1 Evidenced Based Practice Flashcards
What is the definition of EBP?
“… the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. The practice of evidence- based medicine means integrating INDIVIDUAL CLINICAL EXPERTISE with the best available EXTERNAL CLINICAL EVIDENCE for systematic research” - Sackett ret al, 1996
What are the three key contributions to EBP?
Individual clinical expertise
Best external evidence
Patient values and expectations
What is insufficient evidence?
Based on expert opinion and patient values
What are the key steps in EBP development?
1988 - House of Lords select committee recommendations
•1991 - First NHS R&D director appointed
•1991 - Publication of Research for Health
•1992 - Cochrane Centre and Centre for Reviews and Dissemination started
•1993 - Appointment of regional R&D directors to drive local research agenda
•1994 - Culyer report & implementation of central financing for NHS R&D
•1997 - The Clinical Effectiveness initiative (NICE)
•1998 - Increasing research capacity and capability in the NHS (education)
•1999 - The first NHS R&D national programmes: HTA, Service Organisation & Delivery and NEAT programmes
•2005 Publication of the NHS research governance framework
NHS R&D strategy
A key driver for EBP was the development of a national R&D strategy to
•Provide new knowledge to improve NHS performance
•Generate generalisable research findings
•Uphold ethical principles
•Be framed by peer reviewed protocols
•Have clear project management arrangements
•Discharge a responsibility to report and disseminate findings
•Contribute to the wider knowledge economy
What are the challenges of EBP?
Over arching political purpose of health research
Dominance of medical research agenda
Availability of relevant evidence
Quality of available evidence
Transferability (and relevance) of research findings to everyday denial practice
Research knowledge and skills of practitioners
Ability to evaluate and interpret reported research
What is the process of EBP? (In chronological order )
- Topic selection
- Critical appraisal of the evidence
- Implementation of findings ( translation of research into practice)
- Evaluation of the impact of the implementation on patient care and development ( feedback of evaluation into future implementation)
What is meant by topic selection?
Choosing an aspect of clinical practice that is not currently evidence-based
What is critical appraisal?
Evidence must be appraised to determine the extent to which the findings can be used to inform practice. Meaning any evidence published should be high quality, useful or relevant
Critical thinking takes place at this point
Using evidence in critical thinking: what drives EBP?
Professional knowledge and experience
Patient and service user needs
Evidence
Critical thinking
What are the critical appraisal considerations?
Quality of evidence
Reliability of sources
Contradicting evidence
What does it mean to implement findings?
To translate research into everyday practice
What strategies help with implementing findings?
A change champion in the organisation
Piloting the change
Audit and feedback
Building multidisciplinary implementation teams
What is change management?
That changingpractice takes considerable effort from individual and organisation levels
Successful pilot studies can help engagement of key personnel and convincing them to help drive the change
Once ebp change is implemented it is not an innovation but a standard care
What is EBP implementation?
Evidence Based guidelines (national and local)
•Practice Development Units
•Practice protocols
•Organisational implementation models
•Change management systems
•Creating learning environments
How can EBP culture be nurtured
Strategic planning (executive level)
•Professional education
•Personal detailing
•Clinical opinion leaders
•Special interest groups
•Journal clubs
•Audit systems
•PDUs
What is evaluation?
The initiative will be able to demonstrate improved patient outcomes
Considering the impact on department processes, staff, and resources
Make sure the evaluation results feedback into the EBP
