creating an evidence-based practice culture

CREATING AN EVIDENCE-BASED

PRACTICE CULTURE

Practice supported by research findings and/or demonstrated as being effective through a critical examination of current and past practices

What is Evidence-Based Practice?

The ProcessFour parts to using Evidence Based Info• The Question• The Search• Critical Appraisal• Implementation

The QuestionWho can ask a question?

A wise man does not give the right answers, he poses the right

questions.

The Question Questions Can ~

• Stimulate the brain• Create an exchange• Discover knowledge or issues• Encourage listening• Provide the opportunity for

acknowledgment• Lead the process of discovery

The Question• How effective is Tylenol at reducing fever?• Do multi-disciplinary rounds improve patient

outcomes?• How can I keep my patient from pulling at their

lines?• Does relieving a patient’s chest pain minimize

the increase in cardiac enzymes?• Are blood draws from an IV as accurate as a

venipuncture?• How do we reduce the rate of patients that

fall?• Why do we always run out of flushes stocked

in pt rooms but always have tons of IV needles?

• How many people really get sick from eating runny eggs?

Then What?Talk it over with colleagues &

leadershipAsk more questions

• Is Tylenol or Ibuprofen more effective at reducing fever in adults?

• Does an older person with heart failure who gains 5 pounds need to be more concerned than a younger person with heart failure?

• How do we improve the accuracy of blood draws from IV’s?

• Are assistive devices effective in reducing patient falls?

The Question Use a functional format i.e. PICO,

ECLIPSE• Why? To yield the most relevant and best

evidence

• Break into groups for formats• Present group examples – • Ask more questions (Kellie, Renae,

ME) HELP!!!!

P – patient populationI – Intervention of interest or

interest areaC – comparison intervention or

statusO – Outcome

The Question: PICO

P - _______________________________________________

I - _______________________________________________

C - _______________________________________________

O - _______________________________________________

Question:

E – ExpectationC – Client GroupL – LocationI – ImpactP – ProfessionalsS – Service

The Question: ECLIPS(E)

E - _______________________________________________

C - _______________________________________________

L - _______________________________________________

I - _______________________________________________

P - _______________________________________________

S - _______________________________________________

Question:

The SearchFind the answer

• Policies and Procedures• Unit/Department Specific Protocols • Evidence-based Practice Guidelines• Professional Organizations• St.Luke’s Health Sciences Library

• Online and Hardcopy• Up to Date • Micromedex• EBSCO Host

• CINAHL• Medline Plus• Zynx Health

Critical Appraisal Remember to Think-• How much can you trust the source?

• Use Evidence Pyramids• How strong is the evidence?

• Systematic review/meta-analysis• Studies (randomized, double blind, Cohort, case control)• Peer reviewed article• Journal• Textbook• Wikipedia/Google• Testimonials, Newspapers, Ideas, Opinions

• Use a Critical Appraisal Tool• Miser’s Guidelines for Critical Review of Literature• Find on Google• Specific to research you are doing

Library: A good place to start

• Go to: Inside St.Luke’s• Clinical Resource/Health Science Library/Other resources

• Is Tylenol or Ibuprofen more effective at reducing fever in Adult patients?

Results of Librarian Search

• Advisor forum. Acetaminophen vs. ibuprofen as an antipyretic.Hoffman J; Sego S; Clinical Advisor for Nurse Practitioners, 2010 May; 13 (5): 43 (journal article - brief item, questions and answers) ISSN: 1524-7317 CINAHL AN: 2010666447 Persistent link to this record (Permalink):

http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010666447&site=ehost-live

• Effect of paracetamol (acetaminophen) and ibuprofen on body temperature in acute ischemic stroke PISA, a phase II double-blind, randomized, placebo-controlled trial [ISRCTN98608690]. (eng) By Dippel DW, van Breda EJ, van der Worp HB, van Gemert HM, Meijer RJ, Kappelle LJ, Koudstaal PJ, PISA-Investigators, BMC Cardiovascular Disorders [BMC Cardiovasc Disord], ISSN: 1471-2261, 2003 Feb 6; Vol. 3, pp. 2; PMID: 12657165; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12657165&site=ehost-live

• Efficacy and safety of ibuprofen and acetaminophen in children and adults: a meta-analysis and qualitative review. (eng) By Pierce CA, Voss B, The Annals Of Pharmacotherapy [Ann Pharmacother], ISSN: 1542-6270, 2010 Mar; Vol. 44 (3), pp. 489-506; PMID: 20150507; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=20150507&site=ehost-live

• Efficacy and safety of over-the-counter analgesics in the treatment of common cold and flu. (eng) By Eccles R, Journal Of Clinical Pharmacy And Therapeutics [J Clin Pharm Ther], ISSN: 0269-4727, 2006 Aug; Vol. 31 (4), pp. 309-19; PMID: 16882099; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16882099&site=ehost-live

• Fever management: evaluating the use of ibuprofen and paracetamol. (eng) By Crook J, Paediatric Nursing [Paediatr Nurs], ISSN: 0962-9513, 2010 Apr; Vol. 22 (3), pp. 22-6; PMID: 20426354; Persistent link to this record (Permalink): http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=20426354&site=ehost-live

GO FORTH AND CONCUR

Implementation All about teamwork Resources – decide who to go to change or create a policy.

› Unit Services Supervisor› Clinical Nurse Specialist› Manager› Clinical Supervisor› Committee representative about presenting to committee

Shared Governance (if only unit specific) Nurse Practice Council Nursing and Pharmacy Operations Nursing Research Council Nursing Education Council