Welcome back everyone.
Have you ever wondered why nurses started using
alcohol gel in between routine patient contact
instead of washing our
hands with soap and water?
Or why we stopped administering
aspirin to children with fevers?
It's all because of evidence-based practice.
Evidence-based practice is a conscientious,
problem-solving approach to clinical practice
that incorporates the best evidence
from well-designed studies,
patient values and preferences and a clinician's
expertise in making decisions about a patient's care.
The elements of evidence-based
practice includes seven steps,
they inform clinical guidelines and they
contribute to improved patient outcomes.
Now let's review the seven steps
of evidence-based practice.
First, cultivate a spirit of inquiry or continual questioning
of clinical practices within an EBP culture and environment.
Second, ask the burning
question in a PICOT format.
Third, search for and collect the
most relevant best evidence.
Fourth, clinically appraise the evidednce,
for example, use a rapid clinical appraisal,
then evaluate, then synthesize and
come up with your recommendations.
Next, integrate the best evidence with one's clinical
expertise and the patient's preferences and values
in making a practice decision or change.
Next, evaluate the outcomes of the practice
decision or the change based on the evidence.
And finally, disseminate or share the
outcomes of the EBP decision or change.
Now let's go into each one
a little bit further.
The first step in EBP is to cultivate a spirit of inquiry
which is a continual questioning of clinical practices.
Cultures and environments that
support a spirit of inquiry
are more likely to facilitate and sustain
a questioning spirit in clinicians.
When delivering care to patients, it's important
to consistently question current practices.
One example of a great
question would be,
Does double checking pediatric medications
lead to fewer medication errors?
After clinician ask the clinical question, it's
important to place that question in PICOT format
to faciliate an evidence search that is effective in
getting to the best evidence in an efficient manner.
the Intervention or Interest area,
the Comparison intervention or group,
and Time if relevant.
So here's an example of a
constructed PICOT question.
In hospitalized children, how does double-checking
pediatric medications with a second nurse
compared to not double-checking affect
medication errors during a 30-day time period?
Now, let's break it down a little further.
When we say in the question, "in hospitalized
children", we're referring to the patient population.
In the question where it says, "how does double-checking
pediatric medications with a second nurse",
that's referring to the
intervention or the interest area.
The next part of the question when we
say, "compared to not double-checking",
that speaks to comparison
intervention or group.
When we say," affect medication
errors", that relates to the outcome.
And then finally, when we say," during a
30-day time period", that refers to the time.
Now, after placing the clinical question in PICOT
format with the proper template, we do the next steps.
We want to use each keyword in the PICOT question
to systematically search for the best evidence,
that's called keyword searching.
Next, we wanna extend the search to include all
evidence that answers the clinical question.
Then, we're going to enter and search each keyword
or phrase from the PICOT question individually.
And finally, we're going to combine
keywords that were previously searched,
which typically yields a small number of studies
that should help answer the PICOT question.
Next, it's important to conduct a rapid critical
appraisal of each study from the data search
to determine whether they are what we call keeper studies,
that is they indeed answer the clinical question.
Be sure to ask to ask these questions:
First, are the results of the study valid?
Meaning, did the researchers use the best methods to
conduct the study which speaks to study validity?
For example, assessment of a study's validity determines
whether the methods used to conduct the study were rigorous.
The next question you'd
like to ask would be,
What are the results?
Do the results matter and can I get
similar results in my practice?
That speaks to study reliability.
And finally, will the results help
me in caring for my patients?
Is the treatment feasible
to use with my patients?
which speaks to study applicability.
Rapid Critical Appraisal
checklist can assist clinicians
in evaluating validity, reliability, and
applicability of a study in a time-efficient way.
After the body of evidence from the search is
critically appraised, evaluated and synthesized,
it should be integrated with the clinician's expertise
and also the patient's preferences and values
to determine whether the practice
change should be conducted.
Providing the patient with evidence-based information
and involving him or her in the decision
regarding whether he or she should receive a
certain intervention are important steps in EBP.
To facilitate greater involvement of patients in making decisions
about their care in collaboration with healthcare providers,
there has been an accelerated movement in creating
and testing patient decision support tools
which provide evidence-based information
in a relatable, understandable format.
It's important to target the "so-what" outcomes that
the current healthcare system considers important
such as complication rates, length of
stay, rehospitalization rates and costs
given that hospitals are currently being reimbursed
based on their performance on these outcomes.
After making a practice change
based on the best evidence,
it's critical to evaluate outcomes or the
consequences of an intervention or treatment.
For example, an outcome of providing a baby
with a pacifier might be a decrease in crying.
Outcomes evaluation is essential to determine the impact of the
practice changes on healthcare quality and health outcomes.
When we think about dissemination or sharing
the outcomes, it's important to remember
that silos often exist, even within
the same healthcare organization.
So that others can benefit from the positive changes resulting
from EBP, it's important to disseminate or share the findings.
Now, various avenues for
Institutional EBP rounds,
Poster and podium presentations
at local, regional and national conferences,
and also, publications.
Clinical practice guidelines are
systematically developed statements
to assist practitioner decisions about appropriate
health care for specific clinical circumstances.
Guidelines can be used to reduce
inappropriate variations in practice,
promote the delivery of high
quality evidence-based healthcare,
they provide a mechanism by which healthcare professionals
can be made accountable for clinical activities,
And they can be developed either locally, meaning internal
guidelines or regionally/nationally or external guidelines.
Next, let's review the stages
of guideline development.
First, guidelines are based on the best available research
evidence and require a detailed literature search.
Next, using the research evidence, guideline construction
takes place usually through some form of small group work,
with representation from as many
interested parties as possible.
Then, the guideline is tested by asking professionals
not involved in the guideline development
to review it for clarity, internal
consistency and acceptability.
The guideline can then be tested in select healthcare settings
to see whether it's feasible for use in routine practice.
And finally, the guideline should be reviewed after a specified
time period and modified to take into account new knowledge.
In speaking about guideline
dissemination and implementation,
dissemination refers to the method by which
guidelines are made available to potential users.
This can happen through publication in professional
journals, sending the guideline to trageted individuals,
or strategies involved in an
Next is implementation.
and this means ensuring that the users subsequently act
upon the recommendations that you've shared with them.
Evidence-based practice is important because
it aims to provide the most effective care
that is available with the aim
of improving patient outcomes.
Patients expect to receive the most effective
care based on the best available evidence.
Evidence-based practice promotes an attitude of inquiry in health
professionals and starts us thinking about questions like,
Why am I doing this in this way?
Is there evidence that can guide me
to do this in a more effective way?
As health professionals, part of providing a
professional service is ensuring that our practice
is informed by the best
Evidence-based practice also plays a role in
ensuring that finite health sources are used wisely.
And that relevant evidence is considered when
decisions are made about funding health services.
Remember, ensuring that clinicians meet established EBP
competencies, along with creating cultures and environments
that support EBP are key strategies to transform
the current state of nursing practice
and healthcare delivery
to it's highest level.
So in thinking of what we've covered today,
I'd like for you to consider this question:
What are the seven steps of
They are cultivate a spirit of inquiry
within the EBP culture and environment,
ask the burning question
in a PICOT format,
search for and collect the
most relevant best evidence,
critically appraise the evidence,
integrate the best evidence with one's clinical expertise and patient
preferences and values in making a practice decision or change,
evaluate outcomes of the practice
decision or change based on evidence,
and finally, disseminate or share the
outcomes of the EBP decision or change.
I hope that you've enjoyed today's
video on evidence-based practice.
Thanks so much for watching.