Chapter 20: Developing an Evidence-Based Practice
performance gap assessment
informs members at the beginning of change about a practice performance and opportunities for improvement
characteristics that influence change
EBP offers an advantage EBP is more compatible with current norms EBP complexity
formulate question
PICO
decision to change practice
based on evidence derived from several sources consider relevance to practice, consistency, sample characteristics, feasibility, and risk/benefit ratio
three components of EBP
current best practice clinical expertise patient values
retrieve evidence
electronic databases identify key search terms group articles into categories
last step in EBP
evaluation of results
Iowa Model
evidence-based practice to promote quality care
outcome evaluation standards
expected outcomes being achieved comparison to baseline data
evaluation of EBP
goal: to collect and analyze data with regard to use of new EBP and then modify practice as needed should include process measures and outcome evaluation
process measures
how change is implemented is staff using the practice and implementing the practice as written in the new guideline or standard
continuous loop of EBP
improve quality care identify questions conduct research new knowledge disseminate knowledge use findings in practice
form a team
key stakeholders who will be directly affected by change who can facilitate project who will put up barriers
methods of communicating change
mass media educational strategies such as posters, train the trainer, computer assisted training competency testing
opinion leaders
members of peer group viewed as respected source of influence considered as technically competent
audit and feedback
ongoing audit of perfomance indicators aggregating data into reports discussing findings with practitioners occurs during practice change
change champions
practitioners expert clinicians passionate about innovation committed to improving quality of care positive working relationship encouraging and persistent very effective with nurses
develop EBP
put evidence base of practice in writing include type of evidence
strategies for implementing practice change
reinvention of current EBP guideline quick reference guides clinical reminders
first step in EBP
select a topic problem-focused triggers knowledge-focused triggers involve staff in selection of topic
core groups
select group disseminates information members represent various shifts and days of week members are knowledgeable about basis for practice take responsibility reinforce on a daily basis provide positive feedback
research utilization
subset of BEP focuses on application of research findings
educational outreach / academic detailing
topic expert meets one-on-one with practitioners
critique/grade evidence
using team approach determine method to be used quality strength use summary tables to synthesize data
