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QAH HospitalPortsmouth Hospitals NHS Trust 04/19/23 Page 1
Stepping up to Evidence Based Practice - Ideas into Action 4
Debra Ugboma
January 2010
Interpreting the Evidence and Developing a Plan
QAH HospitalPortsmouth Hospitals NHS Trust
Objectives
Provide pointers for reading and organising your literature Identify some resources for helping you critique the
literature Consider factors and influences in preparing for change Have a go at appraisal using a structured critiquing tool.
What do I need for this session:– Worksheet 4– A paper you have identified from your literature search– A critique/appraisal tool (access during the session)
QAH HospitalPortsmouth Hospitals NHS Trust
I have my literature.. What now?
Review and read the information you have found Start with the abstracts which will help indicate if you need
to access the complete paper Don’t waste time reading things that are not relevant Access Journals electronically where-ever you can Read with consideration of the hierarchy of evidence, and
with your question, firmly in mind. Do you have any systematic reviews or meta-analyses?
Keep these to one side.
QAH HospitalPortsmouth Hospitals NHS Trust
Reading and Appraising…
Unless or until you are confident in critiquing the findings of literature/evidence...
Read papers first of all, then appraise more fully (with an appropriate tool)…
As you become more experienced you will be able to appraise at first (well maybe second) reading!
QAH HospitalPortsmouth Hospitals NHS Trust
Sorting out the language…
Do you know your NNT from your p value?
What’s a QUALY?
What is the difference between a systematic review and a meta-analysis?
Try this useful website which helps to explain some of the terminology: http://www.whatisseries.co.uk/whatis/
QAH HospitalPortsmouth Hospitals NHS Trust
Reading and appraising..
Keep any systematic reviews and meta-analyses in a secure place – these are often valuable in answering your question, and helping you find further evidence.
Organise the rest of the literature; consider the “traffic light system”:
– Green = very useful, highly relevant, the article answers the question more or less directly
– Amber = may/will be useful, has some relevance, some aspects help answer the question
– Red = does not appear useful, not relevant to the topic, does not help to answer the question
QAH HospitalPortsmouth Hospitals NHS Trust Page 704/19/23
Look at the evidence?
QAH HospitalPortsmouth Hospitals NHS Trust Page 804/19/23
Appraising the evidence
Is it already appraised? i.e. is it linked to a new policy/national guidance, someone’s EBP project etc.
Find an appraisal tool . The CASP website is a good starting point: http://www.phru.nhs.uk/Pages/PHD/resources.htm ..
Or try the research/EBP text books
Trisha Greenhalgh – “How to read a paper” is also good (book or series of articles) for medical research and statistics
Enlist someone to help you? Share the workload
QAH HospitalPortsmouth Hospitals NHS Trust
Using the appraisal tool..
Choose the right tool for the job e.g. qualitative research studies, cohort studies, reviews etc. CASP has tools for all of these.
Aveyard and Sharp (2009) also has a useful chapter on appraising the evidence and some good resources (chapter 6)
You may need to use different tools for different of papers.
Use the tool as a template
To allow for comparison, try using the headings of the tool in a table format and review each paper in turn, keeping short notes.
QAH HospitalPortsmouth Hospitals NHS Trust
Appraising Clinical Guidelines
The RCN has a very helpful series of web-pages: http://www.rcn.org.uk/development/learning/learningzone/clinical_skills/clinical_guideline_development/appraisal_and_adaptation
QAH HospitalPortsmouth Hospitals NHS Trust
Having a go at appraisal…
Undertake the activity on worksheet 4 (remember you will need to repeat this process with your key papers).
QAH HospitalPortsmouth Hospitals NHS Trust
Answering the question..
Can you answer your question?
Does the evidence support your idea for action or proposed change?
Is there more searching to do or are you happy to progress?
Write a summary or short fact sheet – this will help you present the information to colleagues and get ready for implementation?
QAH HospitalPortsmouth Hospitals NHS Trust
Getting ready for change…
Who do you need to talk with, and discuss the potential change?
Who could lead the change? Who could facilitate the change? Who could support the change?
Is the Team ready for change?
YesHow do you
know?
NoWhat do you needto do to prepare
them?
QAH HospitalPortsmouth Hospitals NHS Trust Page 1404/19/23
Leading and Facilitation
QAH HospitalPortsmouth Hospitals NHS Trust Page 1504/19/23
Context and culture
QAH HospitalPortsmouth Hospitals NHS Trust
Getting ready for change..
What does the evidence say you should do? Discuss with larger team and gain their ideas Give opportunity for discussion and debate How big a change is this for you? Involve other members of multi-professional team Provide a background information/fact sheet Undertake a SWOT analysis to help identify potential
opportunities and threats Who might lead this?
QAH HospitalPortsmouth Hospitals NHS Trust
Planning for change..
Begin to identify what needs to be done! Discuss proposed change at team meetings/after ward
handovers Identify your Lead/Driver(s) Identify your Facillitator and Supporter What resources are required? Do you need to prepare anything e.g. documentation, signage Do you need to audit first?
QAH HospitalPortsmouth Hospitals NHS Trust
A note about toolkits..
Many Government or national policy initiatives often come along with a “Toolkit” to help with implementation e.g. Protected mealtimes, Essence of Care.
With new policy or key national changes in particular, remember to look for one of these as they can make life a lot easier!
QAH HospitalPortsmouth Hospitals NHS Trust Page 1904/19/23
Resources
Aveyard, H. and Sharp, P., 2009. A beginners guide to evidence based practice in health and social care, Maidenhead: Open University Press (chapter 6)
CASP Website for critiquing tools: http://www.phru.nhs.uk/Pages/PHD/resources.htm
Essence of care toolkit: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4127915.pdf
Greenhalgh, T., 1997, How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses), Br Medical Journal, Sep 13 315(7109):672-675
Greenhalgh, T., 1997, How to read a paper: Papers that go beyond numbers, Br Medical Journal, Sep 20 315(7110):740-743
Parahoo, K., 2006, Nursing Research: Principles processes and issues, Basingstoke: Palgrave Macmillan.
RCN – Developing Clinical Guidelines http://www.rcn.org.uk/development/learning/learningzone/clinical_skills/clinical_guideline_development/appraisal_and_adaptation
What is Series: http://www.whatisseries.co.uk/whatis/