Evidence-based PracticeWhat Does it Mean for Nursing?

Nancy WellsVanderbilt Medical CenterOctober, 2007

What is evidence-based practice?

Evidence-based Practice

Process by which clinical decisions are made using:

Best available research evidence

Clinical expertise

Patient preference

Historical Perspective

Variation in practice leads to:

Variable quality of care

Higher cost of care

Potential for errors that may cause harm

Translating research into practice

Skills Required for EBP

Clearly identify practice problem or new knowledge ( innovation)

Find research literature

Critically evaluate research findings

Apply to practice through change process

Identifying Practice Problem

Why are we doing this?

Why are we doing it this way?

Can we produce better outcomes with greater consistency?

Clinical practice problems in your setting?

Critically Evaluating Research

Literature review

Integrative literature review

Systematic literature review

Meta-analysis

Strength of the Evidence

Level I – systematic review, met-analysis, well-designed RCTs

Level VII - opinion

Resources for Reviews

Nursing journals

Clinical work station sitesUp-to-dateZynx

Eskind Digital LibraryCochrane Reviews

Clinical Practice Guidelines

Agency for Healthcare Research & Quality (AHRQ)

Early examplesSkin integrityAcute pain guidelineUrinary incontinence

AHRQ Evidence-based Reports

Examples of reports availableCancer symptom management (2002)Coronary heart disease in women,

systematic review (2003)Mechanical ventilator criteria for weaning

(2000)Wound healing, laser treatment and

vitamin-assisted closure (2004)

Evidence-based Nursing Practice

AHRQ clinical nursing practice guidelines To be released in December

Joanna Briggs Institute (JBI) JBI Connect

National Guideline Clearinghouse Guidelines.gov

Application to Practice

Does the research apply to my patient population?

Would this practice change improve process of care? Patient outcomes?

Is there support for this practice change?

EBP Models

CURN project Research utilizationReview, synthesis, application, evaluation

Stettler Model of Research UtilizationCritical thinking & decision making

Iowa Model of Research in PracticeQuality assurance meets research utilization

Planned Change

Assess current practice (processes and outcomes)

Identify and implement changes to modify processes

Evaluate effects on processes and/or outcomes

Evaluation

Processes of care

Outcomes of care

Documentation of Groin Sites

Investigators: Stacy Sherrard, Grace Vincente & Felicia Lowe

1 month trial of education and coaching to improve documentation of groin sites post-catheterization

Groin Site Documentation

0

20

40

60

80

100

% d

ocu

men

ted

15 min 30 min 1 hour

Time Post-catheterization

Pre

Post

Summary

Reduce variations in practice

Improve the quality of care provided

Maintain or improve patient outcomes