineHow does it all fit together? ShareHow will you share it? ApplyHow will you use it?

14. Question - Keyword KeywordSynonym OsteoporosisBone density, bone loss Adult maleElderly man, older people Calcium supplementAdcal D3, Calcit D3, Calcichew-D3 Alternative/additional measures Diet, exercise, lifestyle John is a 62 year old man who has been diagnosed with osteoporosis. He’s been prescribed a calcium and vitamin D supplement but is interested in other ways protect himself.

15. PICO P Person, population or problem Adult male, elderly male I Intervention (proposed) Diet and lifestyle changes C Comparison/Current intervention Calcium and vitamin D O Outcome(s) expected Improved bone density Now you try an example……

16. Know-what Journals MEDLINE Cochrane reviews Reports Know-where Systems Processes Variation Know-who Service user Practitioner Teams Practice Experience Research

17. Point of care Dynamed Nursing Reference Center Guidelines Evidence summaries Other questions Databases Journals Books Reliable information resources : http://www.knowledge.scot.nhs.uk

18. The Knowledge Network Index

19. Systems Summaries Synthesis of Synopsis Synopsis Synthesis of Single Studies Studies Computerised decision support Guidelines/Protocols/ Evidence Based textbooks Evidence based journal articles eg Evidence Based Nursing Systematic Reviews eg Cochrane Library Original Journal Articles and Studies eg Medline Point of Care Resources eg Dynamed [Adapted from Dicenso A, Bayley L, Haynes RB (2009). Accessing pre-appraised evidence: fine-tuning the 5S model into a 6S model. Evidence-Based Nursing, 12,99-101 ] Evidence-Based Nursing, 12,99-101 ] Know What – Evidence Triangle

20. Other Sources - discussion Know-where Local context Systems Processes Know-who Service users Practitioners Teams Practice Experience Research

21. Possible Sources- depends on topic Grey literature References Epidemiology Drug information Patient stories Case studies Improvement websites eg IHI Books Elearning Videos People Communities of practice MCNs GOOGLE

22. Demo of The Knowledge Network to find the know what and know howThe Knowledge Network

23. Does it answer my question? Do I need to do a full scale critical appraisal?

24. How does all this fit with your previous knowledge and experience / local setting?

25. RefWorks/RefShare

26. Who else needs to know about what you’ve found? How will you let them know about it?

27. Information/knowledge has little value unless it is used How will you - Use the new information? Change your practice? Keep up to date?

28. Barriers and facilitators Barriers Facilitators Barriers Awareness and knowledge Skills Motivation Practicalities Acceptance and beliefs How can I overcome the barriers? Educational materials Opinion leaders Clinical audit and feedback Reminder systems Education outreach visits Educational meetings Patient mediated strategies www.nice.org.uk

29. Practice based small group learning Using real clinical problems to stimulate reflection, discussion and learning among groups of peers Specially prepared modules produced which “closes the gap between current practice and best practice” Knowledge brokers provided support to clinicians in developing a PBSGL module on cervical screening. Educational perspective – clinicians and knowledge brokers working together

30. Sepsis and VTE collaborative The Sepsis Collaborative aims to contribute to overall aim of the Scottish Patient Safety Programme of reducing mortality rates by 20% by December 2015 Knowledge broker involved in a range of activities Educational perspective – knowledge broker role combined with tools and resources produced a positive outcome.

31. Knowledge Management Tools and Techniques Case Studies People Finders Checklists Knowledge Banks and Databases Rapid Evidence Search Expert Evidence Search After Action Reviews Peer Assist Review Knowledge Cafes Communities of Practice Social Media An informal method to stimulate and create ‘awakening and engaging of collective intelligence through conversations about questions that matter’. It is a technique to evoke and make visible the collective intelligence of a group. A community of practice shares a specific interest that becomes a source of identification. This creates a sense of commitment to the community as a whole, not merely connections to a few linking nodes. Eg Dementia MKN Also known as ‘learning before doing.’ A team asks for help: people are invited to share their experience, insights and knowledge with the team. A short, facilitated meeting of project team members (and possibly other stakeholders) to evaluate and capture lessons learned. Task or resource lists as an aide memoire to improve consistency. Knowledge banks are repositories which store knowledge and allow people to retrieve and use the knowledge they contain. For example, SSKS, ASSIA Provide understanding of causal factors, barriers and facilitators that led an event to unfold as it did. Examples on Evidence for Practice tab on SSKS. Librarians and knowledge managers carry out expert searches of research sources. Use of Health Management Library Services Use of the Evidence Informed Practice search option on SSKS Directories of people with contact details and information on skills, practice experience and areas of interest eg members of Dementia MKN Social media tools eg Blogs, Twitter, Facebook, Book Marking, News Feeds, Community Website tools PTO for more info KM Tools and techniques

32. Searching and Synthesis Actionable Knowledge People to people knowledge transfer For more info: There are 2 toolboxes that provide more detail and examples of the suggested tools and techniques The Knowledge Management Toolbox http://www.qihub.scot.nhs.uk/networks-and-communities/knowledge- management-toolbox.aspxhttp://www.qihub.scot.nhs.uk/networks-and-communities/knowledge- management-toolbox.aspx Social Media Toolbox http://www.qihub.scot.nhs.uk/networks-and- communities/social-media-toolbox.aspxhttp://www.qihub.scot.nhs.uk/networks-and- communities/social-media-toolbox.aspx. If you have any comments, suggestions or would like advice on using any of the tools please contact knowledge@nes.scot.nhs.ukknowledge@nes.scot.nhs.uk. The tools and techniques can be described in three categories

33. Help and training Online help Webex sessions for The Knowledge Network and other services – sign up for monthly newsletter knowledge@nes.scot.nhs.uk knowledge@nes.scot.nhs.uk Webex sessions from providers CLEAR service Local NHS librarians Materials for colleagues knowledge@nes.scot.nhs.uk knowledge@nes.scot.nhs.uk Any problems or questions knowledge@nes.scot.nhs.uk knowledge@nes.scot.nhs.uk KnowNet Scotland TKNScotland

34. Thank you for listening Any questions? Learning outcomes 1.Understand the aim Knowledge into Action is to support the implementation of evidence in practice 2.Know what sources to use for different types of evidence 3.Identify knowledge management tools and techniques to support you to get evidence into practice 4.Know where to get help and advice for you and your colleagues