Implementation of EBP at Royal Perth Hospital

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Implementation of EBP at Royal Perth Hospital

• Mary Ward SDE
• Evidence Based Practice 30/10/06

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2003 to 2006 EBP implementation

• Greater than the sum of the parts

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Clinical Governance

• a systematic and integrated approach to
  assurance and review of clinical responsibility
  and accountability that improves quality and
  safety resulting in optimal patient outcomes.
• (Dept of Health, WA,
  2001)

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Sackett et al. EBM what it is and what it
isntBMJ 199631271-72

• The conscientious, explicit and judicious use of
  current best evidence in making decisions about
  the care of individual patients

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Sackett et al 2000

• The practice. Integrates clinical expertise and
  patient values with the best available research
  evidence.

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Divisional Stakeholders

• Advocates for patients and staff in their
  Division
• Ownership of the final product
• Person centred development opportunity

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Tracheostomy NPS

• Standard management for patients with a
  tracheostomy hospital wide

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Tools of the trade

• Audit
• Literature searching
• Critical appraisal
• Computing
• Negotiation
• Change management
• Time management

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5 step of EBP

• 3. Critical appraisal of evidence for validity,
  clinical relevance and applicability
• 4. Application of results in practice
• 5. Evaluation of performance
• Dawes M et al. Siciy statement on evidence based
  practice BMC Medical Education 200551.

• 1. Translation of uncertainty to an answerable
  question
• 2. Systematic retrieval of best available
  evidence

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Kirkpatricks goal-based model1,2,3,4

• Based on four simple questions that translate
  into four levels of evaluation
• Level 1 - Reaction
• Level 2 - Learning
• Level 3 - Behaviour
• Level 4 - Results
• 1. Kirkpatrick DL Techniques for evaluating
  training programs. Journal of ASTD, 195913
  (11)3-9
• 2. Kirkpatrick DL Techniques for evaluating
  training programs Part 2 - Learning. Journal of
  ASTD,195913 (12)21-26
• 3. Kirkpatrick DL Techniques for evaluating
  training programs Part 3 - Behaviour. Journal of
  ASTD,196014 (1)13-18
• 4. Kirkpatrick DL Techniques for evaluating
  training programs Part 4 - Results. Journal of
  ASTD,196013 (2)28-32

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The puzzles

• OVID access
• Limited PC availability in ward areas
• Protected time in winter
• Original word format for NPSs
• Some stakeholders

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What worked?

• Framework for the development of NPSs November
  2003
• Standard track EBP workshops for the novice
• Fast track EBP workshops for those with recent
  EBP skills
• Priority tool for policy development

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Evolution in care

• Culture change within RPH
• But we have always done it like that

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Nurses Board Western Australia

• PD activities
• Recent appraisal
• Peer review
• Professional portfolio
• Reflective practice

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Professional development

• Just another skill nurses need to learn
• Non elite sport
• Building on what works well
• Networking

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Where next?

• Hospital policies
• Regional collaboration
• State peer review
• Patient groups
• National and International benchmarking

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