TIGER Standards & Interoperability Collaborative

Evidence Based Practice Standards Tutorial

Tutorial Outline

• Objective • Definitions• The Practice of Evidence Based Nursing: a. Clinical Questions b. Searching Best Evidence c. Evaluation of Evidence d. Applying Evidence to Practice c. Evaluation• Case Study• Resources: Evidence Based Centers, Websites, Journals• Contact information – TIGER & Authors

Objective

At the completion of the tutorial the nurse will be able to describe the process of evidence based nursing practice (EBNP) and it’s related importance to the practice of professional nursing and delivery of quality healthcare . The nurse can identify the process of translating the best available evidence into practice and will be introduced to EBP internet resources.

Definition: Evidence Based Practice

A problem solving approach to practice that involves the conscientious use ofcurrent best evidence in making decisions about patient care; EBP incorporates asystematic search for and critical appraisal of the most relevant evidence toanswer a clinical question along with one's own clinical expertise and patientvalues and preferences.

Definition: Quality

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Nursing as a Research Based Profession

Current Healthcare Climate Insists on the Wisest Delivery of the Best Clinical Practices and Care:

FACTORS:

1.Explosion of Literature

2.Unmet Information Needs

3. Implementation Delays

4.Aging Population

5.Fewer Financial Resources

6.Higher Acuities

7.Fewer Staff

Definition: Best Practices

Best Practices refers to nursing practices

that are based on the best research

evidence. Synonymous terms include

research based practice and research

utilization. An application example would

be use of an AHRQ Clinical Guideline.

Evidence Based Advocates:

1. Institute Of Medicine: Performance Standards:

The Institute of Medicines’ efforts include redesigning care delivery and keeping patients safe. The IOM’s global focus is on improved quality and a transformation of 21st century care delivery. The 2003 IOM report “Health Professions Education: A Bridge to Quality” recommends integration of core competencies to include EBP into health professions education.

Evidence Based Advocates:

2. AHRQ: Adoption and Consistency of Performance: The Agency for Healthcare Research and Quality’s mission is to improve the quality, safety, efficiency and effectiveness of healthcare for all Americans. The AHRQ funds evidence based centers and supports the National Guideline Clearinghouse

Evidence Based Advocates:

3. Specialty Organizations (i.e., AACN, NANN, Sigma Theta Tau, ONS): These organizations provide resources for nurses to identify, critically appraise, and use evidence in practice.

4. ANCC Magnet Recognition Program

5. Payers, Payees and Patients!

A Model for Evidence Based Practice

• Rosswurm & Larrabee, 1999, Sigma Theta Tau Int.

Assess Link Synthesize Design Implement/ Integrate/

Evaluate Maintain

Not sure about this slide (haven’t added explanation…….It could confuse, however it is the only model I know of that Has the “link” piece which describes selecting in a standardized language

Evidence Based Practice: A 5- Step Process

1. Formulate a well-built question2. Identify evidence based resources that answer

the question3. Critically appraise the evidence4. Apply the evidence5. Re-evaluate the application of evidence

1. Formulate a Well Built Question:

*Construct a specific clinical question using PICO format.

P= Patient PopulationI= Intervention/ Issue of InterestC= Comparison Intervention or Comparison GroupO= Outcome

(T)= Time

1. PICO Example

In adult cardiac surgery patients (P), is morphine (I) or fentanyl (C) more effective in reducing postoperative pain? (O)

2. Identify evidence based resources that answer the question

Search for an evidence based answer using PICO keywords in critically appraised sources (relevant research).

Since some evidence is stronger than others and cannot be regarded equally, evidence hierarchies have been developed which rate the strength of theevidence or grade the recommendations.

2. Identify evidence based resources that answer the question

An example of an evidence hierarchy from the U.S.Dept. Of Health and Human Services ( now AHRQ)National Guidelines Clearinghouse:

Ia Meta-Analysis of randomized control trialsIb One randomized control trial

IIa One well designed control study without randomizationIIb One well designed quasi-experimental study

III Well designed non-experimental studyIV Expert committee reports, expert opinions, consensus statements, expert judgement

2. Identify evidence based resources that answer the question

In 1998 Stetler and colleagues made a contribution to the format which impacted nursing. The admissible evidence was expanded to includequalitative studies, quality improvement and program evaluation.

References