Evidence based practice

unit 1

1. EVIDENCE BASED PRACTICE P R IYANKA J SOLANKI ASSISTANT PROFESSOR

2. I NTRODUCT I O N Evidence-based medicine (EBM) or evidence based practice (EBP), is the judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence-based practice represents both an ideology and a method. The ideology springs from the ethical principle that clients deserve to be provided with the most effective interventions possible. The method of EBP is the way we go about finding and then implementing those interventions.

3. DEFINITIONS Evidence: It is something that furnishes proof or testimony or something legally submitted to ascertain in the truth of matter. Evidence based practice : It is systemic inter connecting of scientifically generated evidence with the tacit knowledge of the expert practitioner to achieve a change in a particular practice for the benefit of a well- defined client / patient group. (French 1999).

4. Evidence based nursing- it is a process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences (mulhall, 1998). Evidence based medicine or practice- The conscientious, explicit and judicious use of current best evidence in making decision about the care of individual patient. (Dr. David Sackett, Rosenberg, 1996)

5. CONTD…. pr o vidi n g EBP i n nur s in g is nursing a way of care th a t i s g u id e d b y the integration of the best available scientific ex pe rtis e . T h i s knowl ed ge with n ur sing approach requires nurses to critically assess relevant scientific data or research evidence and to implement h i gh q u a l ity in t erven t io n s f o r th e ir n ur sing pr a ctic e .

6. Health care that is evidence-based and conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care.

7. KEY COMPONENTS OF EBP Research evidence. Clinical expertise, judicious use. Patient values and circumstances.

8. NEED FOR EBP F o r m a king s ur e t h at each cl i e n t ge t t h e best possible services . Up d a t e know l e d ge an d i s ess e n t i a l f o r lifelong learning . Provide clinical judgment. Improvement care provided and save lives.

9. GOAL OF EBP Provide practicing nurse the evidence based data to deliver effective care . Resolve problem in clinical setting . Achieve excellence in care delivery . Reduces the variations in nursing care and assist with efficient and effective decision making.

10. STEPS IN EBP

11. STEPS OF EVIDENCE BASED PRACTICE Step 1 : formulating a well built question Step 2 : collecting the most relevant and best evidence to answer the clinical question including searching for systematic reviews/identifying articles Step 3 : Critically appraising the evidence that has been collected for its validity, relevance and applicability.

12. Step 4 : integrating the evidence with ones clinical expertise, assessment of patient’s condition and available health care resources along with the patients preferences and values to implement the evidence. Step 5 : Evaluating the change resulting from application of evidence in practice. Determine the areas for improvement.

13. STEP-1: FORMULATING THE QUESTION With clinical areas ,there is often a barrage of details to digest. a well built question includes the following components The patients disorder or disease The intervention or finding under review A comparison intervention The question should be in PICOT or PICO format

14. PICOT FORMAT Patient, Population or Problem What are the characteristics of the patient or population? What is the condition or disease you are interested in? ( i.e. age, gender, ethnicity, with a certain disorder) Intervention or exposure What do you want to do with this patient (e.g. treat, diagnose, observe)? (exposure to a disease, risk behavior, prognostic factor) Comparison What is the alternative to the intervention (e.g. placebo, different drug, surgery)? (could be a placebo or "business as usual" as in no disease, absence of risk factor, Prognostic factor B )

15. Outcome What are the relevant outcomes (e.g. morbidity, death, complications, risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome) Time What time it takes to demonstrate an outcome (e.g. the time it takes for the intervention to achieve an outcome or how long participants are observed).

16. EXAMPLE: Are insulin pumps more effective than conventional therapies in managing type 2 diabetes in pregnant women? Patient/Population - Pregnant women with type 2 diabetes Intervention - Insulin pump therapy Comparison - Conventional insulin therapy Outcome - Improved management of glucose levels

17. SEARCH STRATEGIES BACKGROUND INFORMATION Background information may be found in sources such as: reference book entries  textbooks, chapters, appendices  drug monographs, guides to diagnostic tests  the library’s Bobcat catalog  selected electronic Reference Tools for Background information in the health science.

18. Step 2. DATABASE /RESOURCE SEARCHING Once a clinical practice question has been selected, the next step is to search and assemble research evidence on the topic. In doing a literature review as a background for a new study, the central goal is to discover where the gap are and how best to advance knowledge. Step 3. CRITICALLY APPRAISING THE ARTICLE The assessment of evidence by systematically reviewing its relevance, validity and results of specific situations.

19. Step 4. APPLYING THE EVIDENCE/INTEGRATING EVIDENCE WITH ONES CLINICAL EXPERTISE If the implementation criteria are met the team can design and plot the innovation. To reach your conclusion you may consult questions related to diagnosis ,therapy, harm and prognosis keep in mind that you must interpret the information based on a number of criteria and depending on your skill and experience ,you may need to confer with a peer. example- Sample evidence practice e.g. consider a nine year old girl present in the ER with abdominal pain and you suspect appendicitis. which imaging modality is best for making the diagnosis CT or ultrasound.

20. Step 5. EVALUATING THE CHANGE The fifth step of the process, outcome evaluation, attempts to interpret the results and evaluate the outcomes of the applied evidence (intervention). Outcome measures may be psychosocial (quality of life, improved patient perception of care, reduction in depressive and anxiety symptoms), physiologic (improved health, reduced complications), or functional improvement. Evaluation of the process and the results may occur through peer assessment, audit, or even self reflection.

21. Barriers in EBP Lack of value for research in practice Difficulty in bringing change Lack of administrative support Lack of knowledge mentors Lack of time for research Lack of knowledge about research Research reports not easily available Complexity of research reports Lack of knowledge about EBP

22. Advantages of EBP Provide better information to practitioner Enable consistency of care Better patient outcome Provide client focused care Structured process Increases confidence in decision-making Generalize information Contribute to science of nursing Provide guidelines for further research Helps nurses to provide high quality patient care

23. Disadvantages of EBP Not enough evidence for EBP Time consuming Reduced client choice Reduced professional judgement/ autonomy Supress creativity Influence legal proceedings Publication bias