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EVIDENCE-BASED PRACTICE

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Title: EVIDENCE-BASED PRACTICE


1
EVIDENCE-BASED PRACTICE
  • Author
  • Debra S. Hall, MSN, RN,C, CCRN
  • Clinical Nurse Researcher

2
AUTHOR
3
CONTENT
  • Definition of Evidence-based practice (EBP)
  • Effect of Evidence-based practice
  • Implementation of Evidence-based practice within
    a clinical setting

4
EVIDENCE-BASED MEDICINE
  • A shift in the culture of providing healthcare
    away from basing decisions on opinion, past
    practice, and precedent toward making more use of
    science, research, and
  • evidence to guide
  • clinical decision-making

5
Evidence-based practice is a state of minda
constant process of inquiry.Why am I doing it
this way? Is there evidence that can guide me to
a better outcome?(Foster, 1999)
6
EVIDENCE-BASED PRACTICE (EBP)
  • The conscientious and judicious use of current
    best evidence to guide health care decisions for
    improving patient outcomes.
  • Marita Titler, PhD, RN, FAAN

7
RESEARCH
  • A systematic scientific process that generates
    new knowledge or validates existing knowledge

8
RESEARCH UTILIZATION
  • Research Utilization (RU) differs from
    evidence-based practice (EBP) in that, although
    RU also serves to improve the quality of patient
    care,
  • it utilizes solely research
  • findings as a basis of practice
  • to improve patient care

9
QUALITY IMPROVEMENT
  • The betterment or enhancement of a product or
    service
  • This can be achieved by EBP, but is not limited
    to it

10
PERFORMANCE IMPROVEMENT
  • Focuses on the achievement of human performance
    goals
  • Focuses on the performance of the individual and
    person-specific goals

11
  • Evidence-based practice in the clinical setting
    requires the integration of
  • individual clinical expertise
  • with the
  • best available external clinical evidence from
    systematic research

12
INDIVIDUAL CLINICAL EXPERTISE
  • The proficiency and judgment that clinicians
    acquire through clinical experience and clinical
    practice leading to more effective and efficient
    patient assessment and diagnoses

13
BEST AVAILABLE CLINICAL EVIDENCE
  • Clinically relevant patient-centered research,
    scientific evidence, empirical evidence,
    institutional data, and external data that
    indicate how to achieve patient outcomes that you
    wish to achieve

14
EBP assists in -
  • practicing based on the evidence (rather than
    opinion)
  • Accepting clinical guidelines developed by other
    disciplines
  • Developing indicator conditions in which the
    management and performance of patient care create
    a difference in patient outcomes

15
  • The aim of evidence-based practice (EBP) is to
    reduce wide variations in individual clinicians
    practices, eliminating worst practices, and
    enhancing best practices, thereby reducing costs
    and improving
  • quality.

16
OUTCOMES MANAGEMENT
  • Efficacy the results of an intervention applied
    under ideal conditions (RCT)
  • Effectiveness the results of an intervention
    applied in the real world fewer controls lack
    of random assignment

17
EBP CHANGES THE FOCUS FROM PROCESS TO RESULTS
  • What systems or problems are not allowing growth?
  • What barriers are present that prevent you from
    delivering the quality of care you, and your
    staff, think is needed?

18
USE OF EBP IN ANALYSIS OF CARE ISSUES
  • Use of specialty beds in patients for skin care
  • Evidence supports use of some specialty beds only
    for pulmonary problems

19
USING EBP TO EVALUATE THE QUALITY OF CARE
  • Obstructive sleep apnea (Sonnad, et al., 2003)
  • Cardiac Rehabilitation (Bitzer EM, Klosterhuis H,
    Dorning H, Rose S., 2003)
  • Oncology oral care (Stricker Sullivan, 2003)

20
THE EBP PROCESS
  • Link your use of evidence-based practice to a
    process
  • May choose an existing process
  • May choose another process commonly used in your
    organization/institution

21
  • Assess the need for change in current practice by
  • including the stakeholders
  • collecting internal data about current practice
  • comparing internal/external data (benchmark)
  • identifying your problem statement/desired state

22
  • Link problems, interventions outcomes by
  • using standardized classification systems
    language
  • identifying potential interventions activities
  • selecting outcome indicators

23
PROBLEM STATEMENT
  • There is an increase in requests for nursing
    staff to administer unfamiliar anesthetic and
    sedative agents in the ICU area for procedures
    which affect patient care and staffing.

24
DESIRED STATE
  • Nursing staff will have guidelines for
    administration of sedatives during procedures and
    extended patient treatment and for care of such
    patients in the critical care area

25
  • Synthesize the best evidence by
  • searching literature related to major issues
  • critiquing weighing the evidence
  • assessing the feasibility, benefits, and risks

26
  • Design practice change by
  • defining the proposed change
  • identifying needed resources
  • planning an implementation process
  • defining outcomes

27
OUTCOME INDICATORS
  • Data collected on administration of approved IVP
    drugs by ICU RNs (e.g., frequency)
  • Anecdotal reports from staff on administration of
    approved drugs
  • No negative patient outcomes with non-approved
    drugs

28
  • Implement evaluate the change in practice by
  • pilot study demonstration
  • evaluate process outcome
  • decide to adapt, adopt, or reject practice change

29
  • Integrate maintain change in practice by
  • communicating recommendations to stakeholders
  • staff education on changes in practice
  • integrating changes into standards of practice
  • monitoring the process outcomes

30
WHAT INFORMATION IS AVAILABLE ON THE WEB ON EBP?
  • http//www.ahcpr.gov/
  • www.cochranelibrary.com
  • http//www.cche.net/usersguides/main.asp
  • http//www.shef.ac.uk/scharr/ir/core.html
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